59G-6.010: Payment Methodology for Nursing Home Services
The Florida Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Analysis provides the following public notice regarding reimbursement for nursing home facilities participating in the Florida Medicaid Program.
PURPOSE: To comply with federal public notice requirements in Section 1902(a)(13)(A) of the Social Security Act in changing reimbursement for nursing home facilities, the Agency is publishing the proposed rates, the methodologies underlying the establishment of such rates, and justifications for the proposed rates. The Agency is in the process of amending its Title XIX Long-Term Care Reimbursement Plan (The Plan) to incorporate changes to the reimbursement methodology.
PROPOSED RATES: The purpose of the proposed amendment is to incorporate changes to the Florida Title XIX Long-Term Care Reimbursement Plan payment methodology effective July 1, 2007. The Title XIX Long-Term Care Reimbursement Plan will be modified as follows:
1. The operating and indirect patient care component targets and target rate class ceilings of the Medicaid nursing home per diem rate shall be rebased. The operating and indirect patient care components of the per diem rate shall continue to be limited by the lower of the cost-based class ceiling, the target rate class ceiling, or the individual provider-specific target.
2. Establish a target rate class ceiling floor equal to 90 percent of the cost-based class ceiling.
3. Establish an individual provider-specific target floor equal to 75 percent of the cost-based class ceiling.
4. Modify the inflation multiplier to equal 2.0 times inflation for the individual provider-specific target. (The inflation multiplier for the target rate class ceiling shall remain at 1.4 times inflation.)
5. Modify the calculation of the change of ownership target to equal the previous providers’ operating and indirect patient care cost per diem (excluding incentives), plus 50 percent of the difference between the previous providers’ per diem (excluding incentives) and the effective class ceiling and use an inflation multiplier of 2.0 times inflation. This provision shall be contingent upon federal approval of a Medicaid State Plan amendment to limit Medicaid payments for nursing home Medicare Part A coinsurance. Should the Centers for Medicare and Medicaid Services eliminate nursing home payment of Medicare Part A bad debt, the agency shall reinstate the dually eligible coinsurance payment policy for Medicare nursing home Part A coinsurance claims existing prior to July 1, 2007 in a budget neutral manner that does not increase existing nursing home expenditures. The agency is authorized to reduce nursing home reimbursement rates to fund the reinstatement of the Medicare nursing home Part A coinsurance payments and shall coordinate with the nursing home industry to develop and implement this reduction.
6. The methodology for nursing home special Medicaid payments is being revised.
7. The low occupancy adjustment is being removed.
METHODOLOGIES: The methodology underlying the establishment of the proposed rates for Medicaid nursing facilities will be rates resulting from the revised methodology used to calculate per diem rates in the Title XIX Long-Term Care Reimbursement Plan effective July 1, 2007.
JUSTIFICATION: The justification for the proposed rate change is the 2007-08 General Appropriations Act, Senate Bill 2800, proviso language following Specific Appropriation 242.
The Agency is proposing the above changes effective July 1, 2007. Providers, beneficiaries and their representatives, and other concerned state residents may provide written comment on the proposed rates, methodologies and justification underlying the establishment of such changes.
Written comments may be submitted to: Edwin Stephens, Agency for Health Care Administration,