The Florida Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Analysis provides the following public notice regarding reimbursement for hospitals providing outpatient services 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 hospital outpatient services, the Agency is publishing the final rates, the methodologies underlying the establishment of such rates, and justifications for the final rates. The Agency has amended its Title XIX Outpatient Hospital Reimbursement Plan (The Plan) to incorporate changes effective July 1, 2007.
1. Effective July 1, 2007, the outpatient reimbursement ceilings were eliminated for hospitals that have a minimum of ten licensed Level II Neonatal Intensive Care Beds and are located in Trauma Services Area 2.
2. Effective July 1, 2007, the outpatient reimbursement ceilings were eliminated 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 designated or provisional trauma centers on July 1, 2007, or 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.
3. Effective July 1, 2007, the Medicaid outpatient rate reductions were 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 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 as of March 1, 2007.
4. Addition of the phrase “available to AHCA as of each April 15 and October 15” to Section V.B 1. of the
FINAL RATES: Effective July 1, 2007, the final rates for Medicaid hospital outpatient services are rates resulting from the current methodology used to calculate per diems including appropriations from the 2007-08 General Appropriations Act, Senate Bill 2800, Specific Appropriation 216.
METHODOLOGIES: The methodology underlying the establishment of the final rates for Medicaid hospital outpatient services are rates resulting from the current methodology used to calculate per diems including the 2007-08 General Appropriations Act, Senate Bill 2800, Specific Appropriation 216.
JUSTIFICATION: The justification for the final rate change is based on the legislative direction provided in the 2007-08 General Appropriations Act, Senate Bill 2800, Specific Appropriation 216.
The Agency has implemented the above rates and changes in methodology, effective July 1, 2007. Written comments may be submitted to: Edwin Stephens, Agency for Health Care Administration,