Florida Senate - 2017                                     SB 4-A
       
       
        
       By Senator Flores
       
       
       
       
       
       39-00014-17A                                            20174A__
    1                        A bill to be entitled                      
    2         An act making supplemental appropriations for Medicaid
    3         hospital programs; providing moneys for the annual
    4         period beginning July 1, 2017, and ending June 30,
    5         2018, to fund the state Medicaid program;
    6         incorporating by reference certain calculations of the
    7         Medicaid Disproportionate Share Hospital and Hospital
    8         Reimbursement programs; providing effective dates.
    9          
   10  Be It Enacted by the Legislature of the State of Florida:
   11  
   12         Section 1. Specific Appropriation 198 of Chapter 2017-70,
   13  Laws of Florida, is amended to read:
   14  
   15  SECTION 3 - HUMAN SERVICES
   16  
   17  SPECIFIC APPROPRIATION
   18  
   19  The moneys contained herein are appropriated from the named
   20  funds to the Agency for Health Care Administration, Agency for
   21  Persons with Disabilities, Department of Children and Families,
   22  Department of Elder Affairs, Department of Health, and the
   23  Department of Veterans’ Affairs as the amounts to be used to pay
   24  the salaries, other operational expenditures and fixed capital
   25  outlay of the named agencies.
   26  
   27  AGENCY FOR HEALTH CARE ADMINISTRATION
   28  
   29  From the funds provided in Specific Appropriations 162 through
   30  232, the Agency for Health Care Administration shall submit
   31  quarterly reports on all travel related to training, seminars,
   32  workshops, conferences, or similarly purposed travel that was
   33  completed by senior management employees or division or program
   34  directors. Each quarterly report shall include the following
   35  information: (a) employee name, (b) position title, (c) purpose
   36  of travel, (d) dates and location of travel, (e) confirmation of
   37  agency head authorization if required by SB 2502, and (f) total
   38  travel cost. The report shall be submitted to the chair of the
   39  Senate Appropriations Committee, the chair of the House of
   40  Representatives Appropriations Committee, and the Executive
   41  Office of the Governor. The first report shall be submitted on
   42  July 15, 2017, for the period of April 1, 2017, through June 30,
   43  2017, and quarterly thereafter.
   44  
   45  PROGRAM: HEALTH CARE SERVICES
   46  
   47  MEDICAID SERVICES TO INDIVIDUALS
   48  
   49  From the funds in Specific Appropriations 191 through 220A, the
   50  Agency for Health Care Administration shall provide a quarterly
   51  reconciliation report of all Medicaid service appropriation
   52  expenditures and fund sources. The reconciliation shall compare
   53  actual expenditures paid through each specific appropriation
   54  category by fund either through the Florida Medicaid Management
   55  Information System (FMMIS) or the Agency for Health Care
   56  Administration to expenditure estimates forecasted through the
   57  Social Services Estimating Conference Medicaid services
   58  forecasting model, as directed in section 216.136(6), Florida
   59  Statutes. The comparison shall include fund source detail for
   60  each comparison. For any category where a variance is
   61  identified, the Agency for Health Care Administration shall
   62  submit a written corrective action plan to address each variance
   63  by category and fund source. The reconciliation shall be
   64  submitted to the Office of the Governor, the President of the
   65  Senate, and the Speaker of the House of Representatives no later
   66  than 30 days after the close of each quarter. The Agency for
   67  Health Care Administration may submit budget amendments to the
   68  Legislative Budget Commission to realign appropriation
   69  categories based on the reconciliation pursuant to the
   70  provisions of chapter 216, Florida Statutes.
   71  
   72  198 SPECIAL CATEGORIES                                            
   73  HOSPITAL INPATIENT SERVICES                                            
   74  FROM GENERAL REVENUE FUND256,362,940 285,444,787                      
   75  FROM HEALTH CARE TRUST FUND                                  42,300,000
   76  FROM GRANTS AND DONATIONS TRUST FUND                                  15,915,715
   77  FROM MEDICAL CARE TRUST FUND                      585,613,606 631,984,098
   78  FROM PUBLIC MEDICAL ASSISTANCE TRUST FUND                                  47,450,732
   79  FROM REFUGEE ASSISTANCE TRUST FUND                                   1,362,689
   80  
   81  Funds in Specific Appropriation 198 are contingent upon the
   82  state share being provided through grants and donations from
   83  state, county or other governmental funds. In the event the
   84  state share provided through grants and donations in the Grants
   85  and Donations Trust Fund is not available, the Agency for Health
   86  Care Administration may submit a revised hospital reimbursement
   87  plan, pursuant to chapter 216, Florida Statutes, to the
   88  Legislative Budget Commission for approval.
   89  
   90  From the funds in Specific Appropriation 198, the calculations
   91  of the Medicaid Hospital Funding Programs for the 2017-2018
   92  fiscal year are incorporated by reference in Senate Bill 2502.
   93  The calculations are the basis for the appropriations made in
   94  the General Appropriations Act.
   95  
   96  From the funds in Specific Appropriation 198, the Agency for
   97  Health Care Administration may establish a global fee for bone
   98  marrow transplants and the global fee payment shall be paid to
   99  approved bone marrow transplant providers that provide bone
  100  marrow transplants to Medicaid beneficiaries.
  101  
  102  From the funds in Specific Appropriations 198 and 206,
  103  $2,827,046 from the Grants and Donations Trust Fund and
  104  $4,538,889 from the Medical Care Trust Fund are provided to make
  105  Medicaid payments for multi-visceral transplants and intestine
  106  transplants in Florida. The Agency for Health Care
  107  Administration shall establish a global fee for these transplant
  108  procedures and the payments shall be used to pay approved multi
  109  visceral transplant and intestine transplant facilities a global
  110  fee for providing these transplant services to Medicaid
  111  beneficiaries. Payment of the global fee is contingent upon the
  112  non-federal share being provided through grants and donations
  113  from state, county or other governmental funds. The agency is
  114  authorized to seek any federal waiver or state plan amendment
  115  necessary to implement this provision.
  116  
  117  From the funds in Specific Appropriation 198, the Agency for
  118  Health Care Administration shall continue a Diagnosis Related
  119  Grouping (DRG) reimbursement methodology for hospital inpatient
  120  services as directed in section 409.905 (5)(c), Florida
  121  Statutes.
  122         Base Rate - $3,485.82 $3,310.98
  123         Neonates Service Adjustor Severity Level 1 - 1.0
  124         Neonates Service Adjustor Severity Level 2 - 1.52
  125         Neonates Service Adjustor Severity Level 3 - 1.8
  126         Neonates Service Adjustor Severity Level 4 - 2.0
  127         Neonatal, Pediatric, Transplant Pediatric, Mental Health
  128  and
  129         Rehab DRGs:
  130         Severity Level 1 - 1.0
  131         Severity Level 2 - 1.52
  132         Severity Level 3 - 1.8
  133         Severity Level 4 - 2.0
  134         Free Standing Rehabilitation Provider Adjustor - 2.840
  135  2.843
  136         Rural Provider Adjustor - 2.115 2.116
  137         Long Term Acute Care (LTAC) Provider Adjustor - 2.218
  138  2.199
  139         High Medicaid and High Outlier Provider Adjustor - 2.504
  140  2.548
  141         Outlier Threshold - $60,000
  142         Marginal Cost Percentage - 60%
  143         Marginal Cost Percentage for Pediatric Claims Severity
  144         Levels 3 or 4 - 80%
  145         Marginal Cost Percentage for Neonates Claims Severity
  146         Levels 3 or 4 - 80%
  147         Marginal Cost Percentage for Transplant Pediatric Claims
  148         Severity Levels 3 or 4 - 80%
  149         Documentation and Coding Adjustment - 1/3 of 1%
  150         Level I Trauma Add On - 17%
  151         Level II or Level II and Pediatric Add On - 11%
  152         Pediatric Trauma Add On - 4%
  153  
  154  Funds in Specific Appropriation 198 reflect an increase of
  155  $2,668,209 $2,480,485 in nonrecurring funds from the General
  156  Revenue Fund and $4,283,872 $3,982,478 in nonrecurring funds
  157  from the Medical Care Trust Fund for sole community hospitals
  158  that meet the definition of “rural hospital” under section
  159  395.602 (2) (e), Florida Statutes, to be recognized as rural
  160  hospitals in the Agency for Health Care Administration’s
  161  Diagnosis Related Group (DRG) reimbursement methodology for
  162  hospital inpatient services (HB 3791).
  163  
  164  Funds in Specific Appropriation 198 reflect an increase of
  165  $9,421,726 in the General Revenue Fund, of which, $804,168 is
  166  nonrecurring, and $15,126,804 in the Medical Care Trust Fund, of
  167  which, $1,291,111 is nonrecurring, to increase the High Medicaid
  168  and High Outlier Provider Adjustor for the Agency for Health
  169  Care Administration’s Diagnosis Related Group (DRG)
  170  reimbursement methodology for hospital inpatient services.
  171  
  172  Funds in Specific Appropriations 198 and 207 reflect a reduction
  173  of $58,284,811 from the General Revenue Fund and $93,577,645
  174  from the Medical Care Trust Fund based on a reduction to the
  175  Diagnosis Related Grouping Base Rate.
  176  
  177  Funds in Specific Appropriations 198 and 207 reflect a reduction
  178  of $160,882,696 $160,401,653 from the General Revenue Fund and
  179  $258,300,982 $257,528,657 from the Medical Care Trust Fund as a
  180  result of reducing Hospital Inpatient Automatic Rate
  181  Enhancements. The calculations of the Medicaid Hospital Funding
  182  Programs for the 2017-2018 fiscal year are incorporated by
  183  reference in Senate Bill 2502. The calculations are the basis
  184  for the appropriations made in the General Appropriations Act.
  185  
  186  From the funds in Specific Appropriations 198, and 203, and 207,
  187  $50,000,000 in nonrecurring funds from the General Revenue Fund
  188  and $80,276,186 in nonrecurring funds from the Medical Care
  189  Trust Fund are provided to partially restore reductions applied
  190  to DRG base rates and Hospital Inpatient and Hospital Outpatient
  191  exemption payments.
  192  
  193  From the funds in Specific Appropriations 198, 203, and 207,
  194  $100,000,000 in nonrecurring funds from the General Revenue Fund
  195  and $160,552,371 in nonrecurring funds from the Medical Care
  196  Trust Fund are provided to restore reductions applied to DRG
  197  base rates and Hospital Inpatient and Hospital Outpatient
  198  exemption payments.
  199         Section 2. Specific Appropriation 203 of Chapter 2017-70,
  200  Laws of Florida, is amended to read:
  201  
  202  SECTION 3 - HUMAN SERVICES
  203  
  204  SPECIFIC APPROPRIATION
  205  
  206  The moneys contained herein are appropriated from the named
  207  funds to the Agency for Health Care Administration, Agency for
  208  Persons with Disabilities, Department of Children and Families,
  209  Department of Elder Affairs, Department of Health, and the
  210  Department of Veterans’ Affairs as the amounts to be used to pay
  211  the salaries, other operational expenditures and fixed capital
  212  outlay of the named agencies.
  213  
  214  AGENCY FOR HEALTH CARE ADMINISTRATION
  215  
  216  From the funds provided in Specific Appropriations 162 through
  217  232, the Agency for Health Care Administration shall submit
  218  quarterly reports on all travel related to training, seminars,
  219  workshops, conferences, or similarly purposed travel that was
  220  completed by senior management employees or division or program
  221  directors. Each quarterly report shall include the following
  222  information: (a) employee name, (b) position title, (c) purpose
  223  of travel, (d) dates and location of travel, (e) confirmation of
  224  agency head authorization if required by SB 2502, and (f) total
  225  travel cost. The report shall be submitted to the chair of the
  226  Senate Appropriations Committee, the chair of the House of
  227  Representatives Appropriations Committee, and the Executive
  228  Office of the Governor. The first report shall be submitted on
  229  July 15, 2017, for the period of April 1, 2017, through June 30,
  230  2017, and quarterly thereafter.
  231  
  232  PROGRAM: HEALTH CARE SERVICES
  233  
  234  MEDICAID SERVICES TO INDIVIDUALS
  235  
  236  From the funds in Specific Appropriations 191 through 220A, the
  237  Agency for Health Care Administration shall provide a quarterly
  238  reconciliation report of all Medicaid service appropriation
  239  expenditures and fund sources. The reconciliation shall compare
  240  actual expenditures paid through each specific appropriation
  241  category by fund either through the Florida Medicaid Management
  242  Information System (FMMIS) or the Agency for Health Care
  243  Administration to expenditure estimates forecasted through the
  244  Social Services Estimating Conference Medicaid services
  245  forecasting model, as directed in section 216.136(6), Florida
  246  Statutes. The comparison shall include fund source detail for
  247  each comparison. For any category where a variance is
  248  identified, the Agency for Health Care Administration shall
  249  submit a written corrective action plan to address each variance
  250  by category and fund source. The reconciliation shall be
  251  submitted to the Office of the Governor, the President of the
  252  Senate, and the Speaker of the House of Representatives no later
  253  than 30 days after the close of each quarter. The Agency for
  254  Health Care Administration may submit budget amendments to the
  255  Legislative Budget Commission to realign appropriation
  256  categories based on the reconciliation pursuant to the
  257  provisions of chapter 216, Florida Statutes.
  258  
  259  203 SPECIAL CATEGORIES                                            
  260  HOSPITAL OUTPATIENT SERVICES                                            
  261  FROM GENERAL REVENUE FUND 54,208,290 62,253,217                      
  262  FROM GRANTS AND DONATIONS TRUST FUND                                   5,047,647
  263  FROM MEDICAL CARE TRUST FUND                      129,294,879 142,211,200
  264  FROM PUBLIC MEDICAL ASSISTANCE TRUST FUND                                  20,768,022
  265  FROM REFUGEE ASSISTANCE TRUST FUND                                     948,222
  266  
  267  From the funds in Specific Appropriation 203, the calculations
  268  of the Medicaid Hospital Funding Programs for the 2017-2018
  269  fiscal year are incorporated by reference in Senate Bill 2502.
  270  The calculations are the basis for the appropriations made in
  271  the General Appropriations Act.
  272  
  273  From the funds in Specific Appropriations 203 and 207,
  274  $22,767,278 from the Grants and Donations Trust Fund and
  275  $36,553,405 from the Medical Care Trust Fund are provided to
  276  increase the outpatient cap for adults from $500 to $1,500 per
  277  year. Payments to increase outpatient caps are contingent upon
  278  the non-federal share being provided through intergovernmental
  279  transfers in the Grants and Donations Trust Fund. In the event
  280  the funds are not available in the Grants and Donations Trust
  281  Fund, the State of Florida is not obligated to continue
  282  reimbursements at the higher amount.
  283  
  284  From the funds in Specific Appropriation 203, $400,000 from the
  285  General Revenue Fund and $642,209 from the Medical Care Trust
  286  Fund is provided to Nemours Children’s Hospital as a Hospital
  287  Outpatient exemption payment.
  288  
  289  From the funds in Specific Appropriation 203, the Agency for
  290  Health Care Administration shall implement an Enhanced
  291  Ambulatory Patient Grouping (EAPG) reimbursement methodology for
  292  hospital outpatient services as directed in section
  293  409.905(6)(b), Florida Statutes.
  294  
  295  Ambulatory Surgical Center Base Rate - $276.66
  296  Hospital Outpatient Base Rate - $267.82
  297  Rural Hospital Provider Adjustor - 1.4736
  298  High Medicaid and High Outlier Hospital Adjustor - 2.0182
  299  Documentation and Coding Adjustment - 2%
  300  
  301  From the funds in Specific Appropriation 203, the Agency for
  302  Health Care Administration shall apply a transition methodology
  303  that will limit provider gains and losses in a budget neutral
  304  manner resulting from the implementation of EAPG payment
  305  methodologies. The agency shall cap provider losses from EAPG
  306  payment at 5% for any in-state hospital with at least 1,000
  307  annual Medicaid outpatient visits and a payment decrease
  308  projected to be greater than 5%. For each applicable hospital,
  309  the hospital’s EAPG base rate shall be set to a value that
  310  models EAPG payment to be 95% of the hospital’s current baseline
  311  payment. The agency shall cap gains from EAPG payment at a
  312  percentage to ensure budget neutrality. Both EAPG and current
  313  baseline payments shall be values independent of rate
  314  enhancements. EAPG base rate adjustments shall be applied after
  315  the impact related to Graduate Medical Education funding has
  316  been transferred to the Graduate Medical Education category.
  317  
  318  Funds in Specific Appropriations 203 and 207 reflect a reduction
  319  of $30,832,608 $31,313,536 from the General Revenue Fund and
  320  $49,502,484 $50,274,625 from the Medical Care Trust Fund as a
  321  result of reducing Hospital Outpatient Automatic Rate
  322  Enhancements. The calculations of the Medicaid Hospital Funding
  323  Programs for the 2017-2018 fiscal year are incorporated by
  324  reference in Senate Bill 2502. The calculations are the basis
  325  for the appropriations made in the General Appropriations Act.
  326         Section 3. Specific Appropriation 207 of Chapter 2017-70,
  327  Laws of Florida, is amended to read:
  328  
  329  SECTION 3 - HUMAN SERVICES
  330  
  331  SPECIFIC APPROPRIATION
  332  
  333  The moneys contained herein are appropriated from the named
  334  funds to the Agency for Health Care Administration, Agency for
  335  Persons with Disabilities, Department of Children and Families,
  336  Department of Elder Affairs, Department of Health, and the
  337  Department of Veterans’ Affairs as the amounts to be used to pay
  338  the salaries, other operational expenditures and fixed capital
  339  outlay of the named agencies.
  340  
  341  AGENCY FOR HEALTH CARE ADMINISTRATION
  342  
  343  From the funds provided in Specific Appropriations 162 through
  344  232, the Agency for Health Care Administration shall submit
  345  quarterly reports on all travel related to training, seminars,
  346  workshops, conferences, or similarly purposed travel that was
  347  completed by senior management employees or division or program
  348  directors. Each quarterly report shall include the following
  349  information: (a) employee name, (b) position title, (c) purpose
  350  of travel, (d) dates and location of travel, (e) confirmation of
  351  agency head authorization if required by SB 2502, and (f) total
  352  travel cost. The report shall be submitted to the chair of the
  353  Senate Appropriations Committee, the chair of the House of
  354  Representatives Appropriations Committee, and the Executive
  355  Office of the Governor. The first report shall be submitted on
  356  July 15, 2017, for the period of April 1, 2017, through June 30,
  357  2017, and quarterly thereafter.
  358  
  359  PROGRAM: HEALTH CARE SERVICES
  360  
  361  MEDICAID SERVICES TO INDIVIDUALS
  362  
  363  From the funds in Specific Appropriations 191 through 220A, the
  364  Agency for Health Care Administration shall provide a quarterly
  365  reconciliation report of all Medicaid service appropriation
  366  expenditures and fund sources. The reconciliation shall compare
  367  actual expenditures paid through each specific appropriation
  368  category by fund either through the Florida Medicaid Management
  369  Information System (FMMIS) or the Agency for Health Care
  370  Administration to expenditure estimates forecasted through the
  371  Social Services Estimating Conference Medicaid services
  372  forecasting model, as directed in section 216.136(6), Florida
  373  Statutes. The comparison shall include fund source detail for
  374  each comparison. For any category where a variance is
  375  identified, the Agency for Health Care Administration shall
  376  submit a written corrective action plan to address each variance
  377  by category and fund source. The reconciliation shall be
  378  submitted to the Office of the Governor, the President of the
  379  Senate, and the Speaker of the House of Representatives no later
  380  than 30 days after the close of each quarter. The Agency for
  381  Health Care Administration may submit budget amendments to the
  382  Legislative Budget Commission to realign appropriation
  383  categories based on the reconciliation pursuant to the
  384  provisions of chapter 216, Florida Statutes.
  385  
  386  207 SPECIAL CATEGORIES                                            
  387  PREPAID HEALTH PLANS                                              
  388  FROM GENERAL REVENUE FUND3,259,771,877 3,125,225,879                      
  389  FROM HEALTH CARE TRUST FUND                                 388,170,046
  390  FROM TOBACCO SETTLEMENT TRUST FUND                                 283,209,096
  391  FROM GRANTS AND DONATIONS TRUST FUND                               1,409,122,479
  392  FROM MEDICAL CARE TRUST FUND                      7,521,165,423 7,305,709,389
  393  FROM PUBLIC MEDICAL ASSISTANCE TRUST FUND                                 692,598,885
  394  FROM REFUGEE ASSISTANCE TRUST FUND                                  57,759,492
  395         Section 4. For the purposes of Specific Appropriations 198,
  396  199, 203, and 207 of the 2017-2018 General Appropriations Act,
  397  the calculations for the Medicaid Disproportionate Share
  398  Hospital and Hospital Reimbursement programs for the 2017-2018
  399  fiscal year contained in the document titled “Medicaid Hospital
  400  Funding Programs,” dated June 6, 2017, and filed with the
  401  Secretary of the Senate, are incorporated by reference for the
  402  purpose of displaying the calculations used by the Legislature,
  403  consistent with the requirements of state law, in making
  404  appropriations for the Medicaid Disproportionate Share Hospital
  405  and Hospital Reimbursement programs. This section expires July
  406  1, 2018.
  407         Section 5. This act shall take effect July 1, 2017; or, if
  408  this act fails to become a law until after that date, it shall
  409  take effect upon becoming a law and shall operate retroactively
  410  to July 1, 2017.