AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-6.010Payment Methodology for Nursing Home Services
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 45 No. 223, November 15, 2019 issue of the Florida Administrative Register.
59G-6.010 Payment Methodology for Nursing Home Services.
(1) No change.
(2) Definitions.
(a) Adjusted Facility Sq Ft - Component of the Fair Rental Value System(FRVS) Calculation, the Minimum, Maximum, or Actual Sq. Ft per bed, defined in section 409.908(2)(b)1.g., F.S.
(b) through (c), No change.
(d) Depreciation Factor- Component of the FRVS Calculation, referred to as Obsolescence Factor, defined in section 409.908(2)(b)1.g., F.S.
(e) No change.
(f) Equipment Cost - Component of the FRVS Calculation, referred to as moveable equipment allowance, defined in section 409.908(2)(b)1.g., F.S.
(g) Exempt Providers – Pediatric, facilities operated by the Florida Department of Veterans Affairs, and government-operated facilities are exempt from reimbursement under the prospective payment methodology and shall be reimbursed on a cost-based prospective payment system, as defined in accordance with section 409.908(2)(b)8, Florida Statutes (F.S.). Reimbursement of direct care, indirect care, and operating costs are subject to reimbursement ceilings and targets.
(h) through (j), No change.
(k) FRVS Rate - A Fair Rental Value System (FRVS) Rate - system A FRVS is used to reimburse providers for their facility related capital costs. A provider must submit an FRVS survey to the Agency for Health Care Administration (AHCA) using the electronic form and instructions on the Florida Nursing Home: Fair Rental Value Survey web page. The survey information is used to compute an adjusted age for each provider, based on the most recent survey received by April 30 of each year for the subsequent rate period. The nursing facility provider’s FRVS survey will be used to calculate the rate for a future rate period.
(l) through (m), No change.
(n) Land Allocation Percentage - Component of the FRVS Calculation, referred to as Land Valuation, defined in section 409.908(2)(b)1.g., F.S.
(o) Medians - The mid-points of the inflated per diems for direct care, indirect care, and operating cost components of all included providers in a peer group. Beginning October 1, 2018 separate medians shall be calculated for operating, direct, and indirect cost components based on the most recent cost reports received for the September 2016 rate setting by the rate setting acceptance cut-off date, per section 409.908(2)(b)1.b., F.S. Beginning October 1, 2021 medians shall be calculated based on the most recently finalized, audited cost report, every fourth year.
(p) through (q), No change.
(r) Medicaid Trend Adjustment (MTA) - The MTA is a percentage reduction that is uniformly applied to all Florida Medicaid nursing facility providers each rate period which equals all recurring and nonrecurring budget reductions on an annualized basis. The MTA is built into the final Prospective Payment System rate through budget neutrality multipliers. The exempt providers’ rates are reduced by the appropriate percentage allocation as compared to all Medicaid nursing facility providers. The Medicaid share of the NFQA is not subject to the MTA.
(s) No change.
1. Total patient days minus Medicare days (exclusive of Medicaid Part A) is equal to total non-Medicare days.
2. No change.
3. No change.
(t) Adjusted Facility Sq Ft - Component of the FRVS Calculation, referred to as Minimum Occupancy, defined in section 409.908(2)(b)1.g., F.S. Offense - one month’s total number of resident days not submitted and full quality assessment payment not received by the 20th day of the next succeeding calendar month.
(u) Offense - Full quality assessment payment not received by the 20th day of the next succeeding calendar month.
(v) Quality Assessment Payment – Timely submission of one month’s total number of resident days and rendering of Quality Assessment Fee payment equal to the assessment rate times the reported number of days.
(w) through (x), No change.
(y) Quality Incentive Payment – A provider is awarded points for process, outcome, structural and credentialing measures using most recently reported data on May 31 of the rate period year. To qualify for a quality incentive payment, a provider must meet the minimum threshold defined in section 409.908(2)(b)1.f., F.S. The Quality Incentive budget is defined in section 409.908(2)(b)1.e., F.S.
1. Process Measures - Includes Flu Vaccine, Antipsychotic, and Restraint quality metrics. Providers are ranked based on the percentage of residents who have, or do not have, a particular condition. Providers who are at or above the 90th percentile for a particular measure will be awarded 3 points, those scoring from the 75th up to 90th percentiles will be awarded 2 points, and those scoring from the 50th up to 75th percentiles will receive 1 point. Providers who score below the 50th percentile and achieve a 20 percent improvement from the previous year will receive 0.5 points. Data to calculate these quality metrics is from the Medicare Nursing Home Compare datasets using the most recent four quarter average available on May 31 of the rate period year.
2. No change.
3. No change.
4. Credentialing Measures – Includes CMS Overall 5-Star, Florida Gold Seal, Joint Commission Accreditation, and American Health Care Association National Quality Award. Facilities assigned a rating of 3, 4, or 5 stars in the CMS 5- Star program will receive 1, 3, or 5 points, respectively. For each rate period, the CMS 5-Star Rating Measure will be calculated using the most recent overall rating from the Star Ratings dataset from the Nursing Home Compare datasets provided by CMS as of May 31 of the year in which the rate period begins. Facilities that have either a Florida Gold Seal, Joint Commission Accreditation, or the silver or gold America Health Care Association National Quality Award on May 31 of the current year will be awarded 5 points. Recipients of the Florida Gold Seal Award can be viewed on Florida Health Finder website, recipients of the Joint Commission Accreditation can be viewed on the Joint Commission website, and recipients of the American Health Care Association National Quality Award can be viewed on the American Health Care Association website.
(z) through (dd), No change
(ee) RSMeans Data -The industry-standard materials, labor, and equipment cost information database used by contractors and other professionals to accurately estimate construction project costs.
(ff) through (gg), No change
(3) No change
(4) No change
(a) through (b), No change
(c) FRVS Calculation. The calculation is as follows:
Building = Current Year2018 RSMeans Cost Per Sq Ft * Adjusted Facility Sq Ft * Zip Code Location Factor
Land = Building * Land Allocation Percentage
Undepreciated Value = Building + Land + Equipment
Depreciation = (Building + Equipment) * Depreciation Factor * Facility Adjusted Age
FRVS Rate = (Undepreciated Value – Depreciation) * Fair Rental Rate / (Occupancy Percentage * 365.25)
1. Current Year2018 RSMeans Cost Per Sq Ft and Zip Code Location Factor are defined in the latest Gordian Building Construction Costs publication with RSMeans Data available on March 31 of the year in which the rate period begins.
2. Adjusted Facility Sq Ft, Land Allocation Percentage, Equipment Cost, Depreciation Factor, and Fair Rental Rate are defined in section 409.908(2)(b)1.g., F.S.
3.2. Facility Adjusted Age is calculated using FRVS survey data.
(d) No change
1. Exempt Providers rate components will be limited to Reimbursement Targets and Reimbursement Ceilings (5) No change
(a) No change
(b) Each facility shall report monthly to AHCA its Quality Assessment Payment 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 quality assessment payment no later than 20 days from the next succeeding calendar month.
(c) Providers are subject to the following monetary fines pursuant to section 409.9082(7), for failure to timely submit the Quality Assessment Payment facility total number of resident days and pay the full amount of the quality assessment:
1. No change
2. For any offense subsequent to a first offense, a fine of $1,000 per day shall be imposed until the Quality Assesment Payment total number of resident days is submitted and the quality assessment is paid in full, but in no event shall the fine exceed the amount of the quality assessment.
3. No change
(d) No change
1. No change
2. No change
(e) through (f), No change
(6) No change
Document Information
- Related Rules: (1)
- 59G-6.010. Payment Methodology for Nursing Home Services