AGENCY FOR HEALTH CARE ADMINISTRATION
MedicaidNotice of Final Rates
The Florida Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Analysis, provides the following public notice regarding reimbursement for inpatient hospitals 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 inpatient hospitals, 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 Inpatient Hospital Reimbursement Plan (The Plan) to incorporate changes to the Inpatient Hospital Reimbursement Methodology.
FINAL RATES: Effective July 1, 2007, the final rates for Medicaid inpatient hospitals are rates resulting from revised methodology used to calculate per diem rates and disproportionate share (DSH) payments as follows:
1. Effective July 1, 2007, inpatient reimbursement ceilings were eliminated for hospitals whose charity care and Medicaid days, as a percentage of total adjusted hospital days, equal or exceed 11 percent. The Agency shall use the average of the 2001, 2002, and 2003 audited disproportionate share (DSH) data available as of March 1, 2007. 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 2001, 2002, and 2003 that are available.
2. Effective July 1, 2007, the inpatient 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 were eliminated.
3. Effective July 1, 2007, the inpatient hospital 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 were eliminated. This provision shall apply to all hospitals that are designated or provisional trauma centers on July 1, 2007 and any hospitals that become a designated or provisional trauma center during State Fiscal Year 2007-2008. The Agency shall use the average of the 2001, 2002 and 2003 audited DSH data available as of March 1, 2007. 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 2001, 2002 and 2003 that are available.
4. Effective July 1, 2007, the inpatient reimbursement ceilings were eliminated for teaching, specialty, Community Hospital Education Program hospitals and Level III Neonatal Intensive Care Units that have a minimum of three of the following designated tertiary services as regulated under the Certificate of Need Program: pediatric bone marrow transplantation, pediatric open heart surgery, pediatric cardiac catheterization and pediatric heart transplantation.
5. Effective July 1, 2007 and ending June 30, 2008, the Medicaid Trend Adjustment shall be removed for all hospitals whose Medicaid and charity care days as a percentage to total adjusted days equals or exceeds 30 percent and have more than 10,000 Medicaid days, or a hospital or hospital system that established a provider service network during the prior state fiscal year. The aggregate Medicaid Trend Adjustment shall be reduced by $25,352,420. The Agency shall use the average of the 2001, 2002 and 2003 audited DSH data available as of March 1, 2007.
6. The Agency shall use the average of the 2001, 2002, and 2003 audited disproportionate share data to determine each hospital’s Medicaid days and charity care days for the 2007-2008 State Fiscal Year. For State Fiscal Year 2006-07, the Agency used the average of the 2000, 2001, and 2002 audited disproportionate share data to determine each hospital’s Medicaid days and charity care days.
7. For State Fiscal Year 2007-2008, the Disproportionate Share (DSH) program has appropriated funding as follows:
$148,382,079 is provided for payments to public hospitals;
$48,000,000 is provided for payments to defined statutory teaching hospitals;
$12,000,000 is provided for payments to the family practice teaching hospitals;
$60,998,691 is provided for Mental Health DSH;
$2,444,444 is provided for Specialty DSH; and
$12,718,187 is provided for Rural DSH.
8. Provider Service Network (PSN) – is defined in Section 409.912, F.S., as a network established or organized and operated by a health care provider, or group of affiliated health care providers, which provides a substantial proportion of the health care items and services under a contract directly through the provider or affiliated group of providers.
METHODOLOGIES: The methodology underlying the establishment of the final rates for Medicaid inpatient hospitals were rates resulting from the 2007-08 General Appropriations Act, Senate Bill 2800, Specific Appropriations 206, 211, 212, 244, and 245.
JUSTIFICATION: The justification for the final State Plan Amendment is the 2007-08 General Appropriations Act, Senate Bill 2800, Specific Appropriations 206, 211, 212, 244, and 245.
State residents may provide written comment on the final rates, methodologies and justification underlying the establishment of such rates. Written comments may be submitted to: Edwin Stephens, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 21, Tallahassee, Florida 32308 or at stephene@ahca.myflorida.com.
Copies of the final reimbursement plan incorporating the above changes are available at this time. Please contact the person listed above for a copy.
