The Florida Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Analysis provides the following public notice regarding reimbursement for hospitals providing outpatient services participating in the Florida Medicaid Program.
PURPOSE: To comply with federal public notice requirements in Section 1902(a)(13)(A) of the Social Security Act in changing reimbursement for hospital outpatient services, the Agency is publishing the final rates, the methodologies underlying the establishment of such rates, and justifications for the final rates. The Agency has amended its Title XIX Outpatient Hospital Reimbursement Plan (The Plan) to incorporate changes to the reimbursement methodology.
1. $7,704,802 is provided to eliminate the outpatient reimbursement ceilings for hospitals whose charity care and Medicaid days as a percentage of total adjusted hospital days equals or exceeds 11 percent. For any public hospital that does not qualify for the elimination of the outpatient ceilings under this section, the public hospital shall be exempt from the outpatient reimbursement ceilings contingent on the public hospital or local governmental entity providing the required state match. The Agency shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. In the event the agency does not have the prescribed three years of audited DSH data for a hospital, the agency shall use the average of the audited DSH data for 2000, 2001 and 2002 that are available.
2. $387,284 is provided to eliminate the outpatient reimbursement ceilings for hospitals that have a minimum of ten licensed Level II Neonatal Intensive Care Beds and are located in Trauma Services Area 2.
3. $11,223,355 is provided to eliminate the outpatient reimbursement ceilings for hospitals whose Medicaid days, as a percentage of total hospital days, exceed 7.3 percent, and are designated or provisional trauma centers. This provision shall apply to all hospitals that are designated or provisional trauma centers on July 1, 2006 or become a designated or provisional trauma center during State Fiscal Year 2006-2007. The agency shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. In the event the agency does not have the prescribed three years of audited DSH data for a hospital, the agency shall use the average of the audited DSH data for 2000, 2001 and 2002 that are available.
4. Effective July 1, 2006, the reduction implemented during the period July 1, 2005 through June 30, 2006 shall become a recurring annual reduction. This recurring reduction, called the Medicaid Trend Adjustment, shall be applied proportionally to all rates on an annual basis.
5. The term public hospital has been replaced with non-state-government owned or operated facility in accordance with 42 CFR §417.272.
6. The phrase contingent on the public hospital or local governmental entity providing the required state match has been deleted from the plan language.
FINAL RATES: Effective July 1, 2006, the final rates for Medicaid hospital outpatient services are rates resulting from the current methodology used to calculate per diems including appropriations from the 2006-07 General Appropriations Act, House Bill 5001, Specific Appropriation 217.
METHODOLOGIES: The methodology underlying the establishment of the final rates for Medicaid hospital outpatient services will be rates resulting from the current methodology used to calculate per diems including the 2006-07 General Appropriations Act, House Bill 5001, Specific Appropriation 217.
JUSTIFICATION: The justification for the final rate change is based on the legislative direction provided in the 2006-07 General Appropriations Act, House Bill 5001, Specific Appropriation 217.
The Agency has implemented the above rates and changes in methodology, effective July 1, 2006. Written comments may be submitted to: Edwin Stephens, Agency for Health Care Administration,
