11762916, 59G-6.020 - Florida Administrative Rules, Law, Code, Register

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Notice: 11762916

Notice of Proposed Rule

Department:

AGENCY FOR HEALTH CARE ADMINISTRATION

Division:

Medicaid

Chapter:

REIMBURSEMENT TO PROVIDERS

Overview

RULE:

59G-6.020

Payment Methodology for Inpatient Hospital Services

PURPOSE:

The purpose of this rule is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), effective July 1, 2011. The Plan, effective July 1, 2011, includes the addition of a reference to Rule Number 59G-9.070, F.A.C. for the amount of late cost report sanctions; a reimbursement rate reduction (Medicaid trend adjustment), exemptions from reimbursement ceilings; the opportunity for certain hospitals to buy back their reimbursement rate reductions; a rate freeze on inpatient hospital reimbursement rates; the establishment of hospitals rates being set once a year every July 1; and disproportionate share payments in compliance with the limits set forth in Section 1923(g-j) of the Social Security Act and overpayments made in the disproportionate share program handled in compliance with 42 CFR Part 433, Subpart F; the addition of a definition of a hospital buy back, rate setting unit cost, legislative unit cost, and base rate; statutory teaching hospitals allocation formula changes; updated audited disproportionate share data years used to calculate disproportionate share payments, revised buy back descriptions, and the addition of an appendix explaining Provider Preventable Conditions (PPC).

SUMMARY:

The proposed rule incorporates changes to the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan) payment methodology, effective July 1, 2011 for a recurring reimbursement rate reduction (Medicaid trend adjustment), exemptions, buy backs, specification of the rule for the amount of late cost report sanctions, a reimbursement rate freeze, and an annual reimbursement rate calculation, a buy back definition, and updates to the disproportionate share hospital payment methodology.

RULEMAKING AUTHORITY:

409.919 FS.

LAW:

409.908, 409.911, 409.9112, 409.9113, 409.9115, 409.9116, 409.9117, 409.9118, 409.9118, 409.9119 FS.

PRINT PUBLISH DATE:

7/20/2012 Vol. 38/29

COMMENTS:

From 7/20/2012 To 8/10/2012 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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