Florida 2024 Regular Session

Florida House Bill H5301 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 supplemental payment 2
16	16	programs; amending s. 409.901, F.S.; providing 3
17	17	definitions relating to certain Medicaid supplemental 4
18	18	payment programs; amending s. 409.908, F.S.; providing 5
19	19	requirements for hospital participation in certain 6
20	20	Medicaid supplemental payment programs; providing a 7
21	21	definition; amending s. 409.910, F.S.; conforming a 8
22	22	cross-reference; providing an effective date. 9
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24	24	Be It Enacted by the Legislature of the State of Florida: 11
25	25	12
26	26	Section 1. Subsection (12) and subsections (13) through 13
27	27	(28) of section 409.901, Florida Statutes, are renumbered as 14
28	28	subsection (14) and subsections (16) through (31), respectively, 15
29	29	and new subsections (12), (13), and (15) are added to that 16
30	30	section, to read: 17
31	31	409.901 Definitions; ss. 409.901 -409.920.—As used in ss. 18
32	32	409.901-409.920, except as otherwise specifically provided, the 19
33	33	term: 20
34	34	(12) "Hospital directed payment program" means a 21
35	35	supplemental payment program approved by the Centers for 22
36	36	Medicare and Medicaid Services to provide directed payments to 23
37	37	hospitals in an amount up to the total difference between 24
38	38	Medicaid reimbursement and costs of care for Medicaid 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	recipients. 26
52	52	(13) "Indirect graduate medical education program" means a 27
53	53	supplemental payment program approved by the Centers for 28
54	54	Medicare and Medicaid Services to provide payments directly to 29
55	55	eligible teaching hospitals based on the hospitals' indirect 30
56	56	graduate medical education cost s for services provided. 31
57	57	(15) "Low Income Pool Program" means a supplemental 32
58	58	payment program approved by the Centers for Medicare and 33
59	59	Medicaid Services to provide payments directly to hospitals and 34
60	60	other health care providers to reimburse hospitals and p roviders 35
61	61	for the costs of uncompensated charity care for low -income 36
62	62	individuals. 37
63	63	Section 2. Subsection (27) is added to section 409.908, 38
64	64	Florida Statutes, to read: 39
65	65	409.908 Reimbursement of Medicaid providers. —Subject to 40
66	66	specific appropriations, the a gency shall reimburse Medicaid 41
67	67	providers, in accordance with state and federal law, according 42
68	68	to methodologies set forth in the rules of the agency and in 43
69	69	policy manuals and handbooks incorporated by reference therein. 44
70	70	These methodologies may include fee s chedules, reimbursement 45
71	71	methods based on cost reporting, negotiated fees, competitive 46
72	72	bidding pursuant to s. 287.057, and other mechanisms the agency 47
73	73	considers efficient and effective for purchasing services or 48
74	74	goods on behalf of recipients. If a provider is reimbursed based 49
75	75	on cost reporting and submits a cost report late and that cost 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	report would have been used to set a lower reimbursement rate 51
89	89	for a rate semester, then the provider's rate for that semester 52
90	90	shall be retroactively calculated using the new cost report, and 53
91	91	full payment at the recalculated rate shall be effected 54
92	92	retroactively. Medicare -granted extensions for filing cost 55
93	93	reports, if applicable, shall also apply to Medicaid cost 56
94	94	reports. Payment for Medicaid compensable services made on 57
95	95	behalf of Medicaid-eligible persons is subject to the 58
96	96	availability of moneys and any limitations or directions 59
97	97	provided for in the General Appropriations Act or chapter 216. 60
98	98	Further, nothing in this section shall be construed to prevent 61
99	99	or limit the agency from adjusting fees, reimbursement rates, 62
100	100	lengths of stay, number of visits, or number of services, or 63
101	101	making any other adjustments necessary to comply with the 64
102	102	availability of moneys and any limitations or directions 65
103	103	provided for in the General Appropriations Act, provided the 66
104	104	adjustment is consistent with legislative intent. 67
105	105	(27) A hospital's participation in the Low Income Pool 68
106	106	Program and indirect graduate medical education program, as 69
107	107	defined in s. 409.901, is contingent on the hospital's 70
108	108	participation in the hospital directed payment program, as 71
109	109	defined in s. 409.901. As used in this subsection, the term 72
110	110	"hospital" has the same meaning as in s. 395.002(12) but does 73
111	111	not include a cancer hospital that meets the criteria in 42 74
112	112	U.S.C. s. 1395ww(d)(1)(B)(v), a public hospital, a medical 75
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125	125	school physician practice, a federally qualified health center, 76
126	126	a rural health clinic, or a behavioral health provider. 77
127	127	Section 3. Paragraph (a) of subsection (20) of section 78
128	128	409.910, Florida Statutes, is amended to read: 79
129	129	409.910 Responsibility for payments on behalf of Medicaid -80
130	130	eligible persons when other parties are liable. — 81
131	131	(20)(a) Entities providing health insurance as defined in 82
132	132	s. 624.603, health maintenance organizations and prepaid health 83
133	133	clinics as defined in cha pter 641, and, on behalf of their 84
134	134	clients, third-party administrators, pharmacy benefits managers, 85
135	135	and any other third parties, as defined in s. 409.901 s. 86
136	136	409.901(27), which are legally responsible for payment of a 87
137	137	claim for a health care item or service as a condition of doing 88
138	138	business in the state or providing coverage to residents of this 89
139	139	state, shall provide such records and information as are 90
140	140	necessary to accomplish the purpose of this section, unless such 91
141	141	requirement results in an unreasonable burden . 92
142	142	Section 4. This act shall take effect July 1, 2024. 93