Florida 2023 Regular Session

Florida House Bill H5305 Compare Versions

Only one version of the bill is available at this time.

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10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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14	14	A bill to be entitled 1
15	15	An act relating to Medicaid reimbursement for nursing 2
16	16	home care; amending s. 409.908, F.S.; revising a 3
17	17	parameter to implement a prospective payment 4
18	18	methodology for Medicaid reimbursement rate settings 5
19	19	for nursing home care; providing an effective date. 6
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21	21	Be It Enacted by the Legislature of the State of Florida: 8
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23	23	Section 1. Paragraph (b) of subsection (2) of section 10
24	24	409.908, Florida Statutes, is amended to read: 11
25	25	409.908 Reimbursement of Medicaid providers. —Subject to 12
26	26	specific appropriations, the agency shall reimburse Medicaid 13
27	27	providers, in accordance with state and federal law, according 14
28	28	to methodologies set forth in the rules of the agency and in 15
29	29	policy manuals and handbooks incorporated by reference therein. 16
30	30	These methodologies may include fee schedules, reimbursement 17
31	31	methods based on cost reporting, negotiated fees, competitive 18
32	32	bidding pursuant to s. 287.057, and other mechanisms the agency 19
33	33	considers efficient and effective for purchasing services or 20
34	34	goods on behalf of recipients. If a provider is reimbursed based 21
35	35	on cost reporting and submits a cost report late and that cost 22
36	36	report would have been used to set a lower reimbursement rate 23
37	37	for a rate semester, then the provider's rate for that semester 24
38	38	shall be retroactively calculated using the new cost report, and 25
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47	47	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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51	51	full payment at the recalculated rate shall be effected 26
52	52	retroactively. Medicare -granted extensions for filing cost 27
53	53	reports, if applicable, shall also apply to Medicaid cost 28
54	54	reports. Payment for Medicaid compensable services made on 29
55	55	behalf of Medicaid-eligible persons is subject to the 30
56	56	availability of moneys and any limitations or directions 31
57	57	provided for in the General Appropriations Act or chapter 216. 32
58	58	Further, nothing in this section shall be construed to prevent 33
59	59	or limit the agency from adjusting fees, reimbursement rates, 34
60	60	lengths of stay, number of visits, or number of services, or 35
61	61	making any other adjustments necessary to comply with the 36
62	62	availability of moneys and any limitations or directions 37
63	63	provided for in the General Appropriations Act, provided the 38
64	64	adjustment is consistent with legislative intent. 39
65	65	(2) 40
66	66	(b) Subject to any limitations or directions in the 41
67	67	General Appropriations Act, the age ncy shall establish and 42
68	68	implement a state Title XIX Long -Term Care Reimbursement Plan 43
69	69	for nursing home care in order to provide care and services in 44
70	70	conformance with the applicable state and federal laws, rules, 45
71	71	regulations, and quality and safety standard s and to ensure that 46
72	72	individuals eligible for medical assistance have reasonable 47
73	73	geographic access to such care. 48
74	74	1. The agency shall amend the long -term care reimbursement 49
75	75	plan and cost reporting system to create direct care and 50
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84	84	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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88	88	indirect care subcomponen ts of the patient care component of the 51
89	89	per diem rate. These two subcomponents together shall equal the 52
90	90	patient care component of the per diem rate. Separate prices 53
91	91	shall be calculated for each patient care subcomponent, 54
92	92	initially based on the September 20 16 rate setting cost reports 55
93	93	and subsequently based on the most recently audited cost report 56
94	94	used during a rebasing year. The direct care subcomponent of the 57
95	95	per diem rate for any providers still being reimbursed on a cost 58
96	96	basis shall be limited by the cos t-based class ceiling, and the 59
97	97	indirect care subcomponent may be limited by the lower of the 60
98	98	cost-based class ceiling, the target rate class ceiling, or the 61
99	99	individual provider target. The ceilings and targets apply only 62
100	100	to providers being reimbursed on a cost-based system. Effective 63
101	101	October 1, 2018, a prospective payment methodology shall be 64
102	102	implemented for rate setting purposes with the following 65
103	103	parameters: 66
104	104	a. Peer Groups, including: 67
105	105	(I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee 68
106	106	Counties; and 69
107	107	(II) South-SMMC Regions 10-11, plus Palm Beach and 70
108	108	Okeechobee Counties. 71
109	109	b. Percentage of Median Costs based on the cost reports 72
110	110	used for September 2016 rate setting: 73
111	111	(I) Direct Care Costs ........................ 100 percent. 74
112	112	(II) Indirect Care Costs ...................... 92 percent. 75
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121	121	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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125	125	(III) Operating Costs ......................... 86 percent. 76
126	126	c. Floors: 77
127	127	(I) Direct Care Component ..................... 95 percent. 78
128	128	(II) Indirect Care Component ................ 92.5 percent. 79
129	129	(III) Operating Component ........................... None. 80
130	130	d. Pass-through Payments .................. Real Estate and 81
131	131	Personal Property 82
132	132	Taxes and Property Insurance. 83
133	133	e. Quality Incentive Program Payment 84
134	134	Pool 9 6 percent of September 85
135	135	2016 non-property related 86
136	136	payments of included facilities. 87
137	137	f. Quality Score Threshold to Quality for Quality 88
138	138	Incentive 89
139	139	Payment ................. 20th percentile of included facilities. 90
140	140	g. Fair Rental Value System Payment Parameters: 91
141	141	(I) Building Value per Square Foot based on 2018 RS Means. 92
142	142	(II) Land Valuation .... 10 percent of Gross Building value. 93
143	143	(III) Facility Square Footage ...... Actual Square Footage. 94
144	144	(IV) Moveable Equipment Allowance ......... $8,000 per bed. 95
145	145	(V) Obsolescence Factor ...................... 1.5 percent. 96
146	146	(VI) Fair Rental Rate of Return ................ 8 percent. 97
147	147	(VII) Minimum Occupancy ....................... 90 percent. 98
148	148	(VIII) Maximum Facility Age ..................... 40 years. 99
149	149	(IX) Minimum Square Footage per Bed ................... 350. 100
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158	158	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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162	162	(X) Maximum Square Footage for Bed .................... 500. 101
163	163	(XI) Minimum Cost of a renovation/replacements $500 per bed. 102
164	164	h. Ventilator Supplemental payment of $200 per Medicaid 103
165	165	day of 40,000 ventilator Medicaid days per fiscal year. 104
166	166	2. The direct care subcomponent shall include salaries and 105
167	167	benefits of direct car e staff providing nursing services 106
168	168	including registered nurses, licensed practical nurses, and 107
169	169	certified nursing assistants who deliver care directly to 108
170	170	residents in the nursing home facility, allowable therapy costs, 109
171	171	and dietary costs. This excludes nursi ng administration, staff 110
172	172	development, the staffing coordinator, and the administrative 111
173	173	portion of the minimum data set and care plan coordinators. The 112
174	174	direct care subcomponent also includes medically necessary 113
175	175	dental care, vision care, hearing care, and po diatric care. 114
176	176	3. All other patient care costs shall be included in the 115
177	177	indirect care cost subcomponent of the patient care per diem 116
178	178	rate, including complex medical equipment, medical supplies, and 117
179	179	other allowable ancillary costs. Costs may not be allocat ed 118
180	180	directly or indirectly to the direct care subcomponent from a 119
181	181	home office or management company. 120
182	182	4. On July 1 of each year, the agency shall report to the 121
183	183	Legislature direct and indirect care costs, including average 122
184	184	direct and indirect care costs per resident per facility and 123
185	185	direct care and indirect care salaries and benefits per category 124
186	186	of staff member per facility. 125
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195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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199	199	5. Every fourth year, the agency shall rebase nursing home 126
200	200	prospective payment rates to reflect changes in cost based on 127
201	201	the most recently audited cost report for each participating 128
202	202	provider. 129
203	203	6. A direct care supplemental payment may be made to 130
204	204	providers whose direct care hours per patient day are above the 131
205	205	80th percentile and who provide Medicaid services to a larger 132
206	206	percentage of Medicaid patients than the state average. 133
207	207	7. For the period beginning on October 1, 2018, and ending 134
208	208	on September 30, 2021, the agency shall reimburse providers the 135
209	209	greater of their September 2016 cost -based rate or their 136
210	210	prospective payment rate. Effecti ve October 1, 2021, the agency 137
211	211	shall reimburse providers the greater of 95 percent of their 138
212	212	cost-based rate or their rebased prospective payment rate, using 139
213	213	the most recently audited cost report for each facility. This 140
214	214	subparagraph shall expire September 3 0, 2023. 141
215	215	8. Pediatric, Florida Department of Veterans Affairs, and 142
216	216	government-owned facilities are exempt from the pricing model 143
217	217	established in this subsection and shall remain on a cost -based 144
218	218	prospective payment system. Effective October 1, 2018, the 145
219	219	agency shall set rates for all facilities remaining on a cost -146
220	220	based prospective payment system using each facility's most 147
221	221	recently audited cost report, eliminating retroactive 148
222	222	settlements. 149
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232	232	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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236	236	It is the intent of the Legislature that the reimbursement plan 151
237	237	achieve the goal of providing access to health care for nursing 152
238	238	home residents who require large amounts of care while 153
239	239	encouraging diversion services as an alternative to nursing home 154
240	240	care for residents who can be served within the community. The 155
241	241	agency shall base the establishment of any maximum rate of 156
242	242	payment, whether overall or component, on the available moneys 157
243	243	as provided for in the General Appropriations Act. The agency 158
244	244	may base the maximum rate of payment on the results of 159
245	245	scientifically valid analy sis and conclusions derived from 160
246	246	objective statistical data pertinent to the particular maximum 161
247	247	rate of payment. The agency shall base the rates of payments in 162
248	248	accordance with the minimum wage requirements as provided in the 163
249	249	General Appropriations Act. 164
250	250	Section 2. This act shall take effect October 1, 2023. 165