Florida Senate - 2013 CS for SB 1884
By the Committees on Appropriations; and Health Policy
576-04942A-13 20131884c1
1 A bill to be entitled
2 An act relating to county Medicaid contributions;
3 amending s. 409.915, F.S.; specifying the total
4 contribution for the year and specifying the method
5 for determining the amount in the following years;
6 revising the method for calculating each county’s
7 contribution; providing tables for calculating county
8 contributions; requiring the Agency for Health Care
9 Administration to annually report the status of county
10 billings to the Legislature; authorizing the
11 Department of Revenue to withhold county distributions
12 for failure to remit Medicaid contributions; deleting
13 provisions specifying the care and services that
14 counties must participate in, obsolete bond
15 provisions, and a process for refund requests;
16 specifying the method for calculating each county’s
17 contribution for the 2013-2014 fiscal year; providing
18 an effective date.
19
20 Be It Enacted by the Legislature of the State of Florida:
21
22 Section 1. Section 409.915, Florida Statutes, is amended to
23 read:
24 409.915 County contributions to Medicaid.—Although the
25 state is responsible for the full portion of the state share of
26 the matching funds required for the Medicaid program, in order
27 to acquire a certain portion of these funds, the state shall
28 charge the counties an annual contribution in order to acquire a
29 certain portion of these funds for certain items of care and
30 service as provided in this section.
31 (1) As used in this section, the term “state Medicaid
32 expenditures” means those expenditures used as matching funds
33 for the federal Medicaid program.
34 (2)(a) For the 2013-2014 state fiscal year, the total
35 amount of the counties’ contribution is $269.6 million. For each
36 fiscal year thereafter, the annual amount shall be adjusted by
37 the percentage change in the state Medicaid expenditures as
38 determined by the Social Services Estimating Conference.
39 (b) By March 15 of each year, the Social Services
40 Estimating Conference shall determine the percentage change in
41 state Medicaid expenditures by comparing expenditures for the 2
42 most recent completed state fiscal years.
43 (3)(a)1. The amount of each county’s annual contribution is
44 equal to the product of the amount determined under subsection
45 (2) multiplied by the sum of the percentages calculated in sub
46 subparagraphs a. and b.:
47 a. The enrollment weight provided in subparagraph 2. is
48 multiplied by a fraction, the numerator of which is the number
49 of the county’s Medicaid enrollees as of March 1 of each year,
50 and the denominator of which is the number of all counties’
51 Medicaid enrollees as of March 1 of each year. The agency shall
52 calculate this amount for each county and provide the
53 information to the Department of Revenue by May 15 of each year.
54 b. The payment weight provided in subparagraph 2. is
55 multiplied by the percentage share of payments provided in
56 subparagraph 3. for each county.
57 2. The weights for each fiscal year are equal to:
58
59 WEIGHTS
60
61 FISCAL YEAR ENROLLMENT PAYMENT
62 2013-14 0% 100%
63 2014-15 16.67% 83.33%
64 2015-16 33.34% 66.66%
65 2016-17 50% 50%
66 2017-18 66.66% 33.67%
67 2018-19 83.33% 16.67%
68 2019-20+ 100% 0%
69 3. The percentage share of payments for each county is:
70
71 COUNTY SHARE OF PAYMENTS
72 Alachua 1.278%
73 Baker 0.116%
74 Bay 0.607%
75 Bradford 0.179%
76 Brevard 2.471%
77 Broward 9.226%
78 Calhoun 0.084%
79 Charlotte 0.578%
80 Citrus 0.663%
81 Clay 0.635%
82 Collier 1.160%
83 Columbia 0.557%
84 Dade (Miami-Dade) 18.850%
85 Desoto 0.167%
86 Dixie 0.098%
87 Duval 5.336%
88 Escambia 1.614%
89 Flagler 0.397%
90 Franklin 0.091%
91 Gadsden 0.239%
92 Gilchrist 0.078%
93 Glades 0.055%
94 Gulf 0.076%
95 Hamilton 0.075%
96 Hardee 0.110%
97 Hendry 0.163%
98 Hernando 0.862%
99 Highlands 0.468%
100 Hillsborough 6.952%
101 Holmes 0.101%
102 Indian river 0.397%
103 Jackson 0.218%
104 Jefferson 0.083%
105 Lafayette 0.014%
106 Lake 1.525%
107 Lee 2.511%
108 Leon 0.929%
109 Levy 0.256%
110 Liberty 0.050%
111 Madison 0.086%
112 Manatee 1.622%
113 Marion 1.629%
114 Martin 0.352%
115 Monroe 0.262%
116 Nassau 0.240%
117 Okaloosa 0.566%
118 Okeechobee 0.235%
119 Orange 6.680%
120 Osceola 1.613%
121 Palm Beach 5.898%
122 Pasco 2.391%
123 Pinellas 6.644%
124 Polk 3.642%
125 Putnam 0.417%
126 Saint Johns 0.459%
127 Saint Lucie 1.154%
128 Santa Rosa 0.462%
129 Sarasota 1.230%
130 Seminole 1.739%
131 Sumter 0.218%
132 Suwannee 0.252%
133 Taylor 0.103%
134 Union 0.075%
135 Volusia 2.298%
136 Wakulla 0.103%
137 Walton 0.229%
138 Washington 0.114%
139 (b)1. The Legislature intends to replace the county
140 percentage share provided in subparagraph (a)3. with percentage
141 shares based upon each county’s proportion of the total
142 statewide amount of county billings made under this section from
143 April 1, 2012, through March 31, 2013, for which the state
144 ultimately receives payment.
145 2. By February 1 of each year and continuing until a
146 certification is made under sub-subparagraph b., the agency
147 shall report to the President of the Senate and the Speaker of
148 the House of Representatives the status of the county billings
149 made under this section from April 1, 2012, through March 31,
150 2013, by county, including:
151 a. The amounts billed to each county which remain unpaid,
152 if any; and
153 b. A certification from the agency of a final accounting of
154 the amount of funds received by the state from such billings, by
155 county, upon the expiration of all appeal rights that counties
156 may have to contest such billings.
157 3. By March 15 of the state fiscal year in which the state
158 receives the certification provided for in sub-subparagraph
159 (b)2.b., the Social Services Estimating Conference shall
160 calculate each county’s percentage share of the total statewide
161 amount of county billings made under this section from April 1,
162 2012, through March 31, 2013, for which the state ultimately
163 receives payment.
164 4. Beginning in the state fiscal year following the receipt
165 by the state of the certification provided in sub-subparagraph
166 (b)2.b., each county’s percentage share under subparagraph (a)3.
167 shall be replaced by the percentage calculated under
168 subparagraph (b)3.
169 5. If the court invalidates the replacement of each
170 county’s share as provided in this paragraph, the county share
171 set forth in subparagraph (a)3. shall continue to apply.
172 (4) By June 1 of each year, the Department of Revenue shall
173 notify each county of its required annual contribution. Each
174 county shall pay its contribution, by check or electronic
175 transfer, in equal monthly installments to the department by the
176 5th day of each month. If a county fails to remit the payment by
177 the 5th day of the month, the department shall reduce the
178 monthly distribution of that county pursuant to s. 218.61 and,
179 if necessary, by the amount of the monthly installment pursuant
180 to s. 218.26. The payments and the amounts by which the
181 distributions are reduced shall be transferred to the General
182 Revenue Fund.
183 (1) Each county shall participate in the following items of
184 care and service:
185 (a) For both health maintenance members and fee-for-service
186 beneficiaries, payments for inpatient hospitalization in excess
187 of 10 days, but not in excess of 45 days, with the exception of
188 pregnant women and children whose income is in excess of the
189 federal poverty level and who do not participate in the Medicaid
190 medically needy program, and for adult lung transplant services.
191 (b) For both health maintenance members and fee-for-service
192 beneficiaries, payments for nursing home or intermediate
193 facilities care in excess of $170 per month, with the exception
194 of skilled nursing care for children under age 21.
195 (2) A county’s participation must be 35 percent of the
196 total cost, or the applicable discounted cost paid by the state
197 for Medicaid recipients enrolled in health maintenance
198 organizations or prepaid health plans, of providing the items
199 listed in subsection (1), except that the payments for items
200 listed in paragraph (1)(b) may not exceed $55 per month per
201 person.
202 (3) Each county shall set aside sufficient funds to pay for
203 items of care and service provided to the county’s eligible
204 recipients for which county contributions are required,
205 regardless of where in the state the care or service is
206 rendered.
207 (4) Each county shall contribute its pro rata share of the
208 total county participation based upon statements rendered by the
209 agency. The agency shall render such statements monthly based on
210 each county’s eligible recipients. For purposes of this section,
211 each county’s eligible recipients shall be determined by the
212 recipient’s address information contained in the federally
213 approved Medicaid eligibility system within the Department of
214 Children and Family Services. A county may use the process
215 developed under subsection (10) to request a refund if it
216 determines that the statement rendered by the agency contains
217 errors.
218 (5) In any county in which a special taxing district or
219 authority is located which benefits will benefit from the
220 Medicaid program medical assistance programs covered by this
221 section, the board of county commissioners may divide the
222 county’s financial responsibility for this purpose
223 proportionately, and each such district or authority must
224 furnish its share to the board of county commissioners in time
225 for the board to comply with subsection (4) (3). Any appeal of
226 the proration made by the board of county commissioners must be
227 made to the Department of Financial Services, which shall then
228 set the proportionate share for of each party.
229 (6) Counties are exempt from contributing toward the cost
230 of new exemptions on inpatient ceilings for statutory teaching
231 hospitals, specialty hospitals, and community hospital education
232 program hospitals that came into effect July 1, 2000, and for
233 special Medicaid payments that came into effect on or after July
234 1, 2000.
235 (6)(7)(a) By August 1, 2012, the agency shall certify to
236 each county the amount of such county’s billings from November
237 1, 2001, through April 30, 2012, which remain unpaid. A county
238 may contest the amount certified by filing a petition under the
239 applicable provisions of chapter 120 on or before September 1,
240 2012. This procedure is the exclusive method to challenge the
241 amount certified. In order to successfully challenge the amount
242 certified, a county must show, by a preponderance of the
243 evidence, that a recipient was not an eligible recipient of that
244 county or that the amount certified was otherwise in error.
245 (b) By September 15, 2012, the agency shall certify to the
246 Department of Revenue:
247 1. For each county that files a petition on or before
248 September 1, 2012, the amount certified under paragraph (a); and
249 2. For each county that does not file a petition on or
250 before September 1, 2012, an amount equal to 85 percent of the
251 amount certified under paragraph (a).
252 (c) The filing of a petition under paragraph (a) does shall
253 not stay or stop the Department of Revenue from reducing
254 distributions in accordance with paragraph (b) and subsection
255 (7) (8). If a county that files a petition under paragraph (a)
256 is able to demonstrate that the amount certified should be
257 reduced, the agency shall notify the Department of Revenue of
258 the amount of the reduction. The Department of Revenue shall
259 adjust all future monthly distribution reductions under
260 subsection (7) (8) in a manner that results in the remaining
261 total distribution reduction being applied in equal monthly
262 amounts.
263 (7)(8)(a) Beginning with the October 2012 distribution, the
264 Department of Revenue shall reduce each county’s distributions
265 pursuant to s. 218.26 by one thirty-sixth of the amount
266 certified by the agency under subsection (6) (7) for that
267 county, minus any amount required under paragraph (b). Beginning
268 with the October 2013 distribution, the Department of Revenue
269 shall reduce each county’s distributions pursuant to s. 218.26
270 by one forty-eighth of two-thirds of the amount certified by the
271 agency under subsection (6) (7) for that county, minus any
272 amount required under paragraph (b). However, the amount of the
273 reduction may not exceed 50 percent of each county’s
274 distribution. If, after 60 months, the reductions for any county
275 do not equal the total amount initially certified by the agency,
276 the Department of Revenue shall continue to reduce such county’s
277 distribution by up to 50 percent until the total amount
278 certified is reached. The amounts by which the distributions are
279 reduced shall be transferred to the General Revenue Fund.
280 (b) As an assurance to holders of bonds issued before the
281 effective date of this act to which distributions made pursuant
282 to s. 218.26 are pledged, or bonds issued to refund such bonds
283 which mature no later than the bonds they refunded and which
284 result in a reduction of debt service payable in each fiscal
285 year, the amount available for distribution to a county shall
286 remain as provided by law and continue to be subject to any lien
287 or claim on behalf of the bondholders. The Department of Revenue
288 must ensure, based on information provided by an affected
289 county, that any reduction in amounts distributed pursuant to
290 paragraph (a) does not reduce the amount of distribution to a
291 county below the amount necessary for the timely payment of
292 principal and interest when due on the bonds and the amount
293 necessary to comply with any covenant under the bond resolution
294 or other documents relating to the issuance of the bonds. If a
295 reduction to a county’s monthly distribution must be decreased
296 in order to comply with this paragraph, the Department of
297 Revenue must notify the agency of the amount of the decrease and
298 the agency must send a bill for payment of such amount to the
299 affected county.
300 (9)(a) Beginning May 1, 2012, and each month thereafter,
301 the agency shall certify to the Department of Revenue by the 7th
302 day of each month the amount of the monthly statement rendered
303 to each county pursuant to subsection (4). Beginning with the
304 May 2012 distribution, the Department of Revenue shall reduce
305 each county’s monthly distribution pursuant to s. 218.61 by the
306 amount certified by the agency minus any amount required under
307 paragraph (b). The amounts by which the distributions are
308 reduced shall be transferred to the General Revenue Fund.
309 (b) As an assurance to holders of bonds issued before the
310 effective date of this act to which distributions made pursuant
311 to s. 218.61 are pledged, or bonds issued to refund such bonds
312 which mature no later than the bonds they refunded and which
313 result in a reduction of debt service payable in each fiscal
314 year, the amount available for distribution to a county shall
315 remain as provided by law and continue to be subject to any lien
316 or claim on behalf of the bondholders. The Department of Revenue
317 must ensure, based on information provided by an affected
318 county, that any reduction in amounts distributed pursuant to
319 paragraph (a) does not reduce the amount of distribution to a
320 county below the amount necessary for the timely payment of
321 principal and interest when due on the bonds and the amount
322 necessary to comply with any covenant under the bond resolution
323 or other documents relating to the issuance of the bonds. If a
324 reduction to a county’s monthly distribution must be decreased
325 in order to comply with this paragraph, the Department of
326 Revenue must notify the agency of the amount of the decrease and
327 the agency must send a bill for payment of such amount to the
328 affected county.
329 (10) The agency, in consultation with the Department of
330 Revenue and the Florida Association of Counties, shall develop a
331 process for refund requests which:
332 (a) Allows counties to submit to the agency written
333 requests for refunds of any amounts by which the distributions
334 were reduced as provided in subsection (9) and which set forth
335 the reasons for the refund requests.
336 (b) Requires the agency to make a determination as to
337 whether a refund request is appropriate and should be approved,
338 in which case the agency shall certify the amount of the refund
339 to the department.
340 (c) Requires the department to issue the refund for the
341 certified amount to the county from the General Revenue Fund.
342 The Department of Revenue may issue the refund in the form of a
343 credit against reductions to be applied to subsequent monthly
344 distributions.
345 (8)(11) Beginning in the 2013-2014 fiscal year and each
346 year thereafter through the 2020-2021 fiscal year, the Chief
347 Financial Officer shall transfer from the General Revenue Fund
348 to the Lawton Chiles Endowment Fund an amount equal to the
349 amounts transferred to the General Revenue Fund in the previous
350 fiscal year pursuant to subsections (4) and (7) subsections (8)
351 and (9), reduced by the amount of refunds paid pursuant to
352 subsection (10), which are in excess of the official estimate
353 for medical hospital fees for such previous fiscal year adopted
354 by the Revenue Estimating Conference on January 12, 2012, as
355 reflected in the conference’s workpapers. By July 20 of each
356 year, the Office of Economic and Demographic Research shall
357 certify the amount to be transferred to the Chief Financial
358 Officer. Such transfers must be made before July 31 of each year
359 until the total transfers for all years equal $350 million. If
360 In the event that such transfers do not total $350 million by
361 July 1, 2021, the Legislature shall provide for the transfer of
362 amounts necessary to total $350 million. The Office of Economic
363 and Demographic Research shall publish the official estimates
364 reflected in the conference’s workpapers on its website.
365 (9)(12) The agency may adopt rules to administer this
366 section.
367 Section 2. Notwithstanding s. 409.915(3) and (4), Florida
368 Statutes, as amended by this act, the amount of each county’s
369 contribution during the 2013-2014 state fiscal year shall be
370 determined and provided to the Department of Revenue by the
371 Agency for Health Care Administration by June 15, 2013. The
372 Department of Revenue shall notify each county of its annual
373 contribution by June 20, 2013.
374 Section 3. This act shall take effect upon becoming a law.