House Bill 1905
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Florida House of Representatives - 2000 HB 1905
By Representatives Murman, Feeney, Garcia, Bloom, Casey,
Arnall, Farkas and Cantens
1 A bill to be entitled
2 An act relating to Medicaid; amending s.
3 409.905, F.S.; deleting provisions relating to
4 evaluation and report on implementation of a
5 hospital mental health waiver program;
6 increasing the Medicaid reimbursement
7 limitation for certain hospital outpatient
8 services; amending s. 409.908, F.S.;
9 authorizing the Agency for Health Care
10 Administration to retrospectively adjust or
11 reclassify disproportionate share program
12 distributions as Medicaid benefits; providing
13 exceptions to Medicaid reimbursement
14 limitations for certain hospital inpatient
15 care; authorizing the agency to receive certain
16 funds for such exceptional reimbursements;
17 providing an exemption from county contribution
18 requirements; increasing the Medicaid
19 reimbursement limitation for certain hospital
20 outpatient care; authorizing the agency to
21 receive certain funds for such outpatient care;
22 removing authority for additional reimbursement
23 for hospitals participating in the
24 extraordinary disproportionate share program;
25 authorizing certain retrospective adjustment or
26 reclassification of disproportionate share
27 program distributions as Medicaid benefits;
28 providing an exemption from county contribution
29 requirements; providing an effective date.
30
31 Be It Enacted by the Legislature of the State of Florida:
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1 Section 1. Paragraph (b) of subsection (5) and
2 subsection (6) of section 409.905, Florida Statutes, are
3 amended to read:
4 409.905 Mandatory Medicaid services.--The agency may
5 make payments for the following services, which are required
6 of the state by Title XIX of the Social Security Act,
7 furnished by Medicaid providers to recipients who are
8 determined to be eligible on the dates on which the services
9 were provided. Any service under this section shall be
10 provided only when medically necessary and in accordance with
11 state and federal law. Nothing in this section shall be
12 construed to prevent or limit the agency from adjusting fees,
13 reimbursement rates, lengths of stay, number of visits, number
14 of services, or any other adjustments necessary to comply with
15 the availability of moneys and any limitations or directions
16 provided for in the General Appropriations Act or chapter 216.
17 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay
18 for all covered services provided for the medical care and
19 treatment of a recipient who is admitted as an inpatient by a
20 licensed physician or dentist to a hospital licensed under
21 part I of chapter 395. However, the agency shall limit the
22 payment for inpatient hospital services for a Medicaid
23 recipient 21 years of age or older to 45 days or the number of
24 days necessary to comply with the General Appropriations Act.
25 (b) A licensed hospital maintained primarily for the
26 care and treatment of patients having mental disorders or
27 mental diseases is not eligible to participate in the hospital
28 inpatient portion of the Medicaid program except as provided
29 in federal law. However, the department shall apply for a
30 waiver, within 9 months after June 5, 1991, designed to
31 provide hospitalization services for mental health reasons to
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1 children and adults in the most cost-effective and lowest cost
2 setting possible. Such waiver shall include a request for the
3 opportunity to pay for care in hospitals known under federal
4 law as "institutions for mental disease" or "IMD's." The
5 waiver proposal shall propose no additional aggregate cost to
6 the state or Federal Government, and shall be conducted in
7 Hillsborough County, Highlands County, Hardee County, Manatee
8 County, and Polk County. The waiver proposal may incorporate
9 competitive bidding for hospital services, comprehensive
10 brokering, prepaid capitated arrangements, or other mechanisms
11 deemed by the department to show promise in reducing the cost
12 of acute care and increasing the effectiveness of preventive
13 care. When developing the waiver proposal, the department
14 shall take into account price, quality, accessibility,
15 linkages of the hospital to community services and family
16 support programs, plans of the hospital to ensure the earliest
17 discharge possible, and the comprehensiveness of the mental
18 health and other health care services offered by participating
19 providers. The department is directed to monitor and evaluate
20 the implementation of this waiver program if it is granted and
21 report to the chairs of the appropriations committees of the
22 Senate and the House of Representatives by February 1, 1992.
23 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
24 pay for preventive, diagnostic, therapeutic, or palliative
25 care and other services provided to a recipient in the
26 outpatient portion of a hospital licensed under part I of
27 chapter 395, and provided under the direction of a licensed
28 physician or licensed dentist, except that payment for such
29 care and services is limited to $1,500 $1,000 per state fiscal
30 year per recipient, unless an exception has been made by the
31 agency, and with the exception of a Medicaid recipient under
3
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1 age 21, in which case the only limitation is medical
2 necessity.
3 Section 2. Section 409.908, Florida Statutes, is
4 amended to read:
5 409.908 Reimbursement of Medicaid providers.--Subject
6 to specific appropriations, the agency shall reimburse
7 Medicaid providers, in accordance with state and federal law,
8 according to methodologies set forth in the rules of the
9 agency and in policy manuals and handbooks incorporated by
10 reference therein. These methodologies may include fee
11 schedules, reimbursement methods based on cost reporting,
12 negotiated fees, competitive bidding pursuant to s. 287.057,
13 and other mechanisms the agency considers efficient and
14 effective for purchasing services or goods on behalf of
15 recipients. Payment for Medicaid compensable services made on
16 behalf of Medicaid eligible persons is subject to the
17 availability of moneys and any limitations or directions
18 provided for in the General Appropriations Act or chapter 216.
19 Further, nothing in this section shall be construed to prevent
20 or limit the agency from adjusting fees, reimbursement rates,
21 lengths of stay, number of visits, or number of services, or
22 retrospectively adjusting or reclassifying disproportionate
23 share program distributions as benefits, or making any other
24 adjustments necessary to comply with the availability of
25 moneys and any limitations or directions provided for in the
26 General Appropriations Act, provided the adjustment is
27 consistent with legislative intent.
28 (1) Reimbursement to hospitals licensed under part I
29 of chapter 395 must be made prospectively or on the basis of
30 negotiation.
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1 (a) Reimbursement for inpatient care is limited as
2 provided for in s. 409.905(5), except for:.
3 1. The raising of rate reimbursement caps.
4 2. Recognition of the costs of graduate medical
5 education.
6 3. Other methodologies recognized in the General
7 Appropriations Act.
8
9 The agency is authorized to receive funds from state entities,
10 including, but limited to, the Board of Regents, local
11 governments, and other local political subdivisions, for the
12 purpose of making special exception payments, including
13 federal matching funds, through the Medicaid inpatient
14 reimbursement methodologies. Funds received from state
15 entities or local governments for this purpose shall be
16 separately accounted for and shall not be commingled with
17 other state or local funds in any manner. Notwithstanding this
18 section and s. 409.915, counties are exempt from contributing
19 toward the cost of the special exception reimbursement for
20 hospitals serving a disproportionate share of low-income
21 persons and providing graduate medical education.
22 (b) Reimbursement for hospital outpatient care is
23 limited to $1,500 $1,000 per state fiscal year per recipient,
24 except for:
25 1. Such care provided to a Medicaid recipient under
26 age 21, in which case the only limitation is medical
27 necessity.;
28 2. Renal dialysis services.; and
29 3. Other exceptions made by the agency.
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1 The agency is authorized to receive funds from state entities,
2 including, but not limited to, the Board of Regents, local
3 governments, and other local political subdivisions, for the
4 purpose of making payments, including federal matching funds,
5 through the Medicaid outpatient reimbursement methodologies.
6 Funds received from state entities and local governments for
7 this purpose shall be separately accounted for and shall not
8 be commingled with other state or local funds in any manner.
9 (c)(b) Hospitals that provide services to a
10 disproportionate share of low-income Medicaid recipients, or
11 that participate in the regional perinatal intensive care
12 center program under chapter 383, or that participate in the
13 statutory teaching hospital disproportionate share program, or
14 that participate in the extraordinary disproportionate share
15 program, may receive additional reimbursement. The total
16 amount of payment for disproportionate share hospitals shall
17 be fixed by the General Appropriations Act. The computation of
18 these payments must be made in compliance with all federal
19 regulations and the methodologies described in ss. 409.911,
20 409.9112, and 409.9113. Notwithstanding this section, these
21 payments may be retrospectively adjusted and reclassified as
22 program benefits, and if adjusted and reclassified as such,
23 notwithstanding s. 409.915, counties are exempt from
24 contributing toward the cost of these benefits.
25 (d)(c) The agency is authorized to limit inflationary
26 increases for outpatient hospital services as directed by the
27 General Appropriations Act.
28 (2)(a)1. Reimbursement to nursing homes licensed under
29 part II of chapter 400 and state-owned-and-operated
30 intermediate care facilities for the developmentally disabled
31 licensed under chapter 393 must be made prospectively.
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1 2. Unless otherwise limited or directed in the General
2 Appropriations Act, reimbursement to hospitals licensed under
3 part I of chapter 395 for the provision of swing-bed nursing
4 home services must be made on the basis of the average
5 statewide nursing home payment, and reimbursement to a
6 hospital licensed under part I of chapter 395 for the
7 provision of skilled nursing services must be made on the
8 basis of the average nursing home payment for those services
9 in the county in which the hospital is located. When a
10 hospital is located in a county that does not have any
11 community nursing homes, reimbursement must be determined by
12 averaging the nursing home payments, in counties that surround
13 the county in which the hospital is located. Reimbursement to
14 hospitals, including Medicaid payment of Medicare copayments,
15 for skilled nursing services shall be limited to 30 days,
16 unless a prior authorization has been obtained from the
17 agency. Medicaid reimbursement may be extended by the agency
18 beyond 30 days, and approval must be based upon verification
19 by the patient's physician that the patient requires
20 short-term rehabilitative and recuperative services only, in
21 which case an extension of no more than 15 days may be
22 approved. Reimbursement to a hospital licensed under part I of
23 chapter 395 for the temporary provision of skilled nursing
24 services to nursing home residents who have been displaced as
25 the result of a natural disaster or other emergency may not
26 exceed the average county nursing home payment for those
27 services in the county in which the hospital is located and is
28 limited to the period of time which the agency considers
29 necessary for continued placement of the nursing home
30 residents in the hospital.
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1 (b) Subject to any limitations or directions provided
2 for in the General Appropriations Act, the agency shall
3 establish and implement a Florida Title XIX Long-Term Care
4 Reimbursement Plan (Medicaid) for nursing home care in order
5 to provide care and services in conformance with the
6 applicable state and federal laws, rules, regulations, and
7 quality and safety standards and to ensure that individuals
8 eligible for medical assistance have reasonable geographic
9 access to such care. Effective no earlier than the
10 rate-setting period beginning April 1, 1999, the agency shall
11 establish a case-mix reimbursement methodology for the rate of
12 payment for long-term care services for nursing home
13 residents. The agency shall compute a per diem rate for
14 Medicaid residents, adjusted for case mix, which is based on a
15 resident classification system that accounts for the relative
16 resource utilization by different types of residents and which
17 is based on level-of-care data and other appropriate data. The
18 case-mix methodology developed by the agency shall take into
19 account the medical, behavioral, and cognitive deficits of
20 residents. In developing the reimbursement methodology, the
21 agency shall evaluate and modify other aspects of the
22 reimbursement plan as necessary to improve the overall
23 effectiveness of the plan with respect to the costs of patient
24 care, operating costs, and property costs. In the event
25 adequate data are not available, the agency is authorized to
26 adjust the patient's care component or the per diem rate to
27 more adequately cover the cost of services provided in the
28 patient's care component. The agency shall work with the
29 Department of Elderly Affairs, the Florida Health Care
30 Association, and the Florida Association of Homes for the
31 Aging in developing the methodology. It is the intent of the
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1 Legislature that the reimbursement plan achieve the goal of
2 providing access to health care for nursing home residents who
3 require large amounts of care while encouraging diversion
4 services as an alternative to nursing home care for residents
5 who can be served within the community. The agency shall base
6 the establishment of any maximum rate of payment, whether
7 overall or component, on the available moneys as provided for
8 in the General Appropriations Act. The agency may base the
9 maximum rate of payment on the results of scientifically valid
10 analysis and conclusions derived from objective statistical
11 data pertinent to the particular maximum rate of payment.
12 (3) Subject to any limitations or directions provided
13 for in the General Appropriations Act, the following Medicaid
14 services and goods may be reimbursed on a fee-for-service
15 basis. For each allowable service or goods furnished in
16 accordance with Medicaid rules, policy manuals, handbooks, and
17 state and federal law, the payment shall be the amount billed
18 by the provider, the provider's usual and customary charge, or
19 the maximum allowable fee established by the agency, whichever
20 amount is less, with the exception of those services or goods
21 for which the agency makes payment using a methodology based
22 on capitation rates, average costs, or negotiated fees.
23 (a) Advanced registered nurse practitioner services.
24 (b) Birth center services.
25 (c) Chiropractic services.
26 (d) Community mental health services.
27 (e) Dental services, including oral and maxillofacial
28 surgery.
29 (f) Durable medical equipment.
30 (g) Hearing services.
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1 (h) Occupational therapy for Medicaid recipients under
2 age 21.
3 (i) Optometric services.
4 (j) Orthodontic services.
5 (k) Personal care for Medicaid recipients under age
6 21.
7 (l) Physical therapy for Medicaid recipients under age
8 21.
9 (m) Physician assistant services.
10 (n) Podiatric services.
11 (o) Portable X-ray services.
12 (p) Private-duty nursing for Medicaid recipients under
13 age 21.
14 (q) Registered nurse first assistant services.
15 (r) Respiratory therapy for Medicaid recipients under
16 age 21.
17 (s) Speech therapy for Medicaid recipients under age
18 21.
19 (t) Visual services.
20 (4) Subject to any limitations or directions provided
21 for in the General Appropriations Act, alternative health
22 plans, health maintenance organizations, and prepaid health
23 plans shall be reimbursed a fixed, prepaid amount negotiated,
24 or competitively bid pursuant to s. 287.057, by the agency and
25 prospectively paid to the provider monthly for each Medicaid
26 recipient enrolled. The amount may not exceed the average
27 amount the agency determines it would have paid, based on
28 claims experience, for recipients in the same or similar
29 category of eligibility. The agency shall calculate
30 capitation rates on a regional basis and, beginning September
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1 1, 1995, shall include age-band differentials in such
2 calculations.
3 (5) An ambulatory surgical center shall be reimbursed
4 the lesser of the amount billed by the provider or the
5 Medicare-established allowable amount for the facility.
6 (6) A provider of early and periodic screening,
7 diagnosis, and treatment services to Medicaid recipients who
8 are children under age 21 shall be reimbursed using an
9 all-inclusive rate stipulated in a fee schedule established by
10 the agency. A provider of the visual, dental, and hearing
11 components of such services shall be reimbursed the lesser of
12 the amount billed by the provider or the Medicaid maximum
13 allowable fee established by the agency.
14 (7) A provider of family planning services shall be
15 reimbursed the lesser of the amount billed by the provider or
16 an all-inclusive amount per type of visit for physicians and
17 advanced registered nurse practitioners, as established by the
18 agency in a fee schedule.
19 (8) A provider of home-based or community-based
20 services rendered pursuant to a federally approved waiver
21 shall be reimbursed based on an established or negotiated rate
22 for each service. These rates shall be established according
23 to an analysis of the expenditure history and prospective
24 budget developed by each contract provider participating in
25 the waiver program, or under any other methodology adopted by
26 the agency and approved by the Federal Government in
27 accordance with the waiver. Effective July 1, 1996, privately
28 owned and operated community-based residential facilities
29 which meet agency requirements and which formerly received
30 Medicaid reimbursement for the optional intermediate care
31 facility for the mentally retarded service may participate in
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1 the developmental services waiver as part of a
2 home-and-community-based continuum of care for Medicaid
3 recipients who receive waiver services.
4 (9) A provider of home health care services or of
5 medical supplies and appliances shall be reimbursed the lesser
6 of the amount billed by the provider or the agency's
7 established maximum allowable amount, except that, in the case
8 of the rental of durable medical equipment, the total rental
9 payments may not exceed the purchase price of the equipment
10 over its expected useful life or the agency's established
11 maximum allowable amount, whichever amount is less.
12 (10) A hospice shall be reimbursed through a
13 prospective system for each Medicaid hospice patient at
14 Medicaid rates using the methodology established for hospice
15 reimbursement pursuant to Title XVIII of the federal Social
16 Security Act.
17 (11) A provider of independent laboratory services
18 shall be reimbursed the least of the amount billed by the
19 provider, the provider's usual and customary charge, or the
20 Medicaid maximum allowable fee established by the agency.
21 (12)(a) A physician shall be reimbursed the lesser of
22 the amount billed by the provider or the Medicaid maximum
23 allowable fee established by the agency.
24 (b) The agency shall adopt a fee schedule, subject to
25 any limitations or directions provided for in the General
26 Appropriations Act, based on a resource-based relative value
27 scale for pricing Medicaid physician services. Under this fee
28 schedule, physicians shall be paid a dollar amount for each
29 service based on the average resources required to provide the
30 service, including, but not limited to, estimates of average
31 physician time and effort, practice expense, and the costs of
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1 professional liability insurance. The fee schedule shall
2 provide increased reimbursement for preventive and primary
3 care services and lowered reimbursement for specialty services
4 by using at least two conversion factors, one for cognitive
5 services and another for procedural services. The fee
6 schedule shall not increase total Medicaid physician
7 expenditures unless moneys are available, and shall be phased
8 in over a 2-year period beginning on July 1, 1994. The Agency
9 for Health Care Administration shall seek the advice of a
10 16-member advisory panel in formulating and adopting the fee
11 schedule. The panel shall consist of Medicaid physicians
12 licensed under chapters 458 and 459 and shall be composed of
13 50 percent primary care physicians and 50 percent specialty
14 care physicians.
15 (c) The agency shall monitor closely the utilization
16 rate for physician services and identify any trends which may
17 indicate an effort to increase the volume of services to
18 counteract any losses that might result from the new fee
19 schedule. The agency shall prepare a report to the Legislature
20 on the overall effect of the resource-based relative value
21 scale fee schedule by December 31, 1996.
22 (d) Notwithstanding paragraph (b), reimbursement fees
23 to physicians for providing total obstetrical services to
24 Medicaid recipients, which include prenatal, delivery, and
25 postpartum care, shall be at least $1,500 per delivery for a
26 pregnant woman with low medical risk and at least $2,000 per
27 delivery for a pregnant woman with high medical risk. However,
28 reimbursement to physicians working in Regional Perinatal
29 Intensive Care Centers designated pursuant to chapter 383, for
30 services to certain pregnant Medicaid recipients with a high
31 medical risk, may be made according to obstetrical care and
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1 neonatal care groupings and rates established by the agency.
2 Nurse midwives licensed under chapter 464 or midwives licensed
3 under chapter 467 shall be reimbursed at no less than 80
4 percent of the low medical risk fee. The agency shall by rule
5 determine, for the purpose of this paragraph, what constitutes
6 a high or low medical risk pregnant woman and shall not pay
7 more based solely on the fact that a caesarean section was
8 performed, rather than a vaginal delivery. The agency shall by
9 rule determine a prorated payment for obstetrical services in
10 cases where only part of the total prenatal, delivery, or
11 postpartum care was performed. The Department of Health shall
12 adopt rules for appropriate insurance coverage for midwives
13 licensed under chapter 467. Prior to the issuance and renewal
14 of an active license, or reactivation of an inactive license
15 for midwives licensed under chapter 467, such licensees shall
16 submit proof of coverage with each application.
17 (13) Medicare premiums for persons eligible for both
18 Medicare and Medicaid coverage shall be paid at the rates
19 established by Title XVIII of the Social Security Act. For
20 Medicare services rendered to Medicaid-eligible persons,
21 Medicaid shall pay Medicare deductibles and coinsurance as
22 follows:
23 (a) Medicaid shall make no payment toward deductibles
24 and coinsurance for any service that is not covered by
25 Medicaid.
26 (b) Medicaid's financial obligation for deductibles
27 and coinsurance payments shall be based on Medicare allowable
28 fees, not on a provider's billed charges.
29 (c) Medicaid will pay no portion of Medicare
30 deductibles and coinsurance when payment that Medicare has
31 made for the service equals or exceeds what Medicaid would
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1 have paid if it had been the sole payor. The combined payment
2 of Medicare and Medicaid shall not exceed the amount Medicaid
3 would have paid had it been the sole payor.
4 (d) The following provisions are exceptions to
5 paragraphs (a)-(c):
6 1. Medicaid payments for Nursing Home Medicare part A
7 coinsurance shall be the lesser of the Medicare coinsurance
8 amount or the Medicaid nursing home per diem rate.
9 2. Medicaid shall pay all deductibles and coinsurance
10 for Nursing Home Medicare part B services.
11 3. Medicaid shall pay all deductibles and coinsurance
12 for Medicare-eligible recipients receiving freestanding end
13 stage renal dialysis center services.
14 4. Medicaid shall pay all deductibles and coinsurance
15 for hospital outpatient Medicare part B services.
16 5. Medicaid payments for general hospital inpatient
17 services shall be limited to the Medicare deductible per spell
18 of illness. Medicaid shall make no payment toward coinsurance
19 for Medicare general hospital inpatient services.
20 6. Medicaid shall pay all deductibles and coinsurance
21 for Medicare emergency transportation services provided by
22 ambulances licensed pursuant to chapter 401.
23 (14) A provider of prescribed drugs shall be
24 reimbursed the least of the amount billed by the provider, the
25 provider's usual and customary charge, or the Medicaid maximum
26 allowable fee established by the agency, plus a dispensing
27 fee. The agency is directed to implement a variable dispensing
28 fee for payments for prescribed medicines while ensuring
29 continued access for Medicaid recipients. The variable
30 dispensing fee may be based upon, but not limited to, either
31 or both the volume of prescriptions dispensed by a specific
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1 pharmacy provider and the volume of prescriptions dispensed to
2 an individual recipient. The agency is authorized to limit
3 reimbursement for prescribed medicine in order to comply with
4 any limitations or directions provided for in the General
5 Appropriations Act, which may include implementing a
6 prospective or concurrent utilization review program.
7 (15) A provider of primary care case management
8 services rendered pursuant to a federally approved waiver
9 shall be reimbursed by payment of a fixed, prepaid monthly sum
10 for each Medicaid recipient enrolled with the provider.
11 (16) A provider of rural health clinic services and
12 federally qualified health center services shall be reimbursed
13 a rate per visit based on total reasonable costs of the
14 clinic, as determined by the agency in accordance with federal
15 regulations.
16 (17) A provider of targeted case management services
17 shall be reimbursed pursuant to an established fee, except
18 where the Federal Government requires a public provider be
19 reimbursed on the basis of average actual costs.
20 (18) Unless otherwise provided for in the General
21 Appropriations Act, a provider of transportation services
22 shall be reimbursed the lesser of the amount billed by the
23 provider or the Medicaid maximum allowable fee established by
24 the agency, except when the agency has entered into a direct
25 contract with the provider, or with a community transportation
26 coordinator, for the provision of an all-inclusive service, or
27 when services are provided pursuant to an agreement negotiated
28 between the agency and the provider. The agency, as provided
29 for in s. 427.0135, shall purchase transportation services
30 through the community coordinated transportation system, if
31 available, unless the agency determines a more cost-effective
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1 method for Medicaid clients. Nothing in this subsection shall
2 be construed to limit or preclude the agency from contracting
3 for services using a prepaid capitation rate or from
4 establishing maximum fee schedules, individualized
5 reimbursement policies by provider type, negotiated fees,
6 prior authorization, competitive bidding, increased use of
7 mass transit, or any other mechanism that the agency considers
8 efficient and effective for the purchase of services on behalf
9 of Medicaid clients, including implementing a transportation
10 eligibility process. The agency shall not be required to
11 contract with any community transportation coordinator or
12 transportation operator that has been determined by the
13 agency, the Department of Legal Affairs Medicaid Fraud Control
14 Unit, or any other state or federal agency to have engaged in
15 any abusive or fraudulent billing activities.
16 (19) County health department services may be
17 reimbursed a rate per visit based on total reasonable costs of
18 the clinic, as determined by the agency in accordance with
19 federal regulations under the authority of 42 C.F.R. s.
20 431.615.
21 (20) A renal dialysis facility that provides dialysis
22 services under s. 409.906(9) must be reimbursed the lesser of
23 the amount billed by the provider, the provider's usual and
24 customary charge, or the maximum allowable fee established by
25 the agency, whichever amount is less.
26 (21) The agency shall reimburse school districts which
27 certify the state match pursuant to ss. 236.0812 and 409.9071
28 for the federal portion of the school district's allowable
29 costs to deliver the services, based on the reimbursement
30 schedule. The school district shall determine the costs for
31 delivering services as authorized in ss. 236.0812 and 409.9071
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1 for which the state match will be certified. Reimbursement of
2 school-based providers is contingent on such providers being
3 enrolled as Medicaid providers and meeting the qualifications
4 contained in 42 C.F.R. s. 440.110, unless otherwise waived by
5 the federal Health Care Financing Administration. Speech
6 therapy providers who are certified through the Department of
7 Education pursuant to rule 6A-4.0176, Florida Administrative
8 Code, are eligible for reimbursement for services that are
9 provided on school premises. Any employee of the school
10 district who has been fingerprinted and has received a
11 criminal background check in accordance with Department of
12 Education rules and guidelines shall be exempt from any agency
13 requirements relating to criminal background checks.
14 (22) The agency is directed to implement changes in
15 the Medicaid reimbursement methodology, as soon as feasible,
16 to contain the growth in expenditures in facilities formerly
17 known as ICF/DD facilities. In light of the repeal of the
18 federal Boren Amendment, the agency shall consider, but is not
19 limited to, the following changes in methodology:
20 (a) Reduction in the target rate of inflation.
21 (b) Reduction in the calculation of incentive
22 payments.
23 (c) Ceiling limitations by component of reimbursement.
24 (d) Elimination of rebase provisions.
25 (e) Elimination of component interim rate provisions.
26 (f) Separate reimbursement plans for facilities that
27 are government operated versus facilities that are privately
28 owned.
29
30
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1 The agency may contract with an independent consultant in
2 considering any changes to the reimbursement methodology for
3 these facilities. This subsection is repealed on July 1, 1999.
4 Section 3. This act shall take effect July 1, 2000.
5
6 *****************************************
7 HOUSE SUMMARY
8
Increases from $1,000 to $1,500 the Medicaid
9 reimbursement limitation for specified hospital
outpatient services. Authorizes the Agency for Health
10 Care Administration to receive funds from certain
entities, including the Board of Regents and local
11 political subdivisions, for reimbursement for such
services. Revises Medicaid reimbursement limitations for
12 hospital inpatient services to provide exceptions for
raising reimbursement caps, graduate medical education,
13 and other methodologies provided in the General
Appropriations Act. Authorizes the agency to receive
14 funds from certain entities for purposes of such
exceptional reimbursements, and provides an exemption
15 from county contribution requirements for such
reimbursements for certain hospitals. Removes authority
16 for additional reimbursements for hospitals participating
in the extraordinary disproportionate share program.
17 Authorizes the agency to retrospectively adjust or
reclassify disproportionate share program distributions
18 as Medicaid benefits. Provides an exemption from county
contribution requirements when such adjustment or
19 reclassification occurs.
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31
19