Florida Administrative Code

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. History-New 12-15-96, Amended 7-11-01, Repealed 1-1-10.

A facility must register through the FDDC portal to submit its data file according to the specifications in subsections (1) through (2). (1) The Internet address for submitting inpatient data files is https://apps.ahca.myflorida.com/Fddc/. (2) Beginning with the fourth quarter 20…

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061(13), (16) FS. History-New 12-15-96, Repealed 1-1-10.

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. History-New 12-15-96, Amended 7-11-01. 7-12-05, 5-22-07, Repealed 1-1-10.

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 119.07(1)(a), (2)(a), 408.061(8) FS. History-New 12-15-96, Amended 7-12-05, Repealed 1-1-10.

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. History-New 12-15-96, Amended 7-11-01, 7-12-05, Repealed 1-1-10.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063, 408.05, 408.07, 408.08 FS. History-New 1-1-10, Repealed 5-3-12.

(1) "Acute Care" means inpatient general routine care provided to patients who are in an acute phase of illness, which includes the concentrated and continuous observation and care provided in the intensive care units of an institution. (2) "Comprehensive Rehabilitation" means se…

(1) Hospitals licensed under Chapter 395, F.S., except state-operated hospitals, in operation for all or any of the reporting periods described in subsection 59E-7.023(1), F.A.C., below, shall submit hospital inpatient discharge data to the Agency according to the provisions in R…

(1) All hospitals reporting their inpatient discharge data shall report according to the following schedule: (a) Each data file submitted for the 1st quarter covering inpatient discharges occurring between January 1 and March 31 inclusive, of each year, may be submitted no later …

(1) Submission of data files for all hospitals must be in compliance with Rules 59E-7.012 and 59E-7.021 through 59E-7.030, F.A.C. The executive officer, administrator, or authorized designee shall certify the data quarterly as accurate, complete and verifiable by completing the e…

(1) For purposes of this rule chapter, a report or other information is "incomplete" when it does not contain all data required by the Agency in this rule and in forms incorporated by reference or when it contains inaccurate data. The Agency shall to the extent practical, apply t…

The first record in the data file shall be a header record containing the information described below. (1) Report Year. Enter the year of the data in the format YYYY where YYYY represents the year in four (4) digits. A required field. (2) Report Quarter. Enter the quarter of the …

All hospitals submitting data in compliance with Rules 59E-7.012 and 59E-7.021 through 59E-7.030, F.A.C., shall report the required data elements and data element codes listed below as stipulated by the Agency. (1) AHCA Facility Number. Enter the identification number of the hosp…

(1) Agency records, public records under Chapter 119, F.S. (Florida's Public Records Law), are available for public inspection during normal business hours. Copies of such records may be obtained upon request and upon payment of the cost of copying. (2) Patient-specific records c…

Hospitals submitting inpatient discharge data pursuant to the provisions contained in these rules shall be directed by the following specific general provisions for inpatient data reporting: (1) Any inpatient who is transferred or discharged from the acute care setting into a reh…

Rulemaking Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a) -(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History-New 3-31-94, Repealed 1-1-10.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.08(9), 408.085 FS. History-New 3-31-94, Repealed 1-1-10.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History-New 3-31-94, Repealed 1-1-10.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.08(9), 408.085 FS. History-New 3-31-94, Repealed 1-1-10.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History-New 3-31-94, Repealed 1-1-10.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History-New 3-31-94, Repealed 1-1-10.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History-New 3-31-94, Repealed 1-1-10.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. History-New 3-31-94, Repealed 1-1-10.

(1) The Florida Center for Health Information and Transparency will periodically, but no less frequently than biannually, calculate the average time required to access, merge, validate, and prepare standard information sets for delivery to the requester. These average times will …

(1) The Price List of the Florida Center for Health Information and Transparency is posted at http://www.floridahealthfinder.gov/Researchers/OrderData/order-data.aspx. (2) The Price List dated 8-1-07 is incorporated by reference as AHCA Form FC4200-003. Rulemaking Authority 408.1…

(1) Definitions. (a) "Affiliate" means an entity that exercises control over or is directly or indirectly controlled by the insurer through equity ownership of voting securities; common managerial control; or collusive participation by the management of the insurer and affiliate …

Specific Authority 381.0406(17) FS. Law Implemented 381.0406(2), (3), (4), (11)(c) FS. History-New 12-29-93, Amended 1-29-95, 8-18-96, Transferred to 64I-5.001 .

Specific Authority 381.0406(17) FS. Law Implemented 381.0406(16) FS. History-New 1-29-95, Amended 8-18-96, Transferred to 64I-5.002.

Specific Authority 381.04065(5) FS. Law Implemented 381.04065 FS. History-New 1-24-96, Transferred to 64I-5.003.

The agency adopts these rules to comply with the requirements of Chapter 409, F.S. All rules in Title 59G, F.A.C., must be read in conjunction with the statutes, federal regulations, and all other rules and regulations pertaining to the Medicaid program. Rulemaking Authority 409.…

(1) This rule applies to all providers rendering Florida Medicaid services to recipients. (2) All providers must be in compliance with the provisions of the Florida Medicaid Definitions Policy, May 2024, incorporated by reference. The policy is available on the Agency for Health …

For the purpose of county financial participation in the Medicaid Program, the county of residence for inpatient hospital care and nursing home care is determined by the recipient's address information contained in the federally approved Medicaid eligibility system. (1) For hospi…

Rulemaking Authority 409.919 FS. Law Implemented 409.915 FS. History-New 10-23-12, Repealed 2-23-16.

(1) Definitions. (a) Generally accepted professional medical standards - Standards based on reliable scientific evidence published in peer-reviewed scientific literature generally recognized by the relevant medical community or practitioner specialty associations' recommendations…

(1) This rule applies to any person or entity prescribing or reviewing a request for Florida Medicaid covered services and to all providers of Florida Medicaid covered services who are enrolled in or registered with the Florida Medicaid program. (2) Definitions. Clinical Trials -…

(1) Purpose. This rule applies to all Florida Medicaid-certified nursing facilities (NF), regardless of payer source; all providers rendering NF services to Florida Medicaid recipients; and all entities that perform a function in the Preadmission Screening and Resident Review (PA…

The following forms are incorporated by reference and are used either by other state agencies or providers rendering Florida Medicaid services to recipients. The forms are available from the Agency for Health Care Administration's Web site at http://ahca.myflorida.com/Medicaid/re…

(1) Purpose. This rule specifies requirements that apply to all providers rendering Florida Medicaid services to recipients. (2) Billing the Recipient. Providers must inform a recipient of his or her responsibility to pay for services that are not covered by Florida Medicaid, and…

(1) This policy applies to all persons who are required to notify Florida Medicaid of any third-party benefits a recipient may have and to providers rendering Florida Medicaid services to recipients. (2) Purpose. Third-party liability (TPL) refers to the legal obligation of third…

(1) This rule applies to providers rendering Florida Medicaid services to recipients. (2) All providers must comply with the provisions of the Florida Medicaid Authorization Requirements Policy, June 2016, incorporated by reference. The policy is available on the Agency for Healt…

(1) This rule applies to providers rendering Florida Medicaid services to recipients. (2) Documentation Requirements. (a) All Florida Medicaid providers must: 1. Ensure medical records establish the medical necessity for and the extent of services provided. 2. Sign and date each …

(1) This rule applies to providers rendering Florida Medicaid services to recipients. (2) Requirement. Recipients are responsible for paying all applicable copayment and coinsurance amounts directly to the provider who furnished Florida Medicaid covered services. (3) Amounts. The…

(1) This rule applies to any person or entity prescribing or reviewing a request for Florida Medicaid services and to all providers of Florida Medicaid services that are enrolled in or registered with the Florida Medicaid program. (2) Definition. Telemedicine - The practice of he…

(1) Purpose. This rule specifies recipient eligibility requirements for Florida Medicaid covered services and applies to all providers rendering Florida Medicaid covered services to recipients. (2) Eligibility Determination. The Department of Children and Families (DCF) and the S…

(1) This rule applies to all individuals, groups, and entities that are seeking to enroll, renew, or maintain enrollment as an authorized provider for the Florida Medicaid program. (2) All providers must be in compliance with the provisions of the Florida Medicaid Provider Enroll…

(1) Purpose. This rule establishes procedures applicable to Fair Hearings conducted by the Agency for Health Care Administration (Agency) pursuant to Section 409.285(2), Florida Statutes (F.S.). (2) Definitions. The following definitions are applicable to this rule: (a) Action - …

Rulemaking Authority 408.918 FS. Law Implemented 408.918 FS. History-New 4-24-03, Repealed 9-23-10.

Rulemaking Authority 408.918 FS. Law Implemented 408.918 FS. History-New 4-24-03, Repealed 9-23-10.

Rulemaking Authority 408.918 FS. Law Implemented 408.918 FS. History-New 4-24-03, Repealed 9-23-10.