Florida Medicaid, Managed Care Plans, and Electronic Visit Verification
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.
About this policy
- Policy number
- FL-HC-BUS-02
- Version
- 1.0
- Main rule
- s. 409.913, F.S.
- Library
- Florida home care · 50 policies
- Category
- Business
- Sections
- 17
In short
- 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.
What's inside
17 sections. The full text comes with the One-time Policy Pack.
- 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
An inspector may ask
- Which Medicaid managed care plans do you contract with, and for which services?
- Show me the authorization for this member's services.
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