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 proposed rates, the methodologies underlying the establishment of such rates, and justifications for the proposed rates. The Agency is in the process of amending its Title XIX Inpatient Hospital Reimbursement Plan (The Plan) to incorporate changes to the reimbursement methodology.
PROPOSED RATES: Effective July 1, 2006, the proposed rates for Medicaid inpatient hospitals will be 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. $59,233,070 is provided to eliminate the inpatient reimbursement ceilings for hospitals whose charity care and Medicaid days, as a percentage of total adjusted hospital days, equal or exceed 11 percent. For any public hospital that does 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 shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. In the event the agency does not have the prescribed three years of audited DSH data for a hospital, the agency shall use the average of the audited DSH data for 2000, 2001 and 2002 that are available.
2. $3,270,205 is provided to eliminate 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.
3. $86,544,883 is provided to eliminate 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. This provision shall apply to all hospitals that are a designated or provisional trauma centers on July 1, 2006 and any hospitals that become a designated or provisional trauma center during State Fiscal Year 2006-2007. The agency shall use the average of the 2000, 2001 and 2002 audited DSH data available as of March 1, 2006. In the event the agency does not have the prescribed three years of audited DSH data for a hospital, the agency shall use the average of the audited DSH data for 2000, 2001 and 2002 that are available.
4. $9,932,000 is provided to make Medicaid payments to hospitals. These payments shall be used to pay approved liver transplant facilities a global fee for providing transplant services to Medicaid recipients.
5. $246,408,972 is provided to eliminate the inpatient reimbursement ceilings 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.
6. Effective July 1, 2006, in accordance with the approved Medicaid Reform Section 1115 Demonstration, Special Terms and Conditions 100(b), the current inpatient supplemental payment upper payment limit (UPL) program is 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 will be limited to Medicaid cost as defined in the CMS 2552-96.
DISPROPORTIONATE SHARE (DSH) HOSPITALS
1. $141,124,815 is provided for payments to regular DSH.
2. $60,000,000 is provided for payments to General Medical Education (GME) hospitals.
3. $60,998,691 is provided for payments to mental health DSH.
4. $2,444,444 is provided for payments to specialty DSH.
5. The minimum number of Medicaid days for non-state government owned or operated hospitals has been reduced from 3,300 days to 3,100 days.
METHODOLOGIES: The methodology underlying the establishment of the proposed rates for Medicaid inpatient hospitals will be rates resulting from the 2006-07 General Appropriations Act, House Bill 5001 and the 2006-07 Health Care Implementing Bill, House Bill 5007.
JUSTIFICATION: The justification for the proposed 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.
State residents may provide written comment on the proposed 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 proposed reimbursement plan incorporating the above changes are not available at this time. Please contact the person listed above for a copy once it is available.
