CS/HB 7047

1
A bill to be entitled
2An act relating to health care; amending s. 409.911, F.S.;
3revising the method for calculating disproportionate share
4payments to hospitals; amending s. 409.9112, F.S.;
5revising the time period during which the Agency for
6Health Care Administration is prohibited from distributing
7disproportionate share payments to regional perinatal
8intensive care centers; amending s. 409.9113, F.S.;
9revising the time period for distribution of
10disproportionate share payments to teaching hospitals;
11amending s. 409.9117, F.S.; revising the time period
12during which the agency is prohibited from distributing
13certain moneys under the primary care disproportionate
14share program; amending s. 409.906, F.S.; authorizing the
15agency to pay for certain services provided by an
16anesthesiologist assistant; providing an effective date.
17
18Be It Enacted by the Legislature of the State of Florida:
19
20     Section 1.  Subsection (2) of section 409.911, Florida
21Statutes, is amended to read:
22     409.911  Disproportionate share program.--Subject to
23specific allocations established within the General
24Appropriations Act and any limitations established pursuant to
25chapter 216, the agency shall distribute, pursuant to this
26section, moneys to hospitals providing a disproportionate share
27of Medicaid or charity care services by making quarterly
28Medicaid payments as required. Notwithstanding the provisions of
29s. 409.915, counties are exempt from contributing toward the
30cost of this special reimbursement for hospitals serving a
31disproportionate share of low-income patients.
32     (2)  The Agency for Health Care Administration shall use
33the following actual audited data to determine the Medicaid days
34and charity care to be used in calculating the disproportionate
35share payment:
36     (a)  The average of the 2001, 2002, and 2003 2000, 2001,
37and 2002 audited disproportionate share data to determine each
38hospital's Medicaid days and charity care for the 2007-2008
392006-2007 state fiscal year.
40     (b)  If the Agency for Health Care Administration does not
41have the prescribed 3 years of audited disproportionate share
42data as noted in paragraph (a) for a hospital, the agency shall
43use the average of the years of the audited disproportionate
44share data as noted in paragraph (a) which is available.
45     (c)  In accordance with s. 1923(b) of the Social Security
46Act, a hospital with a Medicaid inpatient utilization rate
47greater than one standard deviation above the statewide mean or
48a hospital with a low-income utilization rate of 25 percent or
49greater shall qualify for reimbursement.
50     Section 2.  Section 409.9112, Florida Statutes, is amended
51to read:
52     409.9112  Disproportionate share program for regional
53perinatal intensive care centers.--In addition to the payments
54made under s. 409.911, the Agency for Health Care Administration
55shall design and implement a system of making disproportionate
56share payments to those hospitals that participate in the
57regional perinatal intensive care center program established
58pursuant to chapter 383. This system of payments shall conform
59with federal requirements and shall distribute funds in each
60fiscal year for which an appropriation is made by making
61quarterly Medicaid payments. Notwithstanding the provisions of
62s. 409.915, counties are exempt from contributing toward the
63cost of this special reimbursement for hospitals serving a
64disproportionate share of low-income patients. For the state
65fiscal year 2007-2008 2005-2006, the agency shall not distribute
66moneys under the regional perinatal intensive care centers
67disproportionate share program.
68     (1)  The following formula shall be used by the agency to
69calculate the total amount earned for hospitals that participate
70in the regional perinatal intensive care center program:
71
72
TAE = HDSP/THDSP
73
74Where:
75     TAE = total amount earned by a regional perinatal intensive
76care center.
77     HDSP = the prior state fiscal year regional perinatal
78intensive care center disproportionate share payment to the
79individual hospital.
80     THDSP = the prior state fiscal year total regional
81perinatal intensive care center disproportionate share payments
82to all hospitals.
83     (2)  The total additional payment for hospitals that
84participate in the regional perinatal intensive care center
85program shall be calculated by the agency as follows:
86
87
TAP = TAE x TA
88
89Where:
90     TAP = total additional payment for a regional perinatal
91intensive care center.
92     TAE = total amount earned by a regional perinatal intensive
93care center.
94     TA = total appropriation for the regional perinatal
95intensive care center disproportionate share program.
96     (3)  In order to receive payments under this section, a
97hospital must be participating in the regional perinatal
98intensive care center program pursuant to chapter 383 and must
99meet the following additional requirements:
100     (a)  Agree to conform to all departmental and agency
101requirements to ensure high quality in the provision of
102services, including criteria adopted by departmental and agency
103rule concerning staffing ratios, medical records, standards of
104care, equipment, space, and such other standards and criteria as
105the department and agency deem appropriate as specified by rule.
106     (b)  Agree to provide information to the department and
107agency, in a form and manner to be prescribed by rule of the
108department and agency, concerning the care provided to all
109patients in neonatal intensive care centers and high-risk
110maternity care.
111     (c)  Agree to accept all patients for neonatal intensive
112care and high-risk maternity care, regardless of ability to pay,
113on a functional space-available basis.
114     (d)  Agree to develop arrangements with other maternity and
115neonatal care providers in the hospital's region for the
116appropriate receipt and transfer of patients in need of
117specialized maternity and neonatal intensive care services.
118     (e)  Agree to establish and provide a developmental
119evaluation and services program for certain high-risk neonates,
120as prescribed and defined by rule of the department.
121     (f)  Agree to sponsor a program of continuing education in
122perinatal care for health care professionals within the region
123of the hospital, as specified by rule.
124     (g)  Agree to provide backup and referral services to the
125department's county health departments and other low-income
126perinatal providers within the hospital's region, including the
127development of written agreements between these organizations
128and the hospital.
129     (h)  Agree to arrange for transportation for high-risk
130obstetrical patients and neonates in need of transfer from the
131community to the hospital or from the hospital to another more
132appropriate facility.
133     (4)  Hospitals which fail to comply with any of the
134conditions in subsection (3) or the applicable rules of the
135department and agency shall not receive any payments under this
136section until full compliance is achieved. A hospital which is
137not in compliance in two or more consecutive quarters shall not
138receive its share of the funds. Any forfeited funds shall be
139distributed by the remaining participating regional perinatal
140intensive care center program hospitals.
141     Section 3.  Section 409.9113, Florida Statutes, is amended
142to read:
143     409.9113  Disproportionate share program for teaching
144hospitals.--In addition to the payments made under ss. 409.911
145and 409.9112, the Agency for Health Care Administration shall
146make disproportionate share payments to statutorily defined
147teaching hospitals for their increased costs associated with
148medical education programs and for tertiary health care services
149provided to the indigent. This system of payments shall conform
150with federal requirements and shall distribute funds in each
151fiscal year for which an appropriation is made by making
152quarterly Medicaid payments. Notwithstanding s. 409.915,
153counties are exempt from contributing toward the cost of this
154special reimbursement for hospitals serving a disproportionate
155share of low-income patients. For the state fiscal year 2007-
1562008 2006-2007, the agency shall distribute the moneys provided
157in the General Appropriations Act to statutorily defined
158teaching hospitals and family practice teaching hospitals under
159the teaching hospital disproportionate share program. The funds
160provided for statutorily defined teaching hospitals shall be
161distributed in the same proportion as the state fiscal year
1622003-2004 teaching hospital disproportionate share funds were
163distributed. The funds provided for family practice teaching
164hospitals shall be distributed equally among family practice
165teaching hospitals.
166     (1)  On or before September 15 of each year, the Agency for
167Health Care Administration shall calculate an allocation
168fraction to be used for distributing funds to state statutory
169teaching hospitals. Subsequent to the end of each quarter of the
170state fiscal year, the agency shall distribute to each statutory
171teaching hospital, as defined in s. 408.07, an amount determined
172by multiplying one-fourth of the funds appropriated for this
173purpose by the Legislature times such hospital's allocation
174fraction. The allocation fraction for each such hospital shall
175be determined by the sum of three primary factors, divided by
176three. The primary factors are:
177     (a)  The number of nationally accredited graduate medical
178education programs offered by the hospital, including programs
179accredited by the Accreditation Council for Graduate Medical
180Education and the combined Internal Medicine and Pediatrics
181programs acceptable to both the American Board of Internal
182Medicine and the American Board of Pediatrics at the beginning
183of the state fiscal year preceding the date on which the
184allocation fraction is calculated. The numerical value of this
185factor is the fraction that the hospital represents of the total
186number of programs, where the total is computed for all state
187statutory teaching hospitals.
188     (b)  The number of full-time equivalent trainees in the
189hospital, which comprises two components:
190     1.  The number of trainees enrolled in nationally
191accredited graduate medical education programs, as defined in
192paragraph (a). Full-time equivalents are computed using the
193fraction of the year during which each trainee is primarily
194assigned to the given institution, over the state fiscal year
195preceding the date on which the allocation fraction is
196calculated. The numerical value of this factor is the fraction
197that the hospital represents of the total number of full-time
198equivalent trainees enrolled in accredited graduate programs,
199where the total is computed for all state statutory teaching
200hospitals.
201     2.  The number of medical students enrolled in accredited
202colleges of medicine and engaged in clinical activities,
203including required clinical clerkships and clinical electives.
204Full-time equivalents are computed using the fraction of the
205year during which each trainee is primarily assigned to the
206given institution, over the course of the state fiscal year
207preceding the date on which the allocation fraction is
208calculated. The numerical value of this factor is the fraction
209that the given hospital represents of the total number of full-
210time equivalent students enrolled in accredited colleges of
211medicine, where the total is computed for all state statutory
212teaching hospitals.
213
214The primary factor for full-time equivalent trainees is computed
215as the sum of these two components, divided by two.
216     (c)  A service index that comprises three components:
217     1.  The Agency for Health Care Administration Service
218Index, computed by applying the standard Service Inventory
219Scores established by the Agency for Health Care Administration
220to services offered by the given hospital, as reported on
221Worksheet A-2 for the last fiscal year reported to the agency
222before the date on which the allocation fraction is calculated.
223The numerical value of this factor is the fraction that the
224given hospital represents of the total Agency for Health Care
225Administration Service Index values, where the total is computed
226for all state statutory teaching hospitals.
227     2.  A volume-weighted service index, computed by applying
228the standard Service Inventory Scores established by the Agency
229for Health Care Administration to the volume of each service,
230expressed in terms of the standard units of measure reported on
231Worksheet A-2 for the last fiscal year reported to the agency
232before the date on which the allocation factor is calculated.
233The numerical value of this factor is the fraction that the
234given hospital represents of the total volume-weighted service
235index values, where the total is computed for all state
236statutory teaching hospitals.
237     3.  Total Medicaid payments to each hospital for direct
238inpatient and outpatient services during the fiscal year
239preceding the date on which the allocation factor is calculated.
240This includes payments made to each hospital for such services
241by Medicaid prepaid health plans, whether the plan was
242administered by the hospital or not. The numerical value of this
243factor is the fraction that each hospital represents of the
244total of such Medicaid payments, where the total is computed for
245all state statutory teaching hospitals.
246
247The primary factor for the service index is computed as the sum
248of these three components, divided by three.
249     (2)  By October 1 of each year, the agency shall use the
250following formula to calculate the maximum additional
251disproportionate share payment for statutorily defined teaching
252hospitals:
253
254
TAP = THAF x A
255
256Where:
257     TAP = total additional payment.
258     THAF = teaching hospital allocation factor.
259     A = amount appropriated for a teaching hospital
260disproportionate share program.
261     Section 4.  Section 409.9117, Florida Statutes, is amended
262to read:
263     409.9117  Primary care disproportionate share program.--For
264the state fiscal year 2007-2008 2006-2007, the agency shall not
265distribute moneys under the primary care disproportionate share
266program.
267     (1)  If federal funds are available for disproportionate
268share programs in addition to those otherwise provided by law,
269there shall be created a primary care disproportionate share
270program.
271     (2)  The following formula shall be used by the agency to
272calculate the total amount earned for hospitals that participate
273in the primary care disproportionate share program:
274
275
TAE = HDSP/THDSP
276
277Where:
278     TAE = total amount earned by a hospital participating in
279the primary care disproportionate share program.
280     HDSP = the prior state fiscal year primary care
281disproportionate share payment to the individual hospital.
282     THDSP = the prior state fiscal year total primary care
283disproportionate share payments to all hospitals.
284     (3)  The total additional payment for hospitals that
285participate in the primary care disproportionate share program
286shall be calculated by the agency as follows:
287
288
TAP = TAE x TA
289
290Where:
291     TAP = total additional payment for a primary care hospital.
292     TAE = total amount earned by a primary care hospital.
293     TA = total appropriation for the primary care
294disproportionate share program.
295     (4)  In the establishment and funding of this program, the
296agency shall use the following criteria in addition to those
297specified in s. 409.911, payments may not be made to a hospital
298unless the hospital agrees to:
299     (a)  Cooperate with a Medicaid prepaid health plan, if one
300exists in the community.
301     (b)  Ensure the availability of primary and specialty care
302physicians to Medicaid recipients who are not enrolled in a
303prepaid capitated arrangement and who are in need of access to
304such physicians.
305     (c)  Coordinate and provide primary care services free of
306charge, except copayments, to all persons with incomes up to 100
307percent of the federal poverty level who are not otherwise
308covered by Medicaid or another program administered by a
309governmental entity, and to provide such services based on a
310sliding fee scale to all persons with incomes up to 200 percent
311of the federal poverty level who are not otherwise covered by
312Medicaid or another program administered by a governmental
313entity, except that eligibility may be limited to persons who
314reside within a more limited area, as agreed to by the agency
315and the hospital.
316     (d)  Contract with any federally qualified health center,
317if one exists within the agreed geopolitical boundaries,
318concerning the provision of primary care services, in order to
319guarantee delivery of services in a nonduplicative fashion, and
320to provide for referral arrangements, privileges, and
321admissions, as appropriate. The hospital shall agree to provide
322at an onsite or offsite facility primary care services within 24
323hours to which all Medicaid recipients and persons eligible
324under this paragraph who do not require emergency room services
325are referred during normal daylight hours.
326     (e)  Cooperate with the agency, the county, and other
327entities to ensure the provision of certain public health
328services, case management, referral and acceptance of patients,
329and sharing of epidemiological data, as the agency and the
330hospital find mutually necessary and desirable to promote and
331protect the public health within the agreed geopolitical
332boundaries.
333     (f)  In cooperation with the county in which the hospital
334resides, develop a low-cost, outpatient, prepaid health care
335program to persons who are not eligible for the Medicaid
336program, and who reside within the area.
337     (g)  Provide inpatient services to residents within the
338area who are not eligible for Medicaid or Medicare, and who do
339not have private health insurance, regardless of ability to pay,
340on the basis of available space, except that nothing shall
341prevent the hospital from establishing bill collection programs
342based on ability to pay.
343     (h)  Work with the Florida Healthy Kids Corporation, the
344Florida Health Care Purchasing Cooperative, and business health
345coalitions, as appropriate, to develop a feasibility study and
346plan to provide a low-cost comprehensive health insurance plan
347to persons who reside within the area and who do not have access
348to such a plan.
349     (i)  Work with public health officials and other experts to
350provide community health education and prevention activities
351designed to promote healthy lifestyles and appropriate use of
352health services.
353     (j)  Work with the local health council to develop a plan
354for promoting access to affordable health care services for all
355persons who reside within the area, including, but not limited
356to, public health services, primary care services, inpatient
357services, and affordable health insurance generally.
358
359Any hospital that fails to comply with any of the provisions of
360this subsection, or any other contractual condition, may not
361receive payments under this section until full compliance is
362achieved.
363     Section 5.  Subsection (26) is added to section 409.906,
364Florida Statutes, to read:
365     409.906  Optional Medicaid services.--Subject to specific
366appropriations, the agency may make payments for services which
367are optional to the state under Title XIX of the Social Security
368Act and are furnished by Medicaid providers to recipients who
369are determined to be eligible on the dates on which the services
370were provided. Any optional service that is provided shall be
371provided only when medically necessary and in accordance with
372state and federal law. Optional services rendered by providers
373in mobile units to Medicaid recipients may be restricted or
374prohibited by the agency. Nothing in this section shall be
375construed to prevent or limit the agency from adjusting fees,
376reimbursement rates, lengths of stay, number of visits, or
377number of services, or making any other adjustments necessary to
378comply with the availability of moneys and any limitations or
379directions provided for in the General Appropriations Act or
380chapter 216. If necessary to safeguard the state's systems of
381providing services to elderly and disabled persons and subject
382to the notice and review provisions of s. 216.177, the Governor
383may direct the Agency for Health Care Administration to amend
384the Medicaid state plan to delete the optional Medicaid service
385known as "Intermediate Care Facilities for the Developmentally
386Disabled." Optional services may include:
387     (26)  ANESTHESIOLOGIST ASSISTANT SERVICES.--The agency may
388pay for all services provided to a recipient by an
389anesthesiologist assistant licensed under s. 458.3475 or s.
390459.023. Reimbursement for such services must be not less than
39180 percent of the reimbursement that would be paid to a
392physician who provided the same services.
393     Section 6.  This act shall take effect July 1, 2007.


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