Freestanding Dialysis Center Services

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.105Freestanding Dialysis Center Services

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. 41 No. 127, July 1, 2015 issue of the Florida Administrative Register.

The following changes have been made to the Florida Medicaid Dialysis Coverage Policy:

The table of contents was updated to reflect changes in the policy.

Section 1.1.1 Florida Medicaid Policies, now reads:

This policy is intended for use by dialysis and hospital providers that render dialysis services to eligible Florida Medicaid recipients. It must be used in conjunction with Florida Medicaid’s general policy and any applicable service-specific and claim reimbursement policies with which providers must comply.

Note: Policies are available on the Florida Medicaid fiscal agent’s Web site at http://portal.flmmis.com/FLPublic. All policies are incorporated by reference in Rule Division 59G, Florida Administrative Code (F.A.C.).

Section 1.3 Definitions, alphabetized subsection titles and renumbered based on policy update. Added beginning paragraph that reads:

The following definitions are applicable to this policy. For additional definitions that are applicable to all sections of Rule Division 59G, F.A.C., please refer to the Florida Medicaid definitions policy.

Section 1.3.1 Claim Reimbursement Policy, definition added and now reads:

A policy document that provides instructions on how to bill for services.

Section 1.3.6 Long-term Care Plan, term and definition removed based on standard language update. Added new term and definition that now reads:

General Policy

A collective term for Florida Medicaid policy documents found in Rule Chapter 59G-1 containing information that applies to all providers (unless otherwise specified) rendering services to recipients.

Section 1.3.7 Managed Medical Assistance Plan, term and definition removed based on standard language update.

Section 1.3.8 Medically Necessary/Medical Necessity, now reads:

As defined in Rule 59G-1.010, F.A.C.

Section 1.3.11 Provider General Handbook, term and definition removed based on standard language update.

Section 1.3.13 Reimbursement Handbook, term and definition removed based on standard language update.

Section 2.2 Who Can Receive, now reads:

Florida Medicaid recipients requiring medically necessary dialysis services. Some services may be subject to additional coverage criteria as specified in section 4.0.

Section 3.1 General Criteria, first paragraph now reads:

Providers must be at least one of the following to be reimbursed for services rendered to eligible recipients:

Section 3.2 Who Can Provide, now reads:

Facilities certified by the Centers for Medicare and Medicaid (CMS), as required in 42 CFR 494, can provide dialysis services.

Section 4.2.1 Dialysis Treatment, now reads:

Florida Medicaid reimburses for the following:

•              Hemodialysis treatments

•              Peritoneal dialysis treatments

The composite fee for dialysis treatment  includes all supervision and management of the dialysis treatment routine, durable and disposable medical supplies, equipment, laboratory tests, support services, parenteral drugs and applicable drug categories (including substitutions), and all necessary training and monitoring for recipients receiving peritoneal dialysis treatment.

Section 6.1 General Criteria, now reads:

For information on general documentation requirements, please refer to Florida Medicaid’s recordkeeping and documentation policy.

Section 7.1 General Criteria, second paragraph, second sentence now reads:

For recipients receiving services through the fee-for-service delivery system, providers should request authorization through the Quality Improvement Organization. For more information on general authorization submission requirements, please refer to Florida Medicaid’s authorization policy.

Section 7.2 Specific Criteria, first sentence now reads:

The authorization information described below is applicable to the fee-for-service delivery system, unless otherwise specified.

Section 8.1 General Criteria, now reads:

The reimbursement information below is applicable to the fee-for-service delivery system, unless otherwise specified.