15760286, 59G-6.020 - Florida Administrative Rules, Law, Code, Register

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Florida Department of State and Division of Library and Information Services

Notice: 15760286

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 the amendment to Rule 59G-6.020 is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XLI, effective July 1, 2014.

SUMMARY:

The amendment will update the Plan to reflect changes to the payment methodology for inpatient hospital services as authorized in House Bill 5001, 2014-15 General Appropriations Act, Specific Appropriation 210, as follows:
1. $2,672,282 is provided to increase the diagnosis related grouping rural hospital provider adjustor for rural hospitals as described in section 395.602, Florida Statutes (F.S.)
2. Any hospital that was exempt from the inpatient reimbursement ceiling in the prior state fiscal year, due to their charity care and Medicaid days as a percentage to total adjusted hospital days equaling or exceeding 11 percent, but no longer meets the 11 percent threshold, because of updated audited DSH data, shall remain exempt from the inpatient reimbursement ceilings for a period of two years
3. A four percent adjustment shall be applied for anticipated case mix increases from improved documentation and coding through the implementation of Diagnosis Related Grouping (DRG) and a one percent adjustment will be applied for real case mix change
4. $7,542,036 in nonrecurring funds for sole community hospitals that meet the definition of "rural hospital" under section 395.602(2)(e)4, F.S., to be recognized as rural hospitals in the Agency for Health Care Administration’s DRG reimbursement methodology
5. Amended cost reports will be applied only to the subsequent rate setting year
6. AHCA may establish a global fee for bone marrow transplants
7. Editorial and technical changes to remove obsolete language and reorganize existing language

RULEMAKING AUTHORITY:

409.919 F.S.

LAW:

409.905(5) 409.908, 409.909, 409.9113, 409.9115, 409.9116, 409.9118, 409.9119, 409.913, F.S.

PRINT PUBLISH DATE:

3/10/2015 Vol. 41/47

COMMENTS:

From 3/10/2015 To 3/31/2015 (21 Days)
The public comment period for this notice has already expired.

REFERENCE MATERIALS:

No reference(s).

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