RULE NO.: RULE TITLE:
59G-6.010: Payment Methodology for Nursing Home Services
PURPOSE AND EFFECT: The amendments to Rule 59G-6.010, F.A.C., incorporate by reference the Florida Title XIX Long-Term Care Reimbursement Plan (the Plan), effective July 1, 2011. The Plan, effective July 1, 2011, includes revisions made in accordance with a request from the Center for Medicare and Medicaid Services (CMS), Senate Bill 2000, 2011-12 General Appropriations Act, Specific Appropriation 208, Senate Bill 2144, Section 1(3)(a) and Section 5 (23)(a). These revisions will be related to the following areas:
1. Section I.L: Providers are subject to sanctions pursuant to Section 409.913(15)(c), F.S., for late cost reports. The amount of the sanctions can be found in Rule 59G-9.070, F.A.C. A cost report is late if it is not received by AHCA, Bureau of Medicaid Program Analysis, on the first cost report acceptance cut-off date after the cost report due date.
2. The agency shall establish rates at a level that ensures no increase in statewide expenditures resulting from a change in unit costs effective July 1, 2011. Reimbursement rates shall be as provided in the General Appropriations Act.
3. $187,751,660 is provided for modifying the reimbursement for nursing home rates. In establishing rates through the normal process, prior to including this reduction, if the unit cost is equal to or less than the unit cost used in establishing the budget, then no additional reduction in rates is necessary. In establishing rates through the normal process, prior to including this reduction, if the unit cost is greater than the unit cost used in establishing the budget, then rates shall be reduced by an amount required to achieve this reduction, but shall not be reduced below the unit cost used in establishing the budget.
4. A minimum weekly average of certified nursing assistant and licensed nursing staffing combined of 3.6, 3.9 hours of direct care per resident per day. As used in this sub-subparagraph, a week is defined as Sunday through Saturday.
b. A minimum certified nursing assistant staffing of 2.5, 2.7 hours of direct care per resident per day. A facility may not staff below one certified nursing assistant per 20 residents.
Other items to be discussed at the rule development workshop but unrelated to any legislation are as follows:
5. Interim rate request cost settlement process and procedures.
6. Editorial revisions to correct typographical errors.
SUBJECT AREA TO BE ADDRESSED: July 1, 2011 nursing home reimbursement rates.
RULEMAKING AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.908, 409.9082 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
DATE AND TIME: July 19, 2011, 9:00 a.m. – 10:00 a.m.
PLACE: 2727 Mahan Drive, Conference Room D, Building 3, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Edwin Stephens, Medicaid Cost Reimbursement, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308, (850)412-4077 or by e-mail at edwin.stephens@ahca.myflorida.com

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS NOT AVAILABLE.