59G-4.192 LTC Program Policy FINAL VERSION W NOC

florida Medicaid Statewide Medicaid Managed Care Long-term Care Program coverage Policy Agency for Health Care Administration March 2017. florida Medicaid Statewide Medicaid Managed Care Long-term Care Program coverage Policy Table of Contents Introduction .. 1 Description and Program Goal .. 1 Legal Authority .. 1 Definitions .. 1 Eligible Recipient .. 3 General Criteria .. 3 Who Can Receive .. 3 Patient Responsibility .. 3 Eligible Provider .. 4 General Criteria .. 4 Who Can Provide .. 4 coverage Information .. 4 General Criteria .. 4 Specific Criteria .. 4 Exclusion .. 8 Documentation .. 8 General Criteria .. 8 Specific Criteria .. 8 Authorization .. 9 Appendix .. 10 Statewide Medicaid Managed Care Long-term Care Provider Qualifications .. 10 Statewide Medicaid Managed Care Long-term Care Program Procedure Codes for Home and Community-Based Supportive services .. 19 i March 2017. florida Medicaid Statewide Medicaid Managed Care Long-term Care Program coverage Policy Introduction Description and Program Goal Under the Statewide Medicaid Managed Care Long-term Care (LTC) Program , managed care plans (LTC plans) are required to provide an array of home and community-based services that enable enrollees to live in the community and to avoid institutionalization.

This policy is intended to provide information about the coverage and limitations of services provided under the LTC program. Note: All Florida Medicaid policies are promulgated in Rule Division 59G, Florida Administrative Code (F.A.C.). Coverage policies are available on the Agency for Health Care Administration’s (AHCA) Web site at

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