The purpose of the amendment to Rule 59G-6.020 is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan, Version XLI, effective July 1, 2014 (the Plan). The amendment will update the Plan to reflect changes to the ...

 

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, F.A.C., is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan, Version XLI, effective July 1, 2014 (the Plan). The amendment will update the Plan to reflect changes to the payment methodology for inpatient hospital services as authorized in House Bill 5001, 2014-15 General Appropriations Act, Specific Appropriation 210, as follows:

1. $2,672,282 is provided to increase the diagnosis related grouping rural hospital provider adjustor for rural hospitals as described in Section 395.602, Florida Statutes (F.S.).

2. Any hospital that was exempt from the inpatient reimbursement ceiling in the prior state fiscal year, due to their charity care and Medicaid days as a percentage to total adjusted hospital days equaling or exceeding 11 percent, but no longer meets the 11 percent threshold, because of updated audited DSH data, shall remain exempt from the inpatient reimbursement ceilings for a period of two years.

3. A four percent adjustment shall be applied for anticipated case mix increases from improved documentation and coding through the implementation of Diagnosis Related Grouping (DRG) and a one percent adjustment will be applied for real case mix change.

4. $7,542,036 in nonrecurring funds for sole community hospitals that meet the definition of "rural hospital" under Section 395.602(2)(e)4, F.S., to be recognized as rural hospitals in the Agency for Health Care Administration’s DRG reimbursement methodology.

5. Amended cost reports will be applied only to the subsequent rate setting year.

6. AHCA will establish a global fee for bone marrow transplants.

7. Editorial and technical changes to remove obsolete language and reorganize existing language.

SUBJECT AREA TO BE ADDRESSED: Payment Methodology for Inpatient Hospital Services.

An additional area to be addressed during the workshop will be the potential regulatory impact the amendment to Rule 59G-6.020, F.A.C., will have as provided for under Sections 120.54 and 120.541, F.S.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.905(5) 409.908, 409.909, 409.9113, 409.9115, 409.9116, 409.9118, 409.9119, 409.913 FS.

IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: Monday, July 28, 2014, 11:00 a.m. ‒ 12:00 Noon

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, Tallahassee, Florida 32308-5407

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Edwin Stephens at the Bureau of Medicaid Services, [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Edwin Stephens, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail]

Comments will be received until 5:00 p.m. on Monday, August 4, 2014.

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS NOT AVAILABLE.