Florida Senate - 2013 SENATOR AMENDMENT
Bill No. CS for SB 1884
Barcode 148516
LEGISLATIVE ACTION
Senate . House
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Floor: 1/AD/2R .
04/29/2013 02:26 PM .
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Senator Grimsley moved the following:
1 Senate Amendment (with title amendment)
2
3 Delete lines 34 - 366
4 and insert:
5 (2)(a) For the 2013-2014 state fiscal year through the
6 2019-2020 state fiscal year, the total amount of the counties’
7 annual contribution is $269.6 million. For each fiscal year
8 thereafter, the annual amount shall be adjusted by the
9 percentage change in the state Medicaid expenditures as
10 determined by the Social Services Estimating Conference.
11 (b) By March 15, 2020, and each year thereafter, the Social
12 Services Estimating Conference shall determine the percentage
13 change in state Medicaid expenditures by comparing expenditures
14 for the 2 most recent completed state fiscal years.
15 (3)(a)1. The amount of each county’s annual contribution is
16 equal to the product of the amount determined under subsection
17 (2) multiplied by the sum of the percentages calculated in sub
18 subparagraphs a. and b.:
19 a. The enrollment weight provided in subparagraph 2. is
20 multiplied by a fraction, the numerator of which is the number
21 of the county’s Medicaid enrollees as of March 1 of each year,
22 and the denominator of which is the number of all counties’
23 Medicaid enrollees as of March 1 of each year. The agency shall
24 calculate this amount for each county and provide the
25 information to the Department of Revenue by May 15 of each year.
26 b. The payment weight provided in subparagraph 2. is
27 multiplied by the percentage share of payments provided in
28 subparagraph 3. for each county.
29 2. The weights for each fiscal year are equal to:
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31 WEIGHTS
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34 FISCAL YEAR ENROLLMENT PAYMENT
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43 3. The percentage share of payments for each county is:
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46 COUNTY SHARE OF PAYMENTS
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116 (b)1. The Legislature intends to replace the county
117 percentage share provided in subparagraph (a)3. with percentage
118 shares based upon each county’s proportion of the total
119 statewide amount of county billings made under this section from
120 April 1, 2012, through March 31, 2013, for which the state
121 ultimately receives payment.
122 2. By February 1 of each year and continuing until a
123 certification is made under sub-subparagraph b., the agency
124 shall report to the President of the Senate and the Speaker of
125 the House of Representatives the status of the county billings
126 made under this section from April 1, 2012, through March 31,
127 2013, by county, including:
128 a. The amounts billed to each county which remain unpaid,
129 if any; and
130 b. A certification from the agency of a final accounting of
131 the amount of funds received by the state from such billings, by
132 county, upon the expiration of all appeal rights that counties
133 may have to contest such billings.
134 3. By March 15 of the state fiscal year in which the state
135 receives the certification provided for in sub-subparagraph
136 (b)2.b., the Social Services Estimating Conference shall
137 calculate each county’s percentage share of the total statewide
138 amount of county billings made under this section from April 1,
139 2012, through March 31, 2013, for which the state ultimately
140 receives payment.
141 4. Beginning in the state fiscal year following the receipt
142 by the state of the certification provided in sub-subparagraph
143 (b)2.b., each county’s percentage share under subparagraph (a)3.
144 shall be replaced by the percentage calculated under
145 subparagraph (b)3.
146 5. If the court invalidates the replacement of each
147 county’s share as provided in this paragraph, the county share
148 set forth in subparagraph (a)3. shall continue to apply.
149 (4) By June 1 of each year, the Department of Revenue shall
150 notify each county of its required annual contribution. Each
151 county shall pay its contribution, by check or electronic
152 transfer, in equal monthly installments to the department by the
153 5th day of each month. If a county fails to remit the payment by
154 the 5th day of the month, the department shall reduce the
155 monthly distribution of that county pursuant to s. 218.61 and,
156 if necessary, by the amount of the monthly installment pursuant
157 to s. 218.26. The payments and the amounts by which the
158 distributions are reduced shall be transferred to the General
159 Revenue Fund.
160 (1) Each county shall participate in the following items of
161 care and service:
162 (a) For both health maintenance members and fee-for-service
163 beneficiaries, payments for inpatient hospitalization in excess
164 of 10 days, but not in excess of 45 days, with the exception of
165 pregnant women and children whose income is in excess of the
166 federal poverty level and who do not participate in the Medicaid
167 medically needy program, and for adult lung transplant services.
168 (b) For both health maintenance members and fee-for-service
169 beneficiaries, payments for nursing home or intermediate
170 facilities care in excess of $170 per month, with the exception
171 of skilled nursing care for children under age 21.
172 (2) A county’s participation must be 35 percent of the
173 total cost, or the applicable discounted cost paid by the state
174 for Medicaid recipients enrolled in health maintenance
175 organizations or prepaid health plans, of providing the items
176 listed in subsection (1), except that the payments for items
177 listed in paragraph (1)(b) may not exceed $55 per month per
178 person.
179 (3) Each county shall set aside sufficient funds to pay for
180 items of care and service provided to the county’s eligible
181 recipients for which county contributions are required,
182 regardless of where in the state the care or service is
183 rendered.
184 (4) Each county shall contribute its pro rata share of the
185 total county participation based upon statements rendered by the
186 agency. The agency shall render such statements monthly based on
187 each county’s eligible recipients. For purposes of this section,
188 each county’s eligible recipients shall be determined by the
189 recipient’s address information contained in the federally
190 approved Medicaid eligibility system within the Department of
191 Children and Family Services. A county may use the process
192 developed under subsection (10) to request a refund if it
193 determines that the statement rendered by the agency contains
194 errors.
195 (5) In any county in which a special taxing district or
196 authority is located which benefits will benefit from the
197 Medicaid program medical assistance programs covered by this
198 section, the board of county commissioners may divide the
199 county’s financial responsibility for this purpose
200 proportionately, and each such district or authority must
201 furnish its share to the board of county commissioners in time
202 for the board to comply with subsection (4) (3). Any appeal of
203 the proration made by the board of county commissioners must be
204 made to the Department of Financial Services, which shall then
205 set the proportionate share for of each party.
206 (6) Counties are exempt from contributing toward the cost
207 of new exemptions on inpatient ceilings for statutory teaching
208 hospitals, specialty hospitals, and community hospital education
209 program hospitals that came into effect July 1, 2000, and for
210 special Medicaid payments that came into effect on or after July
211 1, 2000.
212 (6)(7)(a) By August 1, 2012, the agency shall certify to
213 each county the amount of such county’s billings from November
214 1, 2001, through April 30, 2012, which remain unpaid. A county
215 may contest the amount certified by filing a petition under the
216 applicable provisions of chapter 120 on or before September 1,
217 2012. This procedure is the exclusive method to challenge the
218 amount certified. In order to successfully challenge the amount
219 certified, a county must show, by a preponderance of the
220 evidence, that a recipient was not an eligible recipient of that
221 county or that the amount certified was otherwise in error.
222 (b) By September 15, 2012, the agency shall certify to the
223 Department of Revenue:
224 1. For each county that files a petition on or before
225 September 1, 2012, the amount certified under paragraph (a); and
226 2. For each county that does not file a petition on or
227 before September 1, 2012, an amount equal to 85 percent of the
228 amount certified under paragraph (a).
229 (c) The filing of a petition under paragraph (a) does shall
230 not stay or stop the Department of Revenue from reducing
231 distributions in accordance with paragraph (b) and subsection
232 (7) (8). If a county that files a petition under paragraph (a)
233 is able to demonstrate that the amount certified should be
234 reduced, the agency shall notify the Department of Revenue of
235 the amount of the reduction. The Department of Revenue shall
236 adjust all future monthly distribution reductions under
237 subsection (7) (8) in a manner that results in the remaining
238 total distribution reduction being applied in equal monthly
239 amounts.
240 (7)(8)(a) Beginning with the October 2012 distribution, the
241 Department of Revenue shall reduce each county’s distributions
242 pursuant to s. 218.26 by one thirty-sixth of the amount
243 certified by the agency under subsection (6) (7) for that
244 county, minus any amount required under paragraph (b). Beginning
245 with the October 2013 distribution, the Department of Revenue
246 shall reduce each county’s distributions pursuant to s. 218.26
247 by one forty-eighth of two-thirds of the amount certified by the
248 agency under subsection (6) (7) for that county, minus any
249 amount required under paragraph (b). However, the amount of the
250 reduction may not exceed 50 percent of each county’s
251 distribution. If, after 60 months, the reductions for any county
252 do not equal the total amount initially certified by the agency,
253 the Department of Revenue shall continue to reduce such county’s
254 distribution by up to 50 percent until the total amount
255 certified is reached. The amounts by which the distributions are
256 reduced shall be transferred to the General Revenue Fund.
257 (b) As an assurance to holders of bonds issued before the
258 effective date of this act to which distributions made pursuant
259 to s. 218.26 are pledged, or bonds issued to refund such bonds
260 which mature no later than the bonds they refunded and which
261 result in a reduction of debt service payable in each fiscal
262 year, the amount available for distribution to a county shall
263 remain as provided by law and continue to be subject to any lien
264 or claim on behalf of the bondholders. The Department of Revenue
265 must ensure, based on information provided by an affected
266 county, that any reduction in amounts distributed pursuant to
267 paragraph (a) does not reduce the amount of distribution to a
268 county below the amount necessary for the timely payment of
269 principal and interest when due on the bonds and the amount
270 necessary to comply with any covenant under the bond resolution
271 or other documents relating to the issuance of the bonds. If a
272 reduction to a county’s monthly distribution must be decreased
273 in order to comply with this paragraph, the Department of
274 Revenue must notify the agency of the amount of the decrease and
275 the agency must send a bill for payment of such amount to the
276 affected county.
277 (9)(a) Beginning May 1, 2012, and each month thereafter,
278 the agency shall certify to the Department of Revenue by the 7th
279 day of each month the amount of the monthly statement rendered
280 to each county pursuant to subsection (4). Beginning with the
281 May 2012 distribution, the Department of Revenue shall reduce
282 each county’s monthly distribution pursuant to s. 218.61 by the
283 amount certified by the agency minus any amount required under
284 paragraph (b). The amounts by which the distributions are
285 reduced shall be transferred to the General Revenue Fund.
286 (b) As an assurance to holders of bonds issued before the
287 effective date of this act to which distributions made pursuant
288 to s. 218.61 are pledged, or bonds issued to refund such bonds
289 which mature no later than the bonds they refunded and which
290 result in a reduction of debt service payable in each fiscal
291 year, the amount available for distribution to a county shall
292 remain as provided by law and continue to be subject to any lien
293 or claim on behalf of the bondholders. The Department of Revenue
294 must ensure, based on information provided by an affected
295 county, that any reduction in amounts distributed pursuant to
296 paragraph (a) does not reduce the amount of distribution to a
297 county below the amount necessary for the timely payment of
298 principal and interest when due on the bonds and the amount
299 necessary to comply with any covenant under the bond resolution
300 or other documents relating to the issuance of the bonds. If a
301 reduction to a county’s monthly distribution must be decreased
302 in order to comply with this paragraph, the Department of
303 Revenue must notify the agency of the amount of the decrease and
304 the agency must send a bill for payment of such amount to the
305 affected county.
306 (10) The agency, in consultation with the Department of
307 Revenue and the Florida Association of Counties, shall develop a
308 process for refund requests which:
309 (a) Allows counties to submit to the agency written
310 requests for refunds of any amounts by which the distributions
311 were reduced as provided in subsection (9) and which set forth
312 the reasons for the refund requests.
313 (b) Requires the agency to make a determination as to
314 whether a refund request is appropriate and should be approved,
315 in which case the agency shall certify the amount of the refund
316 to the department.
317 (c) Requires the department to issue the refund for the
318 certified amount to the county from the General Revenue Fund.
319 The Department of Revenue may issue the refund in the form of a
320 credit against reductions to be applied to subsequent monthly
321 distributions.
322 (8)(11) Beginning in the 2013-2014 fiscal year and each
323 year thereafter through the 2020-2021 fiscal year, the Chief
324 Financial Officer shall transfer from the General Revenue Fund
325 to the Lawton Chiles Endowment Fund an amount equal to the
326 amounts transferred to the General Revenue Fund in the previous
327 fiscal year pursuant to subsections (4) and (7) subsections (8)
328 and (9), reduced by the amount of refunds paid pursuant to
329 subsection (10), which are in excess of the official estimate
330 for medical hospital fees for such previous fiscal year adopted
331 by the Revenue Estimating Conference on January 12, 2012, as
332 reflected in the conference’s workpapers. By July 20 of each
333 year, the Office of Economic and Demographic Research shall
334 certify the amount to be transferred to the Chief Financial
335 Officer. Such transfers must be made before July 31 of each year
336 until the total transfers for all years equal $350 million. If
337 In the event that such transfers do not total $350 million by
338 July 1, 2021, the Legislature shall provide for the transfer of
339 amounts necessary to total $350 million. The Office of Economic
340 and Demographic Research shall publish the official estimates
341 reflected in the conference’s workpapers on its website.
342 (9)(12) The agency may adopt rules to administer this
343 section.
344 Section 2. The Agency for Health Care Administration shall
345 provide a data report to the Florida Association of Counties
346 which includes such information as may be necessary for a
347 comprehensive evaluation of the cost and utilization of health
348 services by Medicaid enrollees in each county by service type.
349 The data report shall be provided at least annually at the
350 request of the association. Copies of the data report shall also
351 be provided to the Governor, the President of the Senate, and
352 the Speaker of the House of Representatives. The agency shall
353 provide other information and assistance requested by the
354 association in order to assess the impact on counties of the
355 changes to the methodology for determining county contributions
356 to Medicaid made by this act and to evaluate the impact of
357 various Medicaid policies, including the use of diagnosis
358 related groups on the reimbursement of hospital inpatient
359 services and the implementation of statewide managed care,
360 including managed long-term care. This section is repealed
361 December 31, 2015.
362
363 ================= T I T L E A M E N D M E N T ================
364 And the title is amended as follows:
365 Delete lines 4 - 15
366 and insert:
367 contribution for certain years and specifying the
368 method for determining the amount in the following
369 years; revising the method for calculating each
370 county’s contribution; providing tables for
371 calculating county contributions; requiring the Agency
372 for Health Care Administration to annually report the
373 status of county billings to the Legislature;
374 authorizing the Department of Revenue to withhold
375 county distributions for failure to remit Medicaid
376 contributions; deleting provisions specifying the care
377 and services that counties must participate in,
378 obsolete bond provisions, and a process for refund
379 requests; requiring the agency to provide a report to
380 the Florida Association of Counties and the
381 Legislature on the impact on counties of the changes
382 to the methodology for determining county Medicaid
383 contributions and other factors;