The amendment to Rule 59G-6.090, F.A.C., incorporates by reference the Florida Title XIX Payment Methodology for County Health Departments Reimbursement Plan (the Plan) effective July 1, 2011. The Plan effective July 1, 2011, includes revisions made in accordance with a request from the Centers for Medicare and Medicaid Services (CMS), Senate Bill 2000, 2011-12 General Appropriations Act, Specific Appropriation 201, and House Bill 2144, Section 5 (23)(a). These revisions will be related to the following areas: 1. Section I.K: Providers are subject to sanctions pursuant to Section 409.913(15)(c), F.S., for late cost reports. The amount of the sanctions can be found in Rule 59G-9.070, F.A.C. 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. 2. $14,305,285 rate reduction as a result of modifying the reimbursement for county health department rates. 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. 3. The agency shall establish rates at a level that ensures no increase in statewide expenditures resulting from a change in unit costs effective July 1, 2011. Reimbursement rates shall be as provided in the General Appropriations Act. 4. $64,097,099 is provided to buy back clinic services rate adjustments, effective on or after July 1, 2008.