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1216!2019 Statutes & Constitution :View Statutes : Online Sunshine (i) Optometric services. (j) Orthodontic services. (k) Personal care for Medicaid recipients under age .21. (t) Physical therapy for Medicaid recipients under age 21. (m) Physician assistant services. (n) Podiatric services. (o) Portable X-ray services. (p) Private -duty nursing for Medicaid recipients under age 21 (q) Registered nurse first assistant services. (r) Respiratory therapy for Medicaid recipients under age 21. (s) Speech therapy for Medicaid recipients under age 21. (t) Visual services. (4) Subject to any limitations or directions provided for in the General Appropriations Act, alternative health plans, health maintenance organizations, and prepaid health plans shalt be reimbursed a fixed, prepaid amount negotiated, or competitively bid pursuant to s. 287.057, by the agency and prospectively paid to the provider monthly for each Medicaid recipient enrolled. The amount may not exceed the average amount the agency determines it would have paid, based on claims experience, for recipients in the same or similar category of eligibility. The agency shalt calculate capitation rates on a regional basis and, beginning September 1, 1995, shalt include age -band differentials in such calculations. (5) Effective July 1, 2017, an ambulatory surgical center shalt be reimbursed pursuant to a prospective payment methodology. The agency shalt implement a prospective payment methodology for establishing reimbursement rates for ambulatory surgical centers. Rates shalt be calculated annually and take effect July 1, 2017, and on July 1 each year thereafter. The methodology shall categorize the amount and type of services used in various ambulatory visits which group together procedures and medical visits that share similar characteristics and resource utilization. (6) A provider of early and periodic screening, diagnosis, and treatment services to Medicaid recipients who are children under age 21 shalt be reimbursed using an all-inclusive rate stipulated in a fee schedule established by the agency. A provider of the visual, dental, and hearing components of such services shalt be reimbursed the lesser of the amount billed by the provider or the Medicaid maximum allowable fee established by the agency. (7) A provider of family planning services shalt be reimbursed the lesser of the amount billed by the provider or an all-inclusive amount per type of visit for physicians and advanced practice registered nurses, as established by the agency in a fee schedule. (8) A provider of home-based or community-based services rendered pursuant to a federally approved waiver shall be reimbursed based on an established or negotiated rate for each service. These rates shalt be established according to an analysis of the expenditure history and prospective budget developed by each contract provider participating in the waiver program, or under any other methodology adopted by the agency and approved by the Federal Government in accordance with the waiver. Privately owned and operated community-based residential facilities which meet agency requirements and which formerly received Medicaid reimbursement for the optional intermediate care facility for the intellectually disabled service may participate in the developmental services waiver as part of a home -and -community-based continuum of care for Medicaid recipients who receive waiver services. (9) A provider of home health care services or of medical supplies and appliances shalt be reimbursed on the basis of competitive bidding or for the lesser of the amount billed by the provider or the agency's established maximum allowable amount, except that, in the case of the rental of durable medical equipment, the total rental payments may not exceed the purchase price of the equipment over its expected useful life or the agency's established maximum allowable amount, whichever amount is less. (10) A hospice shall be reimbursed through a prospective system for each Medicaid hospice patient at Medicaid rates using the methodology established for hospice reimbursement pursuant to Title XVIII of the federal SOIN Security Act. www.leg.state.fl.us/statutes/index.cfm?App mode=Display_Statute&URL=0400-049910409/Sections/0409.908.html 6112