The purpose of the amendment to Rule 59G-6.045 is to incorporate by reference the Florida Title XIX Reimbursement Plan for Services in Facilities Not Publicly Owned and Not Publicly Operated (Formerly Known as ICF-MR/DD Facilities), Version IX, ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-6.045 Payment Methodology for Services in Facilities Not Publicly Owned and Publicly Operated (Facilities Formerly Known as ICF-MR/DD Facilities)

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-6.045, F.A.C., is to incorporate by reference the Florida Title XIX Reimbursement Plan for Services in Facilities Not Publicly Owned and Not Publicly Operated (Formerly Known as ICF-MR/DD Facilities), Version IX, effective October 1, 2013 (the Plan).

SUMMARY: The amendment will update the Plan to reflect changes authorized in Senate Bill 1500, 2013-14 General Appropriations Act, Specific Appropriation 238, which authorizes a buy back for Intermediate Care Facilities and a recurring methodology for reimbursement rates effective October 1, 2013. Other changes include the deletion of language allowing for an extension of time for a provider to file cost reports, the deletion of language related to vacancy interim rates, the addition of language related to the fines and penalties for facilities not paying their quality assessment pursuant to the requirements of 409.9083, Florida Statutes, the addition of the methodology used to calculate the upper payment limit (UPL), the addition of definitions, the replacement of “mentally retarded and developmentally disabled” with “individuals with intellectual disabilities,” and a revision of the rule title to Payment Methodology for Services in Facilities Not Publicly Owned and Not Publicly Operated (Facilities Formerly Known as ICF-MR/DD Facilities); Quality Assessment Sanctions.

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: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

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, 409.9083 FS.

LAW IMPLEMENTED: 409.908, 409.9083, 409.913 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: Tuesday, August 26, 2014, 10:00 a.m. – 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, Tallahassee, Florida 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 48 hours before the workshop/meeting by contacting: Edwin Stephens. 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, Bureau of Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308, telephone: [phone], e-mail: [e-mail]

Comments will be received until 5:00 p.m. on Tuesday, September 2, 2014.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-6.045 Payment Methodology for Services in Facilities Not Publicly Owned and Not Publicly Operated (Facilities Formerly Known as ICF-MR/DD Facilities); Quality Assessment Sanctions.

(1) Reimbursement to participating facilities for services provided shall be in accord with the Florida Title XIX ICF-MR/DD Reimbursement Plan for Services in Facilities Not Publicly Owned and Not Publicly Operated (Formerly known as ICF-MR/DD Facilities), Version IX VIII, Effective Date October 1, 2013 July 1, 2012, and incorporated herein by reference. A copy of the Plan may be obtained by writing to the Deputy Secretary for Medicaid, Agency for Health Care Administration, Mail Stop 8, Tallahassee, Florida 32308.

(2) Participating Intermediate Care Facilities (ICF) shall use the Facility Quality Assessment form (only accepted electronically), AHCA Form 5000-3548, October 2013, incorporated by reference, for the submission of its monthly quality assessment.  This form can be accessed at https://apps.ahca.myflorida.com/nfqa/.

(3) Each facility shall report monthly to the Agency, its total number of resident days and remit an amount equal to the assessment rate times the reported number of days. Facilities are required to submit their full quality assessment payment by the 15th day of the next succeeding calendar month.

(4) Providers are subject to the following monetary sanctions pursuant to section 409.9083(6), Florida Statutes, for failure to timely pay a quality assessment:

(a) For a facility’s first offense, a fine of $500 per day shall be imposed until the quality assessment is paid in full, but in no event shall the sanction exceed the amount of the quality assessment.

(b) For any offense subsequent to a first offense, a fine of $1,000 per day shall be imposed until the quality assessment is paid in full, but in no event shall the sanction exceed the amount of the quality assessment. A subsequent offense is defined as any offense within a period of five years preceding the most recent quality assessment due date.

(c) An offense is defined as one month’s quality assessment payment not received by the 15th day of the next succeeding calendar month.

(d) In the event that a provider fails to report their total number of resident days by the 15th day of the next succeeding calendar month, the sanctions in paragraphs (a)-(c) apply and the maximum amount of the sanction shall be equal to their last submitted quality assessment amount.

(5) In addition to the above monetary sanctions, the Agency may withhold any medical assistance reimbursement payments until the delinquent quality assessment amount is paid in full.

(6) Sanctions for failure to timely submit a quality assessment are non-allowable costs for reimbursement purposes and shall not be included in the provider’s Medicaid per diem rate.

(7) The facility may amend any previously submitted quality assessment data; but in no event may an amendment occur more than six months after the due date of the assessment. The deadline for submitting an amended assessment shall not relieve the facility from their obligation to pay any amount previously underpaid and shall not waive the Agency's right to recoup any underpaid assessments.

Rulemaking Authority 409.919, 409.9083 FS. Law Implemented 409.908, 409.9083, 409.913 FS. History–New 3-14-99, Amended 10-12-04, 2-22-06, 4-12-09, 3-3-10, 2-23-11, 7-16-12, 2-13-14,_________.

 

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: May 9, 2014

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: August 29, 2013