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, May 2009, and delete the reference to the Florida Medicaid Provider Reimbursement Handbook, Institutional 021, which was 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 (previously named the Patient Transfer and Continuity of Care Form) and instructions, updated Medicare Part A crossover policy, and revised policy for requesting supplemental payment for residents with AIDS. The revised handbook reiterates the nursing facility’s requirement to enter the recipient’s responsibility on the claim and eliminates the Medicaid Nursing Facility/ICF-DD Contribution Notices, AHCA Form 5000-3300.
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 replaced 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.
In the Notice of Rule Development we stated the effective date of the handbook was July 2008. We changed this date to May 2009.
The effect will be to incorporate by reference in rule the revised Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook, May 2009; delete the reference to the Florida Medicaid Provider Reimbursement Handbook, Institutional 021; and require providers to comply with the provisions of the Florida Medicaid Provider Reimbursement Handbook, UB-04.
SUMMARY: The purpose of this rule amendment is to incorporate by reference into rule the Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook, May 2009. The effect will be to incorporate by reference into rule the Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook, May 2009.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: The agency has determined that this rule amendment will not have an impact on small business. A SERC has not been prepared by the agency.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.908 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: Tuesday, June 2, 2009, 2:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building #3, Conference Room B, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE 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 FULL TEXT OF THE PROPOSED RULE 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, May 2009, 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 Web Portal at http://mymedicaid-florida.com. Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies of the handbook may be obtained 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 Nursing Facility Services Coverage and Limitations Handbook are incorporated by reference:
(a) In Appendix A, AHCA Form 5210-001, May 2009 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, and available from the Department of Children and Families district office CF-ES 2506A, May 2003, Client Referral/Notice, one page. Both forms are available from the Department of Children and Family Services Region or Circuit district offices or photocopying the forms in Appendix B.;
(c) In Appendix C, Medical Certification for Nursing Facility/Home and Community Based Services (MCNF/HCBS) Form AHCA-Med Serv 3008, May 2009, two pages, and Informed Consent Form, AHCA-Med Serv Form 2040, May 2008, in English and Spanish, one page, available from the Department of Elder Affairs website at http://elderaffairs.state.fl.us/english/cares_3008ppp.php.
(d) In Appendix D, Level I PASRR Screen and Determination Checklist, AHCA-Med Serv Form 004, Part A, May 2009, October 2003, three pages, and Request for Level II PASRR Evaluation and Determination, AHCA-Med Serv Form 004, Part B, May 2009, one page, available from the Department of Elder Affairs website at http://elderaffairs.state.fl.us/english/cares_pasrr.php or photocopying the forms in Appendix D. may be photocopied from the Florida Medicaid Nursing Facility Services Coverage and Limitations Handbook; and AHCA Form 5000-3300, April 02, Medicaid Nursing Facility/ICF-DD Contribution Notice available or from the Medicaid area offices.
(e) In Appendix G, AIDS Supplemental Payment Authorization Form, AHCA-Med Serv Form 049, May 2009, two pages, available by photocopying from the handbook.
Rulemaking 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,_________.