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 reimbursement methodology.
FINAL RATES: Effective July 1, 2005, the final rates for Medicaid inpatient hospitals are rates resulting from the revised methodology used to calculate per diems rates including the following appropriations from the 2005-06 General Appropriations Act, Senate Bill 2600, Specific Appropriation 184, 190, 191, 221, 222 and Senate Bill 838, Section 4, 2005-06 Florida Legislature.
Effective July 1, 2005, Special Medicaid Payments will be made on a quarterly basis to statutory teaching hospitals, family practice teaching hospitals, hospitals providing primary care to low-income individuals, hospitals operating as designated or provisional trauma centers, and rural hospitals. Statutory teaching hospitals that received a special Medicaid payment in State Fiscal Year 2003-04 shall be paid interim payments of $12,203,921 distributed in the same proportion as the State Fiscal Year 2003-04 special Medicaid payments to statutory teaching hospitals. Family practice teaching hospitals shall be paid interim payments of $2,330,882 to be distributed equally among the hospitals. Hospitals providing primary care to low-income individuals and participating in the Primary Care DSH program in state Fiscal Year 2003-04 shall be paid interim payments of $12,203,921 distributed in the same proportion as the Primary Care DSH payments for State Fiscal Year 2003-04. Hospitals designated as provisional trauma centers shall be paid interim payments of $12,375,000. Of this amount $5,355,000 shall be distributed equally among hospitals that are a Level I trauma center; $4,500,000 shall be distributed equally among hospitals that are either a Level II or Pediatric trauma center; $2,520,000 shall be distributed equally among the hospitals that are both a Level II and Pediatric trauma center. Rural hospitals participating in the Rural Hospital DSH program shall be paid interim payments of $8,383,500 distributed in the same proportion as the DSH payments.
Effective July 1, 2005, Special Medicaid Payments will be made on a quarterly basis to hospitals that serve as a safety net in providing emergency, specialized pediatric trauma services and inpatient care to low-income individuals. Interim payments will be made in the following manner: $46,121,019 shall be paid to University Medical Center - Shands; $18,914,451 shall be paid to Tampa General Hospital; $9,072,075 shall be paid to Mt. Sinai Medical Center; $6,637,413 shall be paid to All Childrens Hospital; $5,400,229 shall be paid to Miami Childrens Hospital; $5,560,262 shall be paid to Orlando Regional Medical Center; $7,703,253 shall be paid to Shands Teaching Hospital; $3,322,365 shall be paid to Jackson Memorial Hospital; $1,200,000 shall be paid to Lee Memorial Hospital/CMS; $450,000 shall be paid to Baptist Hospital of Pensacola; $55,072 shall be paid to Florida Hospital; $54,402 shall be paid to Tallahassee Memorial Hospital; $52,835 shall be paid to St. Josephs Hospital; $291,706 shall be paid to St. Marys Hospital; $330,366 shall be paid to Broward General Medical Center; $215,975 shall be paid to Bayfront Medical Center and $466,977 shall be paid to Sacred Heart Hospital;$250,000 shall be paid to Naples Community Hospital.
Effective July 1, 2005, Special Medicaid Payments will be made on a quarterly basis to hospitals providing poison control programs. Total payments of $3,183,014 will be made to qualifying hospitals. AHCA shall work in collaboration with the Florida Department of Health to determine which hospitals will receive these payments.
Effective July 1, 2005, interim Special Medicaid Payments up to $7,297,495 will be made on a quarterly basis to hospitals to enhance primary care services to underserved areas of the state. AHCA shall work in collaboration with the Florida Department of Health to determine which hospitals will receive these payments.
Effective July 1, 2005, Special Medicaid Payments in the interim amount of $517,513,720 will be made on a quarterly basis to hospitals providing enhanced services to low-income individuals through agreements with local county or other governmental entities. The amount of the Special Medicaid Payment to each hospital is proportional to the amount of the intergovernmental transfer received from the local county or governmental entity.
Effective July 1, 2005, Special Medicaid Payments in the interim amount of $2,000,000 will be made on a quarterly basis to specialty pediatric facilities. The hospital must be licensed as a childrens specialty hospital and its combined Medicaid managed care and fee-for-service days as a percentage to total inpatient days equals or exceeds thirty 30 percent. The Agency shall use the 2003 Financial Hospital Uniform Reporting System (FHURS) data to determine the combined Medicaid managed care and fee-for-service days. The total special Medicaid payments made shall be distributed equally to the qualifying hospitals.
Effective July 1, 2005, inpatient reimbursement ceilings will be eliminated for hospitals whose sum of charity care and Medicaid days, as a percentage of adjusted patient days, equals or exceeds 11 percent. The Agency will use the average of the 1999, 2000 and 2001 audited DSH data available as of March 1, 2005. In the event the Agency does not have the prescribed three years of audited DSH data for a hospital, the Agency will use the average of the audited DSH data for 1999, 2000 and 2001 that are available. If the prescribed three years of audited DSH data is not available for the public hospital, the Agency shall use the average of the 1999, 2000, and 2001 audited DSH data that is available for the public hospital. Any hospital that met the 11 percent threshold in the State Fiscal Year 2004-2005 and was also exempt from the inpatient reimbursement ceilings shall remain exempt from the inpatient reimbursement ceilings for State Fiscal Year 2005-2006 subject to the payment limitations imposed in this paragraph.
Effective July 1, 2005, 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 shall be eliminated.
Effective July 1, 2005, 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 shall be eliminated. This provision shall apply to all hospitals that are a designated or provisional trauma center on July 1, 2005 and any hospitals that become a designated or provisional trauma center during State Fiscal Year 2005-2006. The agency shall use the average of the 1999, 2000 and 2001 audited DSH data available as of March 1, 2005. In the event the agency does not have the prescribed three years of audited DSH data for a hospital, the agency will use the average of the audited DSH data for 1999, 2000 and 2001 that are available.
Effective July 1, 2005, inpatient reimbursement ceilings shall be 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.
Effective July 1, 2005, the agency shall implement a recurring methodology in the Title XIX Inpatient Hospital Reimbursement Plan that may include, but is not limited to, the inflation factor, variable cost target, county rate ceiling, county ceiling target rate or rate for fixed costs to achieve a recurring reduction of $100,537,618 from inflationary and other price level increases.
For funds appropriated for public disproportionate share payments for state fiscal years beginning July 1, 2004 and later, the TAAPH (total amount available for public hospitals) shall be reduced by $6,365,257 before computing the DSHP (disproportionate share hospital payment) for each public hospital. The $6,365,257 shall be distributed equally between the public hospitals that are also designated statutory teaching hospitals. In computing the above amounts for public hospitals and hospitals that qualify under Section VI.A.2 of the Title XIX Inpatient Hospital Reimbursement Plan, the average of the 1998, 1999, and 2000 audited disproportionate share data will be used to determine each hospitals Medicaid days and charity care for the 2004-2005 state fiscal year and the average of the 1999, 2000, and 2001 audited disproportionate share data to determine the Medicaid days and charity care for the 2005-2006 state fiscal year.
If the Agency does not have the prescribed 3 years of audited disproportionate share data as noted above for a hospital, the agency shall use the average of the years of the audited disproportionate share data as noted in the paragraph above that is available.
Effective July 1, 2005, for the 2005-2006 state fiscal year only, the DSHP (disproportionate share hospital payment) for the public nonstate hospitals shall be computed using a weighted average of the disproportionate share payments for the 2004-2005 state fiscal year which uses an average of the 1998, 1999, and 2000 audited disproportionate share data and the disproportionate share payments for the 2005-2006 state fiscal year as computed using the formula above and using the average of the 1999, 2000, and 2001 audited disproportionate share data. The final DSHP (disproportionate share hospital payment) for the public nonstate hospitals shall be computed as an average using the calculated payments for the 2005-2006 state fiscal year weighted at 65 percent and the disproportionate share payments for the 2004-2005 state fiscal year weighted at 35 percent.
The 2005-06 Disproportionate Share appropriations are as follows:
Regular DSH $200,666,508
Mental Health $60,998,692
Rural $12,743,294
Specialty $2,444,444
The definition of charity care or uncompensated charity care has been updated to include other than restricted or unrestricted revenues provided to a hospital by local governments or tax districts regardless of the method of payment to be in accordance with 409.911, F.S.
In accordance with 409.9062 F.S., lung transplant services for Medicaid recipients, Medicaid will reimburse approved lung transplant facilities a global fee for providing lung transplant services to Medicaid recipients.
METHODOLOGIES: The final rates for Medicaid inpatient hospitals effective July 1, 2005 is the revised methodology used to calculate per diems including the amounts appropriated in the 2005-06 General Appropriations Act, Senate Bill 2600, Specific Appropriation 184, 190, 221, 222 and Senate Bill 838, Section 4, 2005-06 Florida Legislature, and Senate Bill 838, Section 4.
JUSTIFICATION: The justification for the final state plan amendment is the
2005-06 General Appropriations Act, Senate Bill 2600, Specific Appropriation 184, 190, 191, 221,222 and Senate Bill 838, Section 4.
