RULE NO: RULE TITLE
59G-6.010: Payment Methodology for Nursing Home Services
PURPOSE AND EFFECT: The purpose and effect of the proposed rule development is to incorporate editorial changes to the Florida Title XIX Long-Term Care Reimbursement Plan along with detail regarding nursing home staffing ratios found in House Bill 5301, Medicaid Services, effective July 1, 2010, and to address a series of cost report issues.
1. The addition of a definition for “total bed capacity.”
2. Reorganization of Section V. B of the Title XIX Long Term Care Reimbursement Plan regarding the chronology of reimbursement rate reductions.
3. The addition of a deadline for submitting an initial cost report.
4. Modify ceilings from an average of north and south in order to fully implement central ceilings.
5. Delete “resulting from 1. and 2.” from Section IV. J. 4 of the Title XIX Long-Term Care Reimbursement Plan, specific to interim rate requests. The current language could be interpreted incorrectly that interim rate requests for general or professional liability insurance do not have to be submitted within 60 days after the costs are incurred. By removing “resulting from 1., and 2. above” the language makes no distinction between 1, 2 and 3 (general or professional liability) and the proper interpretation can be made that all interim rate requests must be submitted within 60 days.
6. Clarifying the definition of late cost report and acceptance procedures.
7. New policies regarding resubmissions of cost reports by providers.
8. Development of a sanction process (possibly a daily fine) for late cost reports including reimbursement at the lowest per diem by area.
9. Development of new policies and procedures regarding AHCA’s ability to recoup overpayments.
10. AHCA will reserve the right to submit any provider found to be out of compliance with any of the new policies and procedures regarding cost reports to the Bureau of Medicaid Program Integrity for investigations.
11. Addition of Appendix C to the Title XIX Long-Term Care Reimbursement Plan detailing the Medicaid Trend Adjustment to include percentages, annualized reduction amounts, and sample calculations.
12. The agency shall develop efficiency and outcome measures in order to assess the value for patients including both outcomes and costs over the full cycle of care.
13. Revisions to Fair Rental Value System (FRVS) inflation index.
14. Minimum staffing changes:
a. A minimum weekly average of certified nursing assistant and licensed nursing staffing combined of 3.9 hours of direct care per resident per day. A week is defined as Sunday through Saturday.
b. A minimum certified nursing assistant staffing of 2.7 hours of direct care per resident per day. A facility may not staff below one certified nursing assistant per 20 residents.
c. A minimum licensed nursing staffing of 1.0 hour of direct care per resident per day. A facility may not staff below one licensed nurse per 40 residents.
SUBJECT AREA TO BE ADDRESSED: July 1, 2010 ceilings, staffing ratios, cost report issues, FRVS Inflation index, and various technical changes in the Title XIX Long-Term Care Reimbursement Plan.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.908, 409.9082 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: July 13, 2010, 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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Edwin Stephens, Medicaid Cost Reimbursement, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308, (850)412-4077 or by e-mail at edwin.stephens@ahca.myflorida.com

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS NOT AVAILABLE.