Florida Administrative Code

(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…

Rulemaking Authority 409.026(8), 409.910(22), (23), 409.919 FS. Law Implemented 409.910(20), 624.424(9), 641.261, 641.411 FS. History-New 11-14-89, Formerly 10C-7.0302, Amended 11-13-91, Formerly 10C-35.0211, Amended 10-3-96, Repealed 9-24-18.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910(1), (3) FS. History-New 11-13-91, Formerly 10C-35.023, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History-New 11-13-91, Formerly 10C-35.032, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 120.53(1)(b), (c), 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.53(1)(b), (c), 409.910 FS. History-New 11-13-91, Formerly 10C-35.0322, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 120.53(1), 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.53(1), 409.910 FS. History-New 11-13-91, Formerly 10C-35.0331, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History-New 11-13-91, Formerly 10C-35.0332, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 20.05, 120.53(1)(b), (c), 409.026(8), 409.285, 409.910(23), 409.919 FS. Law Implemented 120.53(1)(b), (c), 120.57, 120.58, 409.285, 409.902, 409.910 FS. History-New 11-13-91, Formerly 10C-35.034, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History-New 11-13-91, Formerly 10C-35.035, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History-New 11-13-91, Formerly 10C-35.051, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History-New 11-13-91, Formerly 10C-35.053, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History-New 11-13-91, Formerly 10C-35.054, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(21), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS.; 42 U.S.C. ss. 1396a(a)(25), (a)(27), (a)(45), 1396k (Social Security Act ss. 1902(a)(25), (a)(27), (a)(45), 1912); 42 C.F.R. ss. 433.135-43…

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History-New 11-13-91, Formerly 10C-35.057, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History-New 11-13-91, Formerly 10C-35.058, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920 FS. History-New 11-13-91, Formerly 10C-35.0581, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 120.53, 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.57, 120.58, 120.68, 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History-New 11-13-91, Formerly 10C-35.060, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 120.53, 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.57, 120.58, 120.68, 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History-New 11-13-91, Formerly 10C-35.0601, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History-New 11-13-91, Formerly 10C-35.061, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History-New 11-13-91, Formerly 10C-35.062, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History-New 11-13-91, Formerly 10C-35.063, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.58, 409.257, 409.901, 409.902, 409.910, 409.920(2)(a), (c) FS. History-New 11-13-91, Formerly 10C-35.064, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS. Law Implemented 409.910 FS. History-New 11-13-91, Formerly 10C-35.073, Amended 10-3-96, Repealed 5-10-12.

Rulemaking Authority 409.9124, 409.919 FS. Law Implemented 409.9124(1) FS. History-New 3-9-81, Amended 7-9-84, Formerly 10C-7.524, Amended 4-5-89, Formerly 10C-7.0524, Amended 8-4-02, 1-23-05, 5-9-06, Repealed 8-18-15.

Rulemaking Authority 409.919 FS. Law Implemented 409.906(11), 409.912(7) FS. History-New 9-20-88, Formerly 10C-7.0381, Amended 2-13-96, Repealed 7-26-09.

Rulemaking Authority 409.919 FS. Law Implemented 409.9121, 409.9122 FS. History-New 6-10-91, Formerly 10C-7.067, Amended 12-18-94, Repealed 8-18-15.

(1) Purpose. A Florida Medicaid recipient (herein referred to as an enrollee) who is required to enroll in the Statewide Medicaid Managed Care (SMMC) program, may request to change managed care plans. Requests must be submitted via telephone or in writing to the Agency for Health…

Individuals enrolled as Child Health Services targeted case managers must be in compliance with the Child Health Services Targeted Case Management Coverage and Limitations Handbook, June 2012, https://www.flrules.org/Gateway/reference.asp?No=Ref-01329, which is incorporated by re…

(1) Pursuant to Section 409.967(3)(b), Florida Statutes (F.S.), the Agency for Health Care Administration (hereafter referred to as Agency) shall contract with independent certified public accountants to conduct compliance audits of Florida Medicaid prepaid health plans. (a) Cert…

Rulemaking Authority 409.266(15) FS. Law Implemented 409.026(1), (6), 409.266 FS. History-New 7-16-79, Amended 7-5-81, 1-2-84, 10-15-85, Formerly 10C-7.58, Amended 12-21-87, 5-17-90, Formerly 10C-7.058, Repealed 7-26-09.

(1) Purpose. This rule provides notice of administrative sanctions imposed upon a provider, entity, or person for each violation of any Medicaid-related law. (2) Applying and reporting sanctions. Notice of the application of sanctions will be by way of written correspondence, and…

Rulemaking Authority 490.014(5), 491.014(5) FS. Law Implemented 490.014(5), 491.014(5) FS. History-New 2-10-93, Formerly 21-33.001, 61-33.001, Repealed 5-7-12.