Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 32 No. 51, December 22, 2006 issue of the Florida Administrative Weekly.

These changes are in response to comments received from the Joint Administrative Procedures Committee and comments received at the public hearing. On 2-11-07, Rule 59G-4.230 was amended to incorporate by reference the Florida Medicaid Physician Services Coverage and Limitations Handbook, January 2007. We corrected the rule text to reflect this amendment will incorporate by reference update January 2007 to the Florida Medicaid Physician Services Coverage and Limitations Handbook, January 2007. We also corrected the last sentence of the rule text to state papercopies of the handbooks may be obtained by calling Provider Enrollment, not Provider Inquiry.

The amendment to Rule 59G-4.190, Independent Laboratory Services, incorporates by reference update January 2007 to the Florida Medicaid Independent Laboratory Coverage and Limitations Handbook. The following changes were made to the handbook.

On Page 2-5, we replaced Preconception Genetic Carrier Screening Laboratory Testing Covered Services and Prenatal Genetic Carrier Screening Laboratory Testing Covered Services with the following:

“Covered Services: Medicaid reimburses for preconception and prenatal genetic carrier screening laboratory tests that are accepted by the American College of Medical Genetics and that can be billed using Healthcare Common Procedure Coding System (HCPCS) procedure codes. The laboratory testing method must be considered to be a proven method for the identification of a genetically-linked inheritable disease (i.e., the genotypes to be detected by a genetic test must be shown by scientifically valid methods to be associated with the occurrence of a disease, and the observations must be independently replicated and subject to peer review).”

“Service Requirements: Preconception and prenatal genetic carrier screening laboratory tests must be ordered by a licensed healthcare practitioner authorized within the scope of his practice to order genetic carrier screening laboratory tests. The laboratory must maintain requests for the specific laboratory tests on file with copies of the report of the test results. The recipient must be eligible for Medicaid on the date of service.”

Under DNA-Based Preconception and Prenatal Genetic Laboratory Services Limitations, we deleted the reference to the specific molecular diagnostic codes (83890-83912) and “up to a maximum of six probes of primer pairs per recipient.”

On Page 2-6, we deleted Documentation Required for Preconception or Prenatal Genetic Carrier Screening Laboratory Testing, Preconception or Prenatal Genetic Carrier Screening Laboratory Testing Genetic Carrier Screening Services Exclusions, Accepted Clinical Laboratory Methods for Preconception or Prenatal Genetic Carrier Screenings. We repaginated the pages so that Limitations will begin on Page 2-6.

On Page 2-7 (was page 2-8 in the Proposed Rulemaking version of the handbook), Duplicate Billing Not Allowed, 3rd bullet, we added the following to the last sentence, “unless it is for a separate and distinct test for the same recipient on the same day of service.”

We corrected the Table of Contents for the handbook and on Page 2-1 to note that Limitations are now on Page 2-6 and Exclusions are on Page 2-7.

The amendment to Rule 59G-4.230, Physician Services, incorporates by reference update January 2007 to the Florida Medicaid Physician Services Coverage and Limitations Handbook. The following changes were made to the handbook.

On Page 2-91, Infectious Agent Antigen Detection by Nucleic Acid, we added the following to the last sentence, “unless it is for a separate and distinct test for the same recipient on the same day of service.”

On Page 2-92, we replaced Preconception Genetic Carrier Screening Laboratory Testing Covered and Prenatal Genetic Carrier Screening Laboratory Testing Covered Services with the following:

“Covered Services: Medicaid reimburses for preconception and prenatal genetic carrier screening laboratory tests that are accepted by the American College of Medical Genetics and that can be billed using Healthcare Common Procedure Coding System (HCPCS) procedure codes. The laboratory testing method must be considered to be a proven method for the identification of a genetically-linked inheritable disease (i.e.,the genotypes to be detected by a genetic test must be shown by scientifically valid methods to be associated with the occurrence of a disease, and the observations must be independently replicated and subject to peer review).”

“Recipient Eligibility for Preconception and Prenatal Genetic Carrier Screening Laboratory Testing: Medicaid reimburses for preconception and prenatal genetic carrier screening laboratory testing services for the prospective or expecting mother and father when the following criteria are met:

· The person being tested has a direct risk factor, based on family history or ethnicity analysis, for the development of a genetically-linked inheritable disease.

· To determine the person’s risk of passing on a particular genetic mutation in X-linked and autosomal-recessive conditions to their off-spring.

· The person being tested is eligible for Medicaid on the date of service.”

On Page 2-93, DNA-Based Preconception and Prenatal Genetic Laboratory Services Limitations, we deleted the reference to the specific molecular diagnostic codes (83890-83912) and “up to a maximum of six probes of primer pairs per recipient.”

Under Documentation Required for Preconception or Prenatal Genetic Carrier Screening Laboratory Testing, we deleted the first sentence, “Prior authorization is not required for preconception or prenatal genetic carrier screening laboratory testing.” We deleted “However” from the second sentence.

We deleted Preconception or Prenatal Genetic Carrier Screening Laboratory Testing Genetic Carrier Screening Services Exclusions and Accepted Clinical Laboratory Methods for Preconception or Prenatal Genetic Carrier Screenings.

We repaginated the pages so that Pediatric Critical Services now begin on Page 2-94 and corrected the Table of Contents for the handbook and on Page 2-1.