Home Health Electronic Visit Verification Program

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.: RULE TITLE:

59G-4.132: Home Health Electronic Visit Verification Program

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 47 No. 153, August 9, 2021 issue of the Florida Administrative Register.

The rule text now reads:

(1) This rule applies to providers enrolled in the Florida Medicaid program that furnish home health services (home health visits, private duty nursing, and personal care services) or 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.

(2) No change.

(3) Electronic Visit Verification.

(a) No change.

(b) For providers participating in the fee-for-service delivery system: –

1. The Agency for Health Care Administration (AHCA) contracts with a vendor(s) to electronically verify the delivery of services provided to recipients in their residence or other authorized setting.

2 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 AHCA’s designated vendor’s 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.

3.(4) Providers who furnish home health or behavioral analysis services 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 prior authorizations in the Florida Medicaid Management Information System. Neither a provider who furnishes home health or behavior analysis services, nor a billing agent of that provider, may submit claims directly to the Florida Medicaid fiscal agent irrespective of any other provision including, but not limited to, Rule 59G-4.001, F.A.C.

(4)(5) No changes to the rule text.

(5) This rule is in effect for five years from its effective date.

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,______