59G-6.020: Payment Methodology for Inpatient Hospital Services
The Florida Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Analysis, provides the following public notice regarding reimbursement for inpatient hospitals 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 inpatient hospitals, 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 Inpatient Hospital Reimbursement Plan (The Plan) to incorporate changes to the reimbursement methodology.
PROPOSED RATES: Effective July 1, 2007, the proposed rates for Medicaid inpatient hospitals will be rates resulting from revised methodology used to calculate per diem rates.
1. Effective July 1, 2007, inpatient reimbursement ceilings will be eliminated 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 of the 2007-08 General Appropriations Act or any other proviso listed, 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 2001, 2002, and 2003 audited disproportionate share (DSH) data available as of March 1, 2007. 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 2001, 2002, and 2003 that are available.
2. Effective July 1, 2007, 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 will be eliminated.
3. Effective July 1, 2007, 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 will be eliminated. This provision shall apply to all hospitals that are designated or provisional trauma centers on July 1, 2007 and any hospitals that become a designated or provisional trauma center during State Fiscal Year 2007-2008. The Agency shall use the average of the 2001, 2002 and 2003 audited DSH data available as of March 1, 2007. 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 2001, 2002 and 2003 that are available.
4. Effective July 1, 2007, the inpatient reimbursement ceilings will be eliminated 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.
5. Effective July 1, 2007, the Medicaid inpatient rate reductions shall be reinstated for all hospitals whose Medicaid charity care days as a percentage to total adjusted days equals or exceeds 30 percent and have more than 10,000 Medicaid days, or a hospital or hospital system that established a provider service network during the prior state fiscal year. The Agency shall use the average of the 2001, 2002 and 2003 audited DSH data available at as of March 1, 2007.
Regular DSH
6. The Agency for Health Care Administration shall use the average of the 2001, 2002, and 2003 audited disproportionate share data to determine each hospital's Medicaid days and charity care days for the 2007-2008 state fiscal year.
7. $148,382,079 is provided for payments to public hospitals.
8. $48,000,000 is provided for payments to defined statutory teaching hospitals.
9. $12,000,000 is provided for payments to the family practice teaching hospitals.
Mental Health DSH
10. $60,998,691 is provided for Mental Health DSH.
Specialty DSH
11. $2,444,444 is provided for Specialty DSH.
METHODOLOGIES: The methodology underlying the establishment of the proposed rates for Medicaid inpatient hospitals will be rates resulting from the 2007-08 General Appropriations Act, Senate Bill 2800, Specific Appropriation’s 211, 212, 244, and 245.
JUSTIFICATION: The justification for the proposed state plan amendment is Senate Bill 2800, 2007-08 General Appropriations Act, Specific Appropriation’s 211, 212, 244, and 245.
State residents may provide written comment on the proposed rates, methodologies and justification underlying the establishment of such rates.
Written comments may be submitted to: Edwin Stephens, Agency for Health Care Administration,