59G-6.010: Payment Methodology for Nursing Home Services
PURPOSE AND EFFECT: The purpose and effect of the proposed rule is to incorporate changes to the Florida Title XIX Long-Term Care Reimbursement Plan, effective July 1, 2010, providing clarifying and 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, and compliance with Section 409.913(15)(c), F.S., regarding late cost reports, and Section 409.9082 F.S., regarding the nursing home quality assessment.
1. Reorganization of Section V. B of the Title XIX Long Term Care Reimbursement Plan regarding the chronology of reimbursement rate reductions and define Medicaid trend adjustment.
2. Interim rate requests: Section IV. J. 4 – Deletion of “resulting from 1. and 2”, Section IV.J.7, delete “effective January 1, 2007” and “as providers incurring additional costs to meet the new minimum staffing standards will receive a “gross-up adjustment” as described in section V.B.4.a. and b.”
3. Definitions added regarding cost report acceptance and due dates.
4. AHCA reserves the right to submit any provider found to be out of compliance with any of the policies and procedures regarding cost reports to the Bureau of Medicaid Program Integrity for investigations.
5. Providers are subject to sanctions pursuant to Section 409.913(15)(c), F.S., for late cost reports. A cost report is late if it is not received by AHCA, Bureau of Medicaid Program Analysis, on the first cost report acceptance cut-off date after the cost report due date.
6. 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.
7. 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.
8. 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.
9. Revisions to the nursing home quality assessment fee in accordance with Section 409.9082, F.S.
10. 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.
SUMMARY: The proposed rule incorporates changes to the Florida Title XIX Long-Term Care Reimbursement Plan (the Plan) payment methodology, effective July 1, 2010, including editorial changes along with detail regarding nursing home staffing ratios found in House Bill 5301, Medicaid Services, and compliance with Section 409.913(15)(c), F.S. regarding late cost reports, and Section 409.9082, F.S. regarding the nursing home quality assessment.
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: December 1, 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 IS: Edwin Stephens, Medicaid Program Analysis, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Room 2120B, Mail Stop 21, Tallahassee, Florida 32308, (850)412-4077 or by e-mail at edwin.stephens@ahca.myflorida.com
THE FULL TEXT OF THE PROPOSED RULE IS:
59G-6.010 Payment Methodology for Nursing Home Services.
Reimbursement to participating nursing homes for services provided shall be in accord with the Florida Title XIX Long-Term Care Reimbursement Plan, Version XXXVIII Effective Date July 1, 201009 and incorporated herein by reference. A copy of the Plan as revised may be obtained by writing to the Deputy Secretary for Medicaid, 2727 Mahan Drive, Mail Stop 8, Tallahassee, Florida 32308. The Plan incorporates Provider Reimbursement Manual (CMS Pub. 15-1).
Rulemaking Authority 409.919 FS. Law Implemented 409.908 FS. History–New 7-1-85, Amended 10-1-85, Formerly 10C-7.482, Amended 7-1-86, 1-1-88, 3-26-90, 9-30-90, 12-17-90, 9-15-91, 3-26-92, 10-22-92, 4-13-93, 6-27-93, Formerly 10C-7.0482, Amended 4-10-94, 9-22-94, 5-22-95, 11-27-95, 11-6-97, 2-14-99, 10-18-99, 1-11-00, 4-24-00, 9-20-00, 11-20-01, 2-20-02, 7-14-02, 1-08-03, 6-11-03, 12-3-03, 2-16-04, 7-21-04, 10-12-04, 4-19-06, 8-26-07, 2-12-08, 9-22-08, 3-3-10,_________.