AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-5.110Claims Payment
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. 42 No. 10, January 15, 2016 issue of the Florida Administrative Register.
The following changes have been made to the rule text.
(1) through (2) No change.
(3) Reimbursement Process:
(a) The reimbursement request must include evidence of all out-of-pocket expenses paid to the provider, validated through receipts submitted by the recipient to: Agency for Health Care Administration, 2727 Mahan Drive, MS#58, Tallahassee, FL 32308 400 W. Robinson St., Suite S-309, Orlando, FL 32801.
(b) The Agency for Health Care Administration will send a Florida Medicaid Direct Reimbursement Recipient Information Request, AHCA Form 5240-0002, ________, incorporated by reference and available on the AHCA Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml, or at [DOS place holder Ref-_______] in Rule 59G-1.045, F.A.C., to recipients specifing the information if more information is required to determine their eligibility for direct reimbursement. Recipients must complete and return the signed form in accordance with the instructions provided on the form.
(c) The Agency for Health Care Administration will send a Florida Medicaid Direct Reimbursement Provider Information Request, AHCA Form 5240-0003, _________, incorporated by reference and available on the AHCA Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml, or at [DOS place holder Ref-_______] in Rule 59G-1.045, F.A.C., if more information is needed from the provider to determine recipient eligibility for direct reimbursement. Providers must complete and return the signed form in accordance with the instructions provided on the form.
(4)-(5) No change.
Rulemaking Authority 409.919 FS. Law Implemented 42 CFR 431.246, 409.902 FS. History–New 9-22-93, Formerly 10P-5.110, Amended 5-9-99,____________.
