Florida Senate - 2013 SB 1884
By the Committee on Health Policy
588-04482-13 20131884__
1 A bill to be entitled
2 An act relating to county Medicaid contributions;
3 amending s. 409.915, F.S.; specifying the initial
4 contribution and revising the method for calculating
5 county contributions; providing timetables for
6 calculating contributions and for payment of
7 contributions; deleting provisions specifying the care
8 and services that counties must participate in,
9 obsolete bond provisions, and a process for refund
10 requests; specifying the method for calculating each
11 county’s contribution for the 2013-2014 fiscal year;
12 providing an effective date.
13
14 Be It Enacted by the Legislature of the State of Florida:
15
16 Section 1. Section 409.915, Florida Statutes, is amended to
17 read:
18 409.915 County contributions to Medicaid.—Although the
19 state is responsible for the full portion of the state share of
20 the matching funds required for the Medicaid program, in order
21 to acquire a certain portion of these funds, the state shall
22 charge the counties an annual contribution in order to acquire a
23 certain portion of these funds for certain items of care and
24 service as provided in this section.
25 (1) As used in this section, the term “state Medicaid
26 expenditures,” means those expenditures used as matching funds
27 for the federal Medicaid program.
28 (2)(a) For the 2013-2014 state fiscal year, the total
29 amount of the counties’ contribution is $269.6 million. For each
30 fiscal year thereafter, the annual amount shall be adjusted by
31 the percentage change in the state Medicaid expenditures as
32 determined by the Social Services Estimating Conference.
33 (b) By March 15 of each year, the Social Services
34 Estimating Conference shall determine the percentage change in
35 state Medicaid expenditures by comparing expenditures for the 2
36 most recent completed state fiscal years.
37 (3) The amount of each county’s annual contribution shall
38 be equal to the product of the amount determined under
39 subsection (2) multiplied by a fraction, the numerator of which
40 is the number of the county’s Medicaid enrollees as of March 1
41 of each year, and the denominator of which is the number of all
42 counties’ Medicaid enrollees as of March 1 of each year. The
43 agency shall calculate this amount for each county and provide
44 the information to the Department of Revenue by May 15 of each
45 year.
46 (4) By June 1 of each year, the Department of Revenue shall
47 notify each county of its annual contribution. Each county shall
48 pay its contribution, by check or electronic transfer, in equal
49 monthly installments to the Department of Revenue by the 5th day
50 of each month. If a county fails to remit the payment by the 5th
51 day of the month, the Department of Revenue shall reduce each
52 county’s monthly distribution pursuant to s. 218.61 by the
53 amount of the monthly installment. The payments and the amounts
54 by which the distributions are reduced shall be transferred to
55 the General Revenue Fund.
56 (1) Each county shall participate in the following items of
57 care and service:
58 (a) For both health maintenance members and fee-for-service
59 beneficiaries, payments for inpatient hospitalization in excess
60 of 10 days, but not in excess of 45 days, with the exception of
61 pregnant women and children whose income is in excess of the
62 federal poverty level and who do not participate in the Medicaid
63 medically needy program, and for adult lung transplant services.
64 (b) For both health maintenance members and fee-for-service
65 beneficiaries, payments for nursing home or intermediate
66 facilities care in excess of $170 per month, with the exception
67 of skilled nursing care for children under age 21.
68 (2) A county’s participation must be 35 percent of the
69 total cost, or the applicable discounted cost paid by the state
70 for Medicaid recipients enrolled in health maintenance
71 organizations or prepaid health plans, of providing the items
72 listed in subsection (1), except that the payments for items
73 listed in paragraph (1)(b) may not exceed $55 per month per
74 person.
75 (3) Each county shall set aside sufficient funds to pay for
76 items of care and service provided to the county’s eligible
77 recipients for which county contributions are required,
78 regardless of where in the state the care or service is
79 rendered.
80 (4) Each county shall contribute its pro rata share of the
81 total county participation based upon statements rendered by the
82 agency. The agency shall render such statements monthly based on
83 each county’s eligible recipients. For purposes of this section,
84 each county’s eligible recipients shall be determined by the
85 recipient’s address information contained in the federally
86 approved Medicaid eligibility system within the Department of
87 Children and Family Services. A county may use the process
88 developed under subsection (10) to request a refund if it
89 determines that the statement rendered by the agency contains
90 errors.
91 (5) In any county in which a special taxing district or
92 authority is located which benefits will benefit from the
93 Medicaid program medical assistance programs covered by this
94 section, the board of county commissioners may divide the
95 county’s financial responsibility for this purpose
96 proportionately, and each such district or authority must
97 furnish its share to the board of county commissioners in time
98 for the board to comply with subsection (4) (3). Any appeal of
99 the proration made by the board of county commissioners must be
100 made to the Department of Financial Services, which shall then
101 set the proportionate share for of each party.
102 (6) Counties are exempt from contributing toward the cost
103 of new exemptions on inpatient ceilings for statutory teaching
104 hospitals, specialty hospitals, and community hospital education
105 program hospitals that came into effect July 1, 2000, and for
106 special Medicaid payments that came into effect on or after July
107 1, 2000.
108 (6)(7)(a) By August 1, 2012, the agency shall certify to
109 each county the amount of such county’s billings from November
110 1, 2001, through April 30, 2012, which remain unpaid. A county
111 may contest the amount certified by filing a petition under the
112 applicable provisions of chapter 120 on or before September 1,
113 2012. This procedure is the exclusive method to challenge the
114 amount certified. In order to successfully challenge the amount
115 certified, a county must show, by a preponderance of the
116 evidence, that a recipient was not an eligible recipient of that
117 county or that the amount certified was otherwise in error.
118 (b) By September 15, 2012, the agency shall certify to the
119 Department of Revenue:
120 1. For each county that files a petition on or before
121 September 1, 2012, the amount certified under paragraph (a); and
122 2. For each county that does not file a petition on or
123 before September 1, 2012, an amount equal to 85 percent of the
124 amount certified under paragraph (a).
125 (c) The filing of a petition under paragraph (a) does shall
126 not stay or stop the Department of Revenue from reducing
127 distributions in accordance with paragraph (b) and subsection
128 (7) (8). If a county that files a petition under paragraph (a)
129 is able to demonstrate that the amount certified should be
130 reduced, the agency shall notify the Department of Revenue of
131 the amount of the reduction. The Department of Revenue shall
132 adjust all future monthly distribution reductions under
133 subsection (7) (8) in a manner that results in the remaining
134 total distribution reduction being applied in equal monthly
135 amounts.
136 (7)(8)(a) Beginning with the October 2012 distribution, the
137 Department of Revenue shall reduce each county’s distributions
138 pursuant to s. 218.26 by one thirty-sixth of the amount
139 certified by the agency under subsection (6) (7) for that
140 county, minus any amount required under paragraph (b). Beginning
141 with the October 2013 distribution, the Department of Revenue
142 shall reduce each county’s distributions pursuant to s. 218.26
143 by one forty-eighth of two-thirds of the amount certified by the
144 agency under subsection (6) (7) for that county, minus any
145 amount required under paragraph (b). However, the amount of the
146 reduction may not exceed 50 percent of each county’s
147 distribution. If, after 60 months, the reductions for any county
148 do not equal the total amount initially certified by the agency,
149 the Department of Revenue shall continue to reduce such county’s
150 distribution by up to 50 percent until the total amount
151 certified is reached. The amounts by which the distributions are
152 reduced shall be transferred to the General Revenue Fund.
153 (b) As an assurance to holders of bonds issued before the
154 effective date of this act to which distributions made pursuant
155 to s. 218.26 are pledged, or bonds issued to refund such bonds
156 which mature no later than the bonds they refunded and which
157 result in a reduction of debt service payable in each fiscal
158 year, the amount available for distribution to a county shall
159 remain as provided by law and continue to be subject to any lien
160 or claim on behalf of the bondholders. The Department of Revenue
161 must ensure, based on information provided by an affected
162 county, that any reduction in amounts distributed pursuant to
163 paragraph (a) does not reduce the amount of distribution to a
164 county below the amount necessary for the timely payment of
165 principal and interest when due on the bonds and the amount
166 necessary to comply with any covenant under the bond resolution
167 or other documents relating to the issuance of the bonds. If a
168 reduction to a county’s monthly distribution must be decreased
169 in order to comply with this paragraph, the Department of
170 Revenue must notify the agency of the amount of the decrease and
171 the agency must send a bill for payment of such amount to the
172 affected county.
173 (9)(a) Beginning May 1, 2012, and each month thereafter,
174 the agency shall certify to the Department of Revenue by the 7th
175 day of each month the amount of the monthly statement rendered
176 to each county pursuant to subsection (4). Beginning with the
177 May 2012 distribution, the Department of Revenue shall reduce
178 each county’s monthly distribution pursuant to s. 218.61 by the
179 amount certified by the agency minus any amount required under
180 paragraph (b). The amounts by which the distributions are
181 reduced shall be transferred to the General Revenue Fund.
182 (b) As an assurance to holders of bonds issued before the
183 effective date of this act to which distributions made pursuant
184 to s. 218.61 are pledged, or bonds issued to refund such bonds
185 which mature no later than the bonds they refunded and which
186 result in a reduction of debt service payable in each fiscal
187 year, the amount available for distribution to a county shall
188 remain as provided by law and continue to be subject to any lien
189 or claim on behalf of the bondholders. The Department of Revenue
190 must ensure, based on information provided by an affected
191 county, that any reduction in amounts distributed pursuant to
192 paragraph (a) does not reduce the amount of distribution to a
193 county below the amount necessary for the timely payment of
194 principal and interest when due on the bonds and the amount
195 necessary to comply with any covenant under the bond resolution
196 or other documents relating to the issuance of the bonds. If a
197 reduction to a county’s monthly distribution must be decreased
198 in order to comply with this paragraph, the Department of
199 Revenue must notify the agency of the amount of the decrease and
200 the agency must send a bill for payment of such amount to the
201 affected county.
202 (10) The agency, in consultation with the Department of
203 Revenue and the Florida Association of Counties, shall develop a
204 process for refund requests which:
205 (a) Allows counties to submit to the agency written
206 requests for refunds of any amounts by which the distributions
207 were reduced as provided in subsection (9) and which set forth
208 the reasons for the refund requests.
209 (b) Requires the agency to make a determination as to
210 whether a refund request is appropriate and should be approved,
211 in which case the agency shall certify the amount of the refund
212 to the department.
213 (c) Requires the department to issue the refund for the
214 certified amount to the county from the General Revenue Fund.
215 The Department of Revenue may issue the refund in the form of a
216 credit against reductions to be applied to subsequent monthly
217 distributions.
218 (8)(11) Beginning in the 2013-2014 fiscal year and each
219 year thereafter through the 2020-2021 fiscal year, the Chief
220 Financial Officer shall transfer from the General Revenue Fund
221 to the Lawton Chiles Endowment Fund an amount equal to the
222 amounts transferred to the General Revenue Fund in the previous
223 fiscal year pursuant to subsections (4) and (7) subsections (8)
224 and (9), reduced by the amount of refunds paid pursuant to
225 subsection (10), which are in excess of the official estimate
226 for medical hospital fees for such previous fiscal year adopted
227 by the Revenue Estimating Conference on January 12, 2012, as
228 reflected in the conference’s workpapers. By July 20 of each
229 year, the Office of Economic and Demographic Research shall
230 certify the amount to be transferred to the Chief Financial
231 Officer. Such transfers must be made before July 31 of each year
232 until the total transfers for all years equal $350 million. If
233 In the event that such transfers do not total $350 million by
234 July 1, 2021, the Legislature shall provide for the transfer of
235 amounts necessary to total $350 million. The Office of Economic
236 and Demographic Research shall publish the official estimates
237 reflected in the conference’s workpapers on its website.
238 (9)(12) The agency may adopt rules to administer this
239 section.
240 Section 2. Notwithstanding s. 409.915(3) and (4), Florida
241 Statutes, as amended by this act, the amount of each county’s
242 contribution during the 2013-2014 state fiscal year shall be
243 determined and provided to the Department of Revenue by the
244 Agency for Health Care Administration by June 15, 2013. The
245 Department of Revenue shall notify each county of its annual
246 contribution by June 20, 2013.
247 Section 3. This act shall take effect upon becoming a law.