The purpose of Rule 59G-6.031, Florida Administrative Code (F.A.C.), is to implement the required Outpatient Prospective Payment Systems required for Outpatient Hospital care and Ambulatory Surgical Centers as stated in s. 409.905(6)(b), F.S., and ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-6.031Enhanced Ambulatory Patient Grouping Reimbursment Methodology for Hospital Outpatient Services

PURPOSE AND EFFECT: The purpose of Rule 59G-6.031, Florida Administrative Code (F.A.C.), is to implement the required Outpatient Prospective Payment Systems required for Outpatient Hospital care and Ambulatory Surgical Centers as stated in s. 409.905(6)(b), F.S., and s. 409.908(5), F.S. respectively.

SUBJECT AREA TO BE ADDRESSED: Enhanced Ambulatory Patient Grouping Reimbursement Methodology for Hospital Outpatient Services and Ambulatory Surgical Centers.

Two additional topics will be addressed during the workshop. First, the potential regulatory impact Rule 59G-6.031, F.A.C., will have as provided for under sections 120.54 and 120.541, Florida Statutes. Second, in order to implement Specific Appropriation 203 of the 2017-2018 General Appropriations Act, and subject to federal authorization and the availability of intergovernmental transfer (IGT) funds, the Agency for Health Care Administration is authorized to make Medicaid payments on a cost basis to qualifying Florida cancer hospitals that meet the criteria in 42 U.S.C. s. 1395ww(d)(1)(B)(v) and are members of the Alliance of Dedicated Cancer Centers. Once federal approval is granted and IGT funds are available, the agency is authorized to submit budget amendments requesting the authority for this funding and the release of funds pursuant to the provisions of chapter 216, Florida Statutes. Any release of the funds shall include a plan for how the funds will be dispersed for the purposes specified in this section. This section expires July 1, 2018. The Agency seeks comment from the public regarding the Agency’s implementation of these provisions through rule.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.905, 409.908, 409.913 FS.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: July 25, 2017, 2:30 p.m. to 3:00 p.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, 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: Jonathan Mattingly. 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: Jonathan Mattingly, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail].

Please note that a preliminary draft of the reference material, if available, will be posted prior to the workshop at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received until 5:00 p.m. on July 25, 2017 and may be e-mailed to [e-mail]. For general inquiries and questions about the rule, please contact the person specified above.

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

59G-6.031 Enhanced Ambulatory Patient Grouping Reimbursement Methodology for Hospital Outpatient Services and Ambulatory Surgical Centers.

(1) This rule applies to any Florida Medicaid enrolled outpatient hospital or ambulatory surgical center (ASC) rendering outpatient services to Florida Medicaid recipients through the fee for services delivery system.

(2) Effective July 1, 2017, the Agency for Health Care Administration uses the Enhanced Ambulatory Patient Grouping (EAPG) classification system to reimburse Florida Medicaid enrolled outpatient hospitals and ASC for services provided to Medicaid recipients.  This reimbursement methodology categorizes the amount and type of services provided during an outpatient visit by grouping together procedures, medications, materials and patient factors that share similar characteristics and resource utilization. The 2017 EAPG Outpatient Rates and associated rate methodology upon which hospital specific EAPG rates were calculated are incorporated by reference and available at http://ahca.myflorida.com/medicaid/cost_reim/hospital_rates.shtml.

(3) Transplant services rendered as part of the global fee shall be exempt from this payment methodology.

(4 The EAPG payment methodology will be used to determine the Medicaid allowed amount in the adjudication of Medicare crossover claims.

(5) Pursuant to section 120.536(2)(a), Florida Statutes, and Chapter 2016-65, § 9, Laws of Fla. (2016), amending sections 409.905(6)(b) and 409.908(5), F.S. nullified the prospective application, subsequent to July 1, 2017, of Rule 59G-6.030, F.A.C., and the Florida Title XIX Reimbursement Plan version XXVII, effective July 1, 2016,  incorporated by reference into that rule.

Rulemaking Authority 409.919 FS. Law Implemented 409.905, 409.908, 409.913 FS. History–New_______.