This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h1023c.SAC
DATE: 2/7/2024
HOUSE OF REPRESENTATIVES LOCAL BILL STAFF ANALYSIS
BILL #: HB 1023 St. Lucie County
SPONSOR(S): Trabulsy
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Local Administration, Federal Affairs & Special
Districts Subcommittee
17 Y, 0 N Mwakyanjala Darden
2) State Affairs Committee 20 Y, 0 N Mwakyanjala Williamson
SUMMARY ANALYSIS
Medicare is the federal health insurance program for persons 65 or older, certain younger people with
disabilities, and people with end-stage renal disease. The Centers for Medicare & Medicaid Services (CMS)
develops a fee schedule in order to reimburse health care providers who accept payment via Medicare.
Relative value units (RVUs) are used to calculate physician reimbursements. The 2024 Medicare
reimbursement rate is $32.74 per RVU.
The St. Lucie County Sheriff’s Office manages the St. Lucie County jail. The Detention Administration Division
within the sheriff’s office is responsible for inmate health care.
The bill limits the compensation of health care providers who provide medical services for inmates housed in a
St. Lucie County detention center to 110 percent of the Medicare reimbursement rate if that provider does not
have a contract with St. Lucie County to provide inmate medical services. The bill provides that such
compensation may not exceed 125 percent of the Medicare reimbursement rate if the hospital has reported a
negative operating margin for the previous year to the Agency for Health Care Administration through hospital-
audited financial data.
The bill also provides that compensation to an entity to provide emergency medical transportation services for
an inmate housed in a St. Lucie County detention center may not to exceed 110 percent of the Medicare
reimbursement rate if the entity does not have a contract with St. Lucie County to provide emergency medical
services.
The Economic Impact Statement states that the bill is not expected to have a fiscal impact. However, the bill
may have a fiscal impact for health care providers who have not contracted with St. Lucie County to provide
inmate medical services.
STORAGE NAME: h1023c.SAC PAGE: 2
DATE: 2/7/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Medicare Fee Schedule
Medicare is the federal health insurance program for persons 65 or older, certain younger people with
disabilities, and people with end-stage renal disease.
1
Payments by Medicare to doctors and other
healthcare providers are made subject to a fee schedule developed by the Centers for Medicare &
Medicaid Services (CMS).
2
The fee schedule is a complete listing of fees, including the fee maximums,
that are used to reimburse a physician or other providers on a fee-for-service basis.
The Physician Fee Schedule (PFS) is the primary method of payment for health care providers enrolled
in Medicare. Medicare uses the PFS when paying professional services of physicians and other health
care providers in private practice, services covered incident to physicians’ services (other than certain
drugs covered as incident to services), diagnostic tests (other than clinical laboratory tests), and
radiology services.
3
Relative value units (RVUs) are used to calculate physician reimbursements. RVUs
combine components related to the physician’s work, the practice’s expenses, and, when desired,
liability protection.
4
The Medicare reimbursement rate for 2024 is $32.74 per RVU, a roughly 3.4
percent reduction from 2023 ($33.89).
5
St. Lucie County Sheriff’s Office
The St. Lucie County Sheriff’s Office manages the St. Lucie County jail.
6
The Detention Administration
Division within the Sheriff’s Office is responsible for inmate health care.
7
For the 2023-2024 Fiscal
Year, the Sheriff’s Office had a total budget of $103,122,949.
8
Of this total, $11,574,864 was used for
expenses related to inmate medical costs, training, and the administration of federal, state, and local
grants.
9
The county commission made an operational investment of $1,360,000 for inmate medical
care and expenses for jail medical equipment in this year’s budget, including $1,000,000 for an inmate
medical facility.
10
Effect of Proposed Changes
The bill limits the compensation of health care providers
11
who provide medical services for inmates
housed in a St. Lucie County detention center to 110 percent of the Medicare reimbursement rate if that
provider does not have a contract with St. Lucie County to provide inmate medical services.
1
Medicare.gov, What’s Medicare?, https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare
(last visited Jan. 26, 2024).
2
Centers for Medicare & Medicaid Services, Fee Schedules – General Information, https://www.cms.gov/medicare/payment/fee-
schedules (last visited Jan. 26, 2024).
3
Centers for Medicare & Medicaid Services, Physician Fee Schedule, https://www.cms.gov/medicare/payment/fee-schedules/physician
(last visited Jan. 26, 2024).
4
AMA CPT International, Relative Value Units, https://cpt-international.ama-assn.org/relative-value-units (last visited Jan. 26, 2024).
5
American Academy of Family Physicians, 2024 Medicare physician fee schedule reduces conversion factor, but has positives for
primary care, https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/2024-medicare-fee-schedule.html (last visited Jan. 26, 2024).
6
St. Lucie County Sheriff’s Office, Dept. of Detention, Department of Detention, https://www.stluciesheriff.com/238/Department-of-
Detention (last visited Jan. 26, 2024).
7
St. Lucie County Sheriff’s Office, Dept. of Detention, Detention Administration Division, https://www.stluciesheriff.com/256/Detention-
Administration-Division (last visited Jan. 26, 2024).
8
St. Lucie County, 2024 Final Budget 37, available at
https://www.stlucieco.gov/home/showdocument?id=9113&t=638385048882649770 (last visited Jan. 26, 2024).
9
Id. at 282.
10
Id. at xvi and 314.
11
The bill defines “health care provider” to mean a hospital licensed under ch. 395, F.S.; a physician or physician assistant licensed
under ch. 458, F.S.; an osteopathic physician or physician assistant licensed under ch. 459, F.S.; a podiatric physician licensed under
ch. 461, F.S.; a health maintenance organization certificated under part I of ch. 641, F.S.; an ambulatory surgical center licensed under STORAGE NAME: h1023c.SAC PAGE: 3
DATE: 2/7/2024
The bill provides that health care providers may not be compensated at a rate exceeding 125 percent
of the Medicare reimbursement rate if the health care provider does not have a contract with St. Lucie
County to provide inmate medical services and has reported a negative operating margin for the
previous year to the Agency for Health Care Administration through hospital-audited financial data.
The bill provides that compensation to an entity to provide emergency medical transportation services
12
for an inmate housed in a St. Lucie County detention center may not to exceed 110 percent of the
Medicare reimbursement rate if the entity does not have a contract with St. Lucie County to provide
emergency medical services.
The Economic Impact Statement states that the bill is not expected to have a fiscal impact. However,
the bill may have a negative fiscal impact for health care providers who have not contracted with St.
Lucie County to provide inmate medical services.
B. SECTION DIRECTORY:
Section 1: Provides for an act relating to St. Lucie County.
Section 2: Provides an effective date of upon becoming a law.
II. NOTICE/REFERENDUM AND OTHER REQUIREM ENTS
A. NOTICE PUBLISHED? Yes [X] No []
IF YES, WHEN? November 12, 2023.
WHERE? The Indian River Press Journal, a newspaper of general circulation in St. Lucie
County, Florida.
B. REFERENDUM(S) REQUIRED? Yes [] No [X]
IF YES, WHEN?
C. LOCAL BILL CERTIFICATION FILED? Yes [X] No []
D. ECONOMIC IMPACT STATEMENT FILED? Yes [X] No []
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
None.
ch. 395, F.S.; an other medical facility; and a professional association, partnership, corporation, joint venture, or other association
composed of certain persons for professional activity. The bill defines “other medical facility” to mean a facility the primary purpose of
which is to provide human medical diagnostic services or a facility providing nonsurgical human medical treatment, to which facility the
patient is admitted and from which facility the patient is discharged within the same working day, and which facility is not part of a
hospital. However, a facility existing for the primary purpose of performing terminations of pregnancy or an office maintained by a
physician or dentist for the practice of medicine may not be construed to be an "other medical facility."
12
The bill defines “emergency medical transportation services” to include, but is not limited to, services rendered by means of an
ambulance, emergency medical services vehicle, or air ambulance. The bill defines “air ambulance” to mean a fixed-wing or rotary-wing
aircraft used for, or intended to be used for, air transportation of sick or injured persons requiring or likely to require medical attention
during transport. It also defines “ambulance” or “emergency medical services vehicle” to mean a privately or publicly owned vehicle or
vessel that is designed, constructed, reconstructed, maintained, equipped, or operated for, and is used for, or intended to be used for,
land or water transportation of sick or injured persons requiring or likely to require medical attention during transport.
STORAGE NAME: h1023c.SAC PAGE: 4
DATE: 2/7/2024
B. RULE-MAKING AUTHORITY:
The bill does not provide rulemaking authority or require executive branch rulemaking.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
None.