The purpose and effect of the proposed amendment is to incorporate changes to the Florida Title XIX Payment Methodology for County Health Departments Reimbursement Plan (the Plan) effective July 1, 2010. In accordance with House Bill 5001, 2010-11 General Appropriations Act, Specific Appropriation 212, and to address a series of cost report issues, the Florida Title XIX Payment Methodology for County Health Departments Reimbursement Plan will be amended as follows: 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. Clarifying the definition of late cost report and acceptance procedures. 4. New policies regarding resubmissions of cost reports by providers. 5. Development of a sanction process (possibly a daily fine) for late cost reports including reimbursement at the lowest per diem. 6. Development of new policies and procedures regarding AHCA’s ability to recoup overpayments. 7. AHCA will reserve the right to submit any provider found to be out of compliance with any of the new policies and procedures regarding cost reports to the Bureau of Medicaid Program Integrity for investigations.