The purpose of the amendment to Rule 59G-4.003, F.A.C., is to incorporate by reference the Florida Medicaid Provider Reimbursement Handbook, UB-04, July 2008. The handbook was revised to include billing instructions for Nursing Facilities, ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO: RULE TITLE
59G-4.003: Medicaid Providers Who Bill on the UB-04
59G-4.150: Inpatient Hospital Services
59G-4.160: Outpatient Hospital Services
PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.003, F.A.C., is to incorporate by reference the Florida Medicaid Provider Reimbursement Handbook, UB-04, July 2008. The handbook was revised to include billing instructions for Nursing Facilities, Intermediate Care Facilities, and State Mental Hospitals. Providers for these services will be required to bill on the UB-04 claim form when submitting paper claims. The handbook also contains updated references for the new Medicaid fiscal agent. The effect will be to incorporate by reference in rule the Florida Medicaid Provider Reimbursement Handbook, UB-04, July 2008.
The purpose of the amendment to Rule 59G-4.150, F.A.C., is to change the reference to the Florida Medicaid Provider Reimbursement Handbook, UB-92, to the Florida Medicaid Provider Reimbursement Handbook, UB-04. The effect will be to correct the reference to the Florida Medicaid Provider Reimbursement Handbook, UB-04.
The purpose of the amendment to Rule 59G-4.160, F.A.C., is to change the reference to the Florida Medicaid Provider Reimbursement Handbook, UB-92, to the Florida Medicaid Provider Reimbursement Handbook, UB-04. The effect will be to correct the reference to the Florida Medicaid Provider Reimbursement Handbook, UB-04.
In the Notice of Rule Development published on November 30, 2007, we stated that the Florida Medicaid Provider Reimbursement Handbook, UB-04, was revised March 2008. We changed this date to July 2008, because the new Medicaid fiscal agent implementation date and resulting changes to the claim form were delayed from March 2008 to July 2008.
SUMMARY: The purpose of the amendment to Rule 59G-4.003 is to incorporate by reference the Florida Medicaid Provider Reimbursement Handbook, UB-04, July 2008. The purpose of the amendment to Rule 59G-4.150, F.A.C., is to change the reference to the Florida Medicaid Provider Reimbursement Handbook, UB-92, to the Florida Medicaid Provider Reimbursement Handbook, UB-04. The purpose of the amendment to Rule 59G-4.160, F.A.C., is to change the reference to the Florida Medicaid Provider Reimbursement Handbook, UB-92, to the Florida Medicaid Provider Reimbursement Handbook, UB-04.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: The Agency has determined that this rule amendment will not result in any additional regulatory costs.
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.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.9081, 409.912 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: Wednesday, December 17, 2008, 2:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building #3, Conference Room D, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Catherine McGrath, Medicaid Services, 2727 Mahan Drive, Building 3, Mail Stop 20, Tallahassee, Florida 32308-5407, [phone], [e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

59G-4.003 Medicaid Providers Who Bill on the UB-04.

(1) All Medicaid providers and their billing agents who submit claims on behalf of an enrolled Medicaid provider, who are required by their service-specific coverage and limitations handbook or other notification by the Medicaid Program to bill the Florida Medicaid Program on a paper UB-04 claim form for reimbursement of services performed on a Medicaid eligible recipient, must be in compliance with the provisions of the Florida Medicaid Provider Reimbursement Handbook, UB-04, July 2008 May 2007, which is incorporated by reference. The handbook is available from the Medicaid fiscal agent’s Web Portal website at http://mymedicaid-florida.com floridamedicaid.acs-inc.com. Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies of the handbook may be obtained by calling the Provider Contact Center Medicaid fiscal agent at [phone] and selecting Option 7 377-8216.

(2) The following forms that is are included in the Florida Medicaid Provider Reimbursement Handbook, UB-04, is are incorporated by reference: in Chapter 1, the UB-04 CMS-1450, Approved OMB No. 0938-0997, May 2007, one page double-sided; and in Chapter 2, the State of Florida, Florida Medicaid Authorization Request, PA01 04/2002, one page; Medically Needy Billing Authorization, CF-ES 2902, June 2003, one page; State of Florida, Sterilization Consent Form, SCF 7/94, one page; State of Florida, Hysterectomy Acknowledgment Form, HAF 07/1999, one page; State of Florida, Exception to Hysterectomy Acknowledgment Requirement Form, ETA 07/2001, one page; and State of Florida, Abortion Certification Form, AHCA-Med Serv Form 011, August 2001, one page. All Tthe forms is are available from the Medicaid fiscal agent’s Provider Contact Center by calling [phone] and selecting Option 7 or from its website at http://floridamedicaid.acs-inc.com. Click on Provider Support, and then on Medicaid Forms.

Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912 FS. History–New 10-2-07, Amended________.

 

59G-4.150 Inpatient Hospital Services.

(1) No change.

(2) All hospital providers enrolled in the Medicaid program must comply with the Florida Medicaid Hospital Coverage and Limitations Handbook, incorporated by reference in Rule 59G-4.160, F.A.C., and the Florida Medicaid Provider Reimbursement Handbook, UB-04 92, both incorporated by reference in Rule 59G-4.003 59G-4.160, F.A.C. Both handbooks are available from the fiscal agent’s Web Portal at http://mymedicaid-florida.com contractor. Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies of the handbooks may be obtained by calling the Provider Contact Center at [phone] and selecting Option 7.

Specific Authority 409.919 FS. Law Implemented 409.905, 409.908, 409.9081 FS. History–New 1-1-77, Amended 3-30-78, 1-2-79, 2-3-81, 7-28-81, 7-1-83, 3-1-84, 10-31-85, Formerly 10C-7.39, Amended 10-2-86, 2-28-89, 10-17-89, 10-14-90, 5-21-91, 11-14-91, 3-25-92, 5-13-92, 7-12-92, 8-9-93, 12-21-93, Formerly 10C-7.039, Amended 6-13-94, 12-27-94, 2-21-95, 9-11-95, 11-12-95, 2-20-96, 6-9-96, 5-12-99, 1-1-01,_________.

 

59G-4.160 Outpatient Hospital Services.

(1) No change.

(2) All hospital providers enrolled in the Medicaid program must comply with the provisions of the Florida Medicaid Hospital Services Coverage and Limitations Handbook, June 2005, incorporated by reference, and the Florida Medicaid Provider Reimbursement Handbook, UB-04 92, April 2004, updated August 2005, both incorporated by reference in Rule 59G-4.003, F.A.C. this rule. Both handbooks are available from the Medicaid fiscal agent by calling Provider Enrollment at [phone] or from the fiscal agent’s Web Portal website at http://mymedicaid-florida.com. floridamedicaid.acs-inc.com. Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies of the handbooks may be obtained by calling the Provider Contact Center at [phone] and selecting Option 7.

(3) The following forms that are included in the Florida Medicaid Provider Reimbursement Handbook, UB-92, are incorporated by reference: The UB-92 Claim Form, UB-92 HCFA 1450, one page double-sided; State of Florida, Florida Medicaid Authorization Request, PA01 04/2002, one page; Medically Needy Billing Authorization, DF-ES 2902, June 2003, one page; State of Florida, Sterilization Consent Form, SCF 7/94, one page; State of Florida, Hysterectomy Acknowledgment Form, HAF 07/1999, one-page; State of Florida, Exception to Hysterectomy Acknowledgment Requirement, ETA 07/2001, one page; State of Florida, Abortion Certification Form, August 2001, one page. All the forms are available from the Medicaid fiscal agent by calling Provider Inquiry at [phone] or from its website at http://floridamedicaid.acs-inc.com. Click on Provider Support, and then on Medicaid Forms.

Specific Authority 409.919 FS. Law Implemented 409.905, 409.908, 409.9081 FS. History–New 1-1-77, Revised 12-7-78, 1-18-82, Amended 7-1-83, 7-16-84, 7-1-85, 10-31-85, Formerly 10C-7.40, Amended 9-16-86, 2-28-89, 5-21-91, 5-13-92, 7-12-92, 1-5-93, 6-30-93, 7-20-93, 12-21-93, Formerly 10C-7.040, Amended 6-13-94, 12-27-94, 2-21-95, 9-11-95, 11-12-95, 2-20-96, 10-27-98, 5-12-99, 10-18-99, 3-22-01, 8-12-01, 2-25-03, 8-14-03, 11-28-04, 8-18-05, 1-10-06, 4-16-06,_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Catherine McGrath
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Holly Benson, Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 4, 2008
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: November 30, 2007