The purpose of the amendment to Rule 59G-4.060 is to incorporate by reference the Florida Medicaid Dental Services Coverage Policy,________. The incorporated coverage policy will specify recipient eligibility, provider requirements, service coverage,...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.060Dental Services

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.060, F.A.C. is to incorporate by reference the Florida Medicaid Dental Services Coverage Policy,________. The incorporated coverage policy will specify recipient eligibility, provider requirements, service coverage, and reimbursement information.

SUBJECT AREA TO BE ADDRESSED: Dental Services. An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-4.060, F.A.C., will have as provided for under sections 120.54 and 120.541, Florida Statutes.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: October 14, 2015, from 12:00 p.m. to 2:00 p.m.

PLACE: State Regional Service Center, 400 W. Robinson Street, Suite N-109 (Hurston Building – North Tower), Orlando, Florida 32801.

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: Robert Reifinger. 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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Robert Reifinger, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop #20, Tallahassee, Florida 32308-5407, telephone: [phone] e-mail: [e-mail].

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

59G-4.060 Dental Services.

(1) This rule applies to all providers of dental services dentists who are enrolled in or registered with the Florida Medicaid program for dental services under Section 409.906, F.S.

(2) All providers of dental services providers enrolled in the Medicaid program must be in compliance with the provisions of the Florida Medicaid Dental Services Coverage Policy,__________, incorporated by reference and Limitations Handbook, November 2011, and the Florida Medicaid Provider Reimbursement Handbook, ADA Dental Claim Form, July 2008, which are incorporated by reference, and the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which is incorporated by reference in Rule 59G-4.001, F.A.C. The policy is All handbooks are available from the Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic. www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks. Paper copies of the handbooks may be obtained by calling the Medicaid fiscal agent, Provider Contact Center at 1(800) 289-7799 and selecting Option 7.

(3) The following forms that are included in the Florida Medicaid Dental Services Coverage and Limitations Handbook are incorporated by reference: Medicaid Orthodontic Initial Assessment Form (IAF), AHCA-Med Serv Form 013, January 2006, five pages, located in Appendix A; and the Medical Behavioral Management Report, AHCA-Med Serv Form 012, January 2007, one page, located in Appendix F. The forms are available by photocopying them from the handbook.

(4) The following form that is included in Chapter 1 of the Florida Medicaid Provider Reimbursement Handbook, ADA Dental Claim Form, is incorporated by reference: ADA Dental Claim Form, ©2006 American Dental Association, J404. ADA Dental Claim Forms may be ordered from the American Dental Association at 1(800) 947-4746 or online at www.adacatalog.org. They may also be ordered by calling the Medicaid fiscal agent’s Provider Contact Center at 1(800) 289-7799 and selecting Option 7. The following form that is included in Chapter 3 of the handbook, Medically Needy Billing Authorization, DF-ES 2902, June 2003, is incorporated by reference in Rule 59G-4.001, F.A.C. The form is mailed by the Department of Children and Family Services to providers whose services are eligible for reimbursement.

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History–New 7-10-80, Amended 2-19-81, 10-27-81, 7-21-83, Formerly 10C-7.523, Amended 9-11-90, 11-3-92, Formerly 10C-7.0523, Amended 6-29-93, Formerly 10P-4.060, Amended 7-19-94, 7-16-96, 3-11-98, 10-13-98, 12-28-98, 6-10-99, 4-23-00, 4-24-01, 7-5-01, 2-20-03, 8-5-03, 1-8-04, 10-12-04, 6-28-05, 7-2-06, 5-21-07, 2-23-09, 5-3-12, _____.