RULE NO: RULE TITLE
59G-6.020: Payment Methodology for Inpatient Hospital Services
PURPOSE AND EFFECT: The purpose and effect of the proposed rule development are to incorporate changes to the Florida Title XIX Inpatient Hospital Reimbursement Plan payment methodology, effective July 1, 2006, in accordance with the 2006-07 General Appropriations Act, House Bill 5001, Specific Appropriations 213, 214, 245, and 246.
HOSPITAL INPATIENT SERVICES
1. $13,997,575 is provided to reimburse hospitals 50 percent of the difference between their current Medicaid inpatient rate and their Medicaid inpatient rate if all ceilings and targets were eliminated. This provision shall only apply to those hospitals not exempt under another section of proviso and whose charity care and Medicaid days, as a percentage of total adjusted hospital days, are less than 11 percent but are equal to or exceed 9.70 percent. The only hospitals that will receive additional Medicaid reimbursement are: Coral Gables Hospital; Manatee Memorial Hospital; Palm Springs General Hospital; Kendall Regional Medical Center; Florida Hospital – Heartland/Walker; South Florida Baptist Hospital; and Naples Community Hospital. 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. $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 , 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.
3. $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.
4. $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, 2005 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.
5. $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.
6. $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.
7. $20,000,000 may be used for State Fiscal Year 2006-2007 to increase the Medicaid per diem payments for any individual hospital that has 120,000 or more Medicaid fee-for-service paid days. The maximum amount paid shall not exceed the amount appropriated under this provision.
8. $10,914,383 is provided to increase the Medicaid hospital property allowance reimbursement rate from 80 to 85 percent.
9. Effective July 1, 2006, the upper payment limit (UPL) program is terminated.
REGULAR DISPROPORTIONATE SHARE (DSH)
1. $141,124,815 is provided for payments for regular DSH hospitals.
2. $60,000,000 is provided for payments to General Medical Education (GME) hospitals.
3. $60,998,691 is provided for payments to mental health DSH hospitals.
4. $2,444,444 is provided for payments to specialty hospitals.
SUBJECT AREA TO BE ADDRESSED: Florida Medicaid inpatient hospital special Medicaid payments (SMPs), the termination of the Florida Medicaid inpatient hospital upper payment limit (UPL) program, and the 2006-07 disproportionate share (DSH) payments.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.908 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE TIME, DATE AND PLACE SHOWN BELOW:
TIME AND DATE: June 20, 2006, 10:00 a.m.
PLACE: 2727 Mahan Drive, Conference Room B, 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 Program Analysis, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Room 2120-B, Tallahassee, Florida 32308, (850)414-2759

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