Florida Senate - 2018 COMMITTEE AMENDMENT
Bill No. SPB 2506
Ì164516+Î164516
LEGISLATIVE ACTION
Senate . House
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The Committee on Appropriations (Flores) recommended the
following:
1 Senate Amendment to Amendment (822772) (with title
2 amendment)
3
4 Between lines 23 and 24
5 insert:
6 Section 6. Paragraph (a) of subsection (1) of section
7 409.908, Florida Statutes, is amended to read:
8 409.908 Reimbursement of Medicaid providers.—Subject to
9 specific appropriations, the agency shall reimburse Medicaid
10 providers, in accordance with state and federal law, according
11 to methodologies set forth in the rules of the agency and in
12 policy manuals and handbooks incorporated by reference therein.
13 These methodologies may include fee schedules, reimbursement
14 methods based on cost reporting, negotiated fees, competitive
15 bidding pursuant to s. 287.057, and other mechanisms the agency
16 considers efficient and effective for purchasing services or
17 goods on behalf of recipients. If a provider is reimbursed based
18 on cost reporting and submits a cost report late and that cost
19 report would have been used to set a lower reimbursement rate
20 for a rate semester, then the provider’s rate for that semester
21 shall be retroactively calculated using the new cost report, and
22 full payment at the recalculated rate shall be effected
23 retroactively. Medicare-granted extensions for filing cost
24 reports, if applicable, shall also apply to Medicaid cost
25 reports. Payment for Medicaid compensable services made on
26 behalf of Medicaid eligible persons is subject to the
27 availability of moneys and any limitations or directions
28 provided for in the General Appropriations Act or chapter 216.
29 Further, nothing in this section shall be construed to prevent
30 or limit the agency from adjusting fees, reimbursement rates,
31 lengths of stay, number of visits, or number of services, or
32 making any other adjustments necessary to comply with the
33 availability of moneys and any limitations or directions
34 provided for in the General Appropriations Act, provided the
35 adjustment is consistent with legislative intent.
36 (1) Reimbursement to hospitals licensed under part I of
37 chapter 395 must be made prospectively or on the basis of
38 negotiation.
39 (a) Reimbursement for inpatient care is limited as provided
40 in s. 409.905(5), except as otherwise provided in this
41 subsection.
42 1. If authorized by the General Appropriations Act, the
43 agency may modify reimbursement for specific types of services
44 or diagnoses, recipient ages, and hospital provider types.
45 2. The agency may establish an alternative methodology to
46 the DRG-based prospective payment system to set reimbursement
47 rates for:
48 a. State-owned psychiatric hospitals.
49 b. Newborn hearing screening services.
50 c. Transplant services for which the agency has established
51 a global fee.
52 d. Recipients who have tuberculosis that is resistant to
53 therapy who are in need of long-term, hospital-based treatment
54 pursuant to s. 392.62.
55 e. Class III psychiatric hospitals.
56 3. The agency shall modify reimbursement according to other
57 methodologies recognized in the General Appropriations Act.
58
59 The agency may receive funds from state entities, including, but
60 not limited to, the Department of Health, local governments, and
61 other local political subdivisions, for the purpose of making
62 special exception payments, including federal matching funds,
63 through the Medicaid inpatient reimbursement methodologies.
64 Funds received for this purpose shall be separately accounted
65 for and may not be commingled with other state or local funds in
66 any manner. The agency may certify all local governmental funds
67 used as state match under Title XIX of the Social Security Act,
68 to the extent and in the manner authorized under the General
69 Appropriations Act and pursuant to an agreement between the
70 agency and the local governmental entity. In order for the
71 agency to certify such local governmental funds, a local
72 governmental entity must submit a final, executed letter of
73 agreement to the agency, which must be received by October 1 of
74 each fiscal year and provide the total amount of local
75 governmental funds authorized by the entity for that fiscal year
76 under this paragraph, paragraph (b), or the General
77 Appropriations Act. The local governmental entity shall use a
78 certification form prescribed by the agency. At a minimum, the
79 certification form must identify the amount being certified and
80 describe the relationship between the certifying local
81 governmental entity and the local health care provider. The
82 agency shall prepare an annual statement of impact which
83 documents the specific activities undertaken during the previous
84 fiscal year pursuant to this paragraph, to be submitted to the
85 Legislature annually by January 1.
86 Section 7. Present subsections (4) and (5) of section
87 409.968, Florida Statutes, are redesignated as subsections (5)
88 and (6), respectively, and a new subsection (4) is added to that
89 section, to read:
90 409.968 Managed care plan payments.—
91 (4) Reimbursement for Class III psychiatric hospitals is
92 not defined by the agency’s inpatient hospital APR-DRG
93 compensation methodology and must be established using the
94 federal Centers for Medicare and Medicaid Services prospective
95 payment system pricing methodology or be limited to compensation
96 amounts agreed to by the plan and the hospital.
97 Section 8. Paragraph (d) of subsection (13) of section
98 409.906, Florida Statutes, is amended to read:
99 409.906 Optional Medicaid services.—Subject to specific
100 appropriations, the agency may make payments for services which
101 are optional to the state under Title XIX of the Social Security
102 Act and are furnished by Medicaid providers to recipients who
103 are determined to be eligible on the dates on which the services
104 were provided. Any optional service that is provided shall be
105 provided only when medically necessary and in accordance with
106 state and federal law. Optional services rendered by providers
107 in mobile units to Medicaid recipients may be restricted or
108 prohibited by the agency. Nothing in this section shall be
109 construed to prevent or limit the agency from adjusting fees,
110 reimbursement rates, lengths of stay, number of visits, or
111 number of services, or making any other adjustments necessary to
112 comply with the availability of moneys and any limitations or
113 directions provided for in the General Appropriations Act or
114 chapter 216. If necessary to safeguard the state’s systems of
115 providing services to elderly and disabled persons and subject
116 to the notice and review provisions of s. 216.177, the Governor
117 may direct the Agency for Health Care Administration to amend
118 the Medicaid state plan to delete the optional Medicaid service
119 known as “Intermediate Care Facilities for the Developmentally
120 Disabled.” Optional services may include:
121 (13) HOME AND COMMUNITY-BASED SERVICES.—
122 (d) The agency shall seek federal approval to pay for
123 flexible services for persons with severe mental illness or
124 substance use disorders, including, but not limited to,
125 temporary housing assistance. Payments may be made as enhanced
126 capitation rates or incentive payments to managed care plans
127 that meet the requirements of s. 409.968(5) s. 409.968(4).
128
129 ================= T I T L E A M E N D M E N T ================
130 And the title is amended as follows:
131 After line 32
132 insert:
133 amending s. 409.908, F.S.; removing the agency’s
134 authority to establish an alternative methodology to
135 the DRG-based prospective payment system to set
136 reimbursement rates for Class III psychiatric
137 hospitals; amending s. 409.968, F.S.; revising the
138 rate-setting methodology used in the reimbursement of
139 Class III psychiatric hospitals; amending s. 409.906,
140 F.S.; conforming a cross-reference;