HB 5301 2024
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hb5301-00
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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
A bill to be entitled 1
An act relating to Medicaid supplemental payment 2
programs; amending s. 409.901, F.S.; providing 3
definitions relating to certain Medicaid supplemental 4
payment programs; amending s. 409.908, F.S.; providing 5
requirements for hospital participation in certain 6
Medicaid supplemental payment programs; providing a 7
definition; amending s. 409.910, F.S.; conforming a 8
cross-reference; providing an effective date. 9
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Be It Enacted by the Legislature of the State of Florida: 11
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Section 1. Subsection (12) and subsections (13) through 13
(28) of section 409.901, Florida Statutes, are renumbered as 14
subsection (14) and subsections (16) through (31), respectively, 15
and new subsections (12), (13), and (15) are added to that 16
section, to read: 17
409.901 Definitions; ss. 409.901 -409.920.—As used in ss. 18
409.901-409.920, except as otherwise specifically provided, the 19
term: 20
(12) "Hospital directed payment program" means a 21
supplemental payment program approved by the Centers for 22
Medicare and Medicaid Services to provide directed payments to 23
hospitals in an amount up to the total difference between 24
Medicaid reimbursement and costs of care for Medicaid 25
HB 5301 2024
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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
recipients. 26
(13) "Indirect graduate medical education program" means a 27
supplemental payment program approved by the Centers for 28
Medicare and Medicaid Services to provide payments directly to 29
eligible teaching hospitals based on the hospitals' indirect 30
graduate medical education cost s for services provided. 31
(15) "Low Income Pool Program" means a supplemental 32
payment program approved by the Centers for Medicare and 33
Medicaid Services to provide payments directly to hospitals and 34
other health care providers to reimburse hospitals and p roviders 35
for the costs of uncompensated charity care for low -income 36
individuals. 37
Section 2. Subsection (27) is added to section 409.908, 38
Florida Statutes, to read: 39
409.908 Reimbursement of Medicaid providers. —Subject to 40
specific appropriations, the a gency shall reimburse Medicaid 41
providers, in accordance with state and federal law, according 42
to methodologies set forth in the rules of the agency and in 43
policy manuals and handbooks incorporated by reference therein. 44
These methodologies may include fee s chedules, reimbursement 45
methods based on cost reporting, negotiated fees, competitive 46
bidding pursuant to s. 287.057, and other mechanisms the agency 47
considers efficient and effective for purchasing services or 48
goods on behalf of recipients. If a provider is reimbursed based 49
on cost reporting and submits a cost report late and that cost 50
HB 5301 2024
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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
report would have been used to set a lower reimbursement rate 51
for a rate semester, then the provider's rate for that semester 52
shall be retroactively calculated using the new cost report, and 53
full payment at the recalculated rate shall be effected 54
retroactively. Medicare -granted extensions for filing cost 55
reports, if applicable, shall also apply to Medicaid cost 56
reports. Payment for Medicaid compensable services made on 57
behalf of Medicaid-eligible persons is subject to the 58
availability of moneys and any limitations or directions 59
provided for in the General Appropriations Act or chapter 216. 60
Further, nothing in this section shall be construed to prevent 61
or limit the agency from adjusting fees, reimbursement rates, 62
lengths of stay, number of visits, or number of services, or 63
making any other adjustments necessary to comply with the 64
availability of moneys and any limitations or directions 65
provided for in the General Appropriations Act, provided the 66
adjustment is consistent with legislative intent. 67
(27) A hospital's participation in the Low Income Pool 68
Program and indirect graduate medical education program, as 69
defined in s. 409.901, is contingent on the hospital's 70
participation in the hospital directed payment program, as 71
defined in s. 409.901. As used in this subsection, the term 72
"hospital" has the same meaning as in s. 395.002(12) but does 73
not include a cancer hospital that meets the criteria in 42 74
U.S.C. s. 1395ww(d)(1)(B)(v), a public hospital, a medical 75
HB 5301 2024
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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
school physician practice, a federally qualified health center, 76
a rural health clinic, or a behavioral health provider. 77
Section 3. Paragraph (a) of subsection (20) of section 78
409.910, Florida Statutes, is amended to read: 79
409.910 Responsibility for payments on behalf of Medicaid -80
eligible persons when other parties are liable. — 81
(20)(a) Entities providing health insurance as defined in 82
s. 624.603, health maintenance organizations and prepaid health 83
clinics as defined in cha pter 641, and, on behalf of their 84
clients, third-party administrators, pharmacy benefits managers, 85
and any other third parties, as defined in s. 409.901 s. 86
409.901(27), which are legally responsible for payment of a 87
claim for a health care item or service as a condition of doing 88
business in the state or providing coverage to residents of this 89
state, shall provide such records and information as are 90
necessary to accomplish the purpose of this section, unless such 91
requirement results in an unreasonable burden . 92
Section 4. This act shall take effect July 1, 2024. 93