The purpose of the amendment to Rule 59G-1.045, Florida Administrative Code, is to update forms required by Florida Medicaid that impact multiple services.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-1.045Medicaid Forms

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-1.045, Florida Administrative Code, is to update forms required by Florida Medicaid that impact multiple services.

SUMMARY: The amendment updates existing forms and incorporates by reference additional forms that are specified in various Florida Medicaid coverage policies.

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, 409.961 FS.

LAW IMPLEMENTED: 409.902, 409.905, 409.912, 409.973 FS.

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

DATE AND TIME: May 12, 2016, 10:00 a.m. – 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, 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: Laura Risech. 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: Laura Risech, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail].

Please note that a preliminary draft of the reference material, if available, will be posted prior to the public hearing at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received from the date of this notice until May 13, 2016. Comments may be e-mailed to [e-mail]. For general inquiries and questions about the rule, please contact the person specified above.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-1.045 Medicaid Forms.

The following forms are incorporated by reference and are used either by other state agencies or providers rendering enrolled in, or registered with, the Florida Medicaid services to recipients program. (2) The forms are available from the Agency for Health Care Administration’s Medicaid fiscal agent’s Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml http://portal.flmmis.com/flpublic.

(1) Medical Certification for Medicaid Long-term Care Services and Patient Transfer, AHCA Form 5000-3008, _________October 2015, http://www.flrules.org/Gateway/reference.asp?No=Ref-05826

(2) State of Florida Abortion Certification Form, AHCA MedServ Form 011,  ________August 2011

(3) State of Florida Exception to Hysterectomy Acknowledgment Requirement, ETA, ____________

(4) State of Florida Hysterectomy Acknowledgment Form, HAF, ________

(5) Unborn Activation Form, AHCA Form 5240-006,___________

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.912 FS. History–New 9-28-15, Amended_______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Laura Risech

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

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: April 11, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: January 14, 2016