Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. SB 2636
Barcode 051326
CHAMBER ACTION
Senate House
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11 The Committee on Health Care (Fasano) recommended the
12 following amendment:
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14 Senate Amendment (with title amendment)
15 Delete everything after the enacting clause
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17 and insert:
18 Section 1. Paragraph (a) of subsection (2) of section
19 409.908, Florida Statutes, is amended to read:
20 409.908 Reimbursement of Medicaid providers.--Subject
21 to specific appropriations, the agency shall reimburse
22 Medicaid providers, in accordance with state and federal law,
23 according to methodologies set forth in the rules of the
24 agency and in policy manuals and handbooks incorporated by
25 reference therein. These methodologies may include fee
26 schedules, reimbursement methods based on cost reporting,
27 negotiated fees, competitive bidding pursuant to s. 287.057,
28 and other mechanisms the agency considers efficient and
29 effective for purchasing services or goods on behalf of
30 recipients. If a provider is reimbursed based on cost
31 reporting and submits a cost report late and that cost report
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. SB 2636
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1 would have been used to set a lower reimbursement rate for a
2 rate semester, then the provider's rate for that semester
3 shall be retroactively calculated using the new cost report,
4 and full payment at the recalculated rate shall be effected
5 retroactively. Medicare-granted extensions for filing cost
6 reports, if applicable, shall also apply to Medicaid cost
7 reports. Payment for Medicaid compensable services made on
8 behalf of Medicaid eligible persons is subject to the
9 availability of moneys and any limitations or directions
10 provided for in the General Appropriations Act or chapter 216.
11 Further, nothing in this section shall be construed to prevent
12 or limit the agency from adjusting fees, reimbursement rates,
13 lengths of stay, number of visits, or number of services, or
14 making any other adjustments necessary to comply with the
15 availability of moneys and any limitations or directions
16 provided for in the General Appropriations Act, provided the
17 adjustment is consistent with legislative intent.
18 (2)(a)1. Reimbursement to nursing homes licensed under
19 part II of chapter 400 and state-owned-and-operated
20 intermediate care facilities for the developmentally disabled
21 licensed under chapter 393 must be made prospectively.
22 2. Unless otherwise limited or directed in the General
23 Appropriations Act, reimbursement to hospitals licensed under
24 part I of chapter 395 for the provision of swing-bed nursing
25 home services must be made on the basis of the average
26 statewide nursing home payment, and reimbursement to a
27 hospital licensed under part I of chapter 395 for the
28 provision of skilled nursing services must be made on the
29 basis of the average nursing home payment for those services
30 in the county in which the hospital is located. When a
31 hospital is located in a county that does not have any
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. SB 2636
Barcode 051326
1 community nursing homes, reimbursement must be determined by
2 averaging the nursing home payments, in counties that surround
3 the county in which the hospital is located. Reimbursement to
4 hospitals, including Medicaid payment of Medicare copayments,
5 for skilled nursing services shall be limited to 30 days,
6 unless a prior authorization has been obtained from the
7 agency. Medicaid reimbursement may be extended by the agency
8 beyond 30 days, and approval must be based upon verification
9 by the patient's physician that the patient requires
10 short-term rehabilitative and recuperative services only, in
11 which case an extension of no more than 15 days may be
12 approved. Reimbursement to a hospital licensed under part I of
13 chapter 395 for the temporary provision of skilled nursing
14 services to nursing home residents who have been displaced as
15 the result of a natural disaster or other emergency may not
16 exceed the average county nursing home payment for those
17 services in the county in which the hospital is located and is
18 limited to the period of time which the agency considers
19 necessary for continued placement of the nursing home
20 residents in the hospital.
21 3. The agency shall establish a Nursing Home Voluntary
22 Competitive Bid Pilot Program in two counties for a 12-month
23 period for nursing homes licensed under chapter 400 with empty
24 Medicaid certified beds. Opening bids must be at a rate below
25 existing Medicaid reimbursement rates within the catchment
26 area. All nursing homes with a standard license in the pilot
27 area can voluntarily participate in the program. A nursing
28 home may not participate in the pilot program while it has a
29 conditional license. No rules shall prohibit Medicaid
30 beneficiaries or their families from choosing among those
31 facilities that are Medicaid certified. The agency shall
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. SB 2636
Barcode 051326
1 update and provide a list of approved bidders within the pilot
2 areas to all social service providers in that area, including
3 hospitals, assisted living facilities, and any entity that
4 makes referrals to nursing homes.
5 4. The agency shall evaluate the pilot program after
6 the 12-month period is completed, including an evaluation of
7 the effectiveness of the program, the impact, if any, on
8 quality of care, and the amount of savings to the state and
9 submit a report to the Governor, the President of the Senate,
10 and the Speaker of the House of Representatives no later than
11 90 days after the completion of the pilot program.
12 Section 2. This act shall take effect July 1, 2005.
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16 And the title is amended as follows:
17 Delete everything before the enacting clause
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19 and insert:
20 A bill to be entitled
21 An act relating to Medicaid reimbursement to
22 nursing homes; amending s. 409.908, F.S.;
23 requiring the Agency for Health Care
24 Administration to establish a Nursing Home
25 Voluntary Competitive Bid Pilot Program for
26 certain nursing homes in two counties for a
27 specified period; permitting licensed nursing
28 homes to bid on rates for Medicaid certified
29 beds under certain circumstances; requiring the
30 agency to provide a list of approved bidders to
31 social service providers; requiring the agency
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Florida Senate - 2005 COMMITTEE AMENDMENT
Bill No. SB 2636
Barcode 051326
1 to evaluate the pilot program by a specified
2 time; requiring a report to the Governor and
3 Legislature; providing an effective date.
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