59G-6.045. Payment Methodology for Services in Facilities Not Publicly Owned and Not Publicly Operated  


Effective on Sunday, March 11, 2018
  • 1(1) 2Reimbursement to participating facilities for services provided shall be in accordance with the Florida Title XIX Reimbursement Plan for Services in Facilities Not Publicly Owned and Not Publicly Operated (the Plan), Version XIII, effective July 1, 2017, available at 41http://www.flrules.org/Gateway/reference.asp?No=Ref-09079, 43incorporated by reference. 46The Plan is applicable to 51the fee-for-service delivery system. A copy of the Plan as revised may be obtained by writing to the Bureau of Medicaid Program Finance, Agency for Health Care Administration, Mail Stop 23, Tallahassee, Florida 32308.

    85(2) Participating Intermediate Care Facilities (ICF) shall use the Facility Quality Assessment form (only accepted electronically), AHCA Form 5000-3548, October 2013, incorporated by reference, for the submission of its monthly quality assessment. This form can be accessed at 123https://apps.ahca.myflorida.com/nfqa/.

    124(3) Each facility shall report monthly to the Agency, its total number of resident days and remit an amount equal to the assessment rate times the reported number of days. Facilities are required to submit their full quality assessment payment by the 15th day of the next succeeding calendar month.

    174(4) Providers are subject to the following monetary fines pursuant to Section 186409.9083(6), F.S., 188for failure to timely pay a quality assessment:

    196(a) For a facility’s first offense, a fine of $500 per day shall be imposed until the quality assessment is paid in full, but in no event shall the fine exceed the amount of the quality assessment.

    233(b) For any offense subsequent to a first offense, a fine of 245$1,000 per day shall be imposed until the quality assessment is paid in full, but in no event shall the fine exceed the amount of the quality assessment. A subsequent offense is defined as any offense within a period of five years preceding the most recent quality assessment due date.

    296(c) 297An offense is defined as one month’s quality assessment payment not received by the 20th day of the next succeeding calendar month.

    319(d) 320In the event that a provider fails to report their total number of resident days as defined in Section 339409.9083(1)(c), F.S., 341by the 20th day of the next succeeding calendar month, the fines in paragraphs (a)-(c), apply and the maximum amount of the fines shall be equal to their last submitted quality assessment amount but in no event shall the total fine exceed the amount of the quality assessment.

    389(5) In addition to the aforementioned fines, providers are also subject to the non-monetary remedies enumerated in Section 407409.9083(6), F.S. 409Imposition of the non-monetary remedies by the Agency will be as follows:

    421(a) For a third subsequent offense, the Agency will withhold any medical assistance reimbursement payments until the assessment is recovered.

    441(b) For a fourth or greater subsequent offense, the Agency will seek suspension or revocation of the facility’s license.

    460(6) Sanctions for failure to timely submit a quality assessment are non-allowable costs for reimbursement purposes and shall not be included in the provider’s Medicaid per diem rate.

    488(7) 489The facility may amend any previously submitted quality assessment data, but in no event may an amendment occur more than twelve months after the due date of the assessment. The deadline for submitting an amended assessment shall not relieve the facility from their obligation to pay any amount previously underpaid and shall not waive the Agency’s right to recoup any underpaid assessments.

    551Rulemaking Authority 553409.919 FS. 555Law Implemented 557409.908, 558409.9083 FS. 560History–New 3-14-99, Amended 10-12-04, 2-22-06, 4-12-09, 3-3-10, 2-23-11, 7-16-12, 2-13-14, 2-4-15, 6-15-15, 7-11-16, 6-27-17, 3-11-18.

     

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