HB 1465

1	A bill to be entitled
2	An act relating to Medicaid reimbursement to nursing
3	homes; amending s. 409.908, F.S.; requiring the Agency for
4	Health Care Administration to permit licensed nursing
5	homes to bid on rates for Medicaid certified beds under
6	certain circumstances; providing for rules; requiring the
7	agency to provide a list of approved bidders to social
8	service providers; providing an effective date.
9
10	Be It Enacted by the Legislature of the State of Florida:
11
12	Section 1.  Paragraph (a) of subsection (2) of section
13	409.908, Florida Statutes, is amended to read:
14	409.908  Reimbursement of Medicaid providers.--Subject to
15	specific appropriations, the agency shall reimburse Medicaid
16	providers, in accordance with state and federal law, according
17	to methodologies set forth in the rules of the agency and in
18	policy manuals and handbooks incorporated by reference therein.
19	These methodologies may include fee schedules, reimbursement
20	methods based on cost reporting, negotiated fees, competitive
21	bidding pursuant to s. 287.057, and other mechanisms the agency
22	considers efficient and effective for purchasing services or
23	goods on behalf of recipients. If a provider is reimbursed based
24	on cost reporting and submits a cost report late and that cost
25	report would have been used to set a lower reimbursement rate
26	for a rate semester, then the provider's rate for that semester
27	shall be retroactively calculated using the new cost report, and
28	full payment at the recalculated rate shall be effected
29	retroactively. Medicare-granted extensions for filing cost
30	reports, if applicable, shall also apply to Medicaid cost
31	reports. Payment for Medicaid compensable services made on
32	behalf of Medicaid eligible persons is subject to the
33	availability of moneys and any limitations or directions
34	provided for in the General Appropriations Act or chapter 216.
35	Further, nothing in this section shall be construed to prevent
36	or limit the agency from adjusting fees, reimbursement rates,
37	lengths of stay, number of visits, or number of services, or
38	making any other adjustments necessary to comply with the
39	availability of moneys and any limitations or directions
40	provided for in the General Appropriations Act, provided the
41	adjustment is consistent with legislative intent.
42	(2)(a)1.  Reimbursement to nursing homes licensed under
43	part II of chapter 400 and state-owned-and-operated intermediate
44	care facilities for the developmentally disabled licensed under
45	chapter 393 must be made prospectively.
46	2.  Unless otherwise limited or directed in the General
47	Appropriations Act, reimbursement to hospitals licensed under
48	part I of chapter 395 for the provision of swing-bed nursing
49	home services must be made on the basis of the average statewide
50	nursing home payment, and reimbursement to a hospital licensed
51	under part I of chapter 395 for the provision of skilled nursing
52	services must be made on the basis of the average nursing home
53	payment for those services in the county in which the hospital
54	is located. When a hospital is located in a county that does not
55	have any community nursing homes, reimbursement must be
56	determined by averaging the nursing home payments, in counties
57	that surround the county in which the hospital is located.
58	Reimbursement to hospitals, including Medicaid payment of
59	Medicare copayments, for skilled nursing services shall be
60	limited to 30 days, unless a prior authorization has been
61	obtained from the agency. Medicaid reimbursement may be extended
62	by the agency beyond 30 days, and approval must be based upon
63	verification by the patient's physician that the patient
64	requires short-term rehabilitative and recuperative services
65	only, in which case an extension of no more than 15 days may be
66	approved. Reimbursement to a hospital licensed under part I of
67	chapter 395 for the temporary provision of skilled nursing
68	services to nursing home residents who have been displaced as
69	the result of a natural disaster or other emergency may not
70	exceed the average county nursing home payment for those
71	services in the county in which the hospital is located and is
72	limited to the period of time which the agency considers
73	necessary for continued placement of the nursing home residents
74	in the hospital.
75	3.  The agency shall provide licensed nursing homes the
76	opportunity to competitively bid on per diem rates for Medicaid
77	certified beds within a defined catchment area. The agency shall
78	adopt rules that give priority to the admission of Medicaid
79	patients to a nursing home within the patient's locale. The
80	rules may not prohibit a Medicaid patient from choosing among
81	the lowest-bidding facilities in the area. In all other
82	instances, a patient shall be placed in an available bed in the
83	facility with the lowest bid price. Opening bids must be at a
84	rate below existing Medicaid reimbursement rates within the
85	catchment area. The agency shall provide the list of approved
86	bidders within the catchment area to all social services
87	providers in the area, including hospitals, adult congregate
88	living facilities, and any entity making referrals to nursing
89	homes and update the list as necessary.
90	Section 2.  This act shall take effect July 1, 2005.

CODING: Words stricken are deletions; words underlined are additions.