The purpose of this rule is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), effective July 1, 2011. The Plan, effective July 1, 2011, includes the addition of a reference to Rule Number 59G-9.070, ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO.: RULE TITLE:
59G-6.020: Payment Methodology for Inpatient Hospital Services
PURPOSE AND EFFECT: The purpose of this rule is to incorporate by reference the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan), effective July 1, 2011. The Plan, effective July 1, 2011, includes the addition of a reference to Rule Number 59G-9.070, F.A.C. for the amount of late cost report sanctions; a reimbursement rate reduction (Medicaid trend adjustment), exemptions from reimbursement ceilings; the opportunity for certain hospitals to buy back their reimbursement rate reductions; a rate freeze on inpatient hospital reimbursement rates; the establishment of hospitals rates being set once a year every July 1; and disproportionate share payments in compliance with the limits set forth in Section 1923(g-j) of the Social Security Act and overpayments made in the disproportionate share program handled in compliance with 42 CFR Part 433, Subpart F; the addition of a definition of a hospital buy back, rate setting unit cost, legislative unit cost, and base rate; statutory teaching hospitals allocation formula changes; updated audited disproportionate share data years used to calculate disproportionate share payments, revised buy back descriptions, and the addition of an appendix explaining Provider Preventable Conditions (PPC).
SUMMARY: The proposed rule incorporates changes to the Florida Title XIX Inpatient Hospital Reimbursement Plan (the Plan) payment methodology, effective July 1, 2011 for a recurring reimbursement rate reduction (Medicaid trend adjustment), exemptions, buy backs, specification of the rule for the amount of late cost report sanctions, a reimbursement rate freeze, and an annual reimbursement rate calculation, a buy back definition, and updates to the disproportionate share hospital payment methodology.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:
The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.
The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: At the time of the analysis of the regulatory impact it was determined that this rule will not require ratification by the Legislature pursuant to Section 120.541(3), F.S.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
RULEMAKING AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.908, 409.911, 409.9112, 409.9113, 409.9115, 409.9116, 409.9117, 409.9118, 409.9118, 409.9119 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: August 22, 2012, 10:00 a.m. – 11:00 a.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, Tallahassee, FL 32308
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 7 days before the workshop/meeting by contacting: Edwin Stephens, [phone] or [e-mail]. 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 IS: Edwin Stephens, [phone] or [e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

59G-6.020 Payment Methodology for Inpatient Hospital Services.

Reimbursement to participating inpatient hospitals for services provided shall be in accord with the Florida Title XIX Inpatient Hospital Reimbursement Plan, Version XXXVIII, Effective Date July 1, 20110 and incorporated herein by reference. A copy of the Plan as revised may be obtained by writing to the Office of the Deputy Secretary for Medicaid, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Mail Stop 8, Tallahassee, Florida 32308.

Rulemaking Authority 409.919 FS. Law Implemented 409.908, 409.911, 409.9112, 409.9113, 409.9115, 409.9116, 409.9117, 409.911, 409.9119, 409.913 FS. History–New 10-31-85, Formerly 10C-7.391, Amended 10-1-86, 1-10-89, 11-19-89, 3-26-90, 8-14-90, 9-30-90, 9-16-91, 4-6-92, 11-30-92, 6-30-93, Formerly 10C-7.0391, Amended 4-10-94, 8-15-94, 1-11-95, 5-13-96, 7-1-96, 12-2-96, 11-30-97, 9-16-98, 11-10-99, 9-20-00, 3-31-02, 1-8-03, 7-3-03, 2-1-04, 2-16-04, 2-17-04, 8-10-04, 10-12-04, 1-10-06, 4-19-06, 12-11-06, 3-4-08, 6-10-08, 1-11-09, 3-24-10, 7-5-10, 7-15-10, 2-23-11,_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Edwin Stephens
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 14, 2012
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: June 17, 2011