14670879, 59G-6.020 - Florida Administrative Rules, Law, Code, Register

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Notice: 14670879

Notice of Development of Rulemaking

Department:

AGENCY FOR HEALTH CARE ADMINISTRATION

Division:

Medicaid

Chapter:

REIMBURSEMENT TO PROVIDERS

Overview

RULE:

59G-6.020

Payment Methodology for Inpatient Hospital Services

PURPOSE:

The purpose of the amendment to Rule 59G-6.020 is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan, Version XLI, effective July 1, 2014 (the Plan). The amendment will update the Plan to reflect changes to the payment methodology for inpatient hospital services as authorized in House Bill 5001, 2014-15 General Appropriations Act, Specific Appropriation 210, as follows:
1.	$2,672,282 is provided to increase the diagnosis related grouping rural hospital provider adjustor for rural hospitals as described in section 395.602, Florida Statutes (F.S.).
2.	Any hospital that was exempt from the inpatient reimbursement ceiling in the prior state fiscal year, due to their charity care and Medicaid days as a percentage to total adjusted hospital days equaling or exceeding 11 percent, but no longer meets the 11 percent threshold, because of updated audited DSH data, shall remain exempt from the inpatient reimbursement ceilings for a period of two years.
3.	A four percent adjustment shall be applied for anticipated case mix increases from improved documentation and coding through the implementation of Diagnosis Related Grouping (DRG) and a one percent adjustment will be applied for real case mix change. 
4.	$7,542,036 in nonrecurring funds for sole community hospitals that meet the definition of "rural hospital" under section 395.602(2)(e)4, F.S., to be recognized as rural hospitals in the Agency for Health Care Administration’s DRG reimbursement methodology.
5.	Amended cost reports will be applied only to the subsequent rate setting year.
6.	AHCA will establish a global fee for bone marrow transplants.
7.	Editorial and technical changes to remove obsolete language and reorganize existing language.

SUBJECT:

: Payment Methodology for Inpatient Hospital Services.
An additional area to be addressed during the workshop will be the potential regulatory impact the amendment to Rule 59G-6.020 will have as provided for under sections 120.54 and 120.541, F.S.

RULEMAKING AUTHORITY:

409.919 F.S.

LAW:

409.905(5) 409.908, 409.909, 409.9113, 409.9115, 409.9116, 409.9118, 409.9119, 409.913, F.S.

PRINT PUBLISH DATE:

6/10/2014 Vol. 40/112

RELATED STATUTES
AND LAWS:

409.919 F.S., 409.905(5) 409.908, 409.909, 409.9113, 409.9115, 409.9116, 409.9118, 409.9119, 409.913, F.S.

OVERSIGHT COMMITTEE:

Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)

RELATED COURT CASES:

Division of Administrative Hearings

FEDERAL eRULEMAKING
WEB PORTAL:

Regulations.gov

HOW TO LINK TO
THIS NOTICE:

http://flrules.org/gateway/ruleno.asp?id=59G-6.020&PDate=6/10/2014&Section=1

REFERENCE MATERIALS:

No reference(s).

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