59G-6.020: Payment Methodology for Inpatient Hospital Services
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, 2006, the final rates for Medicaid inpatient hospitals are rates resulting from revised methodology used to calculate per diem rates, special Medicaid payments (SMPs), and disproportionate share (DSH) payments as follows:
HOSPITAL INPATIENT SERVICES
1. Inpatient reimbursement ceilings were eliminated for hospitals whose charity care and Medicaid days, as a percentage of total adjusted hospital days, equaled or exceeded 11 percent. For any public hospital that did not qualify for the elimination of the inpatient ceilings under this Section or any other Section, the public hospital shall be exempt from the inpatient reimbursement ceilings contingent on the public hospital or local governmental entity providing the required state match. The Agency used the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. In the event the Agency did not have the prescribed three years of audited DSH data for a hospital, the Agency used the average of the audited DSH data for 2000, 2001 and 2002 that are available.
2. The inpatient reimbursement ceilings were eliminated for hospitals that had a minimum of ten licensed Level II Neonatal Intensive Care Beds and were located in Trauma Services Area.
3. The inpatient hospital reimbursement ceilings were eliminated for hospitals whose Medicaid days as a percentage of total hospital days exceeded 7.3 percent, and were designated or provisional trauma centers. This provision only applied to hospitals that were a designated or provisional trauma centers on July 1, 2006 and any hospitals that became a designated or provisional trauma center during State Fiscal Year 2006-2007. The Agency used the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. In the event the Agency did not have the prescribed three years of audited DSH data for a hospital, the Agency used the average of the audited DSH data for 2000, 2001 and 2002 that was available.
4. Medicaid payments were made to pay approved liver transplant facilities a global fee for providing transplant services to Medicaid recipients.
5. Inpatient reimbursement ceilings were eliminated for teaching, specialty, Community Hospital Education Program hospitals, and Level III Neonatal Intensive Care Units that had 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.
6. Effective July 1, 2006, in accordance with the approved Medicaid Reform Section 1115 Demonstration, Special Terms and Conditions 100(b), the inpatient supplemental payment upper payment limit (UPL) program was terminated.
7. Effective July 1, 2006, in accordance with the approved Medicaid Reform Section 1115 Demonstration, Special Terms and Conditions 100(c), the inpatient hospital payments for Medicaid eligibles were limited to Medicaid cost as defined in the CMS 2552-96.
8. All references to Data Resources Incorporated (DRI) added the phrase or its successor in order to account for future name changes of the company.
9. The reference to the definition section of the Inpatient Hospital Reimbursement Plan found in Section V. Methods, A.3. was corrected to be Section XII.
DISPROPORTIONATE SHARE (DSH) HOSPITALS
1. $141,124,815 was provided for payments to regular DSH.
2. $60,000,000 was provided for payments to Graduate Medical Education (GME) hospitals.
3. $60,998,691 was provided for payments to mental health DSH.
4. $2,444,444 was provided for payments to specialty DSH.
5. The minimum number of Medicaid days for non-state government owned or operated hospitals was reduced from 3,300 days to 3,100 days.
METHODOLOGIES: The methodology underlying the establishment of the final rates for Medicaid inpatient hospitals were rates resulting from the 2006-07 General Appropriations Act, House Bill 5001 and the 2006-07 Health Care Implementing Bill, House Bill 5007, and the Medicaid Reform Section 1115 Demonstration.
JUSTIFICATION: The justification for the final State Plan Amendment is House Bill 5001, 2006-07 General Appropriations Act, Specific Appropriations 213, 214, 245, 246 and the 2006-07 Health Care Implementing Bill, House Bill 5007 and the Medicaid Reform Section 1115 Demonstration.
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,
Copies of the final reimbursement plan incorporating the above changes are available at this time. Please contact the person listed above for a copy.
