CS for SB 1884 First Engrossed
20131884e1
1 A bill to be entitled
2 An act relating to county Medicaid contributions;
3 amending s. 409.915, F.S.; specifying the total
4 contribution for certain years and specifying the
5 method for determining the amount in the following
6 years; revising the method for calculating each
7 county’s contribution; providing tables for
8 calculating county contributions; requiring the Agency
9 for Health Care Administration to annually report the
10 status of county billings to the Legislature;
11 authorizing the Department of Revenue to withhold
12 county distributions for failure to remit Medicaid
13 contributions; deleting provisions specifying the care
14 and services that counties must participate in,
15 obsolete bond provisions, and a process for refund
16 requests; requiring the agency to provide a report to
17 the Florida Association of Counties and the
18 Legislature on the impact on counties of the changes
19 to the methodology for determining county Medicaid
20 contributions and other factors; specifying the method
21 for calculating each county’s contribution for the
22 2013-2014 fiscal year; providing an effective date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
26 Section 1. Section 409.915, Florida Statutes, is amended to
27 read:
28 409.915 County contributions to Medicaid.—Although the
29 state is responsible for the full portion of the state share of
30 the matching funds required for the Medicaid program, in order
31 to acquire a certain portion of these funds, the state shall
32 charge the counties an annual contribution in order to acquire a
33 certain portion of these funds for certain items of care and
34 service as provided in this section.
35 (1) As used in this section, the term “state Medicaid
36 expenditures” means those expenditures used as matching funds
37 for the federal Medicaid program.
38 (2)(a) For the 2013-2014 state fiscal year through the
39 2019-2020 state fiscal year, the total amount of the counties’
40 annual contribution is $269.6 million. For each fiscal year
41 thereafter, the annual amount shall be adjusted by the
42 percentage change in the state Medicaid expenditures as
43 determined by the Social Services Estimating Conference.
44 (b) By March 15, 2020, and each year thereafter, the Social
45 Services Estimating Conference shall determine the percentage
46 change in state Medicaid expenditures by comparing expenditures
47 for the 2 most recent completed state fiscal years.
48 (3)(a)1. The amount of each county’s annual contribution is
49 equal to the product of the amount determined under subsection
50 (2) multiplied by the sum of the percentages calculated in sub
51 subparagraphs a. and b.:
52 a. The enrollment weight provided in subparagraph 2. is
53 multiplied by a fraction, the numerator of which is the number
54 of the county’s Medicaid enrollees as of March 1 of each year,
55 and the denominator of which is the number of all counties’
56 Medicaid enrollees as of March 1 of each year. The agency shall
57 calculate this amount for each county and provide the
58 information to the Department of Revenue by May 15 of each year.
59 b. The payment weight provided in subparagraph 2. is
60 multiplied by the percentage share of payments provided in
61 subparagraph 3. for each county.
62 2. The weights for each fiscal year are equal to:
63
64 WEIGHTS
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67 FISCAL YEAR ENROLLMENT PAYMENT
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76 3. The percentage share of payments for each county is:
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79 COUNTY SHARE OF PAYMENTS
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150 (b)1. The Legislature intends to replace the county
151 percentage share provided in subparagraph (a)3. with percentage
152 shares based upon each county’s proportion of the total
153 statewide amount of county billings made under this section from
154 April 1, 2012, through March 31, 2013, for which the state
155 ultimately receives payment.
156 2. By February 1 of each year and continuing until a
157 certification is made under sub-subparagraph b., the agency
158 shall report to the President of the Senate and the Speaker of
159 the House of Representatives the status of the county billings
160 made under this section from April 1, 2012, through March 31,
161 2013, by county, including:
162 a. The amounts billed to each county which remain unpaid,
163 if any; and
164 b. A certification from the agency of a final accounting of
165 the amount of funds received by the state from such billings, by
166 county, upon the expiration of all appeal rights that counties
167 may have to contest such billings.
168 3. By March 15 of the state fiscal year in which the state
169 receives the certification provided for in sub-subparagraph
170 (b)2.b., the Social Services Estimating Conference shall
171 calculate each county’s percentage share of the total statewide
172 amount of county billings made under this section from April 1,
173 2012, through March 31, 2013, for which the state ultimately
174 receives payment.
175 4. Beginning in the state fiscal year following the receipt
176 by the state of the certification provided in sub-subparagraph
177 (b)2.b., each county’s percentage share under subparagraph (a)3.
178 shall be replaced by the percentage calculated under
179 subparagraph (b)3.
180 5. If the court invalidates the replacement of each
181 county’s share as provided in this paragraph, the county share
182 set forth in subparagraph (a)3. shall continue to apply.
183 (4) By June 1 of each year, the Department of Revenue shall
184 notify each county of its required annual contribution. Each
185 county shall pay its contribution, by check or electronic
186 transfer, in equal monthly installments to the department by the
187 5th day of each month. If a county fails to remit the payment by
188 the 5th day of the month, the department shall reduce the
189 monthly distribution of that county pursuant to s. 218.61 and,
190 if necessary, by the amount of the monthly installment pursuant
191 to s. 218.26. The payments and the amounts by which the
192 distributions are reduced shall be transferred to the General
193 Revenue Fund.
194 (1) Each county shall participate in the following items of
195 care and service:
196 (a) For both health maintenance members and fee-for-service
197 beneficiaries, payments for inpatient hospitalization in excess
198 of 10 days, but not in excess of 45 days, with the exception of
199 pregnant women and children whose income is in excess of the
200 federal poverty level and who do not participate in the Medicaid
201 medically needy program, and for adult lung transplant services.
202 (b) For both health maintenance members and fee-for-service
203 beneficiaries, payments for nursing home or intermediate
204 facilities care in excess of $170 per month, with the exception
205 of skilled nursing care for children under age 21.
206 (2) A county’s participation must be 35 percent of the
207 total cost, or the applicable discounted cost paid by the state
208 for Medicaid recipients enrolled in health maintenance
209 organizations or prepaid health plans, of providing the items
210 listed in subsection (1), except that the payments for items
211 listed in paragraph (1)(b) may not exceed $55 per month per
212 person.
213 (3) Each county shall set aside sufficient funds to pay for
214 items of care and service provided to the county’s eligible
215 recipients for which county contributions are required,
216 regardless of where in the state the care or service is
217 rendered.
218 (4) Each county shall contribute its pro rata share of the
219 total county participation based upon statements rendered by the
220 agency. The agency shall render such statements monthly based on
221 each county’s eligible recipients. For purposes of this section,
222 each county’s eligible recipients shall be determined by the
223 recipient’s address information contained in the federally
224 approved Medicaid eligibility system within the Department of
225 Children and Family Services. A county may use the process
226 developed under subsection (10) to request a refund if it
227 determines that the statement rendered by the agency contains
228 errors.
229 (5) In any county in which a special taxing district or
230 authority is located which benefits will benefit from the
231 Medicaid program medical assistance programs covered by this
232 section, the board of county commissioners may divide the
233 county’s financial responsibility for this purpose
234 proportionately, and each such district or authority must
235 furnish its share to the board of county commissioners in time
236 for the board to comply with subsection (4) (3). Any appeal of
237 the proration made by the board of county commissioners must be
238 made to the Department of Financial Services, which shall then
239 set the proportionate share for of each party.
240 (6) Counties are exempt from contributing toward the cost
241 of new exemptions on inpatient ceilings for statutory teaching
242 hospitals, specialty hospitals, and community hospital education
243 program hospitals that came into effect July 1, 2000, and for
244 special Medicaid payments that came into effect on or after July
245 1, 2000.
246 (6)(7)(a) By August 1, 2012, the agency shall certify to
247 each county the amount of such county’s billings from November
248 1, 2001, through April 30, 2012, which remain unpaid. A county
249 may contest the amount certified by filing a petition under the
250 applicable provisions of chapter 120 on or before September 1,
251 2012. This procedure is the exclusive method to challenge the
252 amount certified. In order to successfully challenge the amount
253 certified, a county must show, by a preponderance of the
254 evidence, that a recipient was not an eligible recipient of that
255 county or that the amount certified was otherwise in error.
256 (b) By September 15, 2012, the agency shall certify to the
257 Department of Revenue:
258 1. For each county that files a petition on or before
259 September 1, 2012, the amount certified under paragraph (a); and
260 2. For each county that does not file a petition on or
261 before September 1, 2012, an amount equal to 85 percent of the
262 amount certified under paragraph (a).
263 (c) The filing of a petition under paragraph (a) does shall
264 not stay or stop the Department of Revenue from reducing
265 distributions in accordance with paragraph (b) and subsection
266 (7) (8). If a county that files a petition under paragraph (a)
267 is able to demonstrate that the amount certified should be
268 reduced, the agency shall notify the Department of Revenue of
269 the amount of the reduction. The Department of Revenue shall
270 adjust all future monthly distribution reductions under
271 subsection (7) (8) in a manner that results in the remaining
272 total distribution reduction being applied in equal monthly
273 amounts.
274 (7)(8)(a) Beginning with the October 2012 distribution, the
275 Department of Revenue shall reduce each county’s distributions
276 pursuant to s. 218.26 by one thirty-sixth of the amount
277 certified by the agency under subsection (6) (7) for that
278 county, minus any amount required under paragraph (b). Beginning
279 with the October 2013 distribution, the Department of Revenue
280 shall reduce each county’s distributions pursuant to s. 218.26
281 by one forty-eighth of two-thirds of the amount certified by the
282 agency under subsection (6) (7) for that county, minus any
283 amount required under paragraph (b). However, the amount of the
284 reduction may not exceed 50 percent of each county’s
285 distribution. If, after 60 months, the reductions for any county
286 do not equal the total amount initially certified by the agency,
287 the Department of Revenue shall continue to reduce such county’s
288 distribution by up to 50 percent until the total amount
289 certified is reached. The amounts by which the distributions are
290 reduced shall be transferred to the General Revenue Fund.
291 (b) As an assurance to holders of bonds issued before the
292 effective date of this act to which distributions made pursuant
293 to s. 218.26 are pledged, or bonds issued to refund such bonds
294 which mature no later than the bonds they refunded and which
295 result in a reduction of debt service payable in each fiscal
296 year, the amount available for distribution to a county shall
297 remain as provided by law and continue to be subject to any lien
298 or claim on behalf of the bondholders. The Department of Revenue
299 must ensure, based on information provided by an affected
300 county, that any reduction in amounts distributed pursuant to
301 paragraph (a) does not reduce the amount of distribution to a
302 county below the amount necessary for the timely payment of
303 principal and interest when due on the bonds and the amount
304 necessary to comply with any covenant under the bond resolution
305 or other documents relating to the issuance of the bonds. If a
306 reduction to a county’s monthly distribution must be decreased
307 in order to comply with this paragraph, the Department of
308 Revenue must notify the agency of the amount of the decrease and
309 the agency must send a bill for payment of such amount to the
310 affected county.
311 (9)(a) Beginning May 1, 2012, and each month thereafter,
312 the agency shall certify to the Department of Revenue by the 7th
313 day of each month the amount of the monthly statement rendered
314 to each county pursuant to subsection (4). Beginning with the
315 May 2012 distribution, the Department of Revenue shall reduce
316 each county’s monthly distribution pursuant to s. 218.61 by the
317 amount certified by the agency minus any amount required under
318 paragraph (b). The amounts by which the distributions are
319 reduced shall be transferred to the General Revenue Fund.
320 (b) As an assurance to holders of bonds issued before the
321 effective date of this act to which distributions made pursuant
322 to s. 218.61 are pledged, or bonds issued to refund such bonds
323 which mature no later than the bonds they refunded and which
324 result in a reduction of debt service payable in each fiscal
325 year, the amount available for distribution to a county shall
326 remain as provided by law and continue to be subject to any lien
327 or claim on behalf of the bondholders. The Department of Revenue
328 must ensure, based on information provided by an affected
329 county, that any reduction in amounts distributed pursuant to
330 paragraph (a) does not reduce the amount of distribution to a
331 county below the amount necessary for the timely payment of
332 principal and interest when due on the bonds and the amount
333 necessary to comply with any covenant under the bond resolution
334 or other documents relating to the issuance of the bonds. If a
335 reduction to a county’s monthly distribution must be decreased
336 in order to comply with this paragraph, the Department of
337 Revenue must notify the agency of the amount of the decrease and
338 the agency must send a bill for payment of such amount to the
339 affected county.
340 (10) The agency, in consultation with the Department of
341 Revenue and the Florida Association of Counties, shall develop a
342 process for refund requests which:
343 (a) Allows counties to submit to the agency written
344 requests for refunds of any amounts by which the distributions
345 were reduced as provided in subsection (9) and which set forth
346 the reasons for the refund requests.
347 (b) Requires the agency to make a determination as to
348 whether a refund request is appropriate and should be approved,
349 in which case the agency shall certify the amount of the refund
350 to the department.
351 (c) Requires the department to issue the refund for the
352 certified amount to the county from the General Revenue Fund.
353 The Department of Revenue may issue the refund in the form of a
354 credit against reductions to be applied to subsequent monthly
355 distributions.
356 (8)(11) Beginning in the 2013-2014 fiscal year and each
357 year thereafter through the 2020-2021 fiscal year, the Chief
358 Financial Officer shall transfer from the General Revenue Fund
359 to the Lawton Chiles Endowment Fund an amount equal to the
360 amounts transferred to the General Revenue Fund in the previous
361 fiscal year pursuant to subsections (4) and (7) subsections (8)
362 and (9), reduced by the amount of refunds paid pursuant to
363 subsection (10), which are in excess of the official estimate
364 for medical hospital fees for such previous fiscal year adopted
365 by the Revenue Estimating Conference on January 12, 2012, as
366 reflected in the conference’s workpapers. By July 20 of each
367 year, the Office of Economic and Demographic Research shall
368 certify the amount to be transferred to the Chief Financial
369 Officer. Such transfers must be made before July 31 of each year
370 until the total transfers for all years equal $350 million. If
371 In the event that such transfers do not total $350 million by
372 July 1, 2021, the Legislature shall provide for the transfer of
373 amounts necessary to total $350 million. The Office of Economic
374 and Demographic Research shall publish the official estimates
375 reflected in the conference’s workpapers on its website.
376 (9)(12) The agency may adopt rules to administer this
377 section.
378 Section 2. The Agency for Health Care Administration shall
379 provide a data report to the Florida Association of Counties
380 which includes such information as may be necessary for a
381 comprehensive evaluation of the cost and utilization of health
382 services by Medicaid enrollees in each county by service type.
383 The data report shall be provided at least annually at the
384 request of the association. Copies of the data report shall also
385 be provided to the Governor, the President of the Senate, and
386 the Speaker of the House of Representatives. The agency shall
387 provide other information and assistance requested by the
388 association in order to assess the impact on counties of the
389 changes to the methodology for determining county contributions
390 to Medicaid made by this act and to evaluate the impact of
391 various Medicaid policies, including the use of diagnosis
392 related groups on the reimbursement of hospital inpatient
393 services and the implementation of statewide managed care,
394 including managed long-term care. This section is repealed
395 December 31, 2015.
396 Section 3. Notwithstanding s. 409.915(3) and (4), Florida
397 Statutes, as amended by this act, the amount of each county’s
398 contribution during the 2013-2014 state fiscal year shall be
399 determined and provided to the Department of Revenue by the
400 Agency for Health Care Administration by June 15, 2013. The
401 Department of Revenue shall notify each county of its annual
402 contribution by June 20, 2013.
403 Section 4. This act shall take effect upon becoming a law.