995140 Florida Senate - 2019 Committee Amendment SPB2500 AHS 19SA The Committee on Appropriations(Gibson) recommended the following SUBSTITUTE AMENDMENT for 19 (995132):Section: 03 EXPLANATION: On Page: 052 Inserts proviso and provides $10,400,000 in funding from the General Revenue Fund in Specific Spec App: 200 Appropriation 200 for a statutory teaching hospital designated as a Level 1 trauma center and whose commercial to charity ratio exceeds 50 percent. Reduces $10,400,000 in general revenue funds from Specific Appropriation 203 and revises the proviso to reflect the reduction in funds. NET IMPACT ON: Total Funds General Revenue Trust Funds Recurring - 0 0 0 Non-Recurring - 0 0 0 ______________________________________________________________________________________ Positions & Amount Positions & Amount DELETE INSERT AGENCY FOR HEALTH CARE ADMINISTRATION Program: Health Care Services Medicaid Services To Individuals 68501400 In Section 03 On Page 052 200 Special Categories 101321 Grants And Aids - Shands Teaching Hospital IOEB 1000 General Revenue Fund 8,673,569 19,073,569 CA 10,400,000 FSI1 10,400,000 DELETE the proviso immediately following Specific Appropriation 200: The funds in Specific Appropriation 200 shall be primarily designated for transfer to the Agency for Health Care Administration's Grants and Donations Trust Fund for use in the Medicaid program. Should the agency be unable to use the full amount of these designated funds as Medicaid match, the remaining funds may be used secondarily for payments to Shands Teaching Hospital to continue the original purpose of providing health care services to indigent patients through Shands Healthcare System.995140 Log:0186 BRM/BRM 03/26/19 07:21:03 PM Senate Page: 1 AND INSERT: From the funds in Specific Appropriation 200, $8,673,569 from the General Revenue Fund and $1,000,000 from the Grants and Donations Trust Fund shall be primarily designated for transfer to the Agency for Health Care Administration's Grants and Donations Trust Fund for use in the Medicaid program. Should the agency be unable to use the full amount of these designated funds as Medicaid match, the remaining funds may be used secondarily for payments to Shands Teaching Hospital to continue the original purpose of providing health care services to indigent patients through Shands Healthcare System. From the funds in Specific Appropriation 200, $10,400,000 from the General Revenue Fund is provided for a statutory teaching hospital as defined in s. 408.07(44), Florida Statutes, that is a Level 1 trauma center and whose commercial to charity ratio exceeds 50 percent. In Section 03 On Page 053 203 Special Categories 101582 Hospital Inpatient Services IOEE 1000 General Revenue Fund 238,914,580 228,514,580 CA -10,400,000 FSI2 -10,400,000 DELETE the following proviso in Specific Appropriation 203: Base Rate - $3,888.25 Neonates Service Adjustor Severity Level 1 - 1.0 Neonates Service Adjustor Severity Level 2 - 1.52 Neonates Service Adjustor Severity Level 3 - 1.8 Neonates Service Adjustor Severity Level 4 - 2.0 Neonatal, Pediatric, Transplant Pediatric, Mental Health and Rehab DRGs: Severity Level 1 - 1.0 Severity Level 2 - 1.52 Severity Level 3 - 1.8 Severity Level 4 - 2.0 Free Standing Rehabilitation Provider Adjustor - 3.921 Rural Provider Adjustor - 2.093 Long Term Acute Care (LTAC) Provider Adjustor - 2.031 High Medicaid and High Outlier Provider Adjustor - 2.425 Outlier Threshold - $60,000 Marginal Cost Percentage - 60% Marginal Cost Percentage for Pediatric Claims Severity Levels 3 or 4 - 80% Marginal Cost Percentage for Neonates Claims Severity Levels 3 or 4 - 80% Marginal Cost Percentage for Transplant Pediatric Claims Severity Levels 3 or 4 - 80%995140 Log:0186 BRM/BRM 03/26/19 07:21:03 PM Senate Page: 2 Documentation and Coding Adjustment - 1/3 of 1% per year Level I Trauma Add On - 17% Level II or Level II and Pediatric Add On - 11% Pediatric Trauma Add On - 4% Funds in Specific Appropriations 203 and 207 reflect an elimination of Hospital Inpatient and Hospital Outpatient Automatic Rate Enhancements and redirect $123,473,619 from the General Revenue Fund and $195,744,629 from the Medical Care Trust Fund to the Diagnosis Related Grouping (DRG) base rate and the Enhanced Ambulatory Patient Group (EAPG) base rate. AND INSERT: Base Rate - $3,861.32 Neonates Service Adjustor Severity Level 1 - 1.0 Neonates Service Adjustor Severity Level 2 - 1.52 Neonates Service Adjustor Severity Level 3 - 1.8 Neonates Service Adjustor Severity Level 4 - 2.0 Neonatal, Pediatric, Transplant Pediatric, Mental Health and Rehab DRGs: Severity Level 1 - 1.0 Severity Level 2 - 1.52 Severity Level 3 - 1.8 Severity Level 4 - 2.0 Free Standing Rehabilitation Provider Adjustor - 3.921 Rural Provider Adjustor - 2.102 Long Term Acute Care (LTAC) Provider Adjustor - 2.011 High Medicaid and High Outlier Provider Adjustor - 2.403 Outlier Threshold - $60,000 Marginal Cost Percentage - 60% Marginal Cost Percentage for Pediatric Claims Severity Levels 3 or 4 - 80% Marginal Cost Percentage for Neonates Claims Severity Levels 3 or 4 - 80% Marginal Cost Percentage for Transplant Pediatric Claims Severity Levels 3 or 4 - 80% Documentation and Coding Adjustment - 1/3 of 1% per year Level I Trauma Add On - 17% Level II or Level II and Pediatric Add On - 11% Pediatric Trauma Add On - 4% Funds in Specific Appropriations 203 and 207 reflect an elimination of $123,473,619 from the General Revenue Fund and $195,744,629 from the Medical Care Trust Fund in Hospital Inpatient and Hospital Outpatient Automatic Rate Enhancements and redirects $113,073,619 from the General Revenue Fund and $195,744,629 from the Medical Care Trust Fund to the Diagnosis Related Grouping (DRG) base rate and the Enhanced Ambulatory Patient Group (EAPG) base rate.995140 Log:0186 BRM/BRM 03/26/19 07:21:03 PM Senate Page: 3