59G-4.200: Nursing Facility Services
PURPOSE AND EFFECT: The purpose of this rule amendment is to incorporate by reference the revised Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook, July 2008, and delete the reference to the Florida Medicaid Provider Reimbursement Handbook, Institutional 021, which will be obsolete July 1, 2008. The revised Nursing Facility Handbook includes updated Pre-Admission Screening and Resident Review (PASRR) requirements and forms, revised Medical Certification for Nursing Facility/Home and Community Based Services Form and instructions, and updated Medicare Part A crossover policy. The revised handbook reiterates the nursing facility’s requirement to enter the recipient’s responsibility on the claim.
The rule was revised to require nursing facility services providers to comply with the provisions of the Florida Medicaid Provider Reimbursement Handbook, UB-04, which replaces the Florida Medicaid Provider Reimbursement Handbook, Institutional 021. The authorization policies for supplemental payments for medically-fragile recipients under the age of 21 and recipients with AIDS and the Client Discharge/Change Notice, CF-ES 2506, that were in Chapter 2 of the Florida Medicaid Provider Reimbursement Handbook, Institutional 021, were moved to the revised Nursing Facility Handbook.
The effect will be to incorporate by reference in rule the revised Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook, July 2008; deleted the reference to the Florida Medicaid Provider Reimbursement Handbook, Institutional 021; and requires providers to comply with the provisions of the Florida Medicaid Provider Reimbursement Handbook, UB-04.
This Notice of Rule Development replaces the Notice of Rule Development that was published in Vol. 33, No. 27, July 6, 2007, Florida Administrative Weekly.
SUBJECT AREA TO BE ADDRESSED: Nursing Facility Services.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.908 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:
TIME AND DATE: Tuesday, June 3, 2008, 2:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room B, Tallahassee, Florida 32308
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Susan Rinaldi, Medicaid Services, 2727 Mahan Drive, Building 3, Mail Stop 20, Tallahassee, Florida 32308-5407, (850)487-3028, rinaldis@ahca.myflorida.com
THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:
59G-4.200 Nursing Facility Services.
(1) No change.
(2) All participating nursing facility providers must comply with the provisions of the Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook, July 2008, October 2003, updated July 2004, erratum to the July 2004 update, which is incorporated by reference, and the corresponding Florida Medicaid Provider Reimbursement Handbook, UB-04, Institutional 021, October 2003, which is are incorporated by reference in Rule 59G-4.003, F.A.C. Both handbooks are available from the Medicaid fiscal agent’s website at http://mymedicaid-florida.com. Paper copies of the handbook may be obtained by calling the Medicaid fiscal agent at 800-289-7799 and selecting option 4.
(3) The following forms that are included in the Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook are incorporated by reference:
(a) In Appendix A, AHCA Form 5210-001, August 2000, Nurse Aide Training and Competency Evaluation Program Invoice, two pages, available from the Medicaid area offices;
(b) In Appendix B, CF-ES 2506, Feb. 2003, Client Discharge/Change Notice, one page, available from the Department of Children and Family Services district offices or photocopying the form in Appendix B;
(c) In Appendix B, CF-ES 2506A, May 2003, Client Referral/Notice, one page, available from the Department of Children and Family Services district offices or photocopying the form in Appendix B;
(d) In Appendix C, Level I PASRR Screen and Determination Checklist, AHCA-Med Serv Form 004, Part A, March 2008, October 2003, three pages, and Request for Level II PASRR Evaluation and Determination, AHCA-Med Serv Form 004, Part B, March 2008, one page, available from the Department of Elder Affairs website at http://elderaffairs. state.fl.us/english/cares.html or photocopying the form in Appendix C the Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook;
(e) In Appendix D, Medical Certification for Nursing Facility/Home and Community Based Services Form AHCA-Med Serv Form 3008, five pages, and Informed Consent Form, AHCA-Med Serv Form 2040, one page, available from the Department of Elder Affairs website at http://elderaffairs.state.fl.us/english/cares.html. and AHCA Form 5000-3300, April 02, Medicaid Nursing Facility/ICF-DD Contribution Notice available or from the Medicaid area offices.
Specific Authority 409.919 FS. Law Implemented Chapter 400 Part II, 409.902, 409.905, 409.908 FS. History–New 1-1-77, Amended 6-13-77, 10-1-77, 1-1-78, 2-1-78, 12-28-78, 2-14-80, 4-5-83, 1-1-84, 8-29-84, 9-1-84, 9-5-84, 7-1-85, Formerly 10C-7.48, Amended 8-19-86, 6-1-89, 7-2-90, 6-4-92, 8-5-92, 11-2-92, 7-20-93, Formerly 10C-7.048, Amended 11-28-95, 5-9-99, 10-15-00, 10-4-01, 2-10-04, 9-28-04, 8-31-05, 7-23-06,_________.