The purpose of the amendment to Rule 59G-4.160, Florida Administrative Code (F.A.C.), is to incorporate by reference the updated Florida Medicaid Outpatient Hospital Services Coverage Policy, __________. The coverage policy revises the rate ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.160Outpatient Hospital Services

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.160, Florida Administrative Code (F.A.C.), is to incorporate by reference the updated Florida Medicaid Outpatient Hospital Services Coverage Policy, __________. The coverage policy revises the rate calculation information and clarifies authorization requirements.

SUMMARY: The amendment specifies that the Enhanced Ambulatory Patient Grouping reimbursement methodology will be used for provider reimbursement.

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, 409.907, 409.908, 409.912, 409.913, 409.973 FS.

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

DATE AND TIME: June 17, 2019, 11:00 a.m. to 11:30 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: [e-mail].. 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: [e-mail]. Please note that a preliminary draft of the reference material, if available, will be posted prior to the hearing at http://ahca.myflorida.com/medicaid/review/Rules.shtml. Official comments to be entered into the rule record will be received until 5:00 p.m. on June 18, 2019 and 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-4.160 Outpatient Hospital Services.

(1) This rule applies to all providers rendering Florida Medicaid outpatient hospital services to recipients.

(2) All providers must be in compliance with the provisions of the Florida Medicaid Outpatient Hospital Services Coverage Policy, ________July 2016, incorporated by reference. The policy is available on the Agency for Health Care Administration’s Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml and available at  http://www.flrules.org/Gateway/reference.asp?No=Ref-_______ 06979.

(3) The United States Department of Health and Human Services’ Consent for Sterilization Form - HHS-687 (10/12), is incorporated by reference, http://www.flrules.org/Gateway/reference.asp?No=Ref-07025, and available at http://www.hhs.gov/opa/pdfs/consent-for-sterilization-english-updated.pdf.

Rulemaking Authority 409.919, 409.961 FS. Law Implemented 409.902, 409.905, 409.907, 409.908, 409.912, 409.913, 409.973 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, 2-25-09, 6-25-12, 7-11-16,_______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jesse Bottcher

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Mary C. Mayhew

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 13, 2019

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 25, 2017