Florida Administrative Code
59 - AGENCY FOR HEALTH CARE ADMINISTRATION
59G - Medicaid
Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS
Section 59G-6.005 - Reimbursement Methodology for Services Provided by Medical School Faculty
Universal Citation: FL Admin Code R 59G-6.005
Current through Reg. 50, No. 187; September 24, 2024
(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 services, hearing services, and
vision services to Florida Medicaid recipients receiving services through the
fee-for-service delivery system.
(c) Are employed by, or contracted with, a
Florida public or private, non-profit, accredited medical, dental, or optometry
school to provide supervision and teaching of medical, dental, or optometric
students, residents, or fellows.
(2) Reimbursement.
(a) Florida Medicaid reimburses providers for
covered medical, hearing, vision, dental, and behavioral health services listed
on the applicable Florida Medicaid fee schedule, incorporated by reference in
Rule 59G-4.002, F.A.C., at either:
1. Two hundred-three percent of the Medicare
rate, based on Florida locality code 0910299, listed on the 2018 Medicare Part
B physician fee schedule - Loc 03, 04, and 99, incorporated by reference, and
available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-13315,
https://ahca.myflorida.com/medicaid/review/Reimbursement/2018-01-01_Fee_Schedules/Practitioner_Fee_Schedule_2018.pdf,
and at Physician Fee Schedule
https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx
Search (cms.gov).
2. Two
hundred-three percent of the Florida Medicaid rate if the service is not
covered by Medicare.
(b)
Florida Medicaid reimbursement to providers for clean claims submitted to the
Florida Medicaid Management Information System specified in this rule shall not
exceed the amount specified in the General Appropriations Act.
(c) Florida Medicaid will reconcile claims
reimbursed in accordance with this rule on a quarterly basis. Any claims
reimbursed after the maximum reimbursable amount is reached will be recouped,
or adjusted to the standard Florida Medicaid rate, as
appropriate.
(3) Exclusions. Florida Medicaid does not reimburse providers in accordance with this rule for the following:
(a) Services
rendered to dually eligible Medicare and Medicaid recipients.
(b) Vaccine, laboratory, and radiology
services.
(4) This rule is in effect for five years from its effective date.
Rulemaking Authority 409.919 FS. Law Implemented 409.908 FS.
New 6-13-17, Amended 12-25-18, 8-15-21.
Disclaimer: These regulations may not be the most recent version. Florida may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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