995147 GENERAL APPROPRIATIONS BILL Committee Amendment SB2500 HHS 36 Senator(s):Silver moved the following amendment:Section: 03 EXPLANATION: On Page: 052 This amendment provides Special Medicaid Payments for the implementation of a revised Upper Payment Limit Spec App: 222 proposal which incorporates a 17.5% rate of return, modifications of reimbursements for trauma centers, rural hospitals, Graduate Medical Education, Primary Care and the hold harmless reimbursements. The Regular Disproportionate Share Program has been revised to be a public hospital Disproportionate Share Program only. These changes are necessitated because of federal regulations which reduced UPL limits from 150% to 100% for public hospitals. NET IMPACT ON: Total Funds General Revenue Trust Funds Recurring - 38,422,195 6,400,000 32,022,195 Non-Recurring - 0 0 0 _________________________________________________________________________________ Positions & Amount Positions & Amount DELETE INSERT AGENCY FOR HEALTH CARE ADMINISTRATION Program: Health Care Services Medicaid Services To Individuals 68501400 In Section 03 On Page 052 222 Special Categories 101582 Hospital Inpatient Services IOEE 1000 From General Revenue Fund 169,607,035 176,007,035 CA 6,400,000 FSI2 6,400,000 2339 From Grants And Donations Trust 205,254,157 214,749,419 Fund CA 9,495,262 FSI2 9,495,262 2474 From Medical Care Trust Fund 1,083,309,577 1,105,836,510 CA 22,526,933 FSI3 22,526,933 DELETE the second through the eight paragraphs of proviso language following Specific Appropriation 222,995147 Log:0156 EDP/LFB 03/13/02 09:21:39 PM Senate Page: 1 and INSERT the following: From the funds in Specific Appropriation 222, $14,400,741 from the Grants and Donations Trust Fund and $20,408,881 from the Medical Care Trust Fund are provided for special Medicaid payments to statutory teaching hospitals, hospitals providing primary care to low-income individuals, hospitals which operate designated or provisional trauma centers, and rural hospitals. Statutory teaching hospitals that qualify for the Graduate Medical Education disproportionate share (DSH) hospital program shall be paid $10,183,190 distributed in the same proportion as Graduate Medical Education DSH payments. Hospitals providing primary care to low-income individuals and participating in the Primary Care DSH program shall be paid $10,183,190 distributed in the same proportion as the Primary Care DSH payments. Hospitals, which are designated as provisional trauma centers, shall be paid $8,976,621. Of this amount, $3,497,000 shall be distributed equally between hospitals which are a Level I trauma center; $3,789,000 shall be distributed equally between hospitals which are either a Level II or Pediatric trauma center; and $1,690,621 shall be distributed equally between hospitals which are both a Level II and Pediatric trauma center. Rural hospitals participating in the Rural Hospital DSH program shall be paid $5,466,621 distributed in the same proportion as the DSH payments. From the funds in Specific Appropriation 222, $3,744,991 from the Grants and Donations Trust Fund and $5,307,443 from the Medical Care Trust Fund are provided to eliminate the inpatient reimbursement ceilings for hospitals whose charity care and Medicaid days, as a percentage of total hospital days, equals or exceeds 15 percent. Hospitals that exceed 15 percent and are a trauma center shall be paid $2,000,000 if their variable cost rate is less than their variable cost target or county ceiling target. The agency shall use the 1997 audited DSH data available as of March 1, 2001. From the funds in Specific Appropriation 222, $2,199,090 from the Grants and Donations Trust Fund and $3,116,575 from the Medical Care Trust Fund are provided to eliminate the inpatient reimbursement ceilings for hospitals whose Medicaid days, as a percentage of total hospital days, exceeds 9.6 percent and are a trauma center. The Agency shall use the 1997 audited DSH data available as of March 1, 2001. From the funds in Specific Appropriations 222, $9,400,000 from the General Revenue Fund, $26,771,369 from the Grants and Donations Trust Fund, and $51,262,446 from the Medical Care Trust Fund are provided to make special Medicaid payments to hospitals which serve as a safety net in providing emergency and inpatient care to low-income and indigent individuals. These amounts shall be paid to the following: University Medical Center - Shands $53,529,603 All Children's Hospital 6,604,745 St. Mary's Hospital 51,222995147 Log:0156 EDP/LFB 03/13/02 09:21:39 PM Senate Page: 2 Miami Chldren's Hospital 5,750,230 Tampa General Hospital 10,711,480 Glades General Hospital 4,111 Orlando Regional Medical Center 3,641,219 Tallahassee Memorial Healthcare 54,402 St. Joseph's Hospital 52,835 Florida Hospital 55,072 Wellington Regional Medical Center 1,910 Bethesda Memorial Hospital 23,395 Mt. Sinai Medical Center 6,884,094 Boca Raton Community Hospital 1,711 Columbia JFK Medical Center 20,170 Good Samaritan Hospital 16,259 Palm Beach Garden Medical Center 3,515 Delray Medical Center 19,712 West Boca Medical Center 1,300 Palms West Hospital 3,820 Jupiter Medical Center 3,010 Of the amount provided to University Medical Center - Shands, $12,086,053 is contingent upon University Medical Center - Shands submitting a financially balanced break-even operating budget for University Medical Center - Shands. These funds are also contingent upon additional financial commitments from the City of Jacksonville and the parent corporation of University Medical Center - Shands. Prior to the release of these funds the break-even operating budgets and statements of additional financial commitments must be submitted to the Legislative Budget Commission for review and approval. In the event that University Medical Center - Shands is unable to match with federal funds all or some portion of the state funds provided, the unmatched state revenue may be provided directly to University Medical Center - Shands upon approval of the Legislative Budget Commission. From the funds in Specific Appropriation 222, $90,192,230 from the Grants and Donation Trust Fund, and $127,821,379 from the Medical Care Trust Fund are provided for special Medicaid payments to hospitals providing enhanced services to low-income individuals. From the funds in Specific Appropriation 222, $6,157,515 from the Grants and Donations Trust Fund and $8,726,496 from the Medical Care Trust Fund are provided to make special Medicaid payments to the statutory teaching hospitals. These payments shall be used by the teaching hospitals in collaboration with the Department of Health and the Area Health Education Centers to enhance medical education programs. From the funds in Specific Appropriation 222, $39,969,638 from the Grants and Donations Trust Fund and $56,645,393 from the Medical Care Trust Fund are provided to eliminate the inpatient reimbursement ceilings for teaching, specialty and Community Hospital Education Program hospitals.995147 Log:0156 EDP/LFB 03/13/02 09:21:39 PM Senate Page: 3 In Section 03 On Page 054 225 Special Categories 101596 Hospital Outpatient Services IOEE DELETE the first three paragraphs of proviso language immediately following Specific Appropriation 225. and INSERT the following proviso in its place. From the funds in Specific Appropriation 225, $18,216,011 from the Grants and Donations Trust Fund and $25,815,924 from the Medical Care Trust Fund are provided to increase the hospital outpatient cap for adults from $1,000 to $1,500 per year and to eliminate the outpatient reimbursement ceilings for teaching, specialty and Community Health Education Program hospitals. From the funds in Specific Appropriation 225, $833,061 from the Grants and Donations Trust Fund and $1,180,625 from the Medical Care Trust Fund are provided to eliminate the outpatient reimbursement ceilings for hospitals whose charity care and Medicaid days, as a percentage of total hospital days, equals or exceeds 15 percent. The Agency shall use the 1997 audited DSH data available as of March 1, 2001. From the funds in Specific Appropriation 225, $148,702 from the Grants and Donations Trust Fund and $210,741 from the Medical Care Trust Fund are provided to eliminate the outpatient reimbursement ceilings for hospitals whose Medicaid days, as a percentage of total hospital days, exceeds 9.6 percent, and are a trauma center. The agency shall use the 1997 audited DSH data available as of March 1, 2001.
Line item amendments are accepted as part of the amendatory process. However, due to the necessity of using computerized systems this may entail a different placement within a budget entity or the renumbering of the specific appropriation items. 995147 Log:0156 EDP/LFB 03/13/02 09:21:39 PM Senate Page: 4