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.
   29  Be It Enacted by the Legislature of the State of Florida:
   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.