ENROLLED
       2013 Legislature                          SB 1520, 1st Engrossed
       
       
       
       
       
       
                                                             20131520er
    1  
    2         An act relating to Medicaid; repealing s. 381.0403,
    3         F.S., relating to the Community Hospital Education
    4         Act; amending s. 395.602, F.S.; providing that certain
    5         rural hospitals remain rural hospitals under specified
    6         circumstances; amending s. 409.905, F.S.; requiring
    7         the Agency for Health Care Administration to implement
    8         a prospective payment system for inpatient hospital
    9         services using diagnosis-related groups (DRGs);
   10         deleting provisions directing the agency to develop a
   11         plan to convert hospital reimbursement for inpatient
   12         services to a prospective payment system; requiring
   13         hospital reimbursement for outpatient services to be
   14         based on allowable costs; providing that adjustments
   15         may not be made after a certain date; providing for
   16         the reconciliation of errors in source data or
   17         calculations; amending s. 409.908, F.S.; revising
   18         exceptions to limitations on hospital reimbursement
   19         for inpatient services; providing parameters for
   20         submission of letters of agreement by local
   21         governmental entities to the agency relating to funds
   22         for special payments; providing that base rate
   23         reimbursement under a diagnosis-related group
   24         methodology shall be established in the General
   25         Appropriations Act; creating s. 409.909, F.S.;
   26         establishing the Statewide Medicaid Residency Program;
   27         providing the purposes of the program; providing
   28         definitions; providing a formula and limitations for
   29         allocating funds to participating hospitals;
   30         authorizing the agency to adopt rules; amending s.
   31         409.910, F.S.; revising provisions relating to
   32         responsibility for Medicaid payments in settlement
   33         proceedings; providing procedures for a recipient to
   34         contest the amount payable to the agency; amending s.
   35         409.911, F.S.; updating references to data used for
   36         calculations in the disproportionate share program;
   37         amending s. 409.9118, F.S.; amending parameters for
   38         the disproportionate share program for specialty
   39         hospitals; limiting reimbursement to tuberculosis
   40         services provided under contract with the Department
   41         of Health; amending s. 409.9122, F.S.; providing that
   42         certain mandatory managed care provisions that apply
   43         to a Medicaid recipient diagnosed with HIV/AIDS apply
   44         only to a recipient who failed to choose a managed
   45         care option; amending s. 409.915, F.S.; specifying the
   46         total contribution for certain years and specifying
   47         the method for determining the amount in the following
   48         years; revising the method for calculating each
   49         county’s contribution; providing tables for
   50         calculating county contributions; requiring the Agency
   51         for Health Care Administration to annually report the
   52         status of county billings to the Legislature;
   53         authorizing the Department of Revenue to withhold
   54         county distributions for failure to remit Medicaid
   55         contributions; deleting provisions specifying the care
   56         and services that counties must participate in,
   57         obsolete bond provisions, and a process for refund
   58         requests; specifying the method for calculating each
   59         county’s contribution for the 2013-2014 fiscal year;
   60         requiring the agency to submit an annual report to the
   61         Governor, the Legislature, and the Florida Association
   62         of Counties which includes information necessary to
   63         comprehensively evaluate the cost and utilization of
   64         health services by Medicaid enrollees; providing for
   65         the repeal and replacement of specified proviso in the
   66         2013-2014 General Appropriations Act; providing an
   67         effective date.
   68  
   69  Be It Enacted by the Legislature of the State of Florida:
   70  
   71         Section 1. Section 381.0403, Florida Statutes, is repealed.
   72         Section 2. Paragraph (e) of subsection (2) of section
   73  395.602, Florida Statutes, is amended to read:
   74         395.602 Rural hospitals.—
   75         (2) DEFINITIONS.—As used in this part:
   76         (e) “Rural hospital” means an acute care hospital licensed
   77  under this chapter, having 100 or fewer licensed beds and an
   78  emergency room, which is:
   79         1. The sole provider within a county with a population
   80  density of no greater than 100 persons per square mile;
   81         2. An acute care hospital, in a county with a population
   82  density of no greater than 100 persons per square mile, which is
   83  at least 30 minutes of travel time, on normally traveled roads
   84  under normal traffic conditions, from any other acute care
   85  hospital within the same county;
   86         3. A hospital supported by a tax district or subdistrict
   87  whose boundaries encompass a population of 100 persons or fewer
   88  per square mile;
   89         4. A hospital in a constitutional charter county with a
   90  population of over 1 million persons that has imposed a local
   91  option health service tax pursuant to law and in an area that
   92  was directly impacted by a catastrophic event on August 24,
   93  1992, for which the Governor of Florida declared a state of
   94  emergency pursuant to chapter 125, and has 120 beds or less that
   95  serves an agricultural community with an emergency room
   96  utilization of no less than 20,000 visits and a Medicaid
   97  inpatient utilization rate greater than 15 percent;
   98         5. A hospital with a service area that has a population of
   99  100 persons or fewer per square mile. As used in this
  100  subparagraph, the term “service area” means the fewest number of
  101  zip codes that account for 75 percent of the hospital’s
  102  discharges for the most recent 5-year period, based on
  103  information available from the hospital inpatient discharge
  104  database in the Florida Center for Health Information and Policy
  105  Analysis at the agency for Health Care Administration; or
  106         6. A hospital designated as a critical access hospital, as
  107  defined in s. 408.07(15).
  108  
  109  Population densities used in this paragraph must be based upon
  110  the most recently completed United States census. A hospital
  111  that received funds under s. 409.9116 for a quarter beginning no
  112  later than July 1, 2002, is deemed to have been and shall
  113  continue to be a rural hospital from that date through June 30,
  114  2015, if the hospital continues to have 100 or fewer licensed
  115  beds and an emergency room, or meets the criteria of
  116  subparagraph 4. An acute care hospital that has not previously
  117  been designated as a rural hospital and that meets the criteria
  118  of this paragraph shall be granted such designation upon
  119  application, including supporting documentation, to the agency
  120  for Health Care Administration. A hospital that was licensed as
  121  a rural hospital during the 2010-2011 or 2011-2012 fiscal year
  122  shall continue to be a rural hospital from the date of
  123  designation through June 30, 2015, if the hospital continues to
  124  have 100 or fewer licensed beds and an emergency room.
  125         Section 3. Paragraphs (c), (d), and (f) of subsection (5)
  126  and subsection (6) of section 409.905, Florida Statutes, are
  127  amended to read:
  128         409.905 Mandatory Medicaid services.—The agency may make
  129  payments for the following services, which are required of the
  130  state by Title XIX of the Social Security Act, furnished by
  131  Medicaid providers to recipients who are determined to be
  132  eligible on the dates on which the services were provided. Any
  133  service under this section shall be provided only when medically
  134  necessary and in accordance with state and federal law.
  135  Mandatory services rendered by providers in mobile units to
  136  Medicaid recipients may be restricted by the agency. Nothing in
  137  this section shall be construed to prevent or limit the agency
  138  from adjusting fees, reimbursement rates, lengths of stay,
  139  number of visits, number of services, or any other adjustments
  140  necessary to comply with the availability of moneys and any
  141  limitations or directions provided for in the General
  142  Appropriations Act or chapter 216.
  143         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
  144  all covered services provided for the medical care and treatment
  145  of a recipient who is admitted as an inpatient by a licensed
  146  physician or dentist to a hospital licensed under part I of
  147  chapter 395. However, the agency shall limit the payment for
  148  inpatient hospital services for a Medicaid recipient 21 years of
  149  age or older to 45 days or the number of days necessary to
  150  comply with the General Appropriations Act. Effective August 1,
  151  2012, the agency shall limit payment for hospital emergency
  152  department visits for a nonpregnant Medicaid recipient 21 years
  153  of age or older to six visits per fiscal year.
  154         (c) The agency shall implement a prospective payment
  155  methodology for establishing base reimbursement rates for
  156  inpatient hospital services each hospital based on allowable
  157  costs, as defined by the agency. Rates shall be calculated
  158  annually and take effect July 1 of each year based on the most
  159  recent complete and accurate cost report submitted by each
  160  hospital. The methodology shall categorize each inpatient
  161  admission into a diagnosis-related group and assign a relative
  162  payment weight to the base rate according to the average
  163  relative amount of hospital resources used to treat a patient in
  164  a specific diagnosis-related group category. The agency may
  165  adopt the most recent relative weights calculated and made
  166  available by the Nationwide Inpatient Sample maintained by the
  167  Agency for Healthcare Research and Quality or may adopt
  168  alternative weights if the agency finds that Florida-specific
  169  weights deviate with statistical significance from national
  170  weights for high-volume diagnosis-related groups. The agency
  171  shall establish a single, uniform base rate for all hospitals
  172  unless specifically exempt pursuant to s. 409.908(1).
  173         1. Adjustments may not be made to the rates after October
  174  31 of the state fiscal year in which the rates take effect,
  175  except for cases of insufficient collections of
  176  intergovernmental transfers authorized under s. 409.908(1) or
  177  the General Appropriations Act. In such cases, the agency shall
  178  submit a budget amendment or amendments under chapter 216
  179  requesting approval of rate reductions by amounts necessary for
  180  the aggregate reduction to equal the dollar amount of
  181  intergovernmental transfers not collected and the corresponding
  182  federal match. Notwithstanding the $1 million limitation on
  183  increases to an approved operating budget contained in ss.
  184  216.181(11) and 216.292(3), a budget amendment exceeding that
  185  dollar amount is subject to notice and objection procedures set
  186  forth in s. 216.177.
  187         2. Errors in source data or calculations cost reporting or
  188  calculation of rates discovered after October 31 must be
  189  reconciled in a subsequent rate period. However, the agency may
  190  not make any adjustment to a hospital’s reimbursement rate more
  191  than 5 years after a hospital is notified of an audited rate
  192  established by the agency. The prohibition against adjustments
  193  requirement that the agency may not make any adjustment to a
  194  hospital’s reimbursement rate more than 5 years after
  195  notification a hospital is notified of an audited rate
  196  established by the agency is remedial and applies to actions by
  197  providers involving Medicaid claims for hospital services.
  198  Hospital reimbursement is rates are subject to such limits or
  199  ceilings as may be established in law or described in the
  200  agency’s hospital reimbursement plan. Specific exemptions to the
  201  limits or ceilings may be provided in the General Appropriations
  202  Act.
  203         (d) The agency shall implement a comprehensive utilization
  204  management program for hospital neonatal intensive care stays in
  205  certain high-volume participating hospitals, select counties, or
  206  statewide, and replace existing hospital inpatient utilization
  207  management programs for neonatal intensive care admissions. The
  208  program shall be designed to manage appropriate admissions and
  209  discharges the lengths of stay for children being treated in
  210  neonatal intensive care units and must seek the earliest
  211  medically appropriate discharge to the child’s home or other
  212  less costly treatment setting. The agency may competitively bid
  213  a contract for the selection of a qualified organization to
  214  provide neonatal intensive care utilization management services.
  215  The agency may seek federal waivers to implement this
  216  initiative.
  217         (f) The agency shall develop a plan to convert Medicaid
  218  inpatient hospital rates to a prospective payment system that
  219  categorizes each case into diagnosis-related groups (DRG) and
  220  assigns a payment weight based on the average resources used to
  221  treat Medicaid patients in that DRG. To the extent possible, the
  222  agency shall propose an adaptation of an existing prospective
  223  payment system, such as the one used by Medicare, and shall
  224  propose such adjustments as are necessary for the Medicaid
  225  population and to maintain budget neutrality for inpatient
  226  hospital expenditures.
  227         1. The plan must:
  228         a. Define and describe DRGs for inpatient hospital care
  229  specific to Medicaid in this state;
  230         b. Determine the use of resources needed for each DRG;
  231         c. Apply current statewide levels of funding to DRGs based
  232  on the associated resource value of DRGs. Current statewide
  233  funding levels shall be calculated both with and without the use
  234  of intergovernmental transfers;
  235         d. Calculate the current number of services provided in the
  236  Medicaid program based on DRGs defined under this subparagraph;
  237         e. Estimate the number of cases in each DRG for future
  238  years based on agency data and the official workload estimates
  239  of the Social Services Estimating Conference;
  240         f. Calculate the expected total Medicaid payments in the
  241  current year for each hospital with a Medicaid provider
  242  agreement, based on the DRGs and estimated workload;
  243         g. Propose supplemental DRG payments to augment hospital
  244  reimbursements based on patient acuity and individual hospital
  245  characteristics, including classification as a children’s
  246  hospital, rural hospital, trauma center, burn unit, and other
  247  characteristics that could warrant higher reimbursements, while
  248  maintaining budget neutrality; and
  249         h. Estimate potential funding for each hospital with a
  250  Medicaid provider agreement for DRGs defined pursuant to this
  251  subparagraph and supplemental DRG payments using current funding
  252  levels, calculated both with and without the use of
  253  intergovernmental transfers.
  254         2. The agency shall engage a consultant with expertise and
  255  experience in the implementation of DRG systems for hospital
  256  reimbursement to develop the DRG plan under subparagraph 1.
  257         3. The agency shall submit the DRG plan, identifying all
  258  steps necessary for the transition and any costs associated with
  259  plan implementation, to the Governor, the President of the
  260  Senate, and the Speaker of the House of Representatives no later
  261  than January 1, 2013. The plan shall include a timeline
  262  necessary to complete full implementation by July 1, 2013. If,
  263  during implementation of this paragraph, the agency determines
  264  that these timeframes might not be achievable, the agency shall
  265  report to the Legislative Budget Commission the status of its
  266  implementation efforts, the reasons the timeframes might not be
  267  achievable, and proposals for new timeframes.
  268         (6) HOSPITAL OUTPATIENT SERVICES.—
  269         (a) The agency shall pay for preventive, diagnostic,
  270  therapeutic, or palliative care and other services provided to a
  271  recipient in the outpatient portion of a hospital licensed under
  272  part I of chapter 395, and provided under the direction of a
  273  licensed physician or licensed dentist, except that payment for
  274  such care and services is limited to $1,500 per state fiscal
  275  year per recipient, unless an exception has been made by the
  276  agency, and with the exception of a Medicaid recipient under age
  277  21, in which case the only limitation is medical necessity.
  278         (b) The agency shall implement a methodology for
  279  establishing base reimbursement rates for outpatient services
  280  for each hospital based on allowable costs, as defined by the
  281  agency. Rates shall be calculated annually and take effect July
  282  1 of each year based on the most recent complete and accurate
  283  cost report submitted by each hospital.
  284         1. Adjustments may not be made to the rates after October
  285  31 of the state fiscal year in which the rates take effect,
  286  except for cases of insufficient collections of
  287  intergovernmental transfers authorized under s. 409.908(1) or
  288  the General Appropriations Act. In such cases, the agency shall
  289  submit a budget amendment or amendments under chapter 216
  290  requesting approval of rate reductions by amounts necessary for
  291  the aggregate reduction to equal the dollar amount of
  292  intergovernmental transfers not collected and the corresponding
  293  federal match. Notwithstanding the $1 million limitation on
  294  increases to an approved operating budget under ss. 216.181(11)
  295  and 216.292(3), a budget amendment exceeding that dollar amount
  296  is subject to notice and objection procedures set forth in s.
  297  216.177.
  298         2. Errors in source data or calculations discovered after
  299  October 31 must be reconciled in a subsequent rate period.
  300  However, the agency may not make any adjustment to a hospital’s
  301  reimbursement more than 5 years after a hospital is notified of
  302  an audited rate established by the agency. The prohibition
  303  against adjustments more than 5 years after notification is
  304  remedial and applies to actions by providers involving Medicaid
  305  claims for hospital services. Hospital reimbursement is subject
  306  to such limits or ceilings as may be established in law or
  307  described in the agency’s hospital reimbursement plan. Specific
  308  exemptions to the limits or ceilings may be provided in the
  309  General Appropriations Act.
  310         Section 4. Paragraph (a) of subsection (1) and subsection
  311  (23) of section 409.908, Florida Statutes, are amended to read:
  312         409.908 Reimbursement of Medicaid providers.—Subject to
  313  specific appropriations, the agency shall reimburse Medicaid
  314  providers, in accordance with state and federal law, according
  315  to methodologies set forth in the rules of the agency and in
  316  policy manuals and handbooks incorporated by reference therein.
  317  These methodologies may include fee schedules, reimbursement
  318  methods based on cost reporting, negotiated fees, competitive
  319  bidding pursuant to s. 287.057, and other mechanisms the agency
  320  considers efficient and effective for purchasing services or
  321  goods on behalf of recipients. If a provider is reimbursed based
  322  on cost reporting and submits a cost report late and that cost
  323  report would have been used to set a lower reimbursement rate
  324  for a rate semester, then the provider’s rate for that semester
  325  shall be retroactively calculated using the new cost report, and
  326  full payment at the recalculated rate shall be effected
  327  retroactively. Medicare-granted extensions for filing cost
  328  reports, if applicable, shall also apply to Medicaid cost
  329  reports. Payment for Medicaid compensable services made on
  330  behalf of Medicaid eligible persons is subject to the
  331  availability of moneys and any limitations or directions
  332  provided for in the General Appropriations Act or chapter 216.
  333  Further, nothing in this section shall be construed to prevent
  334  or limit the agency from adjusting fees, reimbursement rates,
  335  lengths of stay, number of visits, or number of services, or
  336  making any other adjustments necessary to comply with the
  337  availability of moneys and any limitations or directions
  338  provided for in the General Appropriations Act, provided the
  339  adjustment is consistent with legislative intent.
  340         (1) Reimbursement to hospitals licensed under part I of
  341  chapter 395 must be made prospectively or on the basis of
  342  negotiation.
  343         (a) Reimbursement for inpatient care is limited as provided
  344  for in s. 409.905(5), except as otherwise provided in this
  345  subsection. for:
  346         1. If authorized by the General Appropriations Act, the
  347  agency may modify reimbursement for specific types of services
  348  or diagnoses, recipient ages, and hospital provider types The
  349  raising of rate reimbursement caps, excluding rural hospitals.
  350         2. The agency may establish an alternative methodology to
  351  the DRG-based prospective payment system to set reimbursement
  352  rates for:
  353         a. State-owned psychiatric hospitals.
  354         b. Newborn hearing screening services.
  355         c. Transplant services for which the agency has established
  356  a global fee.
  357         d. Recipients who have tuberculosis that is resistant to
  358  therapy who are in need of long-term, hospital-based treatment
  359  pursuant to s. 392.62 Recognition of the costs of graduate
  360  medical education.
  361         3. The agency shall modify reimbursement according to other
  362  methodologies recognized in the General Appropriations Act.
  363  
  364  During the years funds are transferred from the Department of
  365  Health, any reimbursement supported by such funds shall be
  366  subject to certification by the Department of Health that the
  367  hospital has complied with s. 381.0403. The agency may is
  368  authorized to receive funds from state entities, including, but
  369  not limited to, the Department of Health, local governments, and
  370  other local political subdivisions, for the purpose of making
  371  special exception payments, including federal matching funds,
  372  through the Medicaid inpatient reimbursement methodologies.
  373  Funds received from state entities or local governments for this
  374  purpose shall be separately accounted for and may shall not be
  375  commingled with other state or local funds in any manner. The
  376  agency may certify all local governmental funds used as state
  377  match under Title XIX of the Social Security Act, to the extent
  378  and in the manner authorized under that the identified local
  379  health care provider that is otherwise entitled to and is
  380  contracted to receive such local funds is the benefactor under
  381  the state’s Medicaid program as determined under the General
  382  Appropriations Act and pursuant to an agreement between the
  383  agency for Health Care Administration and the local governmental
  384  entity. In order for the agency to certify such local
  385  governmental funds, a local governmental entity must submit a
  386  final, executed letter of agreement to the agency, which must be
  387  received by October 1 of each fiscal year and provide the total
  388  amount of local governmental funds authorized by the entity for
  389  that fiscal year under this paragraph, paragraph (b), or the
  390  General Appropriations Act. The local governmental entity shall
  391  use a certification form prescribed by the agency. At a minimum,
  392  the certification form must shall identify the amount being
  393  certified and describe the relationship between the certifying
  394  local governmental entity and the local health care provider.
  395  The agency shall prepare an annual statement of impact which
  396  documents the specific activities undertaken during the previous
  397  fiscal year pursuant to this paragraph, to be submitted to the
  398  Legislature annually by no later than January 1, annually.
  399         (23)(a) The agency shall establish rates at a level that
  400  ensures no increase in statewide expenditures resulting from a
  401  change in unit costs effective July 1, 2011. Reimbursement rates
  402  shall be as provided in the General Appropriations Act.
  403         (b) Base rate reimbursement under a diagnosis-related group
  404  payment methodology shall be provided in the General
  405  Appropriations Act.
  406         (c)(b) This subsection applies to the following provider
  407  types:
  408         1. Inpatient hospitals.
  409         2. Outpatient hospitals.
  410         3. Nursing homes.
  411         4. County health departments.
  412         5. Community intermediate care facilities for the
  413  developmentally disabled.
  414         6. Prepaid health plans.
  415         (d)(c) The agency shall apply the effect of this subsection
  416  to the reimbursement rates for nursing home diversion programs.
  417         Section 5. Section 409.909, Florida Statutes, is created to
  418  read:
  419         409.909 Statewide Medicaid Residency Program.—
  420         (1) The Statewide Medicaid Residency Program is established
  421  to improve the quality of care and access to care for Medicaid
  422  recipients, expand graduate medical education on an equitable
  423  basis, and increase the supply of highly trained physicians
  424  statewide. The agency shall make payments to hospitals licensed
  425  under part I of chapter 395 for graduate medical education
  426  associated with the Medicaid program. This system of payments is
  427  designed to generate federal matching funds under Medicaid and
  428  distribute the resulting funds to participating hospitals on a
  429  quarterly basis in each fiscal year for which an appropriation
  430  is made.
  431         (2) On or before September 15 of each year, the agency
  432  shall calculate an allocation fraction to be used for
  433  distributing funds to participating hospitals. On or before the
  434  final business day of each quarter of a state fiscal year, the
  435  agency shall distribute to each participating hospital one
  436  fourth of that hospital’s annual allocation calculated under
  437  subsection (4). The allocation fraction for each participating
  438  hospital is based on the hospital’s number of full-time
  439  equivalent residents and the amount of its Medicaid payments. As
  440  used in this section, the term:
  441         (a) “Full-time equivalent,” or “FTE,” means a resident who
  442  is in his or her initial residency period, which is defined as
  443  the minimum number of years of training required before the
  444  resident may become eligible for board certification by the
  445  American Osteopathic Association Bureau of Osteopathic
  446  Specialists or the American Board of Medical Specialties in the
  447  specialty in which he or she first began training, not to exceed
  448  5 years. A resident training beyond the initial residency period
  449  is counted as 0.5 FTE, unless his or her chosen specialty is in
  450  general surgery or primary care, in which case the resident is
  451  counted as 1.0 FTE. For the purposes of this section, primary
  452  care specialties include:
  453         1. Family medicine;
  454         2. General internal medicine;
  455         3. General pediatrics;
  456         4. Preventive medicine;
  457         5. Geriatric medicine;
  458         6. Osteopathic general practice;
  459         7. Obstetrics and gynecology; and
  460         8. Emergency medicine.
  461         (b) “Medicaid payments” means the estimated total payments
  462  for reimbursing a hospital for direct inpatient services for the
  463  fiscal year in which the allocation fraction is calculated based
  464  on the hospital inpatient appropriation and the parameters for
  465  the inpatient diagnosis-related group base rate, including
  466  applicable intergovernmental transfers, specified in the General
  467  Appropriations Act, as determined by the agency.
  468         (c) “Resident” means a medical intern, fellow, or resident
  469  enrolled in a program accredited by the Accreditation Council
  470  for Graduate Medical Education, the American Association of
  471  Colleges of Osteopathic Medicine, or the American Osteopathic
  472  Association at the beginning of the state fiscal year during
  473  which the allocation fraction is calculated, as reported by the
  474  hospital to the agency.
  475         (3) The agency shall use the following formula to calculate
  476  a participating hospital’s allocation fraction:
  477  
  478             HAF=[0.9 x (HFTE/TFTE)] + [0.1 x (HMP/TMP)]           
  479  
  480         Where:
  481         HAF=A hospital’s allocation fraction.
  482         HFTE=A hospital’s total number of FTE residents.
  483         TFTE=The total FTE residents for all participating
  484  hospitals.
  485         HMP=A hospital’s Medicaid payments.
  486         TMP=The total Medicaid payments for all participating
  487  hospitals.
  488  
  489         (4) A hospital’s annual allocation shall be calculated by
  490  multiplying the funds appropriated for the Statewide Medicaid
  491  Residency Program in the General Appropriations Act by that
  492  hospital’s allocation fraction. If the calculation results in an
  493  annual allocation that exceeds $50,000 per FTE resident, the
  494  hospital’s annual allocation shall be reduced to a sum equaling
  495  no more than $50,000 per FTE resident. The funds calculated for
  496  that hospital in excess of $50,000 per FTE resident shall be
  497  redistributed to participating hospitals whose annual allocation
  498  does not exceed $50,000 per FTE resident, using the same
  499  methodology and payment schedule specified in this section.
  500         (5) The agency may adopt rules to administer this section.
  501         Section 6. Subsection (17) of section 409.910, Florida
  502  Statutes, is amended to read:
  503         409.910 Responsibility for payments on behalf of Medicaid
  504  eligible persons when other parties are liable.—
  505         (17) A recipient or his or her legal representative or any
  506  person representing, or acting as agent for, a recipient or the
  507  recipient’s legal representative, who has notice, excluding
  508  notice charged solely by reason of the recording of the lien
  509  pursuant to paragraph (6)(c), or who has actual knowledge of the
  510  agency’s rights to third-party benefits under this section, who
  511  receives any third-party benefit or proceeds therefrom for a
  512  covered illness or injury, must is required either to pay the
  513  agency, within 60 days after receipt of settlement proceeds, pay
  514  the agency the full amount of the third-party benefits, but not
  515  more than in excess of the total medical assistance provided by
  516  Medicaid, or to place the full amount of the third-party
  517  benefits in an interest-bearing a trust account for the benefit
  518  of the agency pending an judicial or administrative
  519  determination of the agency’s right to the benefits thereto.
  520  Proof that any such person had notice or knowledge that the
  521  recipient had received medical assistance from Medicaid, and
  522  that third-party benefits or proceeds therefrom were in any way
  523  related to a covered illness or injury for which Medicaid had
  524  provided medical assistance, and that any such person knowingly
  525  obtained possession or control of, or used, third-party benefits
  526  or proceeds and failed either to pay the agency the full amount
  527  required by this section or to hold the full amount of third
  528  party benefits or proceeds in an interest-bearing trust account
  529  pending an judicial or administrative determination, unless
  530  adequately explained, gives rise to an inference that such
  531  person knowingly failed to credit the state or its agent for
  532  payments received from social security, insurance, or other
  533  sources, pursuant to s. 414.39(4)(b), and acted with the intent
  534  set forth in s. 812.014(1).
  535         (a) A recipient may contest the amount designated as
  536  recovered medical expense damages payable to the agency pursuant
  537  to the formula specified in paragraph (11)(f) by filing a
  538  petition under chapter 120 within 21 days after the date of
  539  payment of funds to the agency or after the date of placing the
  540  full amount of the third-party benefits in the trust account for
  541  the benefit of the agency. The petition shall be filed with the
  542  Division of Administrative Hearings. For purposes of chapter
  543  120, the payment of funds to the agency or the placement of the
  544  full amount of the third-party benefits in the trust account for
  545  the benefit of the agency constitutes final agency action and
  546  notice thereof. Final order authority for the proceedings
  547  specified in this subsection rests with the Division of
  548  Administrative Hearings. This procedure is the exclusive method
  549  for challenging the amount of third-party benefits payable to
  550  the agency.
  551         1. In order to successfully challenge the amount payable to
  552  the agency, the recipient must prove, by clear and convincing
  553  evidence, that a lesser portion of the total recovery should be
  554  allocated as reimbursement for past and future medical expenses
  555  than the amount calculated by the agency pursuant to the formula
  556  set forth in paragraph (11)(f) or that Medicaid provided a
  557  lesser amount of medical assistance than that asserted by the
  558  agency.
  559         2. The agency’s provider processing system reports are
  560  admissible as prima facie evidence in substantiating the
  561  agency’s claim.
  562         3. Venue for all administrative proceedings pursuant to
  563  this subsection lies in Leon County, at the discretion of the
  564  agency. Venue for all appellate proceedings arising from the
  565  administrative proceeding outlined in this subsection lie at the
  566  First District Court of Appeal in Leon County, at the discretion
  567  of the agency.
  568         4. Each party shall bear its own attorney fees and costs
  569  for any administrative proceeding conducted pursuant to this
  570  paragraph.
  571         (b)(a) In cases of suspected criminal violations or
  572  fraudulent activity, the agency may take any civil action
  573  permitted at law or equity to recover the greatest possible
  574  amount, including, without limitation, treble damages under ss.
  575  772.11 and 812.035(7).
  576         1.(b) The agency may is authorized to investigate and to
  577  request appropriate officers or agencies of the state to
  578  investigate suspected criminal violations or fraudulent activity
  579  related to third-party benefits, including, without limitation,
  580  ss. 414.39 and 812.014. Such requests may be directed, without
  581  limitation, to the Medicaid Fraud Control Unit of the Office of
  582  the Attorney General, or to any state attorney. Pursuant to s.
  583  409.913, the Attorney General has primary responsibility to
  584  investigate and control Medicaid fraud.
  585         2.(c) In carrying out duties and responsibilities related
  586  to Medicaid fraud control, the agency may subpoena witnesses or
  587  materials within or outside the state and, through any duly
  588  designated employee, administer oaths and affirmations and
  589  collect evidence for possible use in either civil or criminal
  590  judicial proceedings.
  591         3.(d) All information obtained and documents prepared
  592  pursuant to an investigation of a Medicaid recipient, the
  593  recipient’s legal representative, or any other person relating
  594  to an allegation of recipient fraud or theft is confidential and
  595  exempt from s. 119.07(1):
  596         a.1. Until such time as the agency takes final agency
  597  action;
  598         b.2. Until such time as the Department of Legal Affairs
  599  refers the case for criminal prosecution;
  600         c.3. Until such time as an indictment or criminal
  601  information is filed by a state attorney in a criminal case; or
  602         d.4. At all times if otherwise protected by law.
  603         Section 7. Paragraph (a) of subsection (2) and paragraph
  604  (d) of subsection (4) of section 409.911, Florida Statutes, are
  605  amended to read:
  606         409.911 Disproportionate share program.—Subject to specific
  607  allocations established within the General Appropriations Act
  608  and any limitations established pursuant to chapter 216, the
  609  agency shall distribute, pursuant to this section, moneys to
  610  hospitals providing a disproportionate share of Medicaid or
  611  charity care services by making quarterly Medicaid payments as
  612  required. Notwithstanding the provisions of s. 409.915, counties
  613  are exempt from contributing toward the cost of this special
  614  reimbursement for hospitals serving a disproportionate share of
  615  low-income patients.
  616         (2) The Agency for Health Care Administration shall use the
  617  following actual audited data to determine the Medicaid days and
  618  charity care to be used in calculating the disproportionate
  619  share payment:
  620         (a) The average of the 2004, 2005, and 2006, and 2007
  621  audited disproportionate share data to determine each hospital’s
  622  Medicaid days and charity care for the 2013-2014 2012-2013 state
  623  fiscal year.
  624         (4) The following formulas shall be used to pay
  625  disproportionate share dollars to public hospitals:
  626         (d) Any nonstate government owned or operated hospital
  627  eligible for payments under this section on July 1, 2011,
  628  remains eligible for payments during the 2013-2014 2012-2013
  629  state fiscal year.
  630         Section 8. Subsection (2) of section 409.9118, Florida
  631  Statutes, is amended to read:
  632         409.9118 Disproportionate share program for specialty
  633  hospitals.— The Agency for Health Care Administration shall
  634  design and implement a system of making disproportionate share
  635  payments to those hospitals licensed in accordance with part I
  636  of chapter 395 as a specialty hospital which meet all
  637  requirements listed in subsection (2). Notwithstanding s.
  638  409.915, counties are exempt from contributing toward the cost
  639  of this special reimbursement for patients.
  640         (2) In order to receive payments under this section, a
  641  hospital must be licensed in accordance with part I of chapter
  642  395, to participate in the Florida Title XIX program, and meet
  643  the following requirements:
  644         (a) Be certified or certifiable to be a provider of Title
  645  XVIII services.
  646         (b) Receive all of its inpatient clients through referrals
  647  or admissions from county public health departments, as defined
  648  in chapter 154.
  649         (c) Require a diagnosis for the control of active
  650  tuberculosis or a history of noncompliance with prescribed drug
  651  regimens for the treatment of tuberculosis a communicable
  652  disease for all admissions for inpatient treatment.
  653         (d) Retain a contract with the Department of Health to
  654  accept clients for admission and inpatient treatment pursuant to
  655  s. 392.62.
  656         Section 9. Paragraphs (b), (l), and (m) of subsection (2)
  657  of section 409.9122, Florida Statutes, are amended, subsections
  658  (3) through (21) of that section are renumbered as subsections
  659  (4) through (22), respectively, and a new subsection (3) is
  660  added to that section, to read:
  661         409.9122 Mandatory Medicaid managed care enrollment;
  662  programs and procedures.—
  663         (2)
  664         (b) A Medicaid recipient may shall not be enrolled in or
  665  assigned to a managed care plan or MediPass unless the managed
  666  care plan or MediPass has complied with the quality-of-care
  667  standards specified in paragraphs (4)(a) (3)(a) and (b),
  668  respectively.
  669         (l) If the Medicaid recipient is diagnosed with HIV/AIDS,
  670  the agency shall assign the Medicaid recipient to a managed care
  671  plan that is a health maintenance organization authorized under
  672  chapter 641, is under contract with the agency on July 1, 2011,
  673  and which offers a delivery system through a university-based
  674  teaching and research-oriented organization that specializes in
  675  providing health care services and treatment for individuals
  676  diagnosed with HIV/AIDS.
  677         (l)(m) Notwithstanding the provisions of chapter 287, the
  678  agency may, at its discretion, renew cost-effective contracts
  679  for choice counseling services once or more for such periods as
  680  the agency may decide. However, all such renewals may not
  681  combine to exceed a total period longer than the term of the
  682  original contract.
  683  
  684  This subsection expires October 1, 2014.
  685         (3) Notwithstanding s. 409.961, if a Medicaid recipient is
  686  diagnosed with HIV/AIDS, the agency shall assign the recipient
  687  to a managed care plan that is a health maintenance organization
  688  authorized under chapter 641, that is under contract with the
  689  agency as an HIV/AIDS specialty plan as of January 1, 2013, and
  690  that offers a delivery system through a university-based
  691  teaching and research-oriented organization that specializes in
  692  providing health care services and treatment for individuals
  693  diagnosed with HIV/AIDS. This subsection applies to recipients
  694  who are subject to mandatory managed care enrollment and have
  695  failed to choose a managed care option.
  696         Section 10. Section 409.915, Florida Statutes, is amended
  697  to read:
  698         409.915 County contributions to Medicaid.—Although the
  699  state is responsible for the full portion of the state share of
  700  the matching funds required for the Medicaid program, in order
  701  to acquire a certain portion of these funds, the state shall
  702  charge the counties an annual contribution in order to acquire a
  703  certain portion of these funds for certain items of care and
  704  service as provided in this section.
  705         (1) As used in this section, the term “state Medicaid
  706  expenditures” means those expenditures used as matching funds
  707  for the federal Medicaid program.
  708         (2)(a) For the 2013-2014 state fiscal year, the total
  709  amount of the counties’ annual contribution is $269.6 million.
  710         (b) For the 2014-2015 state fiscal year, the total amount
  711  of the counties’ annual contribution is $277 million.
  712         (c) By March 15, 2015, and each year thereafter, the Social
  713  Services Estimating Conference shall determine the percentage
  714  change in state Medicaid expenditures by comparing expenditures
  715  for the 2 most recent completed state fiscal years.
  716         (d) For the 2015-2016 state fiscal year through the 2019
  717  2020 state fiscal year, the total amount of the counties’ annual
  718  contribution shall be the total contribution for the prior
  719  fiscal year adjusted by 50 percent of the percentage change in
  720  the state Medicaid expenditures as determined by the Social
  721  Services Estimating Conference.
  722         (e) For each fiscal year after the 2019-2020 state fiscal
  723  year, the total amount of the counties’ annual contribution
  724  shall be the total contribution for the prior fiscal year
  725  adjusted by the percentage change in the state Medicaid
  726  expenditures as determined by the Social Services Estimating
  727  Conference.
  728         (3)(a)1. The amount of each county’s annual contribution is
  729  equal to the product of the amount determined under subsection
  730  (2) multiplied by the sum of the percentages calculated in sub
  731  subparagraphs a. and b.:
  732         a. The enrollment weight provided in subparagraph 2. is
  733  multiplied by a fraction, the numerator of which is the number
  734  of the county’s Medicaid enrollees as of March 1 of each year,
  735  and the denominator of which is the number of all counties’
  736  Medicaid enrollees as of March 1 of each year. The agency shall
  737  calculate this amount for each county and provide the
  738  information to the Department of Revenue by May 15 of each year.
  739         b. The payment weight provided in subparagraph 2. is
  740  multiplied by the percentage share of payments provided in
  741  subparagraph 3. for each county.
  742         2. The weights for each fiscal year are equal to:
  743  
  744      FISCAL YEAR        ENROLLMENT         PAYMENT     
  745  2013-14            0%                 100%            
  746  2014-15            0%                 100%            
  747  2015-16            20%                80%             
  748  2016-17            40%                60%             
  749  2017-18            60%                40%             
  750  2018-19            80%                20%             
  751  2019-20+           100%               0%              
  752  COUNTY              SHARE OF PAYMENTS 
  753  Alachua                  1.278%       
  754  Baker                    0.116%       
  755  Bay                      0.607%       
  756  Bradford                 0.179%       
  757  Brevard                  2.471%       
  758  Broward                  9.228%       
  759  Calhoun                  0.084%       
  760  Charlotte                0.578%       
  761  Citrus                   0.663%       
  762  Clay                     0.635%       
  763  Collier                  1.161%       
  764  Columbia                 0.557%       
  765  Dade (Miami-Dade)        18.853%      
  766  Desoto                   0.167%       
  767  Dixie                    0.098%       
  768  Duval                    5.337%       
  769  Escambia                 1.615%       
  770  Flagler                  0.397%       
  771  Franklin                 0.091%       
  772  Gadsden                  0.239%       
  773  Gilchrist                0.078%       
  774  Glades                   0.055%       
  775  Gulf                     0.076%       
  776  Hamilton                 0.075%       
  777  Hardee                   0.110%       
  778  Hendry                   0.163%       
  779  Hernando                 0.862%       
  780  Highlands                0.468%       
  781  Hillsborough             6.953%       
  782  Holmes                   0.101%       
  783  Indian River             0.397%       
  784  Jackson                  0.219%       
  785  Jefferson                0.083%       
  786  Lafayette                0.014%       
  787  Lake                     1.525%       
  788  Lee                      2.512%       
  789  Leon                     0.929%       
  790  Levy                     0.256%       
  791  Liberty                  0.050%       
  792  Madison                  0.086%       
  793  Manatee                  1.623%       
  794  Marion                   1.630%       
  795  Martin                   0.353%       
  796  Monroe                   0.262%       
  797  Nassau                   0.240%       
  798  Okaloosa                 0.567%       
  799  Okeechobee               0.235%       
  800  Orange                   6.682%       
  801  Osceola                  1.613%       
  802  Palm Beach               5.899%       
  803  Pasco                    2.392%       
  804  Pinellas                 6.645%       
  805  Polk                     3.643%       
  806  Putnam                   0.417%       
  807  Saint Johns              0.459%       
  808  Saint Lucie              1.155%       
  809  Santa Rosa               0.462%       
  810  Sarasota                 1.230%       
  811  Seminole                 1.740%       
  812  Sumter                   0.218%       
  813  Suwannee                 0.252%       
  814  Taylor                   0.103%       
  815  Union                    0.075%       
  816  Volusia                  2.298%       
  817  Wakulla                  0.103%       
  818  Walton                   0.229%       
  819  Washington               0.114%       
  820  
  821         (b)1. The Legislature intends to replace the county
  822  percentage share provided in subparagraph (a)3. with percentage
  823  shares based upon each county’s proportion of the total
  824  statewide amount of county billings made under this section from
  825  April 1, 2012, through March 31, 2013, for which the state
  826  ultimately receives payment.
  827         2. By February 1 of each year and continuing until a
  828  certification is made under sub-subparagraph b., the agency
  829  shall report to the President of the Senate and the Speaker of
  830  the House of Representatives the status of the county billings
  831  made under this section from April 1, 2012, through March 31,
  832  2013, by county, including:
  833         a. The amounts billed to each county which remain unpaid,
  834  if any; and
  835         b. A certification from the agency of a final accounting of
  836  the amount of funds received by the state from such billings, by
  837  county, upon the expiration of all appeal rights that counties
  838  may have to contest such billings.
  839         3. By March 15 of the state fiscal year in which the state
  840  receives the certification provided for in sub-subparagraph
  841  (b)2.b., the Social Services Estimating Conference shall
  842  calculate each county’s percentage share of the total statewide
  843  amount of county billings made under this section from April 1,
  844  2012, through March 31, 2013, for which the state ultimately
  845  receives payment.
  846         4. Beginning in the state fiscal year following the receipt
  847  by the state of the certification provided in sub-subparagraph
  848  (b)2.b., each county’s percentage share under subparagraph (a)3.
  849  shall be replaced by the percentage calculated under
  850  subparagraph (b)3.
  851         5. If the court invalidates the replacement of each
  852  county’s share as provided in this paragraph, the county share
  853  set forth in subparagraph (a)3. shall continue to apply.
  854         (4) By June 1 of each year, the Department of Revenue shall
  855  notify each county of its required annual contribution. Each
  856  county shall pay its contribution, by check or electronic
  857  transfer, in equal monthly installments to the department by the
  858  5th day of each month. If a county fails to remit the payment by
  859  the 5th day of the month, the department shall reduce the
  860  monthly distribution of that county pursuant to s. 218.61 and,
  861  if necessary, by the amount of the monthly installment pursuant
  862  to s. 218.26. The payments and the amounts by which the
  863  distributions are reduced shall be transferred to the General
  864  Revenue Fund.
  865         (1) Each county shall participate in the following items of
  866  care and service:
  867         (a) For both health maintenance members and fee-for-service
  868  beneficiaries, payments for inpatient hospitalization in excess
  869  of 10 days, but not in excess of 45 days, with the exception of
  870  pregnant women and children whose income is in excess of the
  871  federal poverty level and who do not participate in the Medicaid
  872  medically needy program, and for adult lung transplant services.
  873         (b) For both health maintenance members and fee-for-service
  874  beneficiaries, payments for nursing home or intermediate
  875  facilities care in excess of $170 per month, with the exception
  876  of skilled nursing care for children under age 21.
  877         (2) A county’s participation must be 35 percent of the
  878  total cost, or the applicable discounted cost paid by the state
  879  for Medicaid recipients enrolled in health maintenance
  880  organizations or prepaid health plans, of providing the items
  881  listed in subsection (1), except that the payments for items
  882  listed in paragraph (1)(b) may not exceed $55 per month per
  883  person.
  884         (3) Each county shall set aside sufficient funds to pay for
  885  items of care and service provided to the county’s eligible
  886  recipients for which county contributions are required,
  887  regardless of where in the state the care or service is
  888  rendered.
  889         (4) Each county shall contribute its pro rata share of the
  890  total county participation based upon statements rendered by the
  891  agency. The agency shall render such statements monthly based on
  892  each county’s eligible recipients. For purposes of this section,
  893  each county’s eligible recipients shall be determined by the
  894  recipient’s address information contained in the federally
  895  approved Medicaid eligibility system within the Department of
  896  Children and Family Services. A county may use the process
  897  developed under subsection (10) to request a refund if it
  898  determines that the statement rendered by the agency contains
  899  errors.
  900         (5) In any county in which a special taxing district or
  901  authority is located which benefits will benefit from the
  902  Medicaid program medical assistance programs covered by this
  903  section, the board of county commissioners may divide the
  904  county’s financial responsibility for this purpose
  905  proportionately, and each such district or authority must
  906  furnish its share to the board of county commissioners in time
  907  for the board to comply with subsection (4) (3). Any appeal of
  908  the proration made by the board of county commissioners must be
  909  made to the Department of Financial Services, which shall then
  910  set the proportionate share for of each party.
  911         (6) Counties are exempt from contributing toward the cost
  912  of new exemptions on inpatient ceilings for statutory teaching
  913  hospitals, specialty hospitals, and community hospital education
  914  program hospitals that came into effect July 1, 2000, and for
  915  special Medicaid payments that came into effect on or after July
  916  1, 2000.
  917         (6)(7)(a) By August 1, 2012, the agency shall certify to
  918  each county the amount of such county’s billings from November
  919  1, 2001, through April 30, 2012, which remain unpaid. A county
  920  may contest the amount certified by filing a petition under the
  921  applicable provisions of chapter 120 on or before September 1,
  922  2012. This procedure is the exclusive method to challenge the
  923  amount certified. In order to successfully challenge the amount
  924  certified, a county must show, by a preponderance of the
  925  evidence, that a recipient was not an eligible recipient of that
  926  county or that the amount certified was otherwise in error.
  927         (b) By September 15, 2012, the agency shall certify to the
  928  Department of Revenue:
  929         1. For each county that files a petition on or before
  930  September 1, 2012, the amount certified under paragraph (a); and
  931         2. For each county that does not file a petition on or
  932  before September 1, 2012, an amount equal to 85 percent of the
  933  amount certified under paragraph (a).
  934         (c) The filing of a petition under paragraph (a) does shall
  935  not stay or stop the Department of Revenue from reducing
  936  distributions in accordance with paragraph (b) and subsection
  937  (7) (8). If a county that files a petition under paragraph (a)
  938  is able to demonstrate that the amount certified should be
  939  reduced, the agency shall notify the Department of Revenue of
  940  the amount of the reduction. The Department of Revenue shall
  941  adjust all future monthly distribution reductions under
  942  subsection (7) (8) in a manner that results in the remaining
  943  total distribution reduction being applied in equal monthly
  944  amounts.
  945         (7)(8)(a) Beginning with the October 2012 distribution, the
  946  Department of Revenue shall reduce each county’s distributions
  947  pursuant to s. 218.26 by one thirty-sixth of the amount
  948  certified by the agency under subsection (6) (7) for that
  949  county, minus any amount required under paragraph (b). Beginning
  950  with the October 2013 distribution, the Department of Revenue
  951  shall reduce each county’s distributions pursuant to s. 218.26
  952  by one forty-eighth of two-thirds of the amount certified by the
  953  agency under subsection (6) (7) for that county, minus any
  954  amount required under paragraph (b). However, the amount of the
  955  reduction may not exceed 50 percent of each county’s
  956  distribution. If, after 60 months, the reductions for any county
  957  do not equal the total amount initially certified by the agency,
  958  the Department of Revenue shall continue to reduce such county’s
  959  distribution by up to 50 percent until the total amount
  960  certified is reached. The amounts by which the distributions are
  961  reduced shall be transferred to the General Revenue Fund.
  962         (b) As an assurance to holders of bonds issued before the
  963  effective date of this act to which distributions made pursuant
  964  to s. 218.26 are pledged, or bonds issued to refund such bonds
  965  which mature no later than the bonds they refunded and which
  966  result in a reduction of debt service payable in each fiscal
  967  year, the amount available for distribution to a county shall
  968  remain as provided by law and continue to be subject to any lien
  969  or claim on behalf of the bondholders. The Department of Revenue
  970  must ensure, based on information provided by an affected
  971  county, that any reduction in amounts distributed pursuant to
  972  paragraph (a) does not reduce the amount of distribution to a
  973  county below the amount necessary for the timely payment of
  974  principal and interest when due on the bonds and the amount
  975  necessary to comply with any covenant under the bond resolution
  976  or other documents relating to the issuance of the bonds. If a
  977  reduction to a county’s monthly distribution must be decreased
  978  in order to comply with this paragraph, the Department of
  979  Revenue must notify the agency of the amount of the decrease and
  980  the agency must send a bill for payment of such amount to the
  981  affected county.
  982         (9)(a) Beginning May 1, 2012, and each month thereafter,
  983  the agency shall certify to the Department of Revenue by the 7th
  984  day of each month the amount of the monthly statement rendered
  985  to each county pursuant to subsection (4). Beginning with the
  986  May 2012 distribution, the Department of Revenue shall reduce
  987  each county’s monthly distribution pursuant to s. 218.61 by the
  988  amount certified by the agency minus any amount required under
  989  paragraph (b). The amounts by which the distributions are
  990  reduced shall be transferred to the General Revenue Fund.
  991         (b) As an assurance to holders of bonds issued before the
  992  effective date of this act to which distributions made pursuant
  993  to s. 218.61 are pledged, or bonds issued to refund such bonds
  994  which mature no later than the bonds they refunded and which
  995  result in a reduction of debt service payable in each fiscal
  996  year, the amount available for distribution to a county shall
  997  remain as provided by law and continue to be subject to any lien
  998  or claim on behalf of the bondholders. The Department of Revenue
  999  must ensure, based on information provided by an affected
 1000  county, that any reduction in amounts distributed pursuant to
 1001  paragraph (a) does not reduce the amount of distribution to a
 1002  county below the amount necessary for the timely payment of
 1003  principal and interest when due on the bonds and the amount
 1004  necessary to comply with any covenant under the bond resolution
 1005  or other documents relating to the issuance of the bonds. If a
 1006  reduction to a county’s monthly distribution must be decreased
 1007  in order to comply with this paragraph, the Department of
 1008  Revenue must notify the agency of the amount of the decrease and
 1009  the agency must send a bill for payment of such amount to the
 1010  affected county.
 1011         (10) The agency, in consultation with the Department of
 1012  Revenue and the Florida Association of Counties, shall develop a
 1013  process for refund requests which:
 1014         (a) Allows counties to submit to the agency written
 1015  requests for refunds of any amounts by which the distributions
 1016  were reduced as provided in subsection (9) and which set forth
 1017  the reasons for the refund requests.
 1018         (b) Requires the agency to make a determination as to
 1019  whether a refund request is appropriate and should be approved,
 1020  in which case the agency shall certify the amount of the refund
 1021  to the department.
 1022         (c) Requires the department to issue the refund for the
 1023  certified amount to the county from the General Revenue Fund.
 1024  The Department of Revenue may issue the refund in the form of a
 1025  credit against reductions to be applied to subsequent monthly
 1026  distributions.
 1027         (8)(11) Beginning in the 2013-2014 fiscal year and each
 1028  year thereafter through the 2020-2021 fiscal year, the Chief
 1029  Financial Officer shall transfer from the General Revenue Fund
 1030  to the Lawton Chiles Endowment Fund an amount equal to the
 1031  amounts transferred to the General Revenue Fund in the previous
 1032  fiscal year pursuant to subsections (4) and (7) subsections (8)
 1033  and (9), reduced by the amount of refunds paid pursuant to
 1034  subsection (10), which are in excess of the official estimate
 1035  for medical hospital fees for such previous fiscal year adopted
 1036  by the Revenue Estimating Conference on January 12, 2012, as
 1037  reflected in the conference’s workpapers. By July 20 of each
 1038  year, the Office of Economic and Demographic Research shall
 1039  certify the amount to be transferred to the Chief Financial
 1040  Officer. Such transfers must be made before July 31 of each year
 1041  until the total transfers for all years equal $350 million. If
 1042  In the event that such transfers do not total $350 million by
 1043  July 1, 2021, the Legislature shall provide for the transfer of
 1044  amounts necessary to total $350 million. The Office of Economic
 1045  and Demographic Research shall publish the official estimates
 1046  reflected in the conference’s workpapers on its website.
 1047         (9)(12) The agency may adopt rules to administer this
 1048  section.
 1049         Section 11. Notwithstanding s. 409.915(3) and (4), Florida
 1050  Statutes, as amended by this act, the amount of each county’s
 1051  contribution during the 2013-2014 state fiscal year shall be
 1052  determined and provided to the Department of Revenue by the
 1053  Agency for Health Care Administration by June 15, 2013. The
 1054  Department of Revenue shall notify each county of its annual
 1055  contribution by June 20, 2013.
 1056         Section 12. The Agency for Health Care Administration shall
 1057  submit a data report by March 1 of each year to the Governor,
 1058  the President of the Senate, the Speaker of the House of
 1059  Representatives, and the Florida Association of Counties which
 1060  includes such information as may be necessary for
 1061  comprehensively evaluating the cost and utilization of health
 1062  services by Medicaid enrollees by service type in each county.
 1063  This section is repealed December 31, 2015.
 1064         Section 13. The paragraph following Specific Appropriation
 1065  195 contained in SB 1500, if adopted during the 2013 Regular
 1066  Session of the Florida Legislature, is repealed and replaced
 1067  with the following upon SB 1500 becoming a law:
 1068  
 1069         From the funds in Specific Appropriations 195, 197,
 1070         198, 201, 203, 215, 219, 222, and 223, $677,722,971
 1071         from the Medical Care Trust Fund is provided for
 1072         increased reimbursement rates for primary care
 1073         services provided to eligible Medicaid recipients.
 1074  
 1075         Section 14. This act shall take effect July 1, 2013.