The purpose of the amendment to Rule 59G-6.020 is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XLI, effective July 1, 2014.

 

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 Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XLI, effective July 1, 2014.

SUMMARY: The amendment will update the Plan to reflect changes to the payment methodology for inpatient hospital services as authorized in House Bill 5001, 2014-15 General Appropriations Act, Specific Appropriation 210, as follows:

1. $2,672,282 is provided to increase the diagnosis related grouping rural hospital provider adjustor for rural hospitals as described in Section 395.602, Florida Statutes (F.S.)

2. Any hospital that was exempt from the inpatient reimbursement ceiling in the prior state fiscal year, due to their charity care and Medicaid days as a percentage to total adjusted hospital days equaling or exceeding 11 percent, but no longer meets the 11 percent threshold, because of updated audited DSH data, shall remain exempt from the inpatient reimbursement ceilings for a period of two years

3. A four percent adjustment shall be applied for anticipated case mix increases from improved documentation and coding through the implementation of Diagnosis Related Grouping (DRG) and a one percent adjustment will be applied for real case mix change

4. $7,542,036 in nonrecurring funds for sole community hospitals that meet the definition of "rural hospital" under Section 395.602(2)(e)4, F.S., to be recognized as rural hospitals in the Agency for Health Care Administration’s DRG reimbursement methodology

5. Amended cost reports will be applied only to the subsequent rate setting year

6. AHCA may establish a global fee for bone marrow transplants

7. Editorial and technical changes to remove obsolete language and reorganize existing language

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, F.S., 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: Wednesday, April 8, 2015, 11:00 a.m. – 12:00 p.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, 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 24 hours before the workshop/meeting by contacting: Chanda Farcas, Bureau of Medicaid Program Finance, 2727 Mahan Drive, Mail Stop #23, Tallahassee, Florida 32308, telephone: [phone], e-mail: [e-mail]. 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: Chanda Farcas, Bureau of Medicaid Program Finance, 2727 Mahan Drive, Mail Stop #23, Tallahassee, Florida 32308, telephone: [phone], e-mail: [e-mail]

Comments will be received until 5:00 p.m. on Wednesday, April 15, 2015.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-6.020 Payment Methodology for Inpatient Hospital Services.

(1) Reimbursement to participating inpatient hospitals for services provided shall be in accordance with the Florida Title XIX Inpatient Hospital Reimbursement Plan, Version XLI XL, eEffective July 1, 2014 2013, incorporated 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.

(2) The following forms are incorporated by reference, in this rule: CMS-2552-96, June 2003, and CMS-2552-10, October 2012. These forms are available on the Centers for Medicare and Medicaid Services Web site at http://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/CostReports/Hospital-1996-form.html and http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3P240f.pdf respectively.

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. 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, 10-30-12,1-19-15, ______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Chanda Farcas

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

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: February 3, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: June 10, 2014