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    v1.0.30
    OpenPayerPolicy UpdatesAdministrative/Operational PolicyFlorida Medicaid Incontinence Policy Update | Open…
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    CurrentAgency for Health Care AdministrationPolicy 2025-03

    Medical Record Requirements for Incontinence Supplies in the Long-Term Care (LTC) Program

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    Clarifies documentation and authorization requirements for medically necessary incontinence supplies provided to Florida Long-Term Care enrollees under the Statewide Medicaid Managed Care program.

    Policy Summary
    PayerAgency for Health Care Administration
    PolicyMedical Record Requirements for Incontinence Supplies in the Long-Term Care (LTC) Program
    Policy CodePolicy 2025-03
    Change TypeClarification
    Effective DateJanuary 10, 2024
    Next Review DateNot specified
    Key ActionManaged Care Plans must provide medically necessary incontinence supplies and maintain documentation supporting the ordered items and medical necessity.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    LTCProgram
    3Alternative documents
    LTC plan of careAuthorizing document
    21 daysDispute deadline

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    Jan 10, 2024Applies from

    Medically Necessary Incontinence Supplies

    Medically necessary incontinence supplies

    Covered when all of the following criteria are met:

    ALL of the following

    • The individual is enrolled in the Long-Term Care program.
    • The incontinence supplies are medically necessary and supported by the enrollee's approved Long-Term Care plan of care or other acceptable authorizing documentation.
    • The authorizing documentation clearly describes the ordered item.

    Documentation and Authorization Requirements

    Documentation Required

    Document and authorize medically necessary supplies

    Managed Care Plans must provide medically necessary incontinence supplies to Long-Term Care enrollees and maintain documentation supporting the ordered items and medical necessity.

    • The documentation must clearly describe the ordered item.
    • The record must support the enrollee’s medical necessity and care needs.
    Prior Authorization

    Use the approved LTC plan of care as authorization

    Case managers may authorize medical equipment and supplies, in consultation with a medical professional, when the enrollee’s medical necessity and care needs are reflected in the approved Long-Term Care plan of care. That approved plan of care serves as the authorizing document and eliminates the need for a separate written prescription, practitioner-signed certificate of medical necessity, or current hospital discharge plan unless the Managed Care Plan otherwise requires one.

    • Use the approved LTC plan of care as the authorization for medically necessary incontinence supplies.
    • The plan of care must reflect the enrollee’s medical necessity and care needs.

    Approved Long-Term Care Plan of Care

    Approved LTC plan of care
    DefinitionThe enrollee’s approved Long-Term Care plan of care, reflecting medically necessary care needs and authorized through the applicable waiver process.
    Authorization roleServes as the authorizing document for medically necessary incontinence supplies.
    Alternative documentationUnless otherwise required by the Managed Care Plan, it negates the need for a written prescription, practitioner-signed certificate of medical necessity, or current hospital discharge plan.
    Policy Summary
    PayerAgency for Health Care Administration
    PolicyMedical Record Requirements for Incontinence Supplies in the Long-Term Care (LTC) Program
    Policy CodePolicy 2025-03
    Change TypeClarification
    Effective DateJanuary 10, 2024
    Next Review DateNot specified
    Key ActionManaged Care Plans must provide medically necessary incontinence supplies and maintain documentation supporting the ordered items and medical necessity.
    SourceLink
    On This Page
    Medically Necessary Incontinence SuppliesDocumentation and Authorization RequirementsApproved Long-Term Care Plan of Care