380839, 59G-6.030 - Florida Administrative Rules, Law, Code, Register

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Notice: 380839

Notice of Development of Rulemaking

Department:

AGENCY FOR HEALTH CARE ADMINISTRATION

Division:

Medicaid

Chapter:

REIMBURSEMENT TO PROVIDERS

Overview

RULE:

59G-6.030

Payment Methodology for Outpatient Hospital Services

PURPOSE:

The purpose and effect of the proposed rule development are to incorporate changes to the Florida Title XIX Outpatient Hospital Reimbursement plan (the Plan) payment methodology effective July 1, 2006 in accordance with the 2006-07 General Appropriations Act, House Bill 5001, Specific Appropriation 217.
1.	$1,704,539 in non-recurring funds is provided to reimburse hospitals 50 percent of the difference between their current Medicaid outpatient rate and their Medicaid outpatient rate if all ceilings and targets were eliminated. This provision shall only apply to those hospitals not exempt under another section of the Title XIX Outpatient Hospital Reimbursement Plan and whose charity care and Medicaid days as a percentage of total adjusted hospital days are less than 11 percent but equal or exceed 9.70 percent and are listed below. The only hospitals that will receive additional Medicaid reimbursement under this section are: Coral Gables Hospital; Manatee Memorial Hospital; Palm Springs General Hospital; Kendall Regional Medical Center; Florida Hospital – Heartland/Walker; South Florida Baptist Hospital; and Naples Community Hospital. The agency shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. 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 2000, 2001 and 2002 that are available.
2.	$59,135,509 is provided to increase the outpatient cap for adults from $1,000 to $1,500 per year and to eliminate the outpatient reimbursement ceilings for teaching, specialty, Community Health Education Program hospitals and Level III Neonatal Intensive Care Units that have a minimum of three of the following designated tertiary services as regulated under the certificate of need program: pediatric bone marrow transplantation, pediatric open heart surgery, pediatric cardiac catheterization and pediatric heart transplantation.
3.	$7,704,802 is provided to eliminate the outpatient reimbursement ceilings for hospitals whose charity care and Medicaid days as a percentage of total adjusted hospital days equals or exceeds 11 percent. For any public hospital that does not qualify for the elimination of the outpatient ceilings under this section , the public hospital shall be exempt from the outpatient reimbursement ceilings contingent on the public hospital or local governmental entity providing the required state match. The Agency shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. 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 2000, 2001 and 2002 that are available.
4.	$387,284 is provided to eliminate the outpatient reimbursement ceilings for hospitals that have a minimum of ten licensed Level II Neonatal Intensive Care Beds and are located in Trauma Services Area 2.
5.	$11,223,355 is provided to eliminate the outpatient reimbursement ceilings for hospitals whose Medicaid days, as a percentage of total hospital days, exceed 7.3 percent, and are designated or provisional trauma centers. This provision shall apply to all hospitals that are designated or provisional trauma centers on July 1, 2006 or become a designated or provisional trauma center during State Fiscal Year 2006-2007. The agency shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. 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 2000, 2001 and 2002 that are available.
6.	$15,000,000 is appropriated so that the agency may amend its current rules and/or contracts regarding the billing of Medicaid outpatient clinic facility fees and physician services to allow for payments to public hospitals for the cost of providing health care services to Medicaid recipients, when the public hospital assumed the fiscal and operating responsibilities for one or more primary care centers previously operated by the Florida Department of Health or the local county government.

SUBJECT:

Outpatient hospital reimbursement rates and ceilings.

RULEMAKING AUTHORITY:

409.919 FS.

LAW:

409.908 FS.

PRINT PUBLISH DATE:

6/2/2006 Vol. 32/22

RELATED STATUTES
AND LAWS:

409.919 FS., 409.908 FS.

OVERSIGHT COMMITTEE:

Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)

RELATED COURT CASES:

Division of Administrative Hearings

FEDERAL eRULEMAKING
WEB PORTAL:

Regulations.gov

HOW TO LINK TO
THIS NOTICE:

http://flrules.org/gateway/ruleno.asp?id=59G-6.030&PDate=6/2/2006&Section=1

REFERENCE MATERIALS:

No reference(s).

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