Notice of Development of Rulemaking

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid
RULE NO.: RULE TITLE:
59G-4.320: Therapy Services
PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.320, F.A.C., is to incorporate by reference the Florida Medicaid Therapy Services Coverage and Limitations Handbook, October 2011. The rule will update the Medicaid Therapy Services Coverage and Limitations Handbook by clarifying policy and requiring prior authorization for therapy treatment visits, effective November 2011. The prior authorization requirement will satisfy a legislative mandate requiring utilization management for therapy services reimbursed by Medicaid set forth in Section 409.912(42), F.S. The
SUBJECT AREA TO BE ADDRESSED: Therapy Services Coverage and Limitations Handbook contains policy for therapy services reimbursed under the Medicaid program.
Therapy Services.
An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-4.320, 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, 409.907, 409.908, 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: Tuesday, October 18, 2011, 9:00 a.m. – 10:00 a.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, 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: Judy Taylor-Fischer at the Bureau of Medicaid Services, (850)412-4217. 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: Judy Taylor-Fischer, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: (850)412-4217, e-mail: judy.taylor-fischer@ahca.myflorida.com. To download a draft copy of this rule, if available, go to http://ahca.myflorida.com/Medicaid/review/index.shtml

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

59G-4.320 Therapy Services.

(1) This rule applies to all therapy services providers enrolled in the Medicaid program.

(2) All therapy providers enrolled in the Medicaid program must be in compliance with the Florida Medicaid Therapy Services Coverage and Limitations Handbook, October 2011 2003, updated July 2008, incorporated by reference, and the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which is incorporated in Rule 59G-4.001, F.A.C. The Both handbooks is are available from the Medicaid 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 Handbooks. Paper copies of the handbooks may be obtained by calling the Medicaid fiscal agent at 1(800)289-7799 and selecting Option 4.

Rulemaking Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.907, 409.908, 409.912, 409.913 FS. History– New 5-24-92, Amended 4-12-93, Formerly 10C-7.068, Amended 5-4-94, 12-26-95, 3-9-99, 12-2-03, 12-3-08,_______.