Florida Senate - 2011 SENATOR AMENDMENT
Bill No. CS/HB 7107, 2nd Eng.
Barcode 633326
LEGISLATIVE ACTION
Senate . House
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Floor: WD/2R .
05/05/2011 03:17 PM .
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Senator Fasano moved the following:
1 Senate Amendment (with title amendment)
2
3 Between lines 227 and 228
4 insert:
5 Section 1. Subsection (18) of section 409.908, Florida
6 Statutes, is amended to read:
7 409.908 Reimbursement of Medicaid providers.—Subject to
8 specific appropriations, the agency shall reimburse Medicaid
9 providers, in accordance with state and federal law, according
10 to methodologies set forth in the rules of the agency and in
11 policy manuals and handbooks incorporated by reference therein.
12 These methodologies may include fee schedules, reimbursement
13 methods based on cost reporting, negotiated fees, competitive
14 bidding pursuant to s. 287.057, and other mechanisms the agency
15 considers efficient and effective for purchasing services or
16 goods on behalf of recipients. If a provider is reimbursed based
17 on cost reporting and submits a cost report late and that cost
18 report would have been used to set a lower reimbursement rate
19 for a rate semester, then the provider’s rate for that semester
20 shall be retroactively calculated using the new cost report, and
21 full payment at the recalculated rate shall be effected
22 retroactively. Medicare-granted extensions for filing cost
23 reports, if applicable, shall also apply to Medicaid cost
24 reports. Payment for Medicaid compensable services made on
25 behalf of Medicaid eligible persons is subject to the
26 availability of moneys and any limitations or directions
27 provided for in the General Appropriations Act or chapter 216.
28 Further, nothing in this section shall be construed to prevent
29 or limit the agency from adjusting fees, reimbursement rates,
30 lengths of stay, number of visits, or number of services, or
31 making any other adjustments necessary to comply with the
32 availability of moneys and any limitations or directions
33 provided for in the General Appropriations Act, provided the
34 adjustment is consistent with legislative intent.
35 (18) Unless otherwise provided for in the General
36 Appropriations Act, a provider of transportation services shall
37 be reimbursed the lesser of the amount billed by the provider or
38 the Medicaid maximum allowable fee established by the agency,
39 except if when the agency has entered into a direct contract
40 with the provider, or with a community transportation
41 coordinator, for the provision of an all-inclusive service, or
42 if when services are provided pursuant to an agreement
43 negotiated between the agency and the provider. The agency, as
44 provided for in s. 427.0135, shall purchase transportation
45 services through the community coordinated transportation
46 system, if available, unless the agency, after consultation with
47 the commission, determines that it cannot reach mutually
48 acceptable contract terms with the commission. The agency may
49 then contract for the same transportation services provided in a
50 more cost-effective manner and of comparable or higher quality
51 and standards. Nothing in
52 (a) This subsection does not shall be construed to limit or
53 preclude the agency from contracting for services using a
54 prepaid capitation rate or from establishing maximum fee
55 schedules, individualized reimbursement policies by provider
56 type, negotiated fees, prior authorization, competitive bidding,
57 increased use of mass transit, or any other mechanism that the
58 agency considers efficient and effective for the purchase of
59 services on behalf of Medicaid clients, including implementing a
60 transportation eligibility process.
61 (b) The agency may shall not be required to contract with
62 any community transportation coordinator or transportation
63 operator that has been determined by the agency, the Department
64 of Legal Affairs Medicaid Fraud Control Unit, or any other state
65 or federal agency to have engaged in any abusive or fraudulent
66 billing activities.
67 (c) The agency shall is authorized to competitively procure
68 transportation services or make other changes necessary to
69 secure approval of federal waivers needed to permit federal
70 financing of Medicaid transportation services at the service
71 matching rate rather than the administrative matching rate.
72 Notwithstanding chapter 427, the agency is authorized to
73 continue contracting for Medicaid nonemergency transportation
74 services in agency service area 11 with managed care plans that
75 were under contract for those services before July 1, 2004.
76
77 ================= T I T L E A M E N D M E N T ================
78 And the title is amended as follows:
79 Delete line 2
80 and insert:
81 An act relating to Medicaid managed care; amending s.
82 409.908, F.S.; requiring the Agency for Health Care
83 Administration to competitively procure transportation
84 services to permit federal financing of Medicaid
85 transportation services at the service matching rate
86 rather than the administrative matching rate; deleting
87 the provision that authorizes the agency to continue
88 contracting for Medicaid nonemergency transportation
89 services in agency service area 11 with managed care
90 plans that were under contract for those services
91 before a specified date; creating pt. IV