The purpose of the amendment to Rule 59G-6.020, Florida Administrative Code (F.A.C.), is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XLIII, effective July 1, 2016.

 

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, Florida Administrative Code (F.A.C.), is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XLIII, effective July 1, 2016.

SUMMARY: The rule is being updated 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: 409.905, 409.908, 409.909, 409.913, 409.9113, 409.9115, 409.9116, 409.9118, 409.9119 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. May 2, 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-6.020 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 (the Plan), Version XLIII XLII, effective July 1, 2016, 2015, available at [DOS place holder Ref-_______], http://www.flrules.org/Gateway/reference.asp?No=Ref-07021, incorporated by reference. The Plan is applicable to the fee-for-service delivery system. 

(2) A copy of the Plan, as revised, may be obtained by writing to the Bureau of Office of the Deputy Secretary for Medicaid Program Finance, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 23 8, Tallahassee, Florida 32308.

(3) The Provider Reimbursement Manual CMS PUB. 15-1, is incorporated by reference, http://www.flrules.org/Gateway/reference.asp?No=Ref-07043, and available at  https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021929.html. The following cost reports are included in the Plan and are incorporated by reference: CMS-2552-96, June 2003, http://www.flrules.org/Gateway/reference.asp?No=Ref-07058; and CMS-2552-10, October 2012, http://www.flrules.org/Gateway/reference.asp?No=Ref-07059. These cost reports are available on the Centers for Medicare and Medicaid Services website 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, 409.913, 409.9113, 409.9115, 409.9116, 409.9118, 409.9119 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, 4-23-14, 1-19-15, 6-15-15, 7-11-16, _______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Charles McGillen

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

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 12/20/16

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 12/6/16