Proposed Committee Substitute by the Committee on Health and Human

Services Appropriations

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A bill to be entitled

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An act relating to reimbursement of Medicaid providers;

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amending s. 409.908, F.S.; requiring the Agency for Health

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Care Administration to limit the reimbursement rate for

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certain specified providers notwithstanding certain

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provisions and rules to the contrary; providing that the

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limitations apply to prepaid health plans and nursing home

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diversion programs; providing for application; providing

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an effective date.

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Be It Enacted by the Legislature of the State of Florida:

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     Section 1.  Subsection (23) is added to section 409.908,

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Florida Statutes, to read:

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     409.908  Reimbursement of Medicaid providers.--Subject to

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specific appropriations, the agency shall reimburse Medicaid

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providers, in accordance with state and federal law, according to

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methodologies set forth in the rules of the agency and in policy

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manuals and handbooks incorporated by reference therein. These

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methodologies may include fee schedules, reimbursement methods

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based on cost reporting, negotiated fees, competitive bidding

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pursuant to s. 287.057, and other mechanisms the agency considers

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efficient and effective for purchasing services or goods on

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behalf of recipients. If a provider is reimbursed based on cost

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reporting and submits a cost report late and that cost report

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would have been used to set a lower reimbursement rate for a rate

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semester, then the provider's rate for that semester shall be

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retroactively calculated using the new cost report, and full

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payment at the recalculated rate shall be effected retroactively.

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Medicare-granted extensions for filing cost reports, if

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applicable, shall also apply to Medicaid cost reports. Payment

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for Medicaid compensable services made on behalf of Medicaid

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eligible persons is subject to the availability of moneys and any

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limitations or directions provided for in the General

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Appropriations Act or chapter 216. Further, nothing in this

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section shall be construed to prevent or limit the agency from

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adjusting fees, reimbursement rates, lengths of stay, number of

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visits, or number of services, or making any other adjustments

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necessary to comply with the availability of moneys and any

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limitations or directions provided for in the General

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Appropriations Act, provided the adjustment is consistent with

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legislative intent.

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     (23)(a) Notwithstanding the provisions of this section to

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the contrary and any rules adopted thereunder to the contrary,

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the agency shall limit each provider's reimbursement rate by

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reducing the provider's reimbursement rate in an amount necessary

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to reduce the statewide weighted average rate so that the new

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rate semester equals the statewide weighted average rate for the

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preceding rate semester.

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     (b) This subsection applies to the following types of

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providers:

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     1. Inpatient hospitals;

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     2. Outpatient hospitals;

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     3. Nursing homes;

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     4. County health departments; and

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     5. Community intermediate care facilities for the

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developmentally disabled.

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The agency shall apply the effect of these limitations to the

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reimbursement rates for prepaid health plans and nursing home

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diversion programs.

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     (c) This subsection applies to reimbursement rates paid on

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July 1, 2008, and thereafter.

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     Section 2.  This act shall take effect upon becoming a law.