13630942, 59G-1.035 - Florida Administrative Rules, Law, Code, Register

Home

Florida Department of State and Division of Library and Information Services

Notice: 13630942

Notice of Proposed Rule

Department:

AGENCY FOR HEALTH CARE ADMINISTRATION

Division:

Medicaid

Chapter:

GENERAL MEDICAID

Overview

RULE:

59G-1.035

Determining Generally Accepted Professional Medical Standards

PURPOSE:

Rule 59G-1.010(166)(a)3., Florida Administrative Code (F.A.C.), provides in part that in order for a diagnostic test, therapeutic procedure, or medical device or technology to be medically necessary it must be consistent with generally accepted professional medical standards, as determined by the Florida Medicaid program, and not be experimental or investigational as defined in Rule 59G-1.010(84), F.A.C. This new rule specifies Florida Medicaid’s process for determining the circumstances under which a diagnostic test, therapeutic procedure, or medical device or technology is consistent with generally accepted professional medical standards.

SUMMARY:

Medicaid coverage determinations are made when all criteria of medical necessity are met. As such, Florida Medicaid must determine if a diagnostic test, therapeutic procedure, or medical device or technology is experimental or investigational. This rule provides the guidelines that Florida Medicaid will use when determining the circumstances under which a diagnostic test, therapeutic procedure, or medical device or technology is consistent with generally accepted professional medical standards. This rule also includes the types of information to be considered in the decision-making process and names the person(s) qualified to make the final determination.

RULEMAKING AUTHORITY:

409.919

LAW:

409.902, 409.905, 409.912, 409.913 FS.

PRINT PUBLISH DATE:

10/3/2013 Vol. 39/193

COMMENTS:

From 10/3/2013 To 10/24/2013 (21 Days)
The public comment period for this notice has already expired.

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.