| 1 | A bill to be entitled |
| 2 | An act relating to reimbursement of Medicaid providers; |
| 3 | amending s. 409.908, F.S.; requiring the Agency for Health |
| 4 | Care Administration to provide reimbursement for physician |
| 5 | and dental services at certain levels and rates; providing |
| 6 | an effective date. |
| 7 |
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| 8 | Be It Enacted by the Legislature of the State of Florida: |
| 9 |
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| 10 | Section 1. Paragraph (d) is added to subsection (12) of |
| 11 | section 409.908, Florida Statutes, to read: |
| 12 | 409.908 Reimbursement of Medicaid providers.--Subject to |
| 13 | specific appropriations, the agency shall reimburse Medicaid |
| 14 | providers, in accordance with state and federal law, according |
| 15 | to methodologies set forth in the rules of the agency and in |
| 16 | policy manuals and handbooks incorporated by reference therein. |
| 17 | These methodologies may include fee schedules, reimbursement |
| 18 | methods based on cost reporting, negotiated fees, competitive |
| 19 | bidding pursuant to s. 287.057, and other mechanisms the agency |
| 20 | considers efficient and effective for purchasing services or |
| 21 | goods on behalf of recipients. If a provider is reimbursed based |
| 22 | on cost reporting and submits a cost report late and that cost |
| 23 | report would have been used to set a lower reimbursement rate |
| 24 | for a rate semester, then the provider's rate for that semester |
| 25 | shall be retroactively calculated using the new cost report, and |
| 26 | full payment at the recalculated rate shall be effected |
| 27 | retroactively. Medicare-granted extensions for filing cost |
| 28 | reports, if applicable, shall also apply to Medicaid cost |
| 29 | reports. Payment for Medicaid compensable services made on |
| 30 | behalf of Medicaid eligible persons is subject to the |
| 31 | availability of moneys and any limitations or directions |
| 32 | provided for in the General Appropriations Act or chapter 216. |
| 33 | Further, nothing in this section shall be construed to prevent |
| 34 | or limit the agency from adjusting fees, reimbursement rates, |
| 35 | lengths of stay, number of visits, or number of services, or |
| 36 | making any other adjustments necessary to comply with the |
| 37 | availability of moneys and any limitations or directions |
| 38 | provided for in the General Appropriations Act, provided the |
| 39 | adjustment is consistent with legislative intent. |
| 40 | (12) |
| 41 | (d) Notwithstanding any other provision of this |
| 42 | subsection, the agency shall provide reimbursement for physician |
| 43 | and dental services provided to children younger than 21 years |
| 44 | of age at least at the level provided by federal law for |
| 45 | physician reimbursement under the Medicare program and provide |
| 46 | reimbursement for dental services at 50 percent of usual and |
| 47 | customary rates provided for dental services. The agency shall |
| 48 | include in all managed care contracts a requirement to provide |
| 49 | at least such reimbursement for physician and dental services. |
| 50 | Section 2. This act shall take effect July 1, 2007. |