Florida Administrative Code

(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 History-New 8-21-95, Amended 5-28-96, 3-11-98, 10-13-98, 8-9-99, 4-23-00, 8-5-01, 2-20-03, 8-5-03, 8-3-04, 8-18-05, Repealed 10-27-13.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…

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.907, 409.9071, 409.908 FS. History-New 9-22-93, Formerly 10P-5.010, Amended 7-8-97, 9-8-98, 7-5-99, 7-10-00, 5-7-03, 7-7-05, 1-16-20.

(1) All Medicaid providers enrolled in the Medicaid program and billing agents who submit claims to Medicaid on behalf of an enrolled Medicaid provider must comply with the provisions of the Florida Medicaid Provider General Handbook, July 2012, which is incorporated by reference…

(1) Purpose. This rule describes the circumstances when the Agency for Health Care Administration (AHCA) may directly reimburse eligible Florida Medicaid recipients; how AHCA reimburses recipients; and documentation requirements for direct reimbursement. (2) Determination Criteri…

(1) This rule applies to all providers who are enrolled in Florida Medicaid who: (a) Are defined as practitioners under the Centers for Medicare and Medicaid Services' Merit-based Incentive Payment System (MIPS). (b) Provide medical services, dental services, behavioral health se…

(1) This rule applies to all federally qualified health centers (FQHC), community mental health centers (CMHC), rural health clinics (RHC), or certified community behavioral health clinics (CCBHC) participating in the Florida Medicaid program that establish, maintain, or expand a…

(1) This rule applies to all nursing facility providers rendering Florida Medicaid nursing facility services in accordance with Rule 59G-4.200, F.A.C. (2) Definitions. (a) Adjusted Facility Sq Ft - Component of the Fair Rental Value System (FRVS) Calculation, the Minimum, Maximum…

(1) Reimbursement to participating inpatient hospitals for services provided shall be in accordance with the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XLIV, effective July 1, 2017, http://www.flrules.org/Gateway/reference.asp?No=Ref-09420, incorp…

(1) This rule applies to Florida Medicaid providers that render inpatient and outpatient hospital services to recipients through the fee-for-service delivery system. The providers must be considered as a cancer hospital and: (a) Be members of the Alliance of Dedicated Cancer Cent…

Reimbursement to participating outpatient hospitals for services provided shall be in accordance with the Florida Title XIX Outpatient Hospital Reimbursement Plan (the Plan), Version XXVII, effective date July 1, 2016, incorporated by reference and available at http://www.flrules…

(1) This rule applies to all hospitals and ambulatory surgical centers (ASC) rendering Florida Medicaid outpatient hospital services to recipients, in accordance with Rules 59G-4.160 and 59G-4.020, Florida Administrative Code, (F.A.C.), respectively. (2) Definitions. (a) Annual A…

(1) This rule applies to all publicly owned or operated emergency transportation services providers rendering Florida Medicaid emergency transportation services to recipients under the fee-for-service delivery system. (2) Providers must submit AHCA Form 5000-0035, May 2017, Emerg…

Reimbursement to participating ICF/MR-DD facilities for services provided shall be in accord with the Florida Title XIX ICF/MR-DD Reimbursement Plan for Publicly Owned and Publicly Operated Facilities, Version VIII, Effective Date November 21, 2004, and incorporated herein by ref…

(1) This rule applies to participating intermediate care facilities for individuals with intellectual disabilities (ICF/IID) not publicly owned and not publicly operated rendering Florida Medicaid services to recipients in accordance with Rule 59G 4.170, Florida Administrative Co…

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905(1), (6), (7), (9), (10), 409.906(4), (6), (7), (8), (15), (16), 409.908, 409.913(5)(e), (8)(h) FS. History-New 5-14-92, Amended 11-3-92, 2-10-93, 9-6-93, Formerly 10C-7.0382, Amended 6-23-94, 12-29-94, 5-16-95, Rep…

Reimbursement to participating health centers for services provided shall be in accordance with the Florida Title XIX Federally Qualified Health Center and Rural Health Center Reimbursement Plan (the Plan), Version V, effective July 1, 2014, available at http://www.flrules.org/Ga…

(1) This rule applies to all county health departments (CHD)s rendering Florida Medicaid clinic services to recipients in accordance with Rule 59G-4.055, Florida Administrative Code (F.A.C.). (2) Definitions. (a) Allowable Cost - Cost(s) incurred for recipient-related health care…

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History-New 11-13-91, Formerly 10C-35.003, Amended 10-3-96, Repealed 8-14-18.

Rulemaking Authority 120.53(1)(b), (c), 409.026(1), (6), (8), 409.910(23), 409.919 FS. Law Implemented 120.52(16), 120.53(1), 409.910 FS. History-New 11-13-91, Formerly 10C-35.004, Amended 10-3-96, Repealed 5-10-12.

(1) Under the Health Insurance Premium Payment (HIPP) program, the Agency for Health Care Administration (AHCA) shall provide financial assistance to recipients in order to obtain or maintain Employer Sponsored Insurance (ESI) coverage pursuant to sections 409.9122(14) and 409.97…