The purpose of this rule is to incorporate by reference the Florida Title XIX Outpatient Hospital Reimbursement Plan (the Plan), effective July 1, 2012. The amendment to Rule 59G-6.030 will update the Plan to reflect changes authorized in House ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-6.030Payment Methodology for Outpatient Hospital Services

PURPOSE AND EFFECT: The purpose of this rule is to incorporate by reference the Florida Title XIX Outpatient Hospital Reimbursement Plan (the Plan), effective July 1, 2012. The amendment to Rule 59G-6.030, F.A.C., will update the Plan to reflect changes authorized in House Bill 5001, 2012-13 General Appropriations Act, Specific Appropriation 198, which provides for hospital buy backs, exemptions from ceilings, and a reimbursement rate reduction. Additionally, no changes to providers’ rates will be allowed after October 31 of each year, and references to the Bureau of Medicaid Program Analysis have been changed to the Bureau of Medicaid Program Finance. The methodology used to calculate the upper payment limit (UPL) has been added as an appendix to the Plan.

SUMMARY: Rule 59G-6.030, F.A.C., updates the Title XIX Outpatient Hospital Reimbursement Plan to reflect changes authorized in House Bill 5001, 2012-13 General Appropriations Act, Specific Appropriation 198, which provides for hospital buy backs, exemptions from ceilings, and a reimbursement rate reduction. Additionally, no changes to providers’ rates will be allowed after October 31 of each year, and references to the Bureau of Medicaid Program Analysis have been changed to the Bureau of Medicaid Program Finance. The methodology used to calculate the upper payment limit (UPL) has been added as an appendix to the Plan.

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 upon 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: 409.908, 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: February 18, 2014, 9:00 a.m. − 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, Tallahassee, FL 32301

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Edwin Stephens, Medicaid Program Finance, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 23, Tallahassee, Florida 32308, [phone] or by e-mail at [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-6.030 Payment Methodology for Outpatient Hospital Services.

Reimbursement to participating outpatient hospitals for services provided shall be in accordance with the Florida Title XIX Outpatient Hospital Reimbursement Plan, Version XXIII, Effective Date July 1, 20112, and incorporated herein by reference https://www.flrules.org/Gateway/reference.asp?No=Ref_______. 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 409.908, 409.913 FS. History–New 10-31-85, Amended 12-31-85, Formerly 10C-7.401, Amended 10-1-86, 3-26-90, 9-30-90, 10-13-91, 7-1-93, Formerly 10C-7.0401, Amended 4-10-94, 9-18-96, 9-5-99, 9-20-00, 12-6-01, 11-10-02, 2-16-04, 10-12-04, 7-4-05, 4-19-06, 12-11-06, 3-4-08, 6-10-08, 1-11-09, 3-24-10, 6-24-10, 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: January 16, 2014

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: June 29, 2012