Florida Senate - 2015 COMMITTEE AMENDMENT Bill No. SB 322 Ì561494>Î561494 LEGISLATIVE ACTION Senate . House Comm: RCS . 04/15/2015 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Fiscal Policy (Stargel) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete lines 64 - 100 4 and insert: 5 (e)1. As used in this paragraph, the term: 6 a. “Appropriation made by law” has the same meaning as 7 provided in s. 11.066. 8 b. “Reimbursement rate” means the audited hospital cost 9 based per diem reimbursement rate for inpatient or outpatient 10 care established by the agency. 11 2. Pursuant to chapter 120, the agency shall furnish 12 written notice of a reimbursement rate to providers. The written 13 notice constitutes final agency action. A substantially affected 14 provider seeking to correct or adjust the calculation of a 15 reimbursement rate, based on a challenge other than a challenge 16 to a methodology used to calculate a reimbursement rate as 17 described in subparagraph 3., may request an administrative 18 hearing by filing a petition with the agency within 180 days 19 after receipt of the written notice by the provider. The failure 20 to timely file a petition in compliance with this subparagraph 21 is deemed conclusive acceptance of the reimbursement rate. 22 3. An administrative proceeding pursuant to: 23 a. Section 120.569 or s. 120.57 which challenges a 24 methodology that is specified in an agency rule or in a 25 reimbursement plan incorporated by reference in such rule and 26 that is used to calculate a reimbursement rate may not result in 27 a correction or an adjustment of a reimbursement rate for a rate 28 period that occurred more than 5 years before the date the 29 petition initiating the proceeding was filed. 30 b. Section 120.56 or s. 120.57(1)(e) which challenges the 31 validity of an agency rule or an unadopted rule that governs the 32 calculation of a reimbursement rate may not have a retroactive 33 effect on a reimbursement rate for a rate period before the date 34 the petition initiating the proceeding was filed. 35 4. This paragraph applies to any challenge described in 36 subparagraph 2. or subparagraph 3., including a right to 37 challenge which arose before July 1, 2015. A correction or 38 adjustment of a reimbursement rate which is required by an 39 administrative order or appellate decision: 40 a. Must be reconciled in the first rate period after the 41 order or decision becomes final; and 42 b. May not serve as the basis for a challenge to correct or 43 adjust hospital rates required to be paid by a Medicaid managed 44 care provider pursuant to part IV of chapter 409. 45 5. The agency may not be compelled by an administrative 46 body or a court to pay compensation that exceeds $5 million to a 47 hospital relating to the establishment of reimbursement rates by 48 the agency or for remedies relating to such rates, unless an 49 appropriation made by law is enacted for the exclusive, specific 50 purpose of paying such additional compensation. 51 6. A period of time specified in this paragraph is not 52 tolled by the pendency of an administrative or appellate 53 proceeding. 54 7. An administrative proceeding pursuant to chapter 120 is 55 the exclusive means to challenge a reimbursement rate as 56 described under subparagraph 2. before, on, or after July 1, 57 2015, and to challenge a methodology used to calculate a 58 reimbursement rate as described under subparagraph 3. 59 Section 2. For the purpose of incorporating the amendment 60 made by this act to section 409.908, Florida Statutes, in a 61 reference thereto, section 383.18, Florida Statutes, is 62 reenacted to read: 63 383.18 Contracts; conditions.—Participation in the regional 64 perinatal intensive care centers program under ss. 383.15-383.19 65 is contingent upon the department entering into a contract with 66 a provider. The contract shall provide that patients will 67 receive services from the center and that parents or guardians 68 of patients who participate in the program and who are in 69 compliance with Medicaid eligibility requirements as determined 70 by the department are not additionally charged for treatment and 71 care which has been contracted for by the department. Financial 72 eligibility for the program is based on the Medicaid income 73 guidelines for pregnant women and for children under 1 year of 74 age. Funding shall be provided in accordance with ss. 383.19 and 75 409.908. 76 Section 3. For the purpose of incorporating the amendment 77 made by this act to section 409.908, Florida Statutes, in a 78 reference thereto, subsection (4) of section 409.8132, Florida 79 Statutes, is reenacted to read: 80 409.8132 Medikids program component.— 81 (4) APPLICABILITY OF LAWS RELATING TO MEDICAID.—The 82 provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908, 83 409.912, 409.9121, 409.9122, 409.9123, 409.9124, 409.9127, 84 409.9128, 409.913, 409.916, 409.919, 409.920, and 409.9205 apply 85 to the administration of the Medikids program component of the 86 Florida Kidcare program, except that s. 409.9122 applies to 87 Medikids as modified by the provisions of subsection (7). 88 Section 4. For the purpose of incorporating the amendment 89 made by this act to section 409.908, Florida Statutes, in 90 references thereto, paragraph (c) of subsection (5) and 91 paragraph (b) of subsection (6) of section 409.905, Florida 92 Statutes, are reenacted to read: 93 409.905 Mandatory Medicaid services.—The agency may make 94 payments for the following services, which are required of the 95 state by Title XIX of the Social Security Act, furnished by 96 Medicaid providers to recipients who are determined to be 97 eligible on the dates on which the services were provided. Any 98 service under this section shall be provided only when medically 99 necessary and in accordance with state and federal law. 100 Mandatory services rendered by providers in mobile units to 101 Medicaid recipients may be restricted by the agency. Nothing in 102 this section shall be construed to prevent or limit the agency 103 from adjusting fees, reimbursement rates, lengths of stay, 104 number of visits, number of services, or any other adjustments 105 necessary to comply with the availability of moneys and any 106 limitations or directions provided for in the General 107 Appropriations Act or chapter 216. 108 (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for 109 all covered services provided for the medical care and treatment 110 of a recipient who is admitted as an inpatient by a licensed 111 physician or dentist to a hospital licensed under part I of 112 chapter 395. However, the agency shall limit the payment for 113 inpatient hospital services for a Medicaid recipient 21 years of 114 age or older to 45 days or the number of days necessary to 115 comply with the General Appropriations Act. Effective August 1, 116 2012, the agency shall limit payment for hospital emergency 117 department visits for a nonpregnant Medicaid recipient 21 years 118 of age or older to six visits per fiscal year. 119 (c) The agency shall implement a prospective payment 120 methodology for establishing reimbursement rates for inpatient 121 hospital services. Rates shall be calculated annually and take 122 effect July 1 of each year. The methodology shall categorize 123 each inpatient admission into a diagnosis-related group and 124 assign a relative payment weight to the base rate according to 125 the average relative amount of hospital resources used to treat 126 a patient in a specific diagnosis-related group category. The 127 agency may adopt the most recent relative weights calculated and 128 made available by the Nationwide Inpatient Sample maintained by 129 the Agency for Healthcare Research and Quality or may adopt 130 alternative weights if the agency finds that Florida-specific 131 weights deviate with statistical significance from national 132 weights for high-volume diagnosis-related groups. The agency 133 shall establish a single, uniform base rate for all hospitals 134 unless specifically exempt pursuant to s. 409.908(1). 135 1. Adjustments may not be made to the rates after October 136 31 of the state fiscal year in which the rates take effect, 137 except for cases of insufficient collections of 138 intergovernmental transfers authorized under s. 409.908(1) or 139 the General Appropriations Act. In such cases, the agency shall 140 submit a budget amendment or amendments under chapter 216 141 requesting approval of rate reductions by amounts necessary for 142 the aggregate reduction to equal the dollar amount of 143 intergovernmental transfers not collected and the corresponding 144 federal match. Notwithstanding the $1 million limitation on 145 increases to an approved operating budget contained in ss. 146 216.181(11) and 216.292(3), a budget amendment exceeding that 147 dollar amount is subject to notice and objection procedures set 148 forth in s. 216.177. 149 2. Errors in source data or calculations discovered after 150 October 31 must be reconciled in a subsequent rate period. 151 However, the agency may not make any adjustment to a hospital’s 152 reimbursement more than 5 years after a hospital is notified of 153 an audited rate established by the agency. The prohibition 154 against adjustments more than 5 years after notification is 155 remedial and applies to actions by providers involving Medicaid 156 claims for hospital services. Hospital reimbursement is subject 157 to such limits or ceilings as may be established in law or 158 described in the agency’s hospital reimbursement plan. Specific 159 exemptions to the limits or ceilings may be provided in the 160 General Appropriations Act. 161 (6) HOSPITAL OUTPATIENT SERVICES.— 162 (b) The agency shall implement a methodology for 163 establishing base reimbursement rates for outpatient services 164 for each hospital based on allowable costs, as defined by the 165 agency. Rates shall be calculated annually and take effect July 166 1 of each year based on the most recent complete and accurate 167 cost report submitted by each hospital. 168 1. Adjustments may not be made to the rates after October 169 31 of the state fiscal year in which the rates take effect, 170 except for cases of insufficient collections of 171 intergovernmental transfers authorized under s. 409.908(1) or 172 the General Appropriations Act. In such cases, the agency shall 173 submit a budget amendment or amendments under chapter 216 174 requesting approval of rate reductions by amounts necessary for 175 the aggregate reduction to equal the dollar amount of 176 intergovernmental transfers not collected and the corresponding 177 federal match. Notwithstanding the $1 million limitation on 178 increases to an approved operating budget under ss. 216.181(11) 179 and 216.292(3), a budget amendment exceeding that dollar amount 180 is subject to notice and objection procedures set forth in s. 181 216.177. 182 2. Errors in source data or calculations discovered after 183 October 31 must be reconciled in a subsequent rate period. 184 However, the agency may not make any adjustment to a hospital’s 185 reimbursement more than 5 years after a hospital is notified of 186 an audited rate established by the agency. The prohibition 187 against adjustments more than 5 years after notification is 188 remedial and applies to actions by providers involving Medicaid 189 claims for hospital services. Hospital reimbursement is subject 190 to such limits or ceilings as may be established in law or 191 described in the agency’s hospital reimbursement plan. Specific 192 exemptions to the limits or ceilings may be provided in the 193 General Appropriations Act. 194 Section 5. The amendment made by this act to s. 409.908, 195 Florida Statutes, is remedial in nature, confirms and clarifies 196 existing law, and applies to all proceedings pending on or 197 commenced after this act takes effect. 198 199 ================= T I T L E A M E N D M E N T ================ 200 And the title is amended as follows: 201 Delete lines 3 - 27 202 and insert: 203 providers; amending s. 409.908, F.S.; defining terms; 204 requiring the Agency for Health Care Administration to 205 provide written notice, pursuant to ch. 120, F.S., of 206 reimbursement rates to providers; specifying 207 procedures and requirements to challenge the 208 calculation of or the methodology used to calculate 209 such rates; providing that the failure to timely file 210 a certain challenge constitutes acceptance of the 211 rates; specifying limits on and procedures for the 212 correction or adjustment of the rates; providing 213 applicability; prohibiting the agency from being 214 compelled by an administrative body or a court to pay 215 additional compensation that exceeds a certain amount 216 to a hospital for specified matters unless an 217 appropriation is made by law; prohibiting certain 218 periods of time from being tolled under specified 219 circumstances; specifying that an administrative 220 proceeding is the exclusive means for challenging 221 certain issues; reenacting ss. 383.18, 409.8132(4), 222 and 409.905(5)(c) and (6)(b), F.S., relating to 223 contracts for the regional perinatal intensive care 224 centers program, the Medikids program component, and 225 mandatory Medicaid services, respectively, to 226 incorporate the amendment made to s. 409.908, F.S., in 227 references thereto; providing that the act is 228 remedial, intended to confirm and clarify law, and 229 applies to proceedings pending on or commenced after 230 the effective date; providing an effective date.