The purpose of the amendment to Rule 59G-6.020 is to incorporate by reference the Title XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XL, effective July 1, 2013.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-6.020Payment Methodology for Inpatient Hospital Services

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-6.020, F.A.C., is to incorporate by reference the Title XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XL, effective July 1, 2013.

SUMMARY: The amendment will update the Plan to reflect changes authorized in Senate Bill 1500, 2013-14 General Appropriations Act, Specific Appropriation 208, and Section 6, Senate Bill 1502, 2013-14 Implementing Bill. The changes include the criteria for certain hospitals to adjust their prior Medicaid inpatient trend adjustment, adjustments for inpatient reimbursement limitations, the methodology for a Diagnosis Related Group (DRG) based reimbursement system, the elimination of the methodology for cost based hospital reimbursement, special Medicaid payments to Winter Haven Hospital, a reconciliation of transitional DRG payments, the methodology of the upper payment limit (UPL) demonstration, a detailed description of the protocol used to determine certified public expenditures (CPEs) for state-owned psychiatric hospitals, the repeal of the Community Hospital Education Act as established in Section 381.0403, F.S., and the implementation of the Statewide Medicaid Residency Program as established in Senate Bill 1520, which creates Section 409.909, Florida Statutes.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to Section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.905(5), 409.908, 409.909, 409.9113, 409.9115, 409.9116, 409.9118, 409.9119, 409.913 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: Tuesday, September 30, 2014, 10:00 a.m. ‒ 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room D, Tallahassee, Florida 32308

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Edwin Stephens. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Edwin Stephens, Medicaid Services, 2727 Mahan Drive, Mail Stop #20, Tallahassee, Florida 32308, telephone: [phone], e-mail: [e-mail]

Comments will be received until 5:00 p.m. on Tuesday, October 7, 2014.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-6.020 Payment Methodology for Inpatient Hospital Services.

Reimbursement to participating inpatient hospitals for services provided shall be in accordance with the Florida Title XIX Inpatient Hospital Reimbursement Plan, Version XL XXXIX, Effective Date July 1, 2013 2012, and incorporated herein by reference. A copy of the Plan as revised may be obtained by writing to the Office of the Deputy Secretary for Medicaid, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop #8, Tallahassee, Florida 32308.

Rulemaking Authority 409.919 FS. Law Implemented 409.905(5), 409.908, 409.909, 409.911 409.9113, 409.9115, 409.9116, 409.911, 409.9118, 409.9119, 409.913 FS. History–New 10-31-85, Formerly 10C-7.391, Amended 10-1-86, 1-10-89, 11-19-89, 3-26-90, 8-14-90, 9-30-90, 9-16-91, 4-6-92, 11-30-92, 6-30-93, Formerly 10C-7.0391, Amended 4-10-94, 8-15-94, 1-11-95, 5-13-96, 7-1-96, 12-2-96, 11-30-97, 9-16-98, 11-10-99, 9-20-00, 3-31-02, 1-8-03, 7-3-03, 2-1-04, 2-16-04, 2-17-04, 8-10-04, 10-12-04, 1-10-06, 4-19-06, 12-11-06, 3-4-08, 6-10-08, 1-11-09, 3-24-10, 7-5-10, 7-15-10, 2-23-11, 10-30-12,_________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Edwin Stephens

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 12, 2014

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: June 24, 2013