566303, 59G-6.020 - Florida Administrative Rules, Law, Code, Register

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Notice: 566303

Notice of Proposed Rule

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 proposed rule is to incorporate changes to the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan) payment methodology, effective July 1, 2006. In compliance with House Bill 5001, 2006-07 General Appropriations Act, Specific Appropriations 213, 214, 245, 246 and the 2006-07 Health Care Implementing Bill, House Bill 5007, the Florida Title XIX Inpatient Hospital Reimbursement Plan will be amended as follows:
HOSPITAL INPATIENT SERVICES
1. $59,233,070 is provided to eliminate the inpatient reimbursement ceilings for hospitals whose charity care and Medicaid days, as a percentage of total adjusted hospital days, equal or exceed 11 percent. For any public hospital that does not qualify for the elimination of the inpatient ceilings under this section or any other section, the public hospital shall be exempt from the inpatient reimbursement ceilings contingent on the public hospital or local governmental entity providing the required state match. The Agency shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. In the event the Agency does not have the prescribed three years of audited DSH data for a hospital, the Agency shall use the average of the audited DSH data for 2000, 2001 and 2002 that are available.
2. $3,270,205 is provided to eliminate the inpatient reimbursement ceilings for hospitals that have a minimum of ten licensed Level II Neonatal Intensive Care Beds and are located in Trauma Services Area 2.
3. $86,544,883 is provided to eliminate the inpatient hospital reimbursement ceilings for hospitals whose Medicaid days as a percentage of total hospital days exceed 7.3 percent, and are designated or provisional trauma centers. This provision shall apply to all hospitals that are a designated or provisional trauma centers on July 1, 2006 and any hospitals that become a designated or provisional trauma center during State Fiscal Year 2006-2007. The Agency shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. In the event the Agency does not have the prescribed three years of audited DSH data for a hospital, the Agency shall use the average of the audited DSH data for 2000, 2001 and 2002 that are available.
4. $9,932,000 is provided to make Medicaid payments to hospitals. These payments shall be used to pay approved liver transplant facilities a global fee for providing transplant services to Medicaid recipients.
5. $246,408,972 is provided to eliminate the inpatient reimbursement ceilings for teaching, specialty, Community Hospital Education Program hospitals and Level III Neonatal Intensive Care Units that have a minimum of three of the following designated tertiary services as regulated under the certificate of need program: pediatric bone marrow transplantation, pediatric open heart surgery, pediatric cardiac catheterization and pediatric heart transplantation.
6. Effective July 1, 2006, in accordance with the approved Medicaid Reform Section 1115 Demonstration, Special Terms and Conditions 100(b), the current inpatient supplemental payment upper payment limit (UPL) program is terminated.
7. Effective July 1, 2006, in accordance with the approved Medicaid Reform Section 1115 Demonstration, Special Terms and Conditions 100(c), the inpatient hospital payments for Medicaid eligibles will be limited to Medicaid cost as defined in the CMS 2552-96.
8. All references to Data Resources Incorporated (DRI) have added the phrase “or its successor” in order to account for future name changes of the company.
9. The reference to the definition section of the Inpatient Hospital Reimbursement Plan found in Section V. Methods, A.3. has been corrected to be Section XII.
DISPROPORTIONATE SHARE (DSH) HOSPITALS
1. $141,124,815 is provided for payments to regular DSH.
2. $60,000,000 is provided for payments to Graduate Medical Education (GME) hospitals.
3. $60,998,691 is provided for payments to mental health DSH.
4. $2,444,444 is provided for payments to specialty DSH.
5. The minimum number of Medicaid days for non-state government owned or operated hospitals has been reduced from 3,300 days to 3,100 days.

SUMMARY:

The proposed rule change to rule number 59G-6.020 incorporates revisions to the Florida Title XIX Inpatient Hospital Reimbursement Plan. The rule seeks to amend the Title XIX Inpatient Hospital Reimbursement Plan to be in compliance with the 2006-07 General Appropriations Act, the 2006-07 Health Care Implementing Bill, and the Medicaid Reform Section 1115 Demonstration.

RULEMAKING AUTHORITY:

409.919 FS.

LAW:

409.908 FS.

PRINT PUBLISH DATE:

8/4/2006 Vol. 32/31

COMMENTS:

From 8/4/2006 To 8/25/2006 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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