MEDICAID POLICY

Rulemaking Authority 409.919 FS. Law Implemented 409.906(13), 409.908, 409.913(5)(e) FS. History-New 1-1-77, Amended 3-10-83, Formerly 10C-7.34, Amended 12-28-93, Formerly 10C-7.034, Repealed 7-11-16.

(1) Purpose. This rule establishes the level of care criteria that must be met in order for nursing and rehabilitation services to qualify as intermediate care services and clarifies the criteria that must be met in order for such services to qualify as an intermediate level I or…

(1) This rule applies to all providers rendering Florida Medicaid laboratory services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Laboratory Services Coverage Policy, June 2025, incorporated by reference. The policy is availa…

(1) This rule applies to all providers rendering Florida Medicaid Statewide Medicaid Managed Care Long-term Care Program services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Statewide Medicaid Managed Care Long-term Care Prog…

(1) This rule applies to individuals living in their home, or a community setting, who are seeking Florida Medicaid coverage for home and community-based services (HCBS) through the Florida Medicaid Statewide Medicaid Managed Care Long-term Care (LTC) program. (2) Definitions. Th…

Rulemaking Authority 409.919 FS. Law Implemented 409.906, 409.908, 409.9081 FS. History-New 6-29-93, Formerly 10C-7.0520, Amended 3-10-96, 3-11-98, 10-13-98, Repealed 8-28-14.

(1) This rule applies to all providers rendering Florida Medicaid medical foster care services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Medical Foster Care Services Coverage Policy, December 2019, incorporated by reference…

(1) This rule applies to all mental health targeted case management providers enrolled in the Medicaid Mental Health Targeted Case Management Program. (2) All Medicaid-enrolled mental health targeted case management providers must be in compliance with the Florida Medicaid Mental…

(1) This rule applies to any person or entity prescribing or reviewing a request for nursing facility services and to all providers of nursing facility services who are enrolled in or registered with the Florida Medicaid program. (2) All providers of nursing facility services mus…

(1) This rule applies to all providers rendering Florida Medicaid neurology services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Neurology Services Coverage Policy, October 2018, incorporated by reference. The policy is avail…

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.9081, 409.912, 409.913 FS. History-New 6-11-13, Amended 4-1-14, Repealed 7-11-16.

(1) This rule applies to any person or entity prescribing or reviewing a request for oral and maxillofacial surgery services and to all providers of oral and maxillofacial surgery services who are enrolled in or registered with the Florida Medicaid program. (2) All providers of o…

(1) This rule applies to any person or entity prescribing or reviewing a request for visual care services and to all providers of visual care services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection (1), mus…

(1) This rule applies to any person or entity prescribing or reviewing a request for orthopedic services and to all providers of orthopedic services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection (1), must …

(1) This rule applies to all providers rendering Florida Medicaid personal care services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Personal Care Services Coverage Policy, October 2024, incorporated by reference. The policy …

(1) This rule applies to any person or entity prescribing or reviewing a request for podiatry services and to all providers of podiatry services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection (1), must be i…

(1) This rule applies to any person or entity prescribing or reviewing a request for pain management services and to all providers of pain management services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subsection …

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.907, 409.908, 409.9081, 409.912, 409.913 FS. History-New 1-1-77, Revised 2-1-78, 4-1-78, 1-2-79, 1-1-80, Amended 2-8-82, 3-11-84, Formerly 10C-7.38, Amended 1-10-91, 11-5-92, 1-7-93, Formerly 10C-7.038, Amende…

Rulemaking Authority 409.919 FS. Law Implemented 409.906, 409.907, 409.908, 409.9081 FS. History-New 8-21-95, Amended 5-28-96, 3-11-98, 10-13-98, 8-9-99, 4-23-00, 8-5-01, 2-20-03, 8-5-03, 8-3-04, 8-18-05, Repealed 10-27-13.

(1) This rule applies to any person or entity prescribing or reviewing a request for respiratory system services and to all providers of respiratory system services who are enrolled in or registered with the Florida Medicaid program. (2) All persons or entities described in subse…

(1) This rule applies to all providers rendering Florida Medicaid radiology and nuclear medicine services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Radiology and Nuclear Medicine Services Coverage Policy, May 2019, incorpor…

(1) This rule applies to all providers rendering Florida Medicaid prescribed drug services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Prescribed Drug Services Coverage Policy, December 2017, incorporated by reference. The po…

(1) This rule applies to all prescribed drug service providers enrolled in the Florida Medicaid program that provide services under the fee-for-service delivery system in accordance with Rule 59G-4.250, Florida Administrative Code (F.A.C.). (2) Definitions. (a) Actual Acquisition…

(1) This rule applies to all providers rendering Florida Medicaid diabetic supply services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Diabetic Supply Services Coverage Policy, September 2024, incorporated by reference. The p…

(1) Medicaid-participating pharmacies shall provide the pamphlet, Important Information About Your Florida Medicaid Prescription Drug Benefits, 10/03/05, or Información Importante A cerca de sus beneficios de medicamentos con receta del Medicaid de la Florida, 11/01/05, which are…

(1) This rule applies to all providers rendering Florida Medicaid prescribed pediatric extended care (PPEC) services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Prescribed Pediatric Extended Care Services Coverage Policy, Feb…

(1) This rule applies to all providers rendering Florida Medicaid private duty nursing and family home health aide services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Private Duty Nursing and Family Home Health Aide Services…

(1) This rule applies to any person or entity prescribing or reviewing a request for obstetrical and neonatal services provided in a regional perinatal intensive care center (RPICC), and to all physicians providing services in a RPICC who are enrolled in the Florida Medicaid prog…

(1) Purpose. The Agency for Health Care Administration (AHCA), or its designee, will register qualified evaluators for the purpose of determining that a child in the legal custody of the Department of Children and Families (DCF) is suitable for residential treatment services (as …

Rulemaking Authority 409.919 FS. Law Implemented 409.902 409.906, 409.908, 409.9081 FS. History-New 3-11-98, Amended 10-13-98, 5-24-99, 4-23-00, 7-5-01, 2-20-03, 8-5-03, 8-4-04, 8-18-05, Repealed 10-27-13.

(1) This rule applies to all rural health clinic (RHC) providers that are enrolled in or registered with the Florida Medicaid program. (2) All RHC providers must comply with Title 42, Code of Federal Regulations, Parts 440 and 491. (3) Florida Medicaid reimburses for services pro…

(1) Purpose. This rule establishes the level of care criteria that must be met in order for nursing and rehabilitative services to qualify as skilled services under Medicaid. (2) Definitions as used in this section. (a) Continuous. The need for 24-hour care in a skilled nursing f…

(1) This rule applies to all providers rendering Florida Medicaid therapeutic group care services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Therapeutic Group Care Services Coverage Policy, July 2017, incorporated by referen…

(1) This rule applies to all providers rendering Florida Medicaid state mental health hospital services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid State Mental Health Hospital Services Coverage Policy, January 2018, incorpor…

(1) This rule applies to all providers of targeted case management for children at risk of abuse and neglect who are enrolled in the Florida Medicaid program. (2) All providers of targeted case management for children at risk of abuse and neglect must be in compliance with the pr…

(1) This rule applies to all providers rendering Florida Medicaid occupational therapy services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Occupational Therapy Services Coverage Policy, October 2016, incorporated by referenc…

(1) This rule applies to all all providers rendering Florida Medicaid physical therapy services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Physical Therapy Services Coverage Policy, October 2016, incorporated by reference. T…

(1) This rule applies to all providers rendering Florida Medicaid respiratory therapy services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Respiratory Therapy Services Coverage Policy, August 2018, incorporated by reference. …

(1) This rule applies to all providers rendering Florida Medicaid speech-language pathology services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Speech-Language Pathology Services Coverage Policy, October 2016, incorporated b…

(1) This rule applies to all providers rendering Florida Medicaid non-emergency transportation services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Non-Emergency Transportation Services Coverage Policy, November 2019, incorpo…

(1) This rule applies to all providers of visual aid services who are enrolled in or registered with the Florida Medicaid program. (2) All providers of visual aid services must be in compliance with the provisions of the Florida Medicaid Visual Aid Services Coverage Policy, Novem…

(1) This rule applies to all providers rendering Florida Medicaid transplant services. (2) All providers must be in compliance with the provisions of the Florida Medicaid Transplant Services Coverage Policy, May 2019, incorporated by reference. The policy is available on the Agen…

(1) This rule applies to all providers rendering Florida Medicaid behavioral health intervention services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Behavioral Health Intervention Services Coverage Policy, November 2019, inc…