The purpose of Rule 59G-6.005, Florida Administrative Code (F.A.C.), is to describe Florida Medicaid’s payment methodology for services provided to recipients by physicians and other licensed health care practitioners who are enrolled in the Florida ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-6.005Reimbursement Methodology for Services Provided by Medical School Faculty

PURPOSE AND EFFECT: The purpose of Rule 59G-6.005, Florida Administrative Code (F.A.C.), is to describe Florida Medicaid’s payment methodology for services provided to recipients by physicians and other licensed health care practitioners who are enrolled in the Florida Medicaid program and who are employed or contracted with a Florida public or private, non-profit, accredited medical, dental, or optometry school to teach.

SUBJECT AREA TO BE ADDRESSED: Reimbursement Methodology for Services Provided by Medical School Faculty. An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-6.005, F.A.C., will have as provided for under sections 120.54 and 120.541, Florida Statutes.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.908 FS.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: October 20, 2016 from 11:00 a.m. to 12:00 p.m.

PLACE: In Person: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Tallahassee,

Florida 32308-5407. Remote Listeners: Register to view the presentation at https://attendee.gotowebinar.com/register/6593370287623976708. A call number will be provided upon successful registration through which, remote attendees may listen to the discussion via telephone.

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 48 hours before the workshop/meeting by contacting: Monique Johnson. 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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Monique Johnson, Bureau of Medicaid Policy, 2727

Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], email: [e-mail].

Official comments to be entered into the rule record will be received until 5:00 p.m. on October 21, 2016, and may be emailed to [e-mail]. For general inquiries and questions about the rule, please contact the person specified above.

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

59G-6.005 Reimbursement Methodology for Services Provided by Medical School Faculty.

(1) This rule applies to all providers who are enrolled in Florida Medicaid who:

(a) Participate in the Centers for Medicare and Medicaid Services’ Physician Quality Reporting Systems program.

(b) Provide medical services, immunization services, dental services, behavioral health services, hearing services, and vision services to Florida Medicaid recipients receiving services through the fee-for-service delivery system.

(c) Are employed by, or contracted with, a Florida public or private, non-profit, accredited medical, dental, or optometry school to provide supervision and teaching of medical, dental, or optometric students, residents, or fellows.

(2) Reimbursement.

(a) Florida Medicaid reimburses providers for covered medical, hearing, vision, immunization, dental, and behavioral health services listed on the applicable Florida Medicaid fee schedule, incorporated by reference in Rule 59G-4.002, F.A.C., at either:

1. One-hundred-ninety percent of the Medicare rate, based on Florida locality code 0910299, listed on the 2016 Medicare Part B physician fee schedule - Loc 99 (01/02),______, incorporated by reference, and available at http://medicare.fcso.com/Data_files and at [DOS place holder Ref-_______].

2. One-hundred-ninety percent of the Florida Medicaid rate if the service is not covered by Medicare.

(b) Florida Medicaid reimbursement to providers for clean claims submitted to the Florida Medicaid Management Information System specified in this rule shall not exceed $27,863,458 for Fiscal Year 2016-2017.

(c) Florida Medicaid will reconcile claims reimbursed in accordance with this rule on a quarterly basis. Any claims reimbursed after the maximum reimbursable amount is reached will be recouped, or adjusted to the standard Florida Medicaid rate, as appropriate.

Rulemaking Authority 409.919 FS. Law Implemented 409.908 FS. History–New ________.