59G-5.020: Provider Requirements
PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-5.020, F.A.C., is to incorporate by reference the Florida Medicaid Provider General Handbook, October 2011. The handbook is updated in the following areas. First, the handbook will give providers direction on requesting non-emergency out-of-state services by providing general guidelines, adding non-emergency out-of-state services, and requiring a new form OOS PA 02, October 2011. Second, the handbook is updated to reflect Medicaid Qualified Medicare Beneficiary (QMB) cost-sharing initiatives, inclusive of Medicaid cost-sharing for Medicare Part C services copayment, coinsurance and deductible. Third, the handbook is updated to provide for telemedicine services. Last, the handbook is updated as directed by legislation through Senate Bill 1986 increasing the oversight of the Medicaid Program through the provision of general guidelines on termination, suspensions, and administrative sanctioning. Overall, the amendment updates policy, clarifies existing policy, updates forms, and updates fiscal agent information. Existing policies have been clarified and updated to ensure a better understanding of policy requirements.
SUBJECT AREA TO BE ADDRESSED: Provider Requirements.
An additional area to be addressed during the workshop will be the potential regulatory impact the amendment to Rule 59G-5.020, F.A.C., will have as provided for under Sections 120.54 and 120.541, F.S.
RULEMAKING AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.910, 409.912, 409.913 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: Wednesday, August 3, 2011, 9:00 a.m. – 11:00 a.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, 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: Maureen Barker at the Bureau of Medicaid Services, (850)412-4219. 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: Maureen Barker, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: (850)412-4219, e-mail: maureen.barker@ahca.myflorida.com
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:
59G-5.020 Provider Requirements.
(1) All Medicaid providers enrolled in the Medicaid program and billing agents who submit claims to Medicaid on behalf of an enrolled Medicaid provider must comply with the provisions of the Florida Medicaid Provider General Handbook, October 2011 July 2008, which is incorporated by reference and available from the fiscal agent’s Web site Portal at www. http://mymedicaid-florida.com. Select Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. A Paper copy of the handbook may be obtained by calling the
(2) The following form is incorporated by reference: AHCA Form 2200-0004, July 2008, Medicaid Provider Change of Address Form, one page. The form is available from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com. Click on Secure Information for Providers. The form may also be obtained from the Medicaid fiscal agent by calling the Provider Contact Center at (800)289-7799 and selecting Option 7.
(3) The following forms that are included in the Florida Medicaid Provider General Handbook are incorporated by reference. In Chapter 3, Temporary Emergency Medicaid Identification Card, July 2008; one page; CF-ES 2681, Feb 2003, Notice and Proof of Presumptive Eligibility for Medicaid for Pregnant Women, one page; CF-ES Form 2014, Feb 2003, Authorization for Medicaid/Medikids Eligibility, one page; AHCA Form 5240-006, Unborn Activation Form, January 2007, one page; CF-ES 2039, Sep 2002, Medical Assistance Referral, two pages. In Chapter 4, the AHCA-Med Serv 038, July 2008, Crossover with TPL Claim and/or Adjustment Form, one page. The CF-ES forms are available from the Department of Children and Family Services. The other forms are available from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com. Click on Public Information for Providers, then on Provider Support, and then on Forms. Paper copies of the forms may be obtained by calling the Provider Contact Center at 1(800)289-7799 and selecting option 7.
Rulemaking Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.910, 409.912, 409.913 FS. History–New 9-22-93, Formerly 10P-5.020, Amended 7-8-97, 1-9-00, 4-24-01, 8-6-01, 10-8-03, 1-19-05, 5-24-07, 2-25-09,_________.