Florida Statutes 400.5185 – Review and modification of prior authorization
Current as of: 2023 | Check for updates
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Terms Used In Florida Statutes 400.5185
- Agency: means the Agency for Health Care Administration. See Florida Statutes 400.462
- Contract: A legal written agreement that becomes binding when signed.
- Fraud: Intentional deception resulting in injury to another.
- Home health agency: means a person that provides one or more home health services. See Florida Statutes 400.462
- Home health services: means health and medical services and medical supplies furnished to an individual in the individual's home or place of residence. See Florida Statutes 400.462
The Agency for Health Care Administration shall review the process, procedures, and contractor’s performance for the prior authorization of home health agency visits that are in excess of 60 visits over the lifetime of a Medicaid recipient. The agency shall determine whether modifications are necessary in order to reduce Medicaid fraud and abuse related to home health services for a Medicaid recipient which are not medically necessary. If modifications to the prior authorization function are necessary, the agency shall amend the contract to require contractor performance that reduces potential Medicaid fraud and abuse with respect to home health agency visits.