Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. SPB 2506
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/01/2018           .                                

       The Committee on Appropriations (Flores) recommended the
    1         Senate Amendment to Amendment (822772) (with title
    2  amendment)
    4         Between lines 23 and 24
    5  insert:
    6         Section 6. Paragraph (a) of subsection (1) of section
    7  409.908, Florida Statutes, is amended to read:
    8         409.908 Reimbursement of Medicaid providers.—Subject to
    9  specific appropriations, the agency shall reimburse Medicaid
   10  providers, in accordance with state and federal law, according
   11  to methodologies set forth in the rules of the agency and in
   12  policy manuals and handbooks incorporated by reference therein.
   13  These methodologies may include fee schedules, reimbursement
   14  methods based on cost reporting, negotiated fees, competitive
   15  bidding pursuant to s. 287.057, and other mechanisms the agency
   16  considers efficient and effective for purchasing services or
   17  goods on behalf of recipients. If a provider is reimbursed based
   18  on cost reporting and submits a cost report late and that cost
   19  report would have been used to set a lower reimbursement rate
   20  for a rate semester, then the provider’s rate for that semester
   21  shall be retroactively calculated using the new cost report, and
   22  full payment at the recalculated rate shall be effected
   23  retroactively. Medicare-granted extensions for filing cost
   24  reports, if applicable, shall also apply to Medicaid cost
   25  reports. Payment for Medicaid compensable services made on
   26  behalf of Medicaid eligible persons is subject to the
   27  availability of moneys and any limitations or directions
   28  provided for in the General Appropriations Act or chapter 216.
   29  Further, nothing in this section shall be construed to prevent
   30  or limit the agency from adjusting fees, reimbursement rates,
   31  lengths of stay, number of visits, or number of services, or
   32  making any other adjustments necessary to comply with the
   33  availability of moneys and any limitations or directions
   34  provided for in the General Appropriations Act, provided the
   35  adjustment is consistent with legislative intent.
   36         (1) Reimbursement to hospitals licensed under part I of
   37  chapter 395 must be made prospectively or on the basis of
   38  negotiation.
   39         (a) Reimbursement for inpatient care is limited as provided
   40  in s. 409.905(5), except as otherwise provided in this
   41  subsection.
   42         1. If authorized by the General Appropriations Act, the
   43  agency may modify reimbursement for specific types of services
   44  or diagnoses, recipient ages, and hospital provider types.
   45         2. The agency may establish an alternative methodology to
   46  the DRG-based prospective payment system to set reimbursement
   47  rates for:
   48         a. State-owned psychiatric hospitals.
   49         b. Newborn hearing screening services.
   50         c. Transplant services for which the agency has established
   51  a global fee.
   52         d. Recipients who have tuberculosis that is resistant to
   53  therapy who are in need of long-term, hospital-based treatment
   54  pursuant to s. 392.62.
   55         e. Class III psychiatric hospitals.
   56         3. The agency shall modify reimbursement according to other
   57  methodologies recognized in the General Appropriations Act.
   59  The agency may receive funds from state entities, including, but
   60  not limited to, the Department of Health, local governments, and
   61  other local political subdivisions, for the purpose of making
   62  special exception payments, including federal matching funds,
   63  through the Medicaid inpatient reimbursement methodologies.
   64  Funds received for this purpose shall be separately accounted
   65  for and may not be commingled with other state or local funds in
   66  any manner. The agency may certify all local governmental funds
   67  used as state match under Title XIX of the Social Security Act,
   68  to the extent and in the manner authorized under the General
   69  Appropriations Act and pursuant to an agreement between the
   70  agency and the local governmental entity. In order for the
   71  agency to certify such local governmental funds, a local
   72  governmental entity must submit a final, executed letter of
   73  agreement to the agency, which must be received by October 1 of
   74  each fiscal year and provide the total amount of local
   75  governmental funds authorized by the entity for that fiscal year
   76  under this paragraph, paragraph (b), or the General
   77  Appropriations Act. The local governmental entity shall use a
   78  certification form prescribed by the agency. At a minimum, the
   79  certification form must identify the amount being certified and
   80  describe the relationship between the certifying local
   81  governmental entity and the local health care provider. The
   82  agency shall prepare an annual statement of impact which
   83  documents the specific activities undertaken during the previous
   84  fiscal year pursuant to this paragraph, to be submitted to the
   85  Legislature annually by January 1.
   86         Section 7. Present subsections (4) and (5) of section
   87  409.968, Florida Statutes, are redesignated as subsections (5)
   88  and (6), respectively, and a new subsection (4) is added to that
   89  section, to read:
   90         409.968 Managed care plan payments.—
   91         (4) Reimbursement for Class III psychiatric hospitals is
   92  not defined by the agency’s inpatient hospital APR-DRG
   93  compensation methodology and must be established using the
   94  federal Centers for Medicare and Medicaid Services prospective
   95  payment system pricing methodology or be limited to compensation
   96  amounts agreed to by the plan and the hospital.
   97         Section 8. Paragraph (d) of subsection (13) of section
   98  409.906, Florida Statutes, is amended to read:
   99         409.906 Optional Medicaid services.—Subject to specific
  100  appropriations, the agency may make payments for services which
  101  are optional to the state under Title XIX of the Social Security
  102  Act and are furnished by Medicaid providers to recipients who
  103  are determined to be eligible on the dates on which the services
  104  were provided. Any optional service that is provided shall be
  105  provided only when medically necessary and in accordance with
  106  state and federal law. Optional services rendered by providers
  107  in mobile units to Medicaid recipients may be restricted or
  108  prohibited by the agency. Nothing in this section shall be
  109  construed to prevent or limit the agency from adjusting fees,
  110  reimbursement rates, lengths of stay, number of visits, or
  111  number of services, or making any other adjustments necessary to
  112  comply with the availability of moneys and any limitations or
  113  directions provided for in the General Appropriations Act or
  114  chapter 216. If necessary to safeguard the state’s systems of
  115  providing services to elderly and disabled persons and subject
  116  to the notice and review provisions of s. 216.177, the Governor
  117  may direct the Agency for Health Care Administration to amend
  118  the Medicaid state plan to delete the optional Medicaid service
  119  known as “Intermediate Care Facilities for the Developmentally
  120  Disabled.” Optional services may include:
  122         (d) The agency shall seek federal approval to pay for
  123  flexible services for persons with severe mental illness or
  124  substance use disorders, including, but not limited to,
  125  temporary housing assistance. Payments may be made as enhanced
  126  capitation rates or incentive payments to managed care plans
  127  that meet the requirements of s. 409.968(5) s. 409.968(4).
  129  ================= T I T L E  A M E N D M E N T ================
  130  And the title is amended as follows:
  131         After line 32
  132  insert:
  133         amending s. 409.908, F.S.; removing the agency’s
  134         authority to establish an alternative methodology to
  135         the DRG-based prospective payment system to set
  136         reimbursement rates for Class III psychiatric
  137         hospitals; amending s. 409.968, F.S.; revising the
  138         rate-setting methodology used in the reimbursement of
  139         Class III psychiatric hospitals; amending s. 409.906,
  140         F.S.; conforming a cross-reference;