The Florida Agency for Health Care Administration (the Agency), Bureau of Medicaid Program Analysis provides the following public notice regarding reimbursement for outpatient 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 outpatient 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 Outpatient Hospital Reimbursement Plan (The Plan) to incorporate changes to the reimbursement methodology.
1. Effective July 1, 2005 outpatient reimbursement ceilings were eliminated for hospitals whose charity care and Medicaid days as a percentage of total adjusted hospital days equals or exceeds 11 percent. 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. Any hospital that met the 11 percent threshold in State Fiscal Year 2004-2005 and was also exempt from the outpatient reimbursement ceilings shall remain exempt from the outpatient reimbursement ceilings for State Fiscal Year 2005-2006, subject to the payment limitations imposed in this paragraph.
2. Effective July 1, 2005 outpatient reimbursement ceilings were eliminated for hospitals that have a minimum of ten licensed Level II Neonatal Intensive Care Beds and are located in Trauma Services Area 2.
3. Effective July 1, 2005, the outpatient reimbursement ceilings shall be eliminated for hospitals whose Medicaid days, as a percentage of total hospital days, exceed 7.3 percent, and are designated or provisional trauma centers. This provision shall apply to all hospitals that are designated or provisional trauma centers on July 1, 2005 or 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.
4. Effective July 1, 2005 the Agency has implemented a recurring methodology in the Title XIX Outpatient Hospital Reimbursement Plan that may include, but is not limited to, the inflation factor, variable cost target, county rate ceiling or county ceiling target rate to achieve a recurring reduction of $16,796,807 from inflationary and other price level increases. Effective July 1, 2005, a recurring rate reduction shall be established until an aggregate total estimated savings of $16,796,807 is achieved each year. This reduction is the Medicaid Trend Adjustment.
a. The July 1, 2005 and January 1, 2006 reimbursement rates shall be adjusted as follows:
i. Restore the $14,103,000 outpatient hospital reimbursement rate reduction set forth in Section V.B.8 above to the June 30, 2005 reimbursement rate;
ii. Determine the lower of the June 30, 2005 rate with the restoration of the $14,103,000 reduction referenced in (i) above or the July 1, 2005 or January 1, 2006 rates, as applicable, before the application of the Medicaid Trend Adjustment described in (9) above;
iii. Using the rate per (ii) above, determine the final rate by limiting interim Medicaid reimbursement above Medicaid limitations (ceilings, targets, etc.) and up to cost made available through the Upper Payment Limit Program to 50% of the difference between the limited rate and the reported cost, based upon specific criteria as referenced in this section.
b. Effective July 1, 2006 reimbursement rates shall be adjusted as follows:
i. The aggregate annual total estimated savings of $16,796,807 shall be implemented by a proportional adjustment to each providers rate.
ii. Interim Medicaid reimbursement above Medicaid limitations and up to cost made available through the Upper Payment Limit Program shall be limited to 50% of the difference between the limited rate and reported cost, based upon specific criteria as referenced in this section.
5. Updates to the outpatient hospital revenue center codes.
FINAL RATES: Effective July 1, 2005, the final rates for Medicaid outpatient hospitals are rates resulting from the current methodology used to calculate per diems including appropriations from the 2005-06 General Appropriations Act, Senate Bill 2600, Specific Appropriation 194.
METHODOLOGIES: The methodology underlying the establishment of the final rates for Medicaid Outpatient Hospitals will be rates resulting from the current methodology used to calculate per diems including the 2004-05 General Appropriations Act, House Bill 1835, Specific Appropriation 206.
JUSTIFICATION: The justification for the final rate change is based on the legislative direction provided in 2005-06 General Appropriations Act, Senate Bill 2600, Specific Appropriation 194.
The Agency has implemented the above rates and changes in methodology, effective July 1, 2005. Written comments may be submitted to: Edwin Stephens, Agency for Health Care Administration,
