This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h5305a.APC
DATE: 3/28/2023
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: HB 5305 PCB HCA 23-03 Medicaid Reimbursement for Nursing Home Care
SPONSOR(S): Health Care Appropriations Subcommittee, Garrison
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
Orig. Comm.: Health Care Appropriations
Subcommittee
13 Y, 0 N Smith Clark
1) Appropriations Committee 26 Y, 0 N Smith Pridgeon
SUMMARY ANALYSIS
The bill conforms statutes to the funding decisions related to Health Care included in the House proposed
General Appropriations Act (GAA) for Fiscal Year 2023-2024.
On October 1, 2018, Florida Medicaid nursing homes transitioned from facility-specific cost based rates to the
prospective rate reimbursement methodology, which determines rates in advance of payment. The
methodology includes a parameter for Quality Incentive Payment for providers of up to 6 percent of the
September 2016 non-property related payments of included facilities.
The bill modifies the parameters governing the nursing home prospective payment methodology for Medicaid
provider reimbursement to increase the quality incentive payment pool parameter from 6 percent to 9 percent.
The bill has an effective date of October 1, 2023. STORAGE NAME: h5305a.APC PAGE: 2
DATE: 3/28/2023
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Nursing Home Prospective Payment System
On October 1, 2018, Florida Medicaid nursing homes transitioned from facility-specific cost based rates
to the prospective rate reimbursement methodology, which determines rates in advance of payment.
Section 409.908, F.S., provides the methodology
1
and parameters for rate setting including
reimbursement rates for direct care, indirect care, and operating costs.
The methodology includes a parameter for a Quality Incentive Payment, in which a provider is awarded
points for process, outcome, structural and credentialing measures using most recently reported data
on May 31 of the rate period year.
2
The Quality Incentive Payment calculation
3
is as follows:
Payment amounts are limited to 6 percent of the September 2016 non-property related payments of
included facilities.
4
Effect of the Bill
The bill modifies the parameters governing the nursing home prospective payment methodology for
Medicaid provider reimbursement to increase the quality incentive payment pool from 6 percent to 9
percent.
The bill has an effective date of October 1, 2023.
B. SECTION DIRECTORY:
Section 1: Amends s. 409.908, F.S., relating to reimbursement of Medicaid providers.
Section 2: Providing an effective date of October 1, 2023.
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNM ENT:
1. Revenues:
None.
2. Expenditures:
1
Nursing Home Prospective Payment System Calculation: (Operating Price + Direct Care Price - Floor Reduction + Indirect Care Price - Floor Reduction
+ FRVS Rate + Pass Through Payments) * Budget Neutrality Factor + Quality Incentive Payment + Medicaid Share of NFQA + Ventilator Supplemental
Payment + High Medicaid Utilization and High Direct Patient Care Add-On)) + Unit Cost Rate Increase
2
R. 59G-6.010(2)(y), F.A.C.
3
Id.
4
S. 409.908(2)(e), F.S. (2022). Facility Annualized
Medicaid Days
Quality Points with
Lower Limit Total Quality Budget
Average Annualized
Medicaid Days
Sum of Total Points
Awarded to All Facilities
Facility Annualized
Medicaid Days
X X STORAGE NAME: h5305a.APC PAGE: 3
DATE: 3/28/2023
The bill conforms to PCB APC 23-01, the proposed Fiscal Year 2023-2024 House of
Representatives’ General Appropriations Act, which provides $38,699,826 from the General
Revenue Fund and $56,822,005 from the Medical Care Trust Fund for the Quality Incentive
Payment Pool parameter percentage increase.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
None.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
None.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
None.
2. Other:
None.
B. RULE-MAKING AUTHORITY:
None.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
None.