Florida Senate - 2015 SB 322 By Senator Stargel 15-01026-15 2015322__ 1 A bill to be entitled 2 An act relating to Medicaid reimbursement for hospital 3 providers; amending s. 409.908, F.S.; requiring the 4 Agency for Health Care Administration to provide 5 written notice, pursuant to ch. 120, F.S., to 6 providers of hospital reimbursement rates established 7 by the agency; providing that such notice constitutes 8 final agency action; specifying procedures and 9 requirements for a substantially affected provider to 10 challenge the final agency action; providing that the 11 failure to timely file a petition in compliance with 12 the requirements is deemed conclusive acceptance of 13 the reimbursement rates; specifying when a correction 14 or adjustment of a hospital reimbursement rate 15 required by an administrative order or civil judgment 16 may occur; prohibiting the agency from being compelled 17 by an administrative body or court to pay a monetary 18 judgment relating to the establishment of hospital 19 reimbursement rates beyond a specified date; 20 prohibiting specified periods of time from being 21 tolled under certain circumstances; reenacting ss. 22 383.18, 409.8132(4), 409.905(5)(c) and (6)(b), and 23 409.91211(3)(y), F.S., to incorporate the amendment 24 made to s. 409.908, F.S., in references thereto; 25 providing that the act is remedial and intended to 26 clarify existing law; providing for retroactive 27 application; providing an effective date. 28 29 Be It Enacted by the Legislature of the State of Florida: 30 31 Section 1. Paragraph (e) is added to subsection (1) of 32 section 409.908, Florida Statutes, to read: 33 409.908 Reimbursement of Medicaid providers.—Subject to 34 specific appropriations, the agency shall reimburse Medicaid 35 providers, in accordance with state and federal law, according 36 to methodologies set forth in the rules of the agency and in 37 policy manuals and handbooks incorporated by reference therein. 38 These methodologies may include fee schedules, reimbursement 39 methods based on cost reporting, negotiated fees, competitive 40 bidding pursuant to s. 287.057, and other mechanisms the agency 41 considers efficient and effective for purchasing services or 42 goods on behalf of recipients. If a provider is reimbursed based 43 on cost reporting and submits a cost report late and that cost 44 report would have been used to set a lower reimbursement rate 45 for a rate semester, then the provider’s rate for that semester 46 shall be retroactively calculated using the new cost report, and 47 full payment at the recalculated rate shall be effected 48 retroactively. Medicare-granted extensions for filing cost 49 reports, if applicable, shall also apply to Medicaid cost 50 reports. Payment for Medicaid compensable services made on 51 behalf of Medicaid eligible persons is subject to the 52 availability of moneys and any limitations or directions 53 provided for in the General Appropriations Act or chapter 216. 54 Further, nothing in this section shall be construed to prevent 55 or limit the agency from adjusting fees, reimbursement rates, 56 lengths of stay, number of visits, or number of services, or 57 making any other adjustments necessary to comply with the 58 availability of moneys and any limitations or directions 59 provided for in the General Appropriations Act, provided the 60 adjustment is consistent with legislative intent. 61 (1) Reimbursement to hospitals licensed under part I of 62 chapter 395 must be made prospectively or on the basis of 63 negotiation. 64 (e)1. Pursuant to chapter 120, the agency shall furnish to 65 providers written notice of the hospital reimbursement rates 66 established by the agency. The written notice constitutes final 67 agency action. A substantially affected provider may request an 68 administrative hearing to challenge the final agency action by 69 filing a petition with the agency within 21 days after receipt 70 of the written notice. The petition must include all 71 documentation supporting the challenge upon which the provider 72 intends to rely at the administrative hearing or in any 73 subsequent civil action. The failure to timely file a petition 74 in compliance with this subparagraph is deemed conclusive 75 acceptance of the hospital reimbursement rates established by 76 the agency. 77 2. A correction or adjustment of a hospital reimbursement 78 rate that is required by an administrative order or civil 79 judgment shall be reconciled in the first rate period after the 80 order or judgment becomes final; however, such reconciliation 81 may not occur more than 5 years after the date on which the 82 provider received written notice under subparagraph 1. 83 3. The agency may not be compelled by an administrative 84 body or court to pay a monetary judgment relating to the 85 establishment of hospital reimbursement rates by the agency more 86 than 5 years after the date on which the provider received 87 written notice under subparagraph 1. 88 4. The periods of time specified in this paragraph are not 89 tolled by the pendency of an administrative or civil proceeding. 90 Section 2. Section 383.18, subsection (4) of s. 409.8132, 91 paragraph (c) of subsection (5) and paragraph (b) of subsection 92 (6) of s. 409.905, and paragraph (y) of subsection (3) of s. 93 409.91211, Florida Statutes, are reenacted for the purpose of 94 incorporating the amendment made by this act to s. 409.908, 95 Florida Statutes, in references thereto. 96 Section 3. The amendment made by this act to s. 409.908, 97 Florida Statutes, is remedial in nature, is intended to clarify 98 existing law, and applies retroactively to all proceedings 99 pending or commenced on or after the date on which this act 100 takes effect. 101 Section 4. This act shall take effect upon becoming a law.