CODING: Words stricken are deletions; words underlined are additions.
SENATE AMENDMENT
Bill No. CS for SB 2242
Amendment No.
CHAMBER ACTION
Senate House
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11 Senator Saunders moved the following amendment:
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13 Senate Amendment (with title amendment)
14 On page 13, line 22, through
15 page 15, line 9, delete those lines
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17 and insert:
18 Section 8. Paragraph (a) of subsection (1) and
19 paragraph (c) of subsection (13) of section 409.908, Florida
20 Statutes, are amended to read:
21 409.908 Reimbursement of Medicaid providers.--Subject
22 to specific appropriations, the agency shall reimburse
23 Medicaid providers, in accordance with state and federal law,
24 according to methodologies set forth in the rules of the
25 agency and in policy manuals and handbooks incorporated by
26 reference therein. These methodologies may include fee
27 schedules, reimbursement methods based on cost reporting,
28 negotiated fees, competitive bidding pursuant to s. 287.057,
29 and other mechanisms the agency considers efficient and
30 effective for purchasing services or goods on behalf of
31 recipients. Payment for Medicaid compensable services made on
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SENATE AMENDMENT
Bill No. CS for SB 2242
Amendment No.
1 behalf of Medicaid eligible persons is subject to the
2 availability of moneys and any limitations or directions
3 provided for in the General Appropriations Act or chapter 216.
4 Further, nothing in this section shall be construed to prevent
5 or limit the agency from adjusting fees, reimbursement rates,
6 lengths of stay, number of visits, or number of services, or
7 making any other adjustments necessary to comply with the
8 availability of moneys and any limitations or directions
9 provided for in the General Appropriations Act, provided the
10 adjustment is consistent with legislative intent.
11 (1) Reimbursement to hospitals licensed under part I
12 of chapter 395 must be made prospectively or on the basis of
13 negotiation.
14 (a) Reimbursement for inpatient care is limited as
15 provided for in s. 409.905(5). Reimbursement for hospital
16 outpatient care is limited to $1,500 $1,000 per state fiscal
17 year per recipient, except for:
18 1. Such care provided to a Medicaid recipient under
19 age 21, in which case the only limitation is medical
20 necessity;
21 2. Renal dialysis services; and
22 3. Other exceptions made by the agency.
23 (b) Hospitals that provide services to a
24 disproportionate share of low-income Medicaid recipients, or
25 that participate in the regional perinatal intensive care
26 center program under chapter 383, or that participate in the
27 statutory teaching hospital disproportionate share program, or
28 that participate in the extraordinary disproportionate share
29 program, may receive additional reimbursement. The total
30 amount of payment for disproportionate share hospitals shall
31 be fixed by the General Appropriations Act. The computation of
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SENATE AMENDMENT
Bill No. CS for SB 2242
Amendment No.
1 these payments must be made in compliance with all federal
2 regulations and the methodologies described in ss. 409.911,
3 409.9112, and 409.9113.
4 (c) The agency is authorized to limit inflationary
5 increases for outpatient hospital services as directed by the
6 General Appropriations Act.
7 (13) Medicare premiums for persons eligible for both
8 Medicare and Medicaid coverage shall be paid at the rates
9 established by Title XVIII of the Social Security Act. For
10 Medicare services rendered to Medicaid-eligible persons,
11 Medicaid shall pay Medicare deductibles and coinsurance as
12 follows:
13 (c) Medicaid will pay no portion of Medicare
14 deductibles and coinsurance when payment that Medicare has
15 made for the service equals or exceeds what Medicaid would
16 have paid if it had been the sole payor. The combined payment
17 of Medicare and Medicaid shall not exceed the amount Medicaid
18 would have paid had it been the sole payor. The Legislature
19 finds that there has been confusion regarding the
20 reimbursement for services rendered to dually eligible
21 Medicare beneficiaries. Accordingly, the Legislature clarifies
22 that it has always been the intent of the legislature before
23 and after 1991 that, in reimbursing in accordance with fees
24 established by Title XVIII for premiums, deductibles, and
25 coinsurance for Medicare services rendered by physicians to
26 Medicaid eligible persons, that physicians be reimbursed at
27 the lesser of the amount billed by the physician or the
28 Medicaid maximum allowable fee established by the Agency for
29 Health Care Administration, as is permitted by federal law. It
30 has never been the intent of the Legislature with regard to
31 such services rendered by physicians that Medicaid be required
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SENATE AMENDMENT
Bill No. CS for SB 2242
Amendment No.
1 to provide any payment for deductibles, coinsurance, or
2 copayments for Medicare cost-sharing, or any expenses incurred
3 relating thereto, in excess of the payment amount provided for
4 under the State Medicaid plan for such service. This payment
5 methodology is applicable even in those situations in which
6 the payment for Medicare cost-sharing for a qualified Medicare
7 beneficiary with respect to an item or service is reduced or
8 eliminated. This expression of the Legislature is in
9 clarification of existing law and shall apply to payment for,
10 and with respect to provider agreements with respect to, items
11 or services furnished on or after the effective date of this
12 act. This paragraph applies to payment by Medicaid for items
13 and services furnished before the effective date of this act
14 if such payment is the subject of a lawsuit that is based on
15 the provisions of s. 409.908, and that is pending as of, or is
16 initiated after, the effective date of this act.
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20 And the title is amended as follows:
21 On page 1, line 28, after "care;"
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23 insert:
24 providing legislative findings, intent, and
25 clarification; relating to reimbursement for
26 services to dually eligible Medicare
27 beneficiaries; providing applicability;
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