59G-6.030: Payment Methodology for Outpatient Hospital Services
PURPOSE AND EFFECT: The purpose and effect of the proposed rule are to incorporate changes to the Florida Title XIX Outpatient Hospital Reimbursement plan (the Plan) payment methodology effective January 1, 2008 in accordance with the Senate Bill 2-C 2007-08 Special Appropriations Act, Specific Appropriation 107 and Section 13.
1. An additional Medicaid Trend Adjustment shall be applied to achieve a recurring annual reduction of $17,211,796.
2. Effective January 1, 2008, and ending June 30, 2008, the Medicaid Trend Adjustment shall be removed for all certified trauma centers and hospitals defined in section 408.07(45), Florida Statutes. The aggregate Medicaid Trend Adjustment found in item 2 above shall be reduced by up to $2,034,032.
3. In reducing hospital outpatient rates, rural hospitals and hospitals with twenty thousand (20,000) or more combined Medicaid managed care and fee-for-service inpatient days shall not have their outpatient rates reduced below the final rates that are effective on the prior June 30 of each year. The 2002 Financial Hospital Uniform Reporting System (FHURS) data shall be used to determine the combined inpatient Medicaid days.
4. Grammatical corrections throughout the Title XIX Outpatient Hospital Reimbursement Plan.
SUMMARY: The proposed rule change to rule number 59G-6.030 incorporates revisions to the Florida Title XIX Outpatient Hospital Reimbursement Plan. The rule seeks to amend the Title XIX Inpatient Hospital Reimbursement Plan to be in compliance with Senate Bill 2-C, the 2007-08 Special Appropriations Act, effective January 1, 2008.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.908 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: April 16, 2008, 2:00 p.m. – 3:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, Tallahassee, Florida 32308
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Edwin Stephens, Medicaid Program Analysis, 2727 Mahan Drive, Mail Stop 21, Tallahassee, Florida 32308, (850)414-2759 or stephene@ahca.myflorida.com
THE FULL TEXT OF THE PROPOSED RULE IS:
59G-6.030 Payment Methodology for
Reimbursement to participating outpatient hospitals for services provided shall be in accordance with the Florida Title XIX Outpatient Hospital Reimbursement Plan, Version XVII XVI Effective date: January 1, 2008 July 1, 2007 and incorporated herein by reference. A copy of the Plan as revised may be obtained by writing to the Office of the Deputy Secretary for Medicaid, Agency for Health Care Administration,
Specific Authority 409.919 FS. Law Implemented 409.908 FS. History–New 10-31-85, Amended 12-31-85, Formerly 10C-7.401, Amended 10-1-86, 3-26-90, 9-30-90, 10-13-91, 7-1-93, Formerly 10C-7.0401, Amended 4-10-94, 9-18-96, 9-6-99, 9-20-00, 12-6-01, 11-10-02, 2-16-04, 10-12-04, 7-4-05, 4-19-06, 12-11-06, 3-4-08,_________.