The purpose of the amendment to Rule 59G-6.045, Florida Administrative Code, is to incorporate by reference the Florida Title XIX Reimbursement Plan for Services in Facilities Not Publicly Owned and Not Publicly Operated (the Plan), Version XII, ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-6.045Payment Methodology for Services in Facilities Not Publicly Owned and Not Publicly Operated

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-6.045, Florida Administrative Code, is to incorporate by reference the Florida Title XIX Reimbursement Plan for Services in Facilities Not Publicly Owned and Not Publicly Operated (the Plan), Version XII, effective July 1, 2016.

SUMMARY: The rule is being amended to incorporate changes to the amended reimbursement 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 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: 409.908, 409.9083 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Charles McGillen, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail].

Please note that a preliminary draft of the reference material, if available, will be posted at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received from the date of this notice until 5:00 p.m., April 19, 2017. Comments may be e-mailed to [e-mail]. For general inquiries and questions about the rule, or to request a hearing in accordance with section 120.54(3)(c)1 FS., please contact the person specified above.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-6.045 Payment Methodology for Services in Facilities Not Publicly Owned and Not Publicly Operated.

(1) Reimbursement to participating facilities for services provided shall be in accordance accord with the Florida Title XIX Reimbursement Plan for Services in Facilities Not Publicly Owned and Not Publicly Operated (the Plan), Version XII XI, effective July 1, 2016, 2015, available at DOS place holder Ref-_______]http://www.flrules.org/Gateway/reference.asp?No=Ref-_____, incorporated by reference. The Plan is applicable to the fee-for-service delivery system. A copy of the Plan as revised may be obtained by writing to the Bureau of Deputy Secretary for Medicaid Program Finance, Agency for Health Care Administration, Mail Stop 23 8, Tallahassee, Florida 32308.

(2) Participating Intermediate Care Facilities (ICF) shall use the Facility Quality Assessment form (only accepted electronically), AHCA Form 5000-3548, October 2013, incorporated by reference, for the submission of its monthly quality assessment. This form can be accessed at https://apps.ahca.myflorida.com/nfqa/.

(3) Each facility shall report monthly to the Agency, its 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 by the 15th day of the next succeeding calendar month.

(4) Providers are subject to the following monetary fines pursuant to sSection 409.9083(6), F.S., for failure to timely pay a quality assessment:

(a) For a facility’s first offense, a fine of $500 per day shall be imposed until the quality assessment is paid in full, but in no event shall the fine exceed the amount of the quality assessment.

(b) For any offense subsequent to a first offense, a fine of $1,000 per day shall be imposed until the quality assessment is paid in full, but in no event shall the fine exceed the amount of the quality assessment. A subsequent offense is defined as any offense within a period of five years preceding the most recent quality assessment due date.

(c) An offense is defined as one month’s quality assessment payment not received by the 20th day of the next succeeding calendar month.

(d) In the event that a provider fails to report their total number of resident days as defined in sSection 409.9082(1)(c), F.S., by the 20th day of the next succeeding calendar month, the fines in paragraphs (a)-(c) apply and the maximum amount of the fines shall be equal to their last submitted quality assessment amount but in no event shall the total fine exceed the amount of the quality assessment.

(5) In addition to the aforementioned fines, providers are also subject to the non-monetary remedies enumerated in sSection 409.9083(6), F.S. Imposition of the non-monetary remedies by the Aagency will be as follows:

(a) For a third subsequent offense, the Aagency will withhold any medical assistance reimbursement payments until the assessment is recovered.

(b) For a fourth or greater subsequent offense, the Aagency will seek suspension or revocation of the facility’s license.

(6) Sanctions for failure to timely submit a quality assessment are non-allowable costs for reimbursement purposes and shall not be included in the provider’s Medicaid per diem rate.

(7) The facility may amend any previously submitted quality assessment data, but in no event may an amendment occur more than twelve months after the due date of the assessment. The deadline for submitting an amended assessment shall not relieve the facility from their obligation to pay any amount previously underpaid and shall not waive the Agency’s right to recoup any underpaid assessments.

Rulemaking Authority 409.919 FS. Law Implemented 409.908, 409.9083 FS. History–New 3-14-99, Amended 10-12-04, 2-22-06, 4-12-09, 3-3-10, 2-23-11, 7-16-12, 2-13-14, 2-4-15, 6-15-15,7-11-16,_______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Charles McGillen

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Justin M. Senior

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 20, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: December 6, 2016