Fla. Admin. Code Ann. R. 59H-1.0065 - Covered Services
(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 Rule 59G-4.160, F.A.C., 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.
Notes
Rulemaking Authority 154.3105 FS. Law Implemented 154.306, 154.31 FS.
New 3-29-89, Amended 12-24-90, Formerly 10C-26.0065, Amended 6-7-00, 12-9-03, 8-25-16.
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.