AGENCY FOR HEALTH CARE ADMINISTRATION
MedicaidRULE NO.: RULE TITLE:
59G-1.025: Medicaid County BillingNOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., FS., published in Vol. 38, No. 26, June 29, 2012 issue of the Florida Administrative Weekly.
The following changes have been made to the proposed rule.
THE FULL TEXT OF THE PROPOSED RULE IS:
59G-1.025 Medicaid County Billing.
(1) Retrospective Bills. This paragraph applies to the certification of county billings from November 1, 2001, through April 30, 2012, that remain unpaid, as provided in Section 409.915(7), FS.
(a) By August 1, 2012, the Agency will certify to each county the amount that is unpaid for retrospective bills.
(b) By September 1, 2012, a county may contest the amount certified by filing a petition under the applicable provisions of Chapter 120, FS. This procedure is the exclusive method to challenge the amount certified.
(c) September 13, 2012, 5:00 p.m. Eastern Standard Time, each county may make total or partial payment in the form of a check or wire transfer to the Agency of the amount certified by the Agency pursuant to paragraph (1)(a).
(d) By September 15, 2012, the Agency will certify to the Department of Revenue:
1. 100 percent of the amount provided in subsection (1)(a) minus amounts credited to the counties and/or amounts paid and received by the Agency pursuant to paragraph (1)(c) for each county that challenges the certified amount by filing a petition pursuant to paragraph (1)(b) by September 1, 2012.
2. 85 percent of the amount provided in paragraph (1)(a) minus amounts credited to the counties and/or paid and received by the Agency pursuant to paragraph (1)(c) for each county that does not challenge the certified amount by filing a petition pursuant to paragraph (1)(b) by September 1, 2012.
(2) Prospective Bills. This paragraph applies to the monthly amount of each county’s contribution to Medicaid as required in Section 409.915, FS. The monthly bills will be rendered to the counties no later than the second business day of the month.
(a) Certification.
1. For all certifications prior to June 1, 2013, the Agency will certify to the Department of Revenue by the 7th day of each month the amount of the monthly bill rendered one month prior less any amounts as provided in paragraphs (2)(b) and (2)(c).
2. For the June, 2013 certification, the Agency will certify to the Department of Revenue the amount of the monthly bills rendered in May, 2013 and June, 2013 less any amounts credited to a county pursuant to paragraph (2)(b).
3. Beginning July 1, 2013, the Agency will certify to the Department of Revenue by the 7th day of each month the amount of the monthly bill rendered that month less any amounts as provided in paragraph (2)(b).
4. If the 7th day of the month falls on a weekend or holiday, certification will be completed on the first business day following the 7th day of the month.
5. If the Department of Revenue determines there are insufficient funds to pay a county’s monthly certified amount, the Department will notify the Agency of the amount still owed, and the Agency will send an invoice to the affected county within two months of receiving the Department’s notice. The county shall pay the invoice within 60 days of receipt. The balance on any invoice that remains unpaid after 60 days will be re-certified to the Department of Revenue in subsequent months until paid in full.
(b) Payments.
Each county may choose to submit payment in the form of a check or wire transfer to the Agency. Such payment must be received by 5:00 p.m. Eastern Standard Time two business days prior to the date of certification.
(c) Refund Requests.
1. Advanced Refund Request.
a. No later than the last business day of each billing month, each county may request an advanced refund request through the county billing portal for those claims on the same monthly billing that the county disputes. If the request is less than or equal to the amount of the county’s highest monthly dispute rate reasonable, the Agency will stay certification of the amount requested in the for the advanced refund request.
b. Refund requests resulting in certification amounts stayed will be researched within 60 days by the Agency.
I. Denied refund requests will be certified to the county on a subsequent bill no later than 45 days from the completion of Agency research.
II. Bills for which a refund request is granted on the basis that the bill should have been submitted to a different county will be transferred and certified to the appropriate county on a subsequent bill no later than 45 days from the completion of Agency research.
c. A county does not waive any right to subparagraph (c)2., Back End Refund Request, by making an advanced refund request.
d. Except for sub-subparagraph 1.b., subparagraph 1. sShall expire on April 30, 2013.
2. Back End Refund Request.
a. Each county may request a back end refund request no No later than 60 days from the date of certification of the monthly bill for which the back end refund request is being requested the last business day of the month following the bill issuance, each county may request a back end refund request.
b. Back end refund requests must be in writing and must include the reason and documentation for the request, and be received by the agency by the last business day of the month in which that bill was certified.
c. Within 960 days of receipt of the certification request, the Agency will notify the county whether the request is granted, either in part or in whole. If any portion of the request is denied, the agency will provide information as to the reasons for the denial. If any portion of the refund request is granted, the refund will be in the form of a credit notification to the Department of Revenue, or a credit applied to a subsequent bill, within 60 days of the Agency’s decision. Approved refunds that should have been billed to a different county, will be transferred to the appropriate county on a subsequent bill, within 60 days of the Agency’s decision.
(d) Receipts.
1. The Agency will provide each county a monthly receipt of amounts billed, amounts paid and amounts certified to the Department of Revenue.
2. The Agency will provide each county a monthly receipt of action taken on Advance Refund Requests.
Actions taken include:
a. ARR Denied – Advance Refund Request Denied and the claim will appear on a subsequent bill with a status of ARR Denied;
b. ARR Transferred Out – Advance Refund Request Transferred Out and the claim will be transferred to a different county than the county requesting Advanced Refund;
c. Adjusted and closed.
3. The Agency will provide each county a written receipt approving or denying each Back End Refund Request.
a. Approved Back End Refund Requests will be credited to a future bill.
b. Denied Back End Refund Request will state the reason for denial.
Rulemaking Authority 409.919 FS. Law Implemented 409.915 FS. History–New ___________.
