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Florida Medicaid Fee-for-Service Monitoring

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Better Health Care for All Floridians
FLORIDA MEDICAID
A Division of the Agency for Health Care Administration
Florida Medicaid Health Care Alert
February 2015

Provider Type(s): 08, 23, 81, and 67

Medicaid Fee-for-Service Monitoring

Monitoring is being conducted to provide feedback to providers regarding their adherence to Medicaid requirements for recipients who are not enrolled in a Medicaid managed care plan.

The Medicaid Fee-for-Service Monitoring Unit has begun conducting monitoring reviews of service providers for the following programs:

  • Adult Cystic Fibrosis (ACF) Waiver
  • Model Waiver
  • Project AIDS Care (PAC) Waiver
  • Traumatic Brain Injury and Spinal Cord Injury (TBI/SCI) Waiver
  • Early Intervention Services (EIS)
  • Certified School Based Services Match
  • Medical Foster Care (MFC)

Providers will be contacted by telephone or e-mail for notification of the date of review and will receive a letter detailing the documentation the Monitoring Unit will review. A copy of the monitoring tool, based on state and federal Medicaid policy, for the specific service will accompany the letter.  After the review, a monitoring report/summary will be sent to the provider.

Medicaid Provider Agreement (5)(e) and section 409.907(3)(e), Florida Statutes, requires Medicaid providers to send, at the provider’s expense, all Medicaid-related information, which may be in the form of records, logs, documents, or computer files, and other information pertaining to services or goods billed to the Medicaid program, including access to all patient records to the Agency for Health Care Administration, Attorney General, or Federal Government entity.

LINKS

Florida Medicaid Web Portal | Florida Medicaid Health Information Network | Florida Medicaid HIPAA Information | HIPAA Transactions & Code Sets Standard | National Provider Identifier Standard (NPI) | Florida Medicaid EHR Incentive Program | FloridaHealthFinder.gov

QUESTIONS ABOUT FLORIDA MEDICAID?

Please direct questions about Medicaid policies to your local Medicaid field office. The Medicaid field offices’ addresses and phone numbers are available on the Field Offices Web page.

ALERTS INFORMATION

The Florida Medicaid program has created an e-mail alert system to supplement the present method of receiving Provider Alerts information and to alert registered subscribers of “late-breaking” health care information. An e-mail will be delivered to your mailbox when Medicaid policy clarifications or other health care information is available that is appropriate for your selected area and provider type.

Visit the Florida Medicaid’s Health Care Alerts page to subscribe now. You may unsubscribe or update your subscription at any time by clicking on the “Manage your subscription” icon in the footer of each e-mail. Other questions regarding the e-mail alert system can be sent to the Florida Medicaid Alerts Administrator.

© 2015 Agency for Health Care Administration

 

Court Ruling Related to the DOL Companion – Home Care Rule

This is a follow up to the DOL emails we sent earlier today.  After consideration of the parties’ pleadings, the arguments of counsel and relevant law, and the entire record in this case, plaintiffs’ motion for a partial summary judgment is GRANTED, defendants motion is DENIED, and the Department of Labor’s Third Party Employer regulation scheduled to go into effect on Jan 1, is VACATED.  See below for a summary on the decision.

The United States District Court for the District of Columbia has today issued a partial summary judgment on two pieces of a lawsuit filed by the Home Care Association of America and other plaintiffs related to the Department of Labor’s Home Care Rule. Please note that this information is not legal advice, and is shared after a swift and preliminary review of the decision.

The decision notes that after consideration of the parties’ pleadings, the arguments of counsel and relevant law, and the entire record in this case, plaintiffs’ motion for a partial summary judgment is GRANTED, defendants motion is DENIED and the Departments Third Party Employer regulation scheduled to go into effect on Jan 1, is VACATED.

The largest area implicated by this decision is the third party employer regulation, which withdrew the availability of the companionship and live-in caregiver exemptions from third parties.

Companionship Exemption

As you know, the companionship exemption was impacted in two important ways by the Home Care rule. First, the rule established that the companionship services exemption is not applicable when the employee spends more than 20 percent of his or her workweek performing care services. This portion of the regulation is NOT impacted by this decision, so the companionship exemption is available only when this percentage test is met.

Second, the rule set forth that the companionship exemption is not available to third party employers. This portion of the rule, called the Third Party Employer regulation, is impacted by this court decision by allowing third party employers to avail themselves of the exemption. This means that, for situations meeting the definition of and test for companionship, workers can receive straight pay, not overtime for work over 40 hours/week even when there is a third party employer.

Live in Exemption

Like the Companionship exemption, the DOL rule removed the availability of the live-in caregiver exemption from third party employers. This ruling allows third parties to utilize the exemption, enabling straight pay for live-in caregivers, including for those hours worked over 40.  For details on what constitutes a “live-in” domestic service worker and other conditions of the exemption, see Fact Sheet #79B: Live-In Domestic Service Workers Under the FLSA. http://www.dol.gov/whd/regs/compliance/whdfs79b.htm

While this is decision is important, this case has not been fully decided (there are other counts to be considered by the court) and there will likely be appeals filed, even on this limited judgment.  As a result, states should remain vigilant in their planning and budgeting in the event that, at the conclusion of these legal proceedings, the original rule will be in full force and effect.

NASDDDS will continue to closely monitor developments and keep you apprised.

To read the court’s decision, visit:

https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2014cv0967-21