Florida Senate - 2013 COMMITTEE AMENDMENT
Bill No. SB 1884
Barcode 215006
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/25/2013 .
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The Committee on Appropriations (Grimsley) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 409.915, Florida Statutes, is amended to
6 read:
7 409.915 County contributions to Medicaid.—Although the
8 state is responsible for the full portion of the state share of
9 the matching funds required for the Medicaid program, in order
10 to acquire a certain portion of these funds, the state shall
11 charge the counties an annual contribution in order to acquire a
12 certain portion of these funds for certain items of care and
13 service as provided in this section.
14 (1) As used in this section, the term “state Medicaid
15 expenditures” means those expenditures used as matching funds
16 for the federal Medicaid program.
17 (2)(a) For the 2013-2014 state fiscal year, the total
18 amount of the counties’ contribution is $269.6 million. For each
19 fiscal year thereafter, the annual amount shall be adjusted by
20 the percentage change in the state Medicaid expenditures as
21 determined by the Social Services Estimating Conference.
22 (b) By March 15 of each year, the Social Services
23 Estimating Conference shall determine the percentage change in
24 state Medicaid expenditures by comparing expenditures for the 2
25 most recent completed state fiscal years.
26 (3)(a)1. The amount of each county’s annual contribution is
27 equal to the product of the amount determined under subsection
28 (2) multiplied by the sum of the percentages calculated in sub
29 subparagraphs a. and b.:
30 a. The enrollment weight provided in subparagraph 2. is
31 multiplied by a fraction, the numerator of which is the number
32 of the county’s Medicaid enrollees as of March 1 of each year,
33 and the denominator of which is the number of all counties’
34 Medicaid enrollees as of March 1 of each year. The agency shall
35 calculate this amount for each county and provide the
36 information to the Department of Revenue by May 15 of each year.
37 b. The payment weight provided in subparagraph 2. is
38 multiplied by the percentage share of payments provided in
39 subparagraph 3. for each county.
40 2. The weights for each fiscal year are equal to:
41
42
43 Weights
44 Fiscal Year Enrollment Payment
45 2013-14 0% 100%
46 2014-15 16.67% 83.33%
47 2015-16 33.34% 66.66%
48 2016-17 50% 50%
49 2017-18 66.66% 33.34%
50 2018-19 83.33% 16.67%
51 2019-20+ 100% 0%
52 3. The percentage share of payments for each county is:
53
54 County Share of Payments
55 ALACHUA 1.278%
56 BAKER 0.116%
57 BAY 0.607%
58 BRADFORD 0.179%
59 BREVARD 2.471%
60 BROWARD 9.226%
61 CALHOUN 0.084%
62 CHARLOTTE 0.578%
63 CITRUS 0.663%
64 CLAY 0.635%
65 COLLIER 1.160%
66 COLUMBIA 0.557%
67 DADE (MIAMI-DADE)18.850%
68 DESOTO 0.167%
69 DIXIE 0.098%
70 DUVAL 5.336%
71 ESCAMBIA 1.614%
72 FLAGLER 0.397%
73 FRANKLIN 0.091%
74 GADSDEN 0.239%
75 GILCHRIST 0.078%
76 GLADES 0.055%
77 GULF 0.076%
78 HAMILTON 0.075%
79 HARDEE 0.110%
80 HENDRY 0.163%
81 HERNANDO 0.862%
82 HIGHLANDS 0.468%
83 HILLSBOROUGH 6.952%
84 HOLMES 0.101%
85 INDIAN RIVER 0.397%
86 JACKSON 0.218%
87 JEFFERSON 0.083%
88 LAFAYETTE 0.014%
89 LAKE 1.525%
90 LEE 2.511%
91 LEON 0.929%
92 LEVY 0.256%
93 LIBERTY 0.050%
94 MADISON 0.086%
95 MANATEE 1.622%
96 MARION 1.629%
97 MARTIN 0.352%
98 MONROE 0.262%
99 NASSAU 0.240%
100 OKALOOSA 0.566%
101 OKEECHOBEE 0.235%
102 ORANGE 6.680%
103 OSCEOLA 1.613%
104 PALM BEACH 5.898%
105 PASCO 2.391%
106 PINELLAS 6.644%
107 POLK 3.642%
108 PUTNAM 0.417%
109 SAINT JOHNS 0.459%
110 SAINT LUCIE 1.154%
111 SANTA ROSA 0.462%
112 SARASOTA 1.230%
113 SEMINOLE 1.739%
114 SUMTER 0.218%
115 SUWANNEE 0.252%
116 TAYLOR 0.103%
117 UNION 0.075%
118 VOLUSIA 2.298%
119 WAKULLA 0.103%
120 WALTON 0.229%
121 WASHINGTON 0.114%
122 (b)1. The Legislature intends to replace the county
123 percentage share provided in subparagraph (a)3. with percentage
124 shares based upon each county’s proportion of the total
125 statewide amount of county billings made under this section from
126 April 1, 2012, through March 31, 2013, for which the state
127 ultimately receives payment.
128 2. By February 1 of each year and continuing until a
129 certification is made under sub-subparagraph b., the agency
130 shall report to the President of the Senate and the Speaker of
131 the House of Representatives the status of the county billings
132 made under this section from April 1, 2012, through March 31,
133 2013, by county, including:
134 a. The amounts billed to each county which remain unpaid,
135 if any; and
136 b. A certification from the agency of a final accounting of
137 the amount of funds received by the state from such billings, by
138 county, upon the expiration of all appeal rights that counties
139 may have to contest such billings.
140 3. By March 15 of the state fiscal year in which the state
141 receives the certification provided for in sub-subparagraph
142 (b)2.b., the Social Services Estimating Conference shall
143 calculate each county’s percentage share of the total statewide
144 amount of county billings made under this section from April 1,
145 2012, through March 31, 2013, for which the state ultimately
146 receives payment.
147 4. Beginning in the state fiscal year following the receipt
148 by the state of the certification provided in sub-subparagraph
149 (b)2.b., each county’s percentage share under subparagraph (a)3.
150 shall be replaced by the percentage calculated under
151 subparagraph (b)3.
152 5. If the court invalidates the replacement of each
153 county’s share as provided in this paragraph, the county share
154 set forth in subparagraph (a)3. shall continue to apply.
155 (4) By June 1 of each year, the Department of Revenue shall
156 notify each county of its required annual contribution. Each
157 county shall pay its contribution, by check or electronic
158 transfer, in equal monthly installments to the department by the
159 5th day of each month. If a county fails to remit the payment by
160 the 5th day of the month, the department shall reduce the
161 monthly distribution of that county pursuant to s. 218.61 and,
162 if necessary, by the amount of the monthly installment pursuant
163 to s. 218.26. The payments and the amounts by which the
164 distributions are reduced shall be transferred to the General
165 Revenue Fund.
166 (1) Each county shall participate in the following items of
167 care and service:
168 (a) For both health maintenance members and fee-for-service
169 beneficiaries, payments for inpatient hospitalization in excess
170 of 10 days, but not in excess of 45 days, with the exception of
171 pregnant women and children whose income is in excess of the
172 federal poverty level and who do not participate in the Medicaid
173 medically needy program, and for adult lung transplant services.
174 (b) For both health maintenance members and fee-for-service
175 beneficiaries, payments for nursing home or intermediate
176 facilities care in excess of $170 per month, with the exception
177 of skilled nursing care for children under age 21.
178 (2) A county’s participation must be 35 percent of the
179 total cost, or the applicable discounted cost paid by the state
180 for Medicaid recipients enrolled in health maintenance
181 organizations or prepaid health plans, of providing the items
182 listed in subsection (1), except that the payments for items
183 listed in paragraph (1)(b) may not exceed $55 per month per
184 person.
185 (3) Each county shall set aside sufficient funds to pay for
186 items of care and service provided to the county’s eligible
187 recipients for which county contributions are required,
188 regardless of where in the state the care or service is
189 rendered.
190 (4) Each county shall contribute its pro rata share of the
191 total county participation based upon statements rendered by the
192 agency. The agency shall render such statements monthly based on
193 each county’s eligible recipients. For purposes of this section,
194 each county’s eligible recipients shall be determined by the
195 recipient’s address information contained in the federally
196 approved Medicaid eligibility system within the Department of
197 Children and Family Services. A county may use the process
198 developed under subsection (10) to request a refund if it
199 determines that the statement rendered by the agency contains
200 errors.
201 (5) In any county in which a special taxing district or
202 authority is located which benefits will benefit from the
203 Medicaid program medical assistance programs covered by this
204 section, the board of county commissioners may divide the
205 county’s financial responsibility for this purpose
206 proportionately, and each such district or authority must
207 furnish its share to the board of county commissioners in time
208 for the board to comply with subsection (4) (3). Any appeal of
209 the proration made by the board of county commissioners must be
210 made to the Department of Financial Services, which shall then
211 set the proportionate share for of each party.
212 (6) Counties are exempt from contributing toward the cost
213 of new exemptions on inpatient ceilings for statutory teaching
214 hospitals, specialty hospitals, and community hospital education
215 program hospitals that came into effect July 1, 2000, and for
216 special Medicaid payments that came into effect on or after July
217 1, 2000.
218 (6)(7)(a) By August 1, 2012, the agency shall certify to
219 each county the amount of such county’s billings from November
220 1, 2001, through April 30, 2012, which remain unpaid. A county
221 may contest the amount certified by filing a petition under the
222 applicable provisions of chapter 120 on or before September 1,
223 2012. This procedure is the exclusive method to challenge the
224 amount certified. In order to successfully challenge the amount
225 certified, a county must show, by a preponderance of the
226 evidence, that a recipient was not an eligible recipient of that
227 county or that the amount certified was otherwise in error.
228 (b) By September 15, 2012, the agency shall certify to the
229 Department of Revenue:
230 1. For each county that files a petition on or before
231 September 1, 2012, the amount certified under paragraph (a); and
232 2. For each county that does not file a petition on or
233 before September 1, 2012, an amount equal to 85 percent of the
234 amount certified under paragraph (a).
235 (c) The filing of a petition under paragraph (a) does shall
236 not stay or stop the Department of Revenue from reducing
237 distributions in accordance with paragraph (b) and subsection
238 (7) (8). If a county that files a petition under paragraph (a)
239 is able to demonstrate that the amount certified should be
240 reduced, the agency shall notify the Department of Revenue of
241 the amount of the reduction. The Department of Revenue shall
242 adjust all future monthly distribution reductions under
243 subsection (7) (8) in a manner that results in the remaining
244 total distribution reduction being applied in equal monthly
245 amounts.
246 (7)(8)(a) Beginning with the October 2012 distribution, the
247 Department of Revenue shall reduce each county’s distributions
248 pursuant to s. 218.26 by one thirty-sixth of the amount
249 certified by the agency under subsection (6) (7) for that
250 county, minus any amount required under paragraph (b). Beginning
251 with the October 2013 distribution, the Department of Revenue
252 shall reduce each county’s distributions pursuant to s. 218.26
253 by one forty-eighth of two-thirds of the amount certified by the
254 agency under subsection (6) (7) for that county, minus any
255 amount required under paragraph (b). However, the amount of the
256 reduction may not exceed 50 percent of each county’s
257 distribution. If, after 60 months, the reductions for any county
258 do not equal the total amount initially certified by the agency,
259 the Department of Revenue shall continue to reduce such county’s
260 distribution by up to 50 percent until the total amount
261 certified is reached. The amounts by which the distributions are
262 reduced shall be transferred to the General Revenue Fund.
263 (b) As an assurance to holders of bonds issued before the
264 effective date of this act to which distributions made pursuant
265 to s. 218.26 are pledged, or bonds issued to refund such bonds
266 which mature no later than the bonds they refunded and which
267 result in a reduction of debt service payable in each fiscal
268 year, the amount available for distribution to a county shall
269 remain as provided by law and continue to be subject to any lien
270 or claim on behalf of the bondholders. The Department of Revenue
271 must ensure, based on information provided by an affected
272 county, that any reduction in amounts distributed pursuant to
273 paragraph (a) does not reduce the amount of distribution to a
274 county below the amount necessary for the timely payment of
275 principal and interest when due on the bonds and the amount
276 necessary to comply with any covenant under the bond resolution
277 or other documents relating to the issuance of the bonds. If a
278 reduction to a county’s monthly distribution must be decreased
279 in order to comply with this paragraph, the Department of
280 Revenue must notify the agency of the amount of the decrease and
281 the agency must send a bill for payment of such amount to the
282 affected county.
283 (9)(a) Beginning May 1, 2012, and each month thereafter,
284 the agency shall certify to the Department of Revenue by the 7th
285 day of each month the amount of the monthly statement rendered
286 to each county pursuant to subsection (4). Beginning with the
287 May 2012 distribution, the Department of Revenue shall reduce
288 each county’s monthly distribution pursuant to s. 218.61 by the
289 amount certified by the agency minus any amount required under
290 paragraph (b). The amounts by which the distributions are
291 reduced shall be transferred to the General Revenue Fund.
292 (b) As an assurance to holders of bonds issued before the
293 effective date of this act to which distributions made pursuant
294 to s. 218.61 are pledged, or bonds issued to refund such bonds
295 which mature no later than the bonds they refunded and which
296 result in a reduction of debt service payable in each fiscal
297 year, the amount available for distribution to a county shall
298 remain as provided by law and continue to be subject to any lien
299 or claim on behalf of the bondholders. The Department of Revenue
300 must ensure, based on information provided by an affected
301 county, that any reduction in amounts distributed pursuant to
302 paragraph (a) does not reduce the amount of distribution to a
303 county below the amount necessary for the timely payment of
304 principal and interest when due on the bonds and the amount
305 necessary to comply with any covenant under the bond resolution
306 or other documents relating to the issuance of the bonds. If a
307 reduction to a county’s monthly distribution must be decreased
308 in order to comply with this paragraph, the Department of
309 Revenue must notify the agency of the amount of the decrease and
310 the agency must send a bill for payment of such amount to the
311 affected county.
312 (10) The agency, in consultation with the Department of
313 Revenue and the Florida Association of Counties, shall develop a
314 process for refund requests which:
315 (a) Allows counties to submit to the agency written
316 requests for refunds of any amounts by which the distributions
317 were reduced as provided in subsection (9) and which set forth
318 the reasons for the refund requests.
319 (b) Requires the agency to make a determination as to
320 whether a refund request is appropriate and should be approved,
321 in which case the agency shall certify the amount of the refund
322 to the department.
323 (c) Requires the department to issue the refund for the
324 certified amount to the county from the General Revenue Fund.
325 The Department of Revenue may issue the refund in the form of a
326 credit against reductions to be applied to subsequent monthly
327 distributions.
328 (8)(11) Beginning in the 2013-2014 fiscal year and each
329 year thereafter through the 2020-2021 fiscal year, the Chief
330 Financial Officer shall transfer from the General Revenue Fund
331 to the Lawton Chiles Endowment Fund an amount equal to the
332 amounts transferred to the General Revenue Fund in the previous
333 fiscal year pursuant to subsections (4) and (7) subsections (8)
334 and (9), reduced by the amount of refunds paid pursuant to
335 subsection (10), which are in excess of the official estimate
336 for medical hospital fees for such previous fiscal year adopted
337 by the Revenue Estimating Conference on January 12, 2012, as
338 reflected in the conference’s workpapers. By July 20 of each
339 year, the Office of Economic and Demographic Research shall
340 certify the amount to be transferred to the Chief Financial
341 Officer. Such transfers must be made before July 31 of each year
342 until the total transfers for all years equal $350 million. If
343 In the event that such transfers do not total $350 million by
344 July 1, 2021, the Legislature shall provide for the transfer of
345 amounts necessary to total $350 million. The Office of Economic
346 and Demographic Research shall publish the official estimates
347 reflected in the conference’s workpapers on its website.
348 (9)(12) The agency may adopt rules to administer this
349 section.
350 Section 2. Notwithstanding s. 409.915(3) and (4), Florida
351 Statutes, as amended by this act, the amount of each county’s
352 contribution during the 2013-2014 state fiscal year shall be
353 determined and provided to the Department of Revenue by the
354 Agency for Health Care Administration by June 15, 2013. The
355 Department of Revenue shall notify each county of its annual
356 contribution by June 20, 2013.
357 Section 3. This act shall take effect upon becoming a law.
358
359 ================= T I T L E A M E N D M E N T ================
360 And the title is amended as follows:
361 Delete everything before the enacting clause
362 and insert:
363 A bill to be entitled
364 An act relating to county Medicaid contributions;
365 amending s. 409.915, F.S.; specifying the total
366 contribution for the year and specifying the method
367 for determining the amount in the following years;
368 revising the method for calculating each county’s
369 contribution; providing tables for calculating county
370 contributions; requiring the Agency for Health Care
371 Administration to annually report the status of county
372 billings to the Legislature; authorizing the
373 Department of Revenue to withhold county distributions
374 for failure to remit Medicaid contributions; deleting
375 provisions specifying the care and services that
376 counties must participate in, obsolete bond
377 provisions, and a process for refund requests;
378 specifying the method for calculating each county’s
379 contribution for the 2013-2014 fiscal year; providing
380 an effective date.