The purpose and effect of the proposed rule is to incorporate changes to the Florida Title XIX County Health Department Reimbursement Plan in accordance with House Bill 5001, 2010-11 General Appropriations Act, Specific Appropriation 212, and Section 409.913(15)(c), F.S. 1. The Agency shall implement a recurring methodology in the Title XIX County Health Department Reimbursement Plan to achieve a $40,379,100 rate reduction to modify the reimbursement rates for county health departments. In establishing rates through the normal process, prior to including this reduction, if the unit cost is equal to or less than the unit cost used in establishing the budget, then no additional reduction in rates is necessary. In establishing rates through the normal process, prior to including this reduction, if the unit cost is greater than the unit cost used in establishing the budget, then rates shall be reduced by an amount required to achieve this reduction, but shall not be reduced below the unit cost used in establishing the budget. 2. $42,631,388 is provided for county health departments to buy back clinic services rate adjustments, effective on or after July 1, 2008. 3. AHCA reserves the right to submit any provider found to be out of compliance with any of the policies and procedures regarding cost reports to the Bureau of Medicaid Program Integrity for investigations. 4. Providers are subject to sanctions pursuant to Section 409.913(15)(c), F.S., for late cost reports. A cost report is late if it is not received by AHCA, Bureau of Medicaid Program Analysis, on the first cost report acceptance cut-off date after the cost report due date.