The purpose of the amendment to Rule 59G-4.132, Florida Administrative Code (F.A.C.), is to update language relating to providers who must comply with the Florida Medicaid Electronic Visit Verification Program and revise ....

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.132Home Health Electronic Visit Verification Program

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.132, Florida Administrative Code (F.A.C.), is to update language relating to providers who must comply with the Florida Medicaid Electronic Visit Verification Program and revise the rule title.

SUMMARY: The amendment specifies that providers of behavior analysis services must render services to recipients in accordance with Rule 59G-4.132, F.A.C. The rule title is changed to Electronic Visit Verification Program.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 409.919, 409.961 FS.

LAW IMPLEMENTED: 409.906, 409.913, 409.9132, 409.973 FS.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: August 30, 2021 from 2:30 p.m. to 3:00 p.m.

PLACE: The Agency is offering both a remote and an in-person option to attend the hearing at the Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, Florida 32308-5407.

Remote Listeners: Attendees may register for the hearing at: https://attendee.gotowebinar.com/register/5367014639660092941. After registering, a confirmation email will be received containing information about joining the webinar, and opportunities to offer comments and questions will be available.

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: [e-mail].. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: [e-mail]. Please note that a preliminary draft of the reference material, if available, will be posted prior to the hearing at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received until 5:00 p.m. on August 31, 2021 and may be e-mailed to [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-4.132 Home Health Electronic Visit Verification Program.

(1) This rule applies to providers enrolled directly in the Florida Medicaid program that furnish home health services (home health visits, private duty nursing, and personal care services) and behavior analysis services to eligible recipients in accordance with Rules 59G-4.130, 59G-4.261, 59G-4.215, and 59G-4.125, Florida Administrative Code (F.A.C.), respectively. through the fee-for-service delivery system as specified on the Agency for Health Care Administration’s (AHCA) website at http://ahca.myflorida.com/Medicaid/home_health/dmv.shtml in accordance with section 409.9132, Florida Statutes (F.S.).

(2) Definitions. Direct service provider – An individual who personally (face to face) provides services to recipients in accordance with rule 59G-4.261, 59G-4.215 or 59G-4.130, Florida Administrative Code, ( F.A.C.).

(a) Electronic visit verification (EVV) - A process by which service encounters are electronically verified with respect to the type of service performed, the recipient receiving the service, the date of the service, the location of service delivery, the provider rendering the service, and the time the service begins and ends.

(b) Service encounter - A visit occurring on a specific day between a provider and an eligible recipient.

(3) Home Health Electronic Visit Verification Program.

(a) All providers must fully participate in the EVV process comply with section 409.9132, F.S.

(b) For providers participating in the fee-for-service delivery system - The Agency for Health Care Administration (AHCA) contracts with a vendor(s) to electronically verify the delivery of home health services provided to recipients in their residence or other authorized setting.

1. Providers must document the home health service encounter for each recipient served (in accordance with the recipient’s approved plan of care) and verify the delivery of the services rendered using AHCA’s designated vendor’s electronic visit verification (EVV) system, or the provider’s EVV system which must be interoperable with AHCA’s designated vendor’s EVV system.

(c) For providers participating in the Statewide Medicaid Managed Care program - Florida Medicaid managed care plans contract with a vendor(s) to electronically verify the delivery of services covered by the managed care plans and provided to recipients in their residence or other authorized setting.

1. Providers must document the service encounter for each recipient served (in accordance with the recipient’s approved plan of care) and verify delivery of the services rendered using the managed care plan’s designated vendor’s EVV system, or the provider’s EVV system which must be interoperable with the managed care plan’s designated vendor’s EVV system.

2. Direct service providers must verify delivery of the service using the vendor’s system at the beginning and end of each home health service encounter.

(4)3. Providers must submit claims through the AHCA’s designated EVV vendor’s system to the Florida Medicaid fiscal agent for services rendered and verified in accordance with the prior authorizations in the Florida Medicaid Management Information System.

(5)(4) Providers that fail to comply with Florida Medicaid EVV requirements the Home Health Electronic Visit Verification Program are subject to potential denial or non-payment of claims, sanctions, fines, and suspension or termination from the Florida Medicaid program, in accordance with Rrule 59G-9.070, F.A.C.

Rulemaking Authority 409.919, 409.961 FS. Law Implemented 409.905, 409.906, 409.913, 409.9132, 409.973 FS. History–New 2-22-17,______

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Cathy Cross

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Simone Marstiller

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: July 30, 2021

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: May 14, 2021