The purpose of Rule 59G-4.264, Florida Administrative Code, is to clarify requirements for all providers of regional perinatal intensive care center (RPICC) services.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.264Regional Perinatal Intensive Care Center Services

PURPOSE AND EFFECT: The purpose of Rule 59G-4.264, Florida Administrative Code, is to clarify requirements for all providers of regional perinatal intensive care center (RPICC) services.

SUMMARY: This rule specifies provider requirements, service coverage, and reimbursement information for all RPICC providers.

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 FS.

LAW IMPLEMENTED: 409.902, 409.905, 409.907, 409.908, 409.912, 409.913 FS.

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

DATE AND TIME: April 6, 2016, 10:00 a.m. – 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room D, Tallahassee, Florida 32308-5407

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: Jessica Kenny. 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: Jessica Kenny, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-4.264 Regional Perinatal Intensive Care Center Services.

(1) This rule applies to any person or entity prescribing or reviewing a request for obstetrical and neonatal services provided in a regional perinatal intensive care center (RPICC), and to all physicians providing services in a RPICC who are enrolled in the Florida Medicaid program and rendering services in the fee-for-service delivery system.

(2) Definitions.

(a) Global Payment - An all-inclusive payment for services performed by a physician in a RPICC facility.

(b) High-Risk Pregnancy - A pregnancy in which the woman whose medical history and diagnosis indicates, without consideration of a previous cesarean section, that a normal uncomplicated pregnancy and delivery are unlikely to occur.

(c) Level III Intensive Care - Services provided in a neonatal intensive care unit designated by the Agency for Health Care Administration, which include the provision of continuous cardiopulmonary support, 12 or more hours of nursing care per day, complex neonatal surgery, neonatal cardiovascular surgery, pediatric neurology and neurosurgery, and pediatric cardiac catheterization.

(d) Recipient - For the purpose of this rule, the term used to describe an individual enrolled in Florida Medicaid.

(3) Who Can Provide.

(a) Physicians who are participants in the Department of Health’s Children’s Medical Services RPICC program and render inpatient hospital obstetrical and neonatal services to recipients in a designated RPICC facility.

(4) Coverage. Florida Medicaid reimburses for the following services performed by a physician in a RPICC facility:

(a) Obstetrical services for recipients with high-risk pregnancies.

(b) Up to 365 days of neonatal services when the recipient meets all of the following:

1. Is more than 20 weeks gestation.

2. Requires more than 48 hours of services.

3. Requires Level III intensive care.

(5) Documentation. Providers submitting an obstetrical antepartum or postpartum claim, or a neonatal transfer claim, must include a RPICC Entitlement Exception Report, incorporated by reference and available from the University of Florida’s RPICC Data System at https://esteps.med.ufl.edu/, with each claim.

(6) Reimbursement.

(a) Florida Medicaid reimburses providers with a global payment in accordance with the applicable Florida Medicaid fee schedule(s), incorporated by reference in Rule 59G-4.002, F.A.C.

(b) Florida Medicaid apportions reimbursement among providers when a recipient is transferred between RPICC facilities based on the number of days a recipient receives services in each location. Providers must submit claims after the recipient is discharged from the last facility and ensure dates of service on the claim form(s) do not overlap.

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.907, 409.908, 409.912, 409.913 FS. History–New ________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jessica Kenny

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 15, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: November 5, 2015