{"ref":"FL-HC-BUS-02","title":"Florida Medicaid, Managed Care Plans, and Electronic Visit Verification","category":"Business","summary":"Sets how the Agency serves Florida Medicaid recipients and Statewide Medicaid Managed Care members: enrollment and plan contracts, services only as authorized, electronic visit verification for every visit the program or plan requires, documented exceptions, five-year Medicaid record retention, and cooperation with Medicaid program integrity.","inShort":["For Medicaid and managed care clients, give only the services and hours on the authorization.","Check in and check out in the EVV system at the client's home for every visit that needs it.","If check-in fails, call the office before you leave the client so the visit can be confirmed.","Never check in or out for someone else or for a visit that did not happen. That is fraud.","Tell the office when a Medicaid client's needs change or the client goes to the hospital."],"primaryCitation":"s. 409.913, F.S.","citations":["s. 409.913(9), F.S.","s. 409.9132, F.S.","s. 409.920, F.S.","s. 400.474(6)(k), F.S.","s. 408.809(4)(c)-(d), F.S.","s. 408.810(5)(a)3, F.S.","Rule 59G-4.192, F.A.C.","Rule 59G-4.215, F.A.C."],"federalCitations":["42 U.S.C. §1396b(l)"],"surveyorAsks":["Which Medicaid managed care plans do you contract with, and for which services?","Show me the authorization for this member's services."],"forms":[{"ref":"FL-HC-BUS-02-A","title":"Visit Verification Exception Record"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (s. 409.913, F.S.)","5. Enrollment and Plan Contracts","6. Authorization and Delivery of Services","7. Electronic Visit Verification","8. Medicaid Records","9. Program Integrity and Medicaid Fraud","10. Responsibilities","11. Records and Compliance Monitoring","12. Staff Training","13. References","14. Related Policies and Forms","15. Approval","16. Revision History"],"version":"1.0","sample":false,"pack":"fl-hca","state":"Florida","service":"Home care","guides":[{"path":"/guides/home-care-agency-policies/","h1":"What policies does a home care agency need?"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}