The purpose of new Rule 59G-1.025, F.A.C., is to provide implementation guidelines for Medicaid County billing processes per Section 409.915, F.S.

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO.: RULE TITLE:
59G-1.025: Medicaid County Billing
PURPOSE AND EFFECT: The purpose of new Rule 59G-1.025, F.A.C., is to provide implementation guidelines for Medicaid County billing processes per Section 409.915, F.S.
SUMMARY: The implementation guidelines will result in improvements to the Medicaid County billing process.
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, F.S., 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 FS.
LAW IMPLEMENTED: 409.915 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:
DATE AND TIME: Thursday, July 26, 2012, 1:00 p.m. – 3:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, 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: Debbie Smith at the Division of Operations, [phone]. 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: Tonya Kidd, Deputy Secretary of Operations, 2727 Mahan Drive, Mail Stop 2, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail]

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), F.S.

(a) By August 1, 2012, the Agency will certify to each county the amount that is unpaid for retrospective bills. After August 1, 2012, the agency will not change any county’s certified amount.

(b) By September 1, 2012, each county shall notify the Agency of its decision to challenge the certified amount or not.

(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 paragraph (1)(a) minus amounts paid pursuant to paragraph (1)(c) for each county that challenges the certified amount by filing a petition by September 1, 2012.

2. 85 percent of the amount provided in paragraph (1)(a) minus amounts paid pursuant to paragraph (1)(c) for each county that does not challenge the certified amount 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, F.S.

(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.

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. 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 monthly billing that the county disputes. If the request is reasonable, the Agency will stay certification 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.

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.

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. Shall expire on April 30, 2013.

2. Back End Refund Request.

a. No later than 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 60 days of receipt of the 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. Approved refunds that should have been billed to a different county, will be transferred to the appropriate county on a subsequent bill.

(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________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Tonya Kidd
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 20, 2012
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: May 11, 2012