Florida Senate - 2015 CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 2508-A
Ì145994VÎ145994
LEGISLATIVE ACTION
Senate . House
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Floor: AD/CR . Floor: C
06/19/2015 03:47 PM . 06/19/2015 06:28 PM
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The Conference Committee on SB 2508-A recommended the following:
1 Senate Conference Committee Amendment (with title
2 amendment)
3
4 Delete everything after the enacting clause
5 and insert:
6 Section 1. Paragraph (e) of subsection (2) of section
7 395.602, Florida Statutes, is amended to read:
8 395.602 Rural hospitals.—
9 (2) DEFINITIONS.—As used in this part, the term:
10 (e) “Rural hospital” means an acute care hospital licensed
11 under this chapter, having 100 or fewer licensed beds and an
12 emergency room, which is:
13 1. The sole provider within a county with a population
14 density of up to 100 persons per square mile;
15 2. An acute care hospital, in a county with a population
16 density of up to 100 persons per square mile, which is at least
17 30 minutes of travel time, on normally traveled roads under
18 normal traffic conditions, from any other acute care hospital
19 within the same county;
20 3. A hospital supported by a tax district or subdistrict
21 whose boundaries encompass a population of up to 100 persons per
22 square mile;
23 4. A hospital classified as a sole community hospital under
24 42 C.F.R. s. 412.92 which has up to 340 licensed beds;
25 4.5. A hospital with a service area that has a population
26 of up to 100 persons per square mile. As used in this
27 subparagraph, the term “service area” means the fewest number of
28 zip codes that account for 75 percent of the hospital’s
29 discharges for the most recent 5-year period, based on
30 information available from the hospital inpatient discharge
31 database in the Florida Center for Health Information and Policy
32 Analysis at the agency; or
33 5.6. A hospital designated as a critical access hospital,
34 as defined in s. 408.07.
35
36 Population densities used in this paragraph must be based upon
37 the most recently completed United States census. A hospital
38 that received funds under s. 409.9116 for a quarter beginning no
39 later than July 1, 2002, is deemed to have been and shall
40 continue to be a rural hospital from that date through June 30,
41 2021 2015, if the hospital continues to have up to 100 licensed
42 beds and an emergency room. An acute care hospital that has not
43 previously been designated as a rural hospital and that meets
44 the criteria of this paragraph shall be granted such designation
45 upon application, including supporting documentation, to the
46 agency. A hospital that was licensed as a rural hospital during
47 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
48 rural hospital from the date of designation through June 30,
49 2021 2015, if the hospital continues to have up to 100 licensed
50 beds and an emergency room.
51 Section 2. Effective upon this act becoming a law,
52 paragraphs (c) and (d) of subsection (1) of section 409.908,
53 Florida Statutes, are redesignated as paragraphs (d) and (e),
54 respectively, and new paragraphs (c) and (f) are added to that
55 subsection, to read:
56 409.908 Reimbursement of Medicaid providers.—Subject to
57 specific appropriations, the agency shall reimburse Medicaid
58 providers, in accordance with state and federal law, according
59 to methodologies set forth in the rules of the agency and in
60 policy manuals and handbooks incorporated by reference therein.
61 These methodologies may include fee schedules, reimbursement
62 methods based on cost reporting, negotiated fees, competitive
63 bidding pursuant to s. 287.057, and other mechanisms the agency
64 considers efficient and effective for purchasing services or
65 goods on behalf of recipients. If a provider is reimbursed based
66 on cost reporting and submits a cost report late and that cost
67 report would have been used to set a lower reimbursement rate
68 for a rate semester, then the provider’s rate for that semester
69 shall be retroactively calculated using the new cost report, and
70 full payment at the recalculated rate shall be effected
71 retroactively. Medicare-granted extensions for filing cost
72 reports, if applicable, shall also apply to Medicaid cost
73 reports. Payment for Medicaid compensable services made on
74 behalf of Medicaid eligible persons is subject to the
75 availability of moneys and any limitations or directions
76 provided for in the General Appropriations Act or chapter 216.
77 Further, nothing in this section shall be construed to prevent
78 or limit the agency from adjusting fees, reimbursement rates,
79 lengths of stay, number of visits, or number of services, or
80 making any other adjustments necessary to comply with the
81 availability of moneys and any limitations or directions
82 provided for in the General Appropriations Act, provided the
83 adjustment is consistent with legislative intent.
84 (1) Reimbursement to hospitals licensed under part I of
85 chapter 395 must be made prospectively or on the basis of
86 negotiation.
87 (c) The agency may receive intergovernmental transfers of
88 funds from governmental entities, including, but not limited to,
89 the Department of Health, local governments, and other local
90 political subdivisions, for the advancement of the Medicaid
91 program and for enhancing or supplementing provider
92 reimbursement under this part and part IV. The agency shall seek
93 and maintain a low-income pool in a manner authorized by federal
94 waiver and implemented under spending authority granted in the
95 General Appropriations Act. The low-income pool must be used to
96 support enhanced access to services by offsetting shortfalls in
97 Medicaid reimbursement or paying for otherwise uncompensated
98 care, and the agency shall seek waiver authority to encourage
99 the donation of intergovernmental transfers and to utilize
100 intergovernmental transfers as the state’s share of Medicaid
101 funding within the low-income pool.
102 (f)1. Pursuant to chapter 120, the agency shall furnish to
103 providers written notice of the audited hospital cost-based per
104 diem reimbursement rate for inpatient and outpatient care
105 established by the agency. The written notice constitutes final
106 agency action. A substantially affected provider seeking to
107 correct or adjust the calculation of the audited hospital cost
108 based per diem reimbursement rate for inpatient and outpatient
109 care, other than a challenge to the methodologies set forth in
110 the rules of the agency and in reimbursement plans incorporated
111 by reference therein used to calculate the reimbursement rate
112 for inpatient and outpatient care, may request an administrative
113 hearing to challenge the final agency action by filing a
114 petition with the agency within 180 days after receipt of the
115 written notice by the provider. The petition must include all
116 documentation supporting the challenge upon which the provider
117 intends to rely at the administrative hearing and may not be
118 amended or supplemented except as authorized under uniform rules
119 adopted pursuant to s. 120.54(5). The failure to timely file a
120 petition in compliance with this subparagraph is deemed
121 conclusive acceptance of the audited hospital cost-based per
122 diem reimbursement rate for inpatient and outpatient care
123 established by the agency.
124 2. Any challenge to the methodologies set forth in the
125 rules of the agency and in reimbursement plans incorporated by
126 reference therein used to calculate the reimbursement rate for
127 inpatient and outpatient care may not result in a correction or
128 an adjustment of a reimbursement rate for a rate period that
129 occurred more than 5 years before the date the petition
130 initiating the proceeding was filed.
131 3. This paragraph applies to any challenge to final agency
132 action which seeks the correction or adjustment of a provider’s
133 audited hospital cost-based per diem reimbursement rate for
134 inpatient and outpatient care and to any challenge to the
135 methodologies set forth in the rules of the agency and in
136 reimbursement plans incorporated by reference therein used to
137 calculate the reimbursement rate for inpatient and outpatient
138 care, including any right to challenge which arose before July
139 1, 2015. A correction or adjustment of an audited hospital cost
140 based per diem reimbursement rate for inpatient and outpatient
141 care which is required by an administrative order or appellate
142 decision:
143 a. Must be reconciled in the first rate period after the
144 order or decision becomes final;
145 b. May not be the basis for any challenge to correct or
146 adjust hospital rates required to be paid by any Medicaid
147 managed care provider pursuant to part IV of chapter 409.
148 4. The agency may not be compelled by an administrative
149 body or a court to pay additional compensation to a hospital
150 relating to the establishment of audited hospital cost-based per
151 diem reimbursement rates by the agency or for remedies relating
152 to such rates, unless an appropriation has been made by law for
153 the exclusive, specific purpose of paying such additional
154 compensation. As used in this subparagraph, the term
155 “appropriation made by law” has the same meaning as provided in
156 s. 11.066.
157 5. Any period of time specified in this paragraph is not
158 tolled by the pendency of any administrative or appellate
159 proceeding.
160 6. The exclusive means to challenge a written notice of an
161 audited hospital cost-based per diem reimbursement rate for
162 inpatient and outpatient care for the purpose of correcting or
163 adjusting such rate before, on, or after July 1, 2015, or to
164 challenge the methodologies set forth in the rules of the agency
165 and in reimbursement plans incorporated by reference therein
166 used to calculate the reimbursement rate for inpatient and
167 outpatient care is through an administrative proceeding pursuant
168 to chapter 120.
169 Section 3. For the purpose of incorporating paragraph (f)
170 of subsection (1) of section 409.908, Florida Statutes, as
171 created by this act, in a reference thereto, section 383.18,
172 Florida Statutes, is reenacted to read:
173 383.18 Contracts; conditions.—Participation in the regional
174 perinatal intensive care centers program under ss. 383.15-383.19
175 is contingent upon the department entering into a contract with
176 a provider. The contract shall provide that patients will
177 receive services from the center and that parents or guardians
178 of patients who participate in the program and who are in
179 compliance with Medicaid eligibility requirements as determined
180 by the department are not additionally charged for treatment and
181 care which has been contracted for by the department. Financial
182 eligibility for the program is based on the Medicaid income
183 guidelines for pregnant women and for children under 1 year of
184 age. Funding shall be provided in accordance with ss. 383.19 and
185 409.908.
186 Section 4. For the purpose of incorporating paragraph (f)
187 of subsection (1) of section 409.908, Florida Statutes, as
188 created by this act, in a reference thereto, subsection (4) of
189 section 409.8132, Florida Statutes, is reenacted to read:
190 409.8132 Medikids program component.—
191 (4) APPLICABILITY OF LAWS RELATING TO MEDICAID.—The
192 provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908,
193 409.912, 409.9121, 409.9122, 409.9123, 409.9124, 409.9127,
194 409.9128, 409.913, 409.916, 409.919, 409.920, and 409.9205 apply
195 to the administration of the Medikids program component of the
196 Florida Kidcare program, except that s. 409.9122 applies to
197 Medikids as modified by the provisions of subsection (7).
198 Section 5. For the purpose of incorporating paragraph (f)
199 of subsection (1) of section 409.908, Florida Statutes, as
200 created by this act, in references thereto, paragraph (c) of
201 subsection (5) and paragraph (b) of subsection (6) of section
202 409.905, Florida Statutes, are reenacted to read:
203 409.905 Mandatory Medicaid services.—The agency may make
204 payments for the following services, which are required of the
205 state by Title XIX of the Social Security Act, furnished by
206 Medicaid providers to recipients who are determined to be
207 eligible on the dates on which the services were provided. Any
208 service under this section shall be provided only when medically
209 necessary and in accordance with state and federal law.
210 Mandatory services rendered by providers in mobile units to
211 Medicaid recipients may be restricted by the agency. Nothing in
212 this section shall be construed to prevent or limit the agency
213 from adjusting fees, reimbursement rates, lengths of stay,
214 number of visits, number of services, or any other adjustments
215 necessary to comply with the availability of moneys and any
216 limitations or directions provided for in the General
217 Appropriations Act or chapter 216.
218 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
219 all covered services provided for the medical care and treatment
220 of a recipient who is admitted as an inpatient by a licensed
221 physician or dentist to a hospital licensed under part I of
222 chapter 395. However, the agency shall limit the payment for
223 inpatient hospital services for a Medicaid recipient 21 years of
224 age or older to 45 days or the number of days necessary to
225 comply with the General Appropriations Act. Effective August 1,
226 2012, the agency shall limit payment for hospital emergency
227 department visits for a nonpregnant Medicaid recipient 21 years
228 of age or older to six visits per fiscal year.
229 (c) The agency shall implement a prospective payment
230 methodology for establishing reimbursement rates for inpatient
231 hospital services. Rates shall be calculated annually and take
232 effect July 1 of each year. The methodology shall categorize
233 each inpatient admission into a diagnosis-related group and
234 assign a relative payment weight to the base rate according to
235 the average relative amount of hospital resources used to treat
236 a patient in a specific diagnosis-related group category. The
237 agency may adopt the most recent relative weights calculated and
238 made available by the Nationwide Inpatient Sample maintained by
239 the Agency for Healthcare Research and Quality or may adopt
240 alternative weights if the agency finds that Florida-specific
241 weights deviate with statistical significance from national
242 weights for high-volume diagnosis-related groups. The agency
243 shall establish a single, uniform base rate for all hospitals
244 unless specifically exempt pursuant to s. 409.908(1).
245 1. Adjustments may not be made to the rates after October
246 31 of the state fiscal year in which the rates take effect,
247 except for cases of insufficient collections of
248 intergovernmental transfers authorized under s. 409.908(1) or
249 the General Appropriations Act. In such cases, the agency shall
250 submit a budget amendment or amendments under chapter 216
251 requesting approval of rate reductions by amounts necessary for
252 the aggregate reduction to equal the dollar amount of
253 intergovernmental transfers not collected and the corresponding
254 federal match. Notwithstanding the $1 million limitation on
255 increases to an approved operating budget contained in ss.
256 216.181(11) and 216.292(3), a budget amendment exceeding that
257 dollar amount is subject to notice and objection procedures set
258 forth in s. 216.177.
259 2. Errors in source data or calculations discovered after
260 October 31 must be reconciled in a subsequent rate period.
261 However, the agency may not make any adjustment to a hospital’s
262 reimbursement more than 5 years after a hospital is notified of
263 an audited rate established by the agency. The prohibition
264 against adjustments more than 5 years after notification is
265 remedial and applies to actions by providers involving Medicaid
266 claims for hospital services. Hospital reimbursement is subject
267 to such limits or ceilings as may be established in law or
268 described in the agency’s hospital reimbursement plan. Specific
269 exemptions to the limits or ceilings may be provided in the
270 General Appropriations Act.
271 (6) HOSPITAL OUTPATIENT SERVICES.—
272 (b) The agency shall implement a methodology for
273 establishing base reimbursement rates for outpatient services
274 for each hospital based on allowable costs, as defined by the
275 agency. Rates shall be calculated annually and take effect July
276 1 of each year based on the most recent complete and accurate
277 cost report submitted by each hospital.
278 1. Adjustments may not be made to the rates after October
279 31 of the state fiscal year in which the rates take effect,
280 except for cases of insufficient collections of
281 intergovernmental transfers authorized under s. 409.908(1) or
282 the General Appropriations Act. In such cases, the agency shall
283 submit a budget amendment or amendments under chapter 216
284 requesting approval of rate reductions by amounts necessary for
285 the aggregate reduction to equal the dollar amount of
286 intergovernmental transfers not collected and the corresponding
287 federal match. Notwithstanding the $1 million limitation on
288 increases to an approved operating budget under ss. 216.181(11)
289 and 216.292(3), a budget amendment exceeding that dollar amount
290 is subject to notice and objection procedures set forth in s.
291 216.177.
292 2. Errors in source data or calculations discovered after
293 October 31 must be reconciled in a subsequent rate period.
294 However, the agency may not make any adjustment to a hospital’s
295 reimbursement more than 5 years after a hospital is notified of
296 an audited rate established by the agency. The prohibition
297 against adjustments more than 5 years after notification is
298 remedial and applies to actions by providers involving Medicaid
299 claims for hospital services. Hospital reimbursement is subject
300 to such limits or ceilings as may be established in law or
301 described in the agency’s hospital reimbursement plan. Specific
302 exemptions to the limits or ceilings may be provided in the
303 General Appropriations Act.
304 Section 6. Paragraph (c) of subsection (23) of section
305 409.908, Florida Statutes, is amended to read:
306 409.908 Reimbursement of Medicaid providers.—Subject to
307 specific appropriations, the agency shall reimburse Medicaid
308 providers, in accordance with state and federal law, according
309 to methodologies set forth in the rules of the agency and in
310 policy manuals and handbooks incorporated by reference therein.
311 These methodologies may include fee schedules, reimbursement
312 methods based on cost reporting, negotiated fees, competitive
313 bidding pursuant to s. 287.057, and other mechanisms the agency
314 considers efficient and effective for purchasing services or
315 goods on behalf of recipients. If a provider is reimbursed based
316 on cost reporting and submits a cost report late and that cost
317 report would have been used to set a lower reimbursement rate
318 for a rate semester, then the provider’s rate for that semester
319 shall be retroactively calculated using the new cost report, and
320 full payment at the recalculated rate shall be effected
321 retroactively. Medicare-granted extensions for filing cost
322 reports, if applicable, shall also apply to Medicaid cost
323 reports. Payment for Medicaid compensable services made on
324 behalf of Medicaid eligible persons is subject to the
325 availability of moneys and any limitations or directions
326 provided for in the General Appropriations Act or chapter 216.
327 Further, nothing in this section shall be construed to prevent
328 or limit the agency from adjusting fees, reimbursement rates,
329 lengths of stay, number of visits, or number of services, or
330 making any other adjustments necessary to comply with the
331 availability of moneys and any limitations or directions
332 provided for in the General Appropriations Act, provided the
333 adjustment is consistent with legislative intent.
334 (23)
335 (c) This subsection applies to the following provider
336 types:
337 1. Inpatient hospitals.
338 2. Outpatient hospitals.
339 3. Nursing homes.
340 4. County health departments.
341 5. Community intermediate care facilities for the
342 developmentally disabled.
343 5.6. Prepaid health plans.
344 Section 7. Subsection (2) of section 409.9082, Florida
345 Statutes, is amended to read:
346 409.9082 Quality assessment on nursing home facility
347 providers; exemptions; purpose; federal approval required;
348 remedies.—
349 (2) A quality assessment is imposed upon each nursing home
350 facility. The aggregated amount of assessments for all nursing
351 home facilities in a given year shall be an amount not exceeding
352 the maximum percentage allowed under federal law of the total
353 aggregate net patient service revenue of assessed facilities.
354 The agency shall calculate the quality assessment rate annually
355 on a per-resident-day basis, exclusive of those resident days
356 funded by the Medicare program, as reported by the facilities.
357 The per-resident-day assessment rate must be uniform except as
358 prescribed in subsection (3). Each facility shall report monthly
359 to the agency its total number of resident days, exclusive of
360 Medicare Part A resident days, and remit an amount equal to the
361 assessment rate times the reported number of days. The agency
362 shall collect, and each facility shall pay, the quality
363 assessment each month. The agency shall collect the assessment
364 from nursing home facility providers by the 20th 15th day of the
365 next succeeding calendar month. The agency shall notify
366 providers of the quality assessment and provide a standardized
367 form to complete and submit with payments. The collection of the
368 nursing home facility quality assessment shall commence no
369 sooner than 5 days after the agency’s initial payment of the
370 Medicaid rates containing the elements prescribed in subsection
371 (4). Nursing home facilities may not create a separate line-item
372 charge for the purpose of passing the assessment through to
373 residents.
374 Section 8. Section 409.909, Florida Statutes, is amended to
375 read:
376 409.909 Statewide Medicaid Residency Program.—
377 (1) The Statewide Medicaid Residency Program is established
378 to improve the quality of care and access to care for Medicaid
379 recipients, expand graduate medical education on an equitable
380 basis, and increase the supply of highly trained physicians
381 statewide. The agency shall make payments to hospitals licensed
382 under part I of chapter 395 for graduate medical education
383 associated with the Medicaid program. This system of payments is
384 designed to generate federal matching funds under Medicaid and
385 distribute the resulting funds to participating hospitals on a
386 quarterly basis in each fiscal year for which an appropriation
387 is made.
388 (2) On or before September 15 of each year, the agency
389 shall calculate an allocation fraction to be used for
390 distributing funds to participating hospitals. On or before the
391 final business day of each quarter of a state fiscal year, the
392 agency shall distribute to each participating hospital one
393 fourth of that hospital’s annual allocation calculated under
394 subsection (4). The allocation fraction for each participating
395 hospital is based on the hospital’s number of full-time
396 equivalent residents and the amount of its Medicaid payments. As
397 used in this section, the term:
398 (a) “Full-time equivalent,” or “FTE,” means a resident who
399 is in his or her residency period, with the initial residency
400 period, which is defined as the minimum number of years of
401 training required before the resident may become eligible for
402 board certification by the American Osteopathic Association
403 Bureau of Osteopathic Specialists or the American Board of
404 Medical Specialties in the specialty in which he or she first
405 began training, not to exceed 5 years. The residency specialty
406 is defined as reported using the current residency type codes in
407 the Intern and Resident Information System (IRIS), required by
408 Medicare. A resident training beyond the initial residency
409 period is counted as 0.5 FTE, unless his or her chosen specialty
410 is in general surgery or primary care, in which case the
411 resident is counted as 1.0 FTE. For the purposes of this
412 section, primary care specialties include:
413 1. Family medicine;
414 2. General internal medicine;
415 3. General pediatrics;
416 4. Preventive medicine;
417 5. Geriatric medicine;
418 6. Osteopathic general practice;
419 7. Obstetrics and gynecology; and
420 8. Emergency medicine; and
421 9. General surgery.
422 (b) “Medicaid payments” means the estimated total payments
423 for reimbursing a hospital for direct inpatient services for the
424 fiscal year in which the allocation fraction is calculated based
425 on the hospital inpatient appropriation and the parameters for
426 the inpatient diagnosis-related group base rate, including
427 applicable intergovernmental transfers, specified in the General
428 Appropriations Act, as determined by the agency.
429 (c) “Resident” means a medical intern, fellow, or resident
430 enrolled in a program accredited by the Accreditation Council
431 for Graduate Medical Education, the American Association of
432 Colleges of Osteopathic Medicine, or the American Osteopathic
433 Association at the beginning of the state fiscal year during
434 which the allocation fraction is calculated, as reported by the
435 hospital to the agency.
436 (3) The agency shall use the following formula to calculate
437 a participating hospital’s allocation fraction:
438
439 HAF=[0.9 x (HFTE/TFTE)] + [0.1 x (HMP/TMP)]
440
441 Where:
442 HAF=A hospital’s allocation fraction.
443 HFTE=A hospital’s total number of FTE residents.
444 TFTE=The total FTE residents for all participating
445 hospitals.
446 HMP=A hospital’s Medicaid payments.
447 TMP=The total Medicaid payments for all participating
448 hospitals.
449
450 (4) A hospital’s annual allocation shall be calculated by
451 multiplying the funds appropriated for the Statewide Medicaid
452 Residency Program in the General Appropriations Act by that
453 hospital’s allocation fraction. If the calculation results in an
454 annual allocation that exceeds two times the average $50,000 per
455 FTE resident amount for all hospitals, the hospital’s annual
456 allocation shall be reduced to a sum equaling no more than two
457 times the average $50,000 per FTE resident. The funds calculated
458 for that hospital in excess of two times the average $50,000 per
459 FTE resident amount for all hospitals shall be redistributed to
460 participating hospitals whose annual allocation does not exceed
461 two times the average $50,000 per FTE resident amount for all
462 hospitals, using the same methodology and payment schedule
463 specified in this section.
464 (5) The Graduate Medical Education Startup Bonus Program is
465 established to provide resources for the education and training
466 of physicians in specialties which are in a statewide supply
467 and-demand deficit. Hospitals eligible for participation in
468 subsection (1) are eligible to participate in the Graduate
469 Medical Education Startup Bonus Program established under this
470 subsection. Notwithstanding subsection (4) or an FTE’s residency
471 period, and in any state fiscal year in which funds are
472 appropriated for the startup bonus program, the agency shall
473 allocate a $100,000 startup bonus for each newly created
474 resident position that is authorized by the Accreditation
475 Council for Graduate Medical Education or Osteopathic
476 Postdoctoral Training Institution in an initial or established
477 accredited training program that is in a physician specialty in
478 statewide supply-and-demand deficit. In any year in which
479 funding is not sufficient to provide $100,000 for each newly
480 created resident position, funding shall be reduced pro rata
481 across all newly created resident positions in physician
482 specialties in statewide supply-and-demand deficit.
483 (a) Hospitals applying for a startup bonus must submit to
484 the agency by March 1 their Accreditation Council for Graduate
485 Medical Education or Osteopathic Postdoctoral Training
486 Institution approval validating the new resident positions
487 approved in physician specialties in statewide supply-and-demand
488 deficit in the current fiscal year. An applicant hospital may
489 validate a change in the number of residents by comparing the
490 number in the prior period Accreditation Council for Graduate
491 Medical Education or Osteopathic Postdoctoral Training
492 Institution approval to the number in the current year.
493 (b) Any unobligated startup bonus funds on April 15 of each
494 fiscal year shall be proportionally allocated to hospitals
495 participating under subsection (3) for existing FTE residents in
496 the physician specialties in statewide supply-and-demand
497 deficit. This nonrecurring allocation shall be in addition to
498 the funds allocated in subsection (4). Notwithstanding
499 subsection (4), the allocation under this subsection may not
500 exceed $100,000 per FTE resident.
501 (c) For purposes of this subsection, physician specialties
502 and subspecialties, both adult and pediatric, in statewide
503 supply-and-demand deficit are those identified in the General
504 Appropriations Act.
505 (d) The agency shall distribute all funds authorized under
506 the Graduate Medical Education Startup Bonus Program on or
507 before the final business day of the fourth quarter of a state
508 fiscal year.
509 (6)(5) Beginning in the 2015-2016 state fiscal year, the
510 agency shall reconcile each participating hospital’s total
511 number of FTE residents calculated for the state fiscal year 2
512 years before prior with its most recently available Medicare
513 cost reports covering the same time period. Reconciled FTE
514 counts shall be prorated according to the portion of the state
515 fiscal year covered by a Medicare cost report. Using the same
516 definitions, methodology, and payment schedule specified in this
517 section, the reconciliation shall apply any differences in
518 annual allocations calculated under subsection (4) to the
519 current year’s annual allocations.
520 (7)(6) The agency may adopt rules to administer this
521 section.
522 Section 9. Paragraph (a) of subsection (2) and paragraph
523 (d) of subsection (4) of section 409.911, Florida Statutes, are
524 amended to read:
525 409.911 Disproportionate share program.—Subject to specific
526 allocations established within the General Appropriations Act
527 and any limitations established pursuant to chapter 216, the
528 agency shall distribute, pursuant to this section, moneys to
529 hospitals providing a disproportionate share of Medicaid or
530 charity care services by making quarterly Medicaid payments as
531 required. Notwithstanding the provisions of s. 409.915, counties
532 are exempt from contributing toward the cost of this special
533 reimbursement for hospitals serving a disproportionate share of
534 low-income patients.
535 (2) The Agency for Health Care Administration shall use the
536 following actual audited data to determine the Medicaid days and
537 charity care to be used in calculating the disproportionate
538 share payment:
539 (a) The average of the 2005, 2006, and 2007, 2008, and 2009
540 audited disproportionate share data to determine each hospital’s
541 Medicaid days and charity care for the 2015-2016 2014-2015 state
542 fiscal year.
543 (4) The following formulas shall be used to pay
544 disproportionate share dollars to public hospitals:
545 (d) Any nonstate government owned or operated hospital
546 eligible for payments under this section on July 1, 2011,
547 remains eligible for payments during the 2015-2016 2014-2015
548 state fiscal year.
549 Section 10. Paragraph (f) of subsection (3) and paragraph
550 (c) of subsection (4) of section 409.967, Florida Statutes, are
551 amended to read:
552 409.967 Managed care plan accountability.—
553 (3) ACHIEVED SAVINGS REBATE.—
554 (f) Achieved savings rebates validated by the certified
555 public accountant are due within 30 days after the report is
556 submitted. Except as provided in paragraph (h), the achieved
557 savings rebate is established by determining pretax income as a
558 percentage of revenues and applying the following income sharing
559 ratios:
560 1. One hundred percent of income up to and including 5
561 percent of revenue shall be retained by the plan.
562 2. Fifty percent of income above 5 percent and up to 10
563 percent shall be retained by the plan, and the other 50 percent
564 refunded to the state and transferred to the General Revenue
565 Fund, unallocated.
566 3. One hundred percent of income above 10 percent of
567 revenue shall be refunded to the state and transferred to the
568 General Revenue Fund, unallocated.
569 (4) MEDICAL LOSS RATIO.—If required as a condition of a
570 waiver, the agency may calculate a medical loss ratio for
571 managed care plans. The calculation shall use uniform financial
572 data collected from all plans and shall be computed for each
573 plan on a statewide basis. The method for calculating the
574 medical loss ratio shall meet the following criteria:
575 (c) Before Prior to final determination of the medical loss
576 ratio for any period, a plan may contribute to a designated
577 state trust fund for the purpose of supporting Medicaid and
578 indigent care and have the contribution counted as a medical
579 expenditure for the period. Funds contributed for this purpose
580 shall be deposited into the Grants and Donations Trust Fund.
581 Section 11. Section 409.97, Florida Statutes, is repealed.
582 Section 12. Paragraph (a) of subsection (4) of section
583 409.975, Florida Statutes, is amended to read:
584 409.975 Managed care plan accountability.—In addition to
585 the requirements of s. 409.967, plans and providers
586 participating in the managed medical assistance program shall
587 comply with the requirements of this section.
588 (4) MOMCARE NETWORK.—
589 (a) The agency shall contract with an administrative
590 services organization representing all Healthy Start Coalitions
591 providing risk appropriate care coordination and other services
592 in accordance with a federal waiver and pursuant to s. 409.906.
593 The contract shall require the network of coalitions to provide
594 counseling, education, risk-reduction and case management
595 services, and quality assurance for all enrollees of the waiver.
596 The agency shall evaluate the impact of the MomCare network by
597 monitoring each plan’s performance on specific measures to
598 determine the adequacy, timeliness, and quality of services for
599 pregnant women and infants. The agency shall support this
600 contract with certified public expenditures of general revenue
601 appropriated for Healthy Start services and any earned federal
602 matching funds.
603 Section 13. Subsection (6) of section 409.983, Florida
604 Statutes, is amended to read:
605 409.983 Long-term care managed care plan payment.—In
606 addition to the payment provisions of s. 409.968, the agency
607 shall provide payment to plans in the long-term care managed
608 care program pursuant to this section.
609 (6) The agency shall establish nursing-facility-specific
610 payment rates for each licensed nursing home based on facility
611 costs adjusted for inflation and other factors as authorized in
612 the General Appropriations Act. Payments to long-term care
613 managed care plans shall be reconciled to reimburse actual
614 payments to nursing facilities resulting from changes in nursing
615 home per diem rates, but may not be reconciled to actual days
616 experienced by the long-term care managed care plans.
617 Section 14. Effective upon this act becoming a law, the
618 Agency for Health Care Administration may partner with any other
619 state or territory for the purposes of providing Medicaid fiscal
620 agent operations only if any resulting agreement or contract
621 provides for termination when the State of Florida decides it is
622 not in the best interest of the state. Any such agreement or
623 contract may not impact Florida’s current Medicaid Management
624 Information System and each state or territory shall deal
625 directly with the federal Centers for Medicare and Medicaid
626 Services independently regarding any billing or matching
627 requirements.
628 Section 15. Subsection (43) of section 408.07, Florida
629 Statutes, is amended to read:
630 408.07 Definitions.—As used in this chapter, with the
631 exception of ss. 408.031-408.045, the term:
632 (43) “Rural hospital” means an acute care hospital licensed
633 under chapter 395, having 100 or fewer licensed beds and an
634 emergency room, and which is:
635 (a) The sole provider within a county with a population
636 density of no greater than 100 persons per square mile;
637 (b) An acute care hospital, in a county with a population
638 density of no greater than 100 persons per square mile, which is
639 at least 30 minutes of travel time, on normally traveled roads
640 under normal traffic conditions, from another acute care
641 hospital within the same county;
642 (c) A hospital supported by a tax district or subdistrict
643 whose boundaries encompass a population of 100 persons or fewer
644 per square mile;
645 (d) A hospital with a service area that has a population of
646 100 persons or fewer per square mile. As used in this paragraph,
647 the term “service area” means the fewest number of zip codes
648 that account for 75 percent of the hospital’s discharges for the
649 most recent 5-year period, based on information available from
650 the hospital inpatient discharge database in the Florida Center
651 for Health Information and Policy Analysis at the Agency for
652 Health Care Administration; or
653 (e) A critical access hospital.
654
655 Population densities used in this subsection must be based upon
656 the most recently completed United States census. A hospital
657 that received funds under s. 409.9116 for a quarter beginning no
658 later than July 1, 2002, is deemed to have been and shall
659 continue to be a rural hospital from that date through June 30,
660 2015, if the hospital continues to have 100 or fewer licensed
661 beds and an emergency room, or meets the criteria of s.
662 395.602(2)(e)4. An acute care hospital that has not previously
663 been designated as a rural hospital and that meets the criteria
664 of this subsection shall be granted such designation upon
665 application, including supporting documentation, to the Agency
666 for Health Care Administration.
667 Section 16. The model, methodology, and framework for
668 hospital funding programs contained in the document titled
669 “Medicaid Hospital Funding Programs,” dated June 16, 2015, and
670 filed with the Secretary of the Senate, are incorporated by
671 reference for the purpose of displaying, demonstrating, and
672 explaining the calculations used by the Legislature, consistent
673 with the requirements of state law, when making appropriations
674 in the General Appropriations Act for the 2015-2016 fiscal year
675 for the Rural Hospital Financial Assistance Program, Hospital
676 Inpatient Services, Hospital Outpatient Services, Low-Income
677 Pool, the Disproportionate Share Hospital Program, Graduate
678 Medical Education, and Prepaid Health Plans. The document titled
679 “Medicaid Hospital Funding Programs” does not allocate or
680 appropriate any funds. The Agency for Health Care Administration
681 shall rely solely on the model, methodology, and framework
682 displayed, demonstrated, and explained in the document titled
683 “Medicaid Hospital Funding Programs” and the proviso applicable
684 to appropriations for Medicaid funding when setting hospital
685 rates, calculating the hospital components of prepaid health
686 plan capitation rates, and making payments to hospitals and
687 other providers. This section expires July 1, 2016.
688 Section 17. The Legislature has determined that this act,
689 including the document titled “Medicaid Hospital Funding
690 Programs,” together with the specific appropriations contained
691 in the fiscal year 2015-2016 General Appropriations Act for the
692 Rural Hospital Financial Assistance Program, Hospital Inpatient
693 Services, Hospital Outpatient Services, Low-Income Pool, the
694 Disproportionate Share Hospital Program, Graduate Medical
695 Education, and Prepaid Health Plans, are interdependent and
696 interrelated, are directly and rationally related to the overall
697 purposes of the state’s Medicaid program, and are advisable only
698 if considered together and balanced when allocating the state’s
699 resources, especially considering the complexities of Florida’s
700 Statewide Medicaid Managed Care program; how hospital rates are
701 determined in the marketplace, including Medicaid; how the
702 individual component Medicaid appropriations impact the rates
703 Florida’s Medicaid managed care entities pay for services; and
704 the large amounts of uncompensated care provided by Florida’s
705 Medicaid hospital service providers and the relative potential
706 impact of that uncompensated care on the overall economic
707 viability of those institutions. If this act, or any portion of
708 this act, including the document titled “Medicaid Hospital
709 Funding Programs,” or any portion thereof, is determined to be
710 unconstitutional or the applicability thereof to any person or
711 circumstance is held invalid, then: (1) such determination shall
712 render all other provisions or applications of this act invalid;
713 (2) the provisions of this act are not severable; and (3) this
714 entire act shall be deemed never to have become law. This
715 section expires July 1, 2016.
716 Section 18. Section 409.908(1)(f), Florida Statutes, as
717 created by this act, is remedial in nature, confirms and
718 clarifies existing law, and applies to all proceedings pending
719 on or commenced after this act takes effect.
720 Section 19. If any law amended by this act was also amended
721 by a law enacted during the 2015 Regular Session of the
722 Legislature, such laws shall be construed as if enacted during
723 the same session of the Legislature, and full effect shall be
724 given to each if possible.
725 Section 20. Except as otherwise expressly provided in this
726 act and except for this section, which shall take effect upon
727 this act becoming a law, this act shall take effect July 1,
728 2015, or, if this act fails to become a law until after that
729 date, it shall take effect upon becoming a law and operate
730 retroactively to July 1, 2015.
731
732 ================= T I T L E A M E N D M E N T ================
733 And the title is amended as follows:
734 Delete everything before the enacting clause
735 and insert:
736 A bill to be entitled
737 An act relating to Medicaid; amending s. 395.602,
738 F.S.; revising the term “rural hospital”; amending s.
739 409.908, F.S.; authorizing the Agency for Health Care
740 Administration to receive intergovernmental transfers
741 of funds from governmental entities for specified
742 purposes; requiring the agency to seek and maintain a
743 low-income pool under certain parameters; requiring
744 the agency to seek Medicaid waiver authority for the
745 use of local intergovernmental transfers under certain
746 parameters; requiring the Agency for Health Care
747 Administration to provide written notice, pursuant to
748 ch. 120, F.S., of reimbursement rates to providers;
749 specifying procedures and requirements to challenge
750 the calculation of or the methodology used to
751 calculate such rates; providing that the failure to
752 timely file a certain challenge constitutes acceptance
753 of the rates; specifying limits on and procedures for
754 the correction or adjustment of the rates; providing
755 applicability; prohibiting the agency from being
756 compelled by an administrative body or a court to pay
757 additional compensation that exceeds a certain amount
758 to a hospital for specified matters unless an
759 appropriation is made by law; prohibiting certain
760 periods of time from being tolled under specified
761 circumstances; specifying that an administrative
762 proceeding is the exclusive means for challenging
763 certain issues; reenacting ss. 383.18, 409.8132(4),
764 and 409.905(5)(c) and (6)(b), F.S., relating to
765 contracts for the regional perinatal intensive care
766 centers program, the Medikids program component, and
767 mandatory Medicaid services, respectively, to
768 incorporate the amendment made to s. 409.908, F.S., in
769 references thereto; amending s. 409.908, F.S.;
770 revising the list of provider types that are subject
771 to certain statutory provisions relating to the
772 establishment of rates; amending s. 409.9082, F.S.;
773 revising the date in each calendar month on which the
774 agency shall collect an assessment from nursing home
775 facility providers; amending s. 409.909, F.S.;
776 revising a term; revising the annual allocation cap
777 for hospitals participating in the Statewide Medicaid
778 Residency Program; establishing the Graduate Medical
779 Education Startup Bonus Program; providing allocations
780 for the program; amending s. 409.911, F.S.; updating
781 references to data used for calculating
782 disproportionate share program payments to certain
783 hospitals for the 2015-2016 fiscal year; amending s.
784 409.967, F.S.; requiring that certain achieved savings
785 rebates be placed in the General Revenue Fund,
786 unallocated; requiring that certain funds to support
787 Medicaid and indigent care be deposited into the
788 Grants and Donations Trust Fund; repealing s. 409.97,
789 F.S, relating to state and local Medicaid
790 partnerships; amending s. 409.975, F.S.; deleting a
791 requirement that the agency support Healthy Start
792 services with public expenditures and federal matching
793 funds; amending s. 409.983, F.S.; providing parameters
794 for the reconciliation of managed care plan payments
795 in the long-term care managed care program;
796 authorizing the agency to partner with other states or
797 territories to provide Medicaid fiscal agent
798 operations under certain conditions and limitations;
799 amending s. 408.07, F.S.; conforming a cross
800 reference; providing an incorporation by reference,
801 the purposes and legislative intent of the
802 incorporation, and for the expiration of the section;
803 providing a legislative determination of the
804 interdependence and interrelatedness of the act, the
805 incorporation by reference and certain specific
806 appropriations; providing that, if the act or any
807 portion of the act is determined to be
808 unconstitutional or held invalid, then all other
809 provisions or applications of the act are invalid and
810 not severable; providing for the expiration of the
811 section; providing that the act is remedial, intended
812 to confirm and clarify law, and applies to proceedings
813 pending on or commenced after the effective date;
814 providing for construction of the act in pari materia
815 with laws enacted during the 2015 Regular Session of
816 the Legislature; providing for contingent retroactive
817 operation; providing effective dates.