Notice of Proposed Rule

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid
RULE NO: RULE TITLE
59G-6.020: Payment Methodology for Inpatient Hospital Services
PURPOSE AND EFFECT: To incorporate changes to the Florida Title XIX Inpatient Hospital Reimbursement Plan payment methodology, effective March 1, 2009, in accordance with Senate Bill 2-A, 2008-2009 Special Appropriations Act, Specific Appropriation 110.
1. Effective March 1, 2009, the Agency for Health Care Administration shall implement a recurring methodology in the Title XIX Inpatient Hospital Reimbursement Plan to reduce individual hospital rates proportionately until the required savings is achieved. Hospitals that are licensed as a children’s specialty hospital and whose Medicaid days plus charity care days divided by total adjusted patient days equals or exceeds 30 percent are excluded from this reduction.
2. Public hospitals, teaching hospitals as defined in Section 408.07(45) or 395.805, Florida Statutes, which have seventy or more full-time equivalent resident physicians, designated trauma centers and those hospitals whose Medicaid and charity care days divided by total adjusted days exceeds 25 percent are permitted to buy back the Medicaid inpatient trend adjustment applied to their individual hospital rates and other Medicaid reductions to their inpatient rates up to actual Medicaid inpatient cost. The Agency shall use the average of 2002, 2003 and 2004 audited DSH data available as of March 1, 2008. 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 2002, 2003 and 2004 that are available.
SUMMARY: Effective March 1, 2009, in accordance with Senate Bill 2-A, 2008-2009 Special Appropriations Act, Specific Appropriation 110, the Agency for Health Care Administration shall implement a recurring methodology in the Title XIX Inpatient Hospital Reimbursement Plan to reduce individual hospital rates proportionately until the required savings is achieved. Hospitals that meet specific criteria are eligible to buy back their rate cut.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: The Agency has determined that this rule will not have an impact on small business. A SERC has not been prepared by the Agency.
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: May 12, 2009, 9:00 a.m. – 10:00 a.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, Tallahassee, FL 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-6.020 Payment Methodology for Inpatient Hospital Services.

Reimbursement to participating inpatient hospitals for services provided shall be in accord with the Florida Title XIX Inpatient Hospital Reimbursement Plan, Version XXXIIIV, Effective Date March 1, 2009 July 1, 2008 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, 2727 Mahan Drive, Building 3, Mail Stop 8, Tallahassee, Florida 32308.

Rulemaking Specific Authority 409.919 FS. Law Implemented 409.908, 409.9117 FS. History–New 10-31-85, Formerly 10C-7.391, Amended 10-1-86, 1-10-89, 11-19-89, 3-26-90, 8-14-90, 9-30-90, 9-16-91, 4-6-92, 11-30-92, 6-30-93, Formerly 10C-7.0391, Amended 4-10-94, 8-15-94, 1-11-95, 5-13-96, 7-1-96, 12-2-96, 11-30-97, 9-16-98, 11-10-99, 9-20-00, 3-31-02, 1-8-03, 7-3-03, 2-1-04, 2-16-04, 2-17-04, 8-10-04, 10-12-04, 4-19-06, 12-11-06, 3-4-08, 6-10-08, 1-11-09, ________.


NAME OF PERSON ORIGINATING PROPOSED RULE: Edwin Stephens
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Holly Benson
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: April 01, 2009
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: February 27, 2009