11593748, 59G-1.035 - Florida Administrative Rules, Law, Code, Register

Home

Florida Department of State and Division of Library and Information Services

Notice: 11593748

Notice of Development of Rulemaking

Department:

AGENCY FOR HEALTH CARE ADMINISTRATION

Division:

Medicaid

Chapter:

GENERAL MEDICAID

Overview

RULE:

59G-1.035

Determining Generally Accepted Professional Medical Standards

PURPOSE:

Subparagraph 59G-1.010(166)(a)3., Florida Administrative Code (F.A.C.) provides that medical necessity must be consistent with generally accepted professional medical standards, as determined by the Medicaid program, and not by experimental or investigational standards as defined in subsection 59G-1.010(84), F.A.C. This rule specifies the Medicaid program’s process for determining the circumstances under which a drug, device, medical or therapeutic treatment, or procedure is consistent with generally accepted professional medical practice and standards. It provides guidelines which are to be used when making a coverage determination of a new drug, device, medical or therapeutic treatment or procedure, including services such as applied behavior analysis. The rule includes the types of data referenced in the decision making process and names the person(s) qualified to make the final coverage determination.

SUBJECT:

Determining Generally Accepted Professional Medical Standards.
An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-1.035, F.A.C., will have as provided for under Sections 120.54 and 120.541, F.S.

RULEMAKING AUTHORITY:

409.919 FS.

LAW:

409.902, 409.905, 409.912, 409.913 FS.

PRINT PUBLISH DATE:

6/15/2012 Vol. 38/24

RELATED STATUTES
AND LAWS:

409.919 FS., 409.902, 409.905, 409.912, 409.913 FS.

OVERSIGHT COMMITTEE:

Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)

RELATED COURT CASES:

Division of Administrative Hearings

FEDERAL eRULEMAKING
WEB PORTAL:

Regulations.gov

HOW TO LINK TO
THIS NOTICE:

http://flrules.org/gateway/ruleno.asp?id=59G-1.035&PDate=6/15/2012&Section=1

REFERENCE MATERIALS:

No reference(s).

Under Florida law, E-mail addresses are public records. If you do not want your E-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.