Fla. Admin. Code R. 59H-1.0065

Current through Reg. 50, No. 235-239, December 10, 2024

Section 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.

Fla. Admin. Code Ann. R. 59H-1.0065

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, Amended by Florida Register Volume 42, Number 154, August 9, 2016 effective 8/25/2016.

New 3-29-89, Amended 12-24-90, Formerly 10C-26.0065, Amended 6-7-00, 12-9-03, 8-25-16.