Senate Bill 0954c2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for CS for SB 954
By the Committees on Fiscal Resource; Health, Aging and
Long-Term Care; and Senators Saunders and Kirkpatrick
314-2202A-00
1 A bill to be entitled
2 An act relating to health care; amending s.
3 395.701, F.S.; reducing the annual assessment
4 on hospitals for outpatient services; amending
5 s. 395.7015, F.S.; reducing the annual
6 assessment against certain health care
7 entities; amending s. 408.904, F.S.; increasing
8 benefits for certain persons who receive
9 hospital outpatient services; amending s.
10 408.905, F.S.; increasing benefits furnished by
11 Medicaid providers to recipients of hospital
12 outpatient services; amending s. 905.908, F.S.;
13 increasing reimbursement to hospitals for
14 outpatient care; amending s. 409.912, F.S.;
15 providing for a contract with and reimbursement
16 of an entity in Pasco County or Pinellas County
17 which provides in-home physician services to
18 Medicaid recipients with degenerative
19 neurological diseases; providing for future
20 repeal; requiring certain health care providers
21 to conduct an annual survey and produce an
22 annual report on uncompensated care; providing
23 appropriations; providing an effective date.
24
25 Be It Enacted by the Legislature of the State of Florida:
26
27 Section 1. Subsection (2) of section 395.701, Florida
28 Statutes, is amended to read:
29 395.701 Annual assessments on net operating revenues
30 to fund public medical assistance; administrative fines for
31 failure to pay assessments when due; exemption.--
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for CS for SB 954
314-2202A-00
1 (2)(a) There is imposed upon each hospital an
2 assessment in an amount equal to 1.5 percent of the annual net
3 operating revenue for inpatient services for each hospital,
4 such revenue to be determined by the agency, based on the
5 actual experience of the hospital as reported to the agency.
6 Within 6 months after the end of each hospital fiscal year,
7 the agency shall certify the amount of the assessment for each
8 hospital. The assessment shall be payable to and collected by
9 the agency in equal quarterly amounts, on or before the first
10 day of each calendar quarter, beginning with the first full
11 calendar quarter that occurs after the agency certifies the
12 amount of the assessment for each hospital. All moneys
13 collected pursuant to this paragraph subsection shall be
14 deposited into the Public Medical Assistance Trust Fund.
15 (b) There is imposed upon each hospital an assessment
16 in an amount equal to 1.0 percent of the annual net operating
17 revenue for outpatient services for each hospital, such
18 revenue to be determined by the agency, based on the actual
19 experience of the hospital as reported to the agency. Within 6
20 months after the end of each hospital fiscal year, the agency
21 shall certify the amount of the assessment for each hospital.
22 The assessment shall be payable to and collected by the agency
23 in equal quarterly amounts, on or before the first day of each
24 calendar quarter, beginning with the first full calendar
25 quarter that occurs after the agency certifies the amount of
26 the assessment for each hospital. All moneys collected
27 pursuant to this paragraph shall be deposited into the Public
28 Medical Assistance Trust Fund.
29 Section 2. Paragraph (a) of subsection (2) of section
30 395.7015, Florida Statutes, is amended to read:
31 395.7015 Annual assessment on health care entities.--
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for CS for SB 954
314-2202A-00
1 (2) There is imposed an annual assessment against
2 certain health care entities as described in this section:
3 (a) The assessment shall be equal to 1.0 1.5 percent
4 of the annual net operating revenues of health care entities.
5 The assessment shall be payable to and collected by the
6 agency. Assessments shall be based on annual net operating
7 revenues for the entity's most recently completed fiscal year
8 as provided in subsection (3).
9 Section 3. Paragraph (c) of subsection (2) of section
10 408.904, Florida Statutes, is amended to read:
11 408.904 Benefits.--
12 (2) Covered health services include:
13 (c) Hospital outpatient services. Those services
14 provided to a member in the outpatient portion of a hospital
15 licensed under part I of chapter 395, up to a limit of $1,500
16 $1,000 per calendar year per member, that are preventive,
17 diagnostic, therapeutic, or palliative.
18 Section 4. Subsection (6) of section 409.905, Florida
19 Statutes, is amended to read:
20 409.905 Mandatory Medicaid services.--The agency may
21 make payments for the following services, which are required
22 of the state by Title XIX of the Social Security Act,
23 furnished by Medicaid providers to recipients who are
24 determined to be eligible on the dates on which the services
25 were provided. Any service under this section shall be
26 provided only when medically necessary and in accordance with
27 state and federal law. Nothing in this section shall be
28 construed to prevent or limit the agency from adjusting fees,
29 reimbursement rates, lengths of stay, number of visits, number
30 of services, or any other adjustments necessary to comply with
31
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for CS for SB 954
314-2202A-00
1 the availability of moneys and any limitations or directions
2 provided for in the General Appropriations Act or chapter 216.
3 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
4 pay for preventive, diagnostic, therapeutic, or palliative
5 care and other services provided to a recipient in the
6 outpatient portion of a hospital licensed under part I of
7 chapter 395, and provided under the direction of a licensed
8 physician or licensed dentist, except that payment for such
9 care and services is limited to $1,500 $1,000 per state fiscal
10 year per recipient, unless an exception has been made by the
11 agency, and with the exception of a Medicaid recipient under
12 age 21, in which case the only limitation is medical
13 necessity.
14 Section 5. Paragraph (a) of subsection (1) of section
15 409.908, Florida Statutes, is amended to read:
16 409.908 Reimbursement of Medicaid providers.--Subject
17 to specific appropriations, the agency shall reimburse
18 Medicaid providers, in accordance with state and federal law,
19 according to methodologies set forth in the rules of the
20 agency and in policy manuals and handbooks incorporated by
21 reference therein. These methodologies may include fee
22 schedules, reimbursement methods based on cost reporting,
23 negotiated fees, competitive bidding pursuant to s. 287.057,
24 and other mechanisms the agency considers efficient and
25 effective for purchasing services or goods on behalf of
26 recipients. Payment for Medicaid compensable services made on
27 behalf of Medicaid eligible persons is subject to the
28 availability of moneys and any limitations or directions
29 provided for in the General Appropriations Act or chapter 216.
30 Further, nothing in this section shall be construed to prevent
31 or limit the agency from adjusting fees, reimbursement rates,
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for CS for SB 954
314-2202A-00
1 lengths of stay, number of visits, or number of services, or
2 making any other adjustments necessary to comply with the
3 availability of moneys and any limitations or directions
4 provided for in the General Appropriations Act, provided the
5 adjustment is consistent with legislative intent.
6 (1) Reimbursement to hospitals licensed under part I
7 of chapter 395 must be made prospectively or on the basis of
8 negotiation.
9 (a) Reimbursement for inpatient care is limited as
10 provided for in s. 409.905(5). Reimbursement for hospital
11 outpatient care is limited to $1,500 $1,000 per state fiscal
12 year per recipient, except for:
13 1. Such care provided to a Medicaid recipient under
14 age 21, in which case the only limitation is medical
15 necessity;
16 2. Renal dialysis services; and
17 3. Other exceptions made by the agency.
18 Section 6. Paragraph (e) is added to subsection (3) of
19 section 409.912, Florida Statutes, to read:
20 409.912 Cost-effective purchasing of health care.--The
21 agency shall purchase goods and services for Medicaid
22 recipients in the most cost-effective manner consistent with
23 the delivery of quality medical care. The agency shall
24 maximize the use of prepaid per capita and prepaid aggregate
25 fixed-sum basis services when appropriate and other
26 alternative service delivery and reimbursement methodologies,
27 including competitive bidding pursuant to s. 287.057, designed
28 to facilitate the cost-effective purchase of a case-managed
29 continuum of care. The agency shall also require providers to
30 minimize the exposure of recipients to the need for acute
31
5
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for CS for SB 954
314-2202A-00
1 inpatient, custodial, and other institutional care and the
2 inappropriate or unnecessary use of high-cost services.
3 (3) The agency may contract with:
4 (e) An entity in Pasco County or Pinellas County which
5 provides in-home physician services to Medicaid recipients
6 having degenerative neurological diseases in order to test the
7 cost-effectiveness of enhanced home-based medical care. The
8 entity providing the services shall be reimbursed on a
9 fee-for-service basis at a rate not less than comparable
10 Medicare reimbursement rates. The agency may apply for waivers
11 of federal regulations necessary to implement such program.
12 This paragraph expires July 1, 2002.
13 Section 7. The Department of Health's Volunteer Health
14 Care Provider Program, or its successor program, shall
15 coordinate with the Agency for Health Care Administration, the
16 Florida Board of Medicine, the Florida Board of Osteopathic
17 Medicine, the Florida Medical Association, the Florida
18 Osteopathic Medical Association, the Florida Hospital
19 Association, Community Hospitals and Health Systems, and the
20 Florida League of Hospitals to conduct a survey and produce
21 for the Legislature by December 31 of each calendar year a
22 report relative to uncompensated care and the Florida Medicaid
23 program. The report shall include: the dollar amount of
24 uncompensated care for which the physician receives no
25 reimbursement provided by physicians licensed pursuant to
26 chapter 458, Florida Statutes, or chapter 459, Florida
27 Statutes, by medical specialty and by county; the dollar
28 amount of uncompensated care for which the hospital receives
29 no reimbursement provided by Florida hospitals licensed under
30 chapter 395, Florida Statutes, by medical specialty and by
31 county; and the number of Medicaid physicians in the state by
6
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for CS for SB 954
314-2202A-00
1 medical specialty and county and the average number of
2 encounters per physician. The results of the Medicaid provider
3 survey shall be compared with the projected need for Medicaid
4 services by specialty and county, as determined by the
5 department. The report that is to be filed on December 31,
6 2000, shall also include the following information: a
7 comparison of Florida Medicaid reimbursement rates with
8 Medicaid reimbursement rates for other states; a comparison of
9 Florida Medicaid reimbursement rates with Medicare
10 reimbursement rates; a comparison of Florida Medicaid
11 reimbursement rates with fee-for-service rates; and a
12 historical report on Florida Medicaid reimbursement rates.
13 Section 8. The Legislature shall appropriate each
14 fiscal year from the General Revenue Fund to the Public
15 Medical Assistance Trust Fund an amount sufficient to replace
16 the funds lost due to the reduction by this act of the
17 assessment on other health care entities under section
18 395.7015, Florida Statutes, and the reduction by this act in
19 the assessment on hospitals under section 395.701, Florida
20 Statutes, and to maintain federal approval of the reduced
21 amount of funds deposited into the Public Medical Assistance
22 Trust Fund under section 395.701, Florida Statutes, as state
23 matching funds for the state's Medicaid program.
24 Section 9. The sum of $28.3 million is appropriated
25 from the General Revenue Fund to the Agency for Health Care
26 Administration for the purpose of implementing this act.
27 However, such appropriation shall be reduced by an amount
28 equal to any similar appropriation for the same purpose which
29 is contained in other legislation adopted during the 2000
30 legislative session and which becomes a law.
31 Section 10. This act shall take effect July 1, 2000.
7
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for CS for SB 954
314-2202A-00
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 CS/SB 954
3
4 The Committee Substitute made the following changes to
CS/CS/SB 954:
5
1) Reduces the hospital assessment fee on outpatient
6 services, ambulatory surgical centers, mobile surgical
facilities, certain clinical laboratories, freestanding
7 radiation therapy centers and diagnostic imaging centers
from 1.5% to 1.0%
8
2) Instead of repealing the fee, the CS reduces the
9 hospital assessment fee on ambulatory surgical centers,
mobile surgical facilities, certain clinical
10 laboratories, freestanding radiation therapy centers and
diagnostic imaging centers from 1.5% to 1.0%.
11
3) Increases the annual reimbursement limit on hospital
12 outpatient services from $1,000 to $1,500. The bill
increased it to $2,000.
13
4) Provides a $28.3 million GR appropriation to the PMATF
14 to cover the loss in revenue from the bill and directs
the Legislature to annually appropriate revenues from GR
15 to the PMATF to replace the loss in revenues created by
this act.
16
5) Requires the Department of Health's Volunteer Health
17 Care Provider Program to conduct a survey and publish a
report annually on the uncompensated care for which
18 health providers receive no reimbursement.
19 6) The bill changes the effective date from July 1,
2000,except that the amendment to s. 395.701, Florida
20 Statutes, to eliminate the annual PMATF assessment on
net operating revenues attributed to hospital outpatient
21 services shall take effect only upon receipt by the
Agency for HealthCare Administration of written
22 confirmation from the federal Health Care Financing
Administration that the changes contained in such
23 amendment will not adversely affect the use of the
remaining assessments as state match for the state's
24 Medicaid program, to July 1, 2000.
25
26
27
28
29
30
31
8