To submit this form, ensure all sections are completed accurately. You can submit the form via email to Medicaid Services at MedicaidSubmit@ahca.myflorida.com. Fax the completed form to (850) 922-XXXX. Alternatively, submit online through the Medicaid provider portal at http://ahca.myflorida.com/Medicaid/review/index.shtml. For physical submission, mail the completed form to Florida Medicaid Office, 2727 Mahan Drive, Tallahassee, FL 32308. Review for completeness and accuracy before submission. Following submission, confirm receipt and status with the Medicaid office.

Ensure to stay updated with any revisions and policies on the AHCA website for the years 2024 and 2025.

The Florida Medicaid Home Health Visit Services Coverage Policy serves as a comprehensive guide for the provision of home health services under Florida Medicaid. It aims to ensure that recipients receive medically necessary care in their homes or communities, complying with state and federal laws. By outlining eligibility criteria, coverage details, and documentation requirements, the policy helps providers deliver appropriate care and facilitates accurate reimbursement. Accurate completion of this policy is vital for both providers and recipients. It enables providers to understand their obligations and ensures recipients receive the care they are entitled to. The policy also serves to prevent fraud and abuse in the Medicaid program by clearly defining the covered services and the criteria for reimbursement. Providers should familiarize themselves with this policy to ensure compliance and optimal service delivery. Recipients and their families can also benefit from understanding the coverage details, helping them make informed decisions about their home health care. Compliance with the policy guidelines ultimately contributes to better health outcomes and more efficient use of Medicaid resources.

• 1. Section 1.0 - Introduction: This section provides an overview of the policy, its purpose, and its intended audience.
• 2. Section 1.1 - Description: Details the scope of home health services covered by Medicaid.
• 3. Section 1.2 - Legal Authority: Lists the legal statutes and regulations authorizing the policy.
• 4. Section 1.3 - Definitions: Defines key terms used throughout the policy.
• 5. Section 2.0 - Eligible Recipient: Outlines criteria for recipient eligibility and specifics about who can receive services.
• 6. Section 3.0 - Eligible Provider: Details criteria for provider eligibility and specifies who can provide the services.
• 7. Section 4.0 - Coverage Information: Provides general and specific criteria for coverage.
• 8. Section 5.0 - Exclusions: Lists non-covered services and criteria.
• 9. Section 6.0 - Documentation: Specifies the required documentation for service provision and reimbursement.
• 10. Section 7.0 - Authorization: Outlines the criteria and process for service authorization.
• 11. Section 8.0 - Reimbursement: Provides information regarding billing codes, claim types, and rates.
• 12. Section 9.0 - Appendix: Includes additional forms like the Parent or Legal Guardian Medical Limitations Form and others.

Failure to submit this form can result in denial of coverage and delayed care delivery. Ensure all sections are accurately completed and submit the form by the specified deadline.

• Denial of Coverage: Incomplete or incorrect forms will lead to denial of Medicaid coverage for home health services.
• Delayed Care: Failure to submit the form on time can delay the delivery of necessary home health services.
• Inaccurate Reimbursement: Improper submission can affect the reimbursement process for providers.

• 1. Initial Service Request: When a new Medicaid recipient requires home health services for the first time.
• 2. Service Renewal: For continuing home health services beyond the initial coverage period.
• 3. Change in Medical Condition: When there is a significant change in the recipient's medical condition necessitating home health services.
• 4. Authorization Update: To update or revise the existing authorization for home health services.
• 5. Coverage Verification: To verify coverage and eligibility before the provision of home health services.