Florida Regulations 59H-1.0065: Covered Services
Current as of: 2024 | Check for updates
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(1) Covered services are limited to hospital services as defined in Rules 59G-4.160 and 59G-4.150, F.A.C., and the Florida Medicaid – Outpatient Hospital Services Coverage Policy, incorporated by reference in Fl. Admin. Code R. 59G-4.160, unless otherwise specified in this rule. Copies of the policy may be obtained at https://www.flrules.org/Gateway/reference.asp?No=Ref-06979.
(2) The county of residence shall be liable for the cost of emergency services and care or treatment for emergency medical conditions in a hospital emergency room, as defined in the Florida Medicaid – Outpatient Hospital Services Coverage Policy, unless otherwise specified in this rule.
(3) Elective or non-emergency services or admissions require written pre-authorization and pre-approval if the county of residence has established written procedures to authorize and approve admissions to an out-of-county hospital for such services and admissions. The procedures shall include requirements for hospitals to request and obtain written authorization and approval for elective and non-emergency admissions or services.
(4) Elective or non-emergency admissions or services are not covered when a county provides funding for such services and the services are available at a local hospital within the county where the individual resides.
Rulemaking Authority 154.3105 FS. Law Implemented 154.306, 154.31 FS. History-New 3-29-89, Amended 12-24-90, Formerly 10C-26.0065, Amended 6-7-00, 12-9-03, 8-25-16.
(3) Elective or non-emergency services or admissions require written pre-authorization and pre-approval if the county of residence has established written procedures to authorize and approve admissions to an out-of-county hospital for such services and admissions. The procedures shall include requirements for hospitals to request and obtain written authorization and approval for elective and non-emergency admissions or services.
(4) Elective or non-emergency admissions or services are not covered when a county provides funding for such services and the services are available at a local hospital within the county where the individual resides.
Rulemaking Authority 154.3105 FS. Law Implemented 154.306, 154.31 FS. History-New 3-29-89, Amended 12-24-90, Formerly 10C-26.0065, Amended 6-7-00, 12-9-03, 8-25-16.