RULE NO: RULE TITLE
59G-6.090: Payment Methodology for County Health Departments
PURPOSE AND EFFECT: The purpose and effect of the proposed amendment is to incorporate changes to the Florida Title XIX Payment Methodology for County Health Departments Reimbursement Plan (the Plan) effective July 1, 2010. In accordance with House Bill 5001, 2010-11 General Appropriations Act, Specific Appropriation 212, and to address a series of cost report issues, the Florida Title XIX Payment Methodology for County Health Departments Reimbursement Plan will be amended as follows:
1. The Agency shall implement a recurring methodology in the Title XIX County Health Department Reimbursement Plan to achieve a $40,379,100 rate reduction to modify the reimbursement rates for county health departments. In establishing rates through the normal process, prior to including this reduction, if the unit cost is equal to or less than the unit cost used in establishing the budget, then no additional reduction in rates is necessary. In establishing rates through the normal process, prior to including this reduction, if the unit cost is greater than the unit cost used in establishing the budget, then rates shall be reduced by an amount required to achieve this reduction, but shall not be reduced below the unit cost used in establishing the budget.
2. $42,631,388 is provided for county health departments to buy back clinic services rate adjustments, effective on or after July 1, 2008.
3. Clarifying the definition of late cost report and acceptance procedures.
4. New policies regarding resubmissions of cost reports by providers.
5. Development of a sanction process (possibly a daily fine) for late cost reports including reimbursement at the lowest per diem.
6. Development of new policies and procedures regarding AHCA’s ability to recoup overpayments.
7. 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.
SUBJECT AREA TO BE ADDRESSED: July 1, 2010, County Health Department reimbursement rates and cost reporting issues.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.908 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, 11:00 a.m. – 12:00 Noon
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 Program Analysis, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Room 2149A, Tallahassee, Florida 32308, (850)412-4077 or at edwin.stephens@ahca.myflorida.com

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