ENROLLED
       2021 Legislature                                   CS for SB 348
       
       
       
       
       
       
                                                              2021348er
    1  
    2         An act relating to Medicaid; amending s. 409.908,
    3         F.S.; revising the types of emergency transportation
    4         vehicle services provided to Medicare-eligible persons
    5         for which Medicaid shall pay deductibles and
    6         coinsurance; specifying that such payments must be
    7         made according to certain procedure codes; providing
    8         an effective date.
    9          
   10  Be It Enacted by the Legislature of the State of Florida:
   11  
   12         Section 1. Paragraph (c) of subsection (13) of section
   13  409.908, Florida Statutes, is amended to read:
   14         409.908 Reimbursement of Medicaid providers.—Subject to
   15  specific appropriations, the agency shall reimburse Medicaid
   16  providers, in accordance with state and federal law, according
   17  to methodologies set forth in the rules of the agency and in
   18  policy manuals and handbooks incorporated by reference therein.
   19  These methodologies may include fee schedules, reimbursement
   20  methods based on cost reporting, negotiated fees, competitive
   21  bidding pursuant to s. 287.057, and other mechanisms the agency
   22  considers efficient and effective for purchasing services or
   23  goods on behalf of recipients. If a provider is reimbursed based
   24  on cost reporting and submits a cost report late and that cost
   25  report would have been used to set a lower reimbursement rate
   26  for a rate semester, then the provider’s rate for that semester
   27  shall be retroactively calculated using the new cost report, and
   28  full payment at the recalculated rate shall be effected
   29  retroactively. Medicare-granted extensions for filing cost
   30  reports, if applicable, shall also apply to Medicaid cost
   31  reports. Payment for Medicaid compensable services made on
   32  behalf of Medicaid eligible persons is subject to the
   33  availability of moneys and any limitations or directions
   34  provided for in the General Appropriations Act or chapter 216.
   35  Further, nothing in this section shall be construed to prevent
   36  or limit the agency from adjusting fees, reimbursement rates,
   37  lengths of stay, number of visits, or number of services, or
   38  making any other adjustments necessary to comply with the
   39  availability of moneys and any limitations or directions
   40  provided for in the General Appropriations Act, provided the
   41  adjustment is consistent with legislative intent.
   42         (13) Medicare premiums for persons eligible for both
   43  Medicare and Medicaid coverage shall be paid at the rates
   44  established by Title XVIII of the Social Security Act. For
   45  Medicare services rendered to Medicaid-eligible persons,
   46  Medicaid shall pay Medicare deductibles and coinsurance as
   47  follows:
   48         (c) Notwithstanding paragraphs (a) and (b):
   49         1. Medicaid payments for Nursing Home Medicare part A
   50  coinsurance are limited to the Medicaid nursing home per diem
   51  rate less any amounts paid by Medicare, but only up to the
   52  amount of Medicare coinsurance. The Medicaid per diem rate shall
   53  be the rate in effect for the dates of service of the crossover
   54  claims and may not be subsequently adjusted due to subsequent
   55  per diem rate adjustments.
   56         2. Medicaid shall pay all deductibles and coinsurance for
   57  Medicare-eligible recipients receiving freestanding end stage
   58  renal dialysis center services.
   59         3. Medicaid payments for general and specialty hospital
   60  inpatient services are limited to the Medicare deductible and
   61  coinsurance per spell of illness. Medicaid payments for hospital
   62  Medicare Part A coinsurance shall be limited to the Medicaid
   63  hospital per diem rate less any amounts paid by Medicare, but
   64  only up to the amount of Medicare coinsurance. Medicaid payments
   65  for coinsurance shall be limited to the Medicaid per diem rate
   66  in effect for the dates of service of the crossover claims and
   67  may not be subsequently adjusted due to subsequent per diem
   68  adjustments.
   69         4. Medicaid shall pay all deductibles and coinsurance for
   70  Medicare-covered Medicare emergency transportation services
   71  provided to Medicare-eligible recipients by ambulances licensed
   72  pursuant to chapter 401 according to the corresponding procedure
   73  codes for such services.
   74         5. Medicaid shall pay all deductibles and coinsurance for
   75  portable X-ray Medicare Part B services provided in a nursing
   76  home, in an assisted living facility, or in the patient’s home.
   77         Section 2. This act shall take effect July 1, 2021.