Title: Supplemental Appropriations for Medicaid Hospital Programs

Summary: Providing moneys for the annual period beginning July 1, 2017, and ending June 30, 2018, to fund the state Medicaid program; incorporating by reference certain calculations of the Medicaid Disproportionate Share Hospital and Hospital Reimbursement programs, etc.

Full Text:
SB 4-A First Engrossed (ntc) 20174Ae1 A bill to be entitled An act making supplemental appropriations for Medicaid hospital programs; providing moneys for the annual period beginning July 1, 2017, and ending June 30, 2018, to fund the state Medicaid program; incorporating by reference certain calculations of the Medicaid Disproportionate Share Hospital and Hospital Reimbursement programs; providing effective dates. Be It Enacted by the Legislature of the State of Florida: Section 1. Specific Appropriation of Chapter 2017-70, Laws of Florida, is amended to read: SECTION-HUMAN SERVICES SPECIFIC APPROPRIATION The moneys contained herein are appropriated from the named funds to the Agency for Health Care Administration, Agency for Persons with Disabilities, Department of Children and Families, Department of Elder Affairs, Department of Health, and the Department of Veterans  Affairs as the amounts to be used to pay the salaries, other operational expenditures and fixed capital outlay of the named agencies. AGENCY FOR HEALTH CARE ADMINISTRATION From the funds provided in Specific Appropriations through 232, the Agency for Health Care Administration shall submit quarterly reports on all travel related to training, seminars, workshops, conferences, or similarly purposed travel that was completed by senior management employees or division or program directors. Each quarterly report shall include the following information: (a) employee name, (b) position title, (c) purpose of travel, (d) dates and location of travel, (e) confirmation of agency head authorization if required by SB 2502, and (f) total travel cost. The report shall be submitted to the chair of the Senate Appropriations Committee, the chair of the House of Representatives Appropriations Committee, and the Executive Office of the Governor. The first report shall be submitted on July 15, 2017, for the period of April 1, 2017, through June 30, 2017, and quarterly thereafter. PROGRAM: HEALTH CARE SERVICES MEDICAID SERVICES TO INDIVIDUALS From the funds in Specific Appropriations through 220A, the Agency for Health Care Administration shall provide a quarterly reconciliation report of all Medicaid service appropriation expenditures and fund sources. The reconciliation shall compare actual expenditures paid through each specific appropriation category by fund either through the Florida Medicaid Management Information System (FMMIS) or the Agency for Health Care Administration to expenditure estimates forecasted through the Social Services Estimating Conference Medicaid services forecasting model, as directed in section 216.136(6), Florida Statutes. The comparison shall include fund source detail for each comparison. For any category where a variance is identified, the Agency for Health Care Administration shall submit a written corrective action plan to address each variance by category and fund source. The reconciliation shall be submitted to the Office of the Governor, the President of the Senate, and the Speaker of the House of Representatives no later than days after the close of each quarter. The Agency for Health Care Administration may submit budget amendments to the Legislative Budget Commission to realign appropriation categories based on the reconciliation pursuant to the provisions of chapter 216, Florida Statutes. SPECIAL CATEGORIES HOSPITAL INPATIENT SERVICES FROM GENERAL REVENUE FUND 256,362,940 285,444,787 FROM HEALTH CARE TRUST FUND 42,300,000 FROM GRANTS AND DONATIONS TRUST FUND 15,915,715 FROM MEDICAL CARE TRUST FUND 585,613,606 631,984,098 FROM PUBLIC MEDICAL ASSISTANCE TRUST FUND 47,450,732 FROM REFUGEE ASSISTANCE TRUST FUND 1,362,689 Funds in Specific Appropriation are contingent upon the state share being provided through grants and donations from state, county or other governmental funds. In the event the state share provided through grants and donations in the Grants and Donations Trust Fund is not available, the Agency for Health Care Administration may submit a revised hospital reimbursement plan, pursuant to chapter 216, Florida Statutes, to the Legislative Budget Commission for approval. From the funds in Specific Appropriation 198, the calculations of the Medicaid Hospital Funding Programs for the 2017-2018 fiscal year are incorporated by reference in Senate Bill 2502. The calculations are the basis for the appropriations made in the General Appropriations Act. From the funds in Specific Appropriation 198, the Agency for Health Care Administration may establish a global fee for bone marrow transplants and the global fee payment shall be paid to approved bone marrow transplant providers that provide bone marrow transplants to Medicaid beneficiaries. From the funds in Specific Appropriations and 206, $2,827,046 from the Grants and Donations Trust Fund and $4,538,889 from the Medical Care Trust Fund are provided to make Medicaid payments for multi-visceral transplants and intestine transplants in Florida. The Agency for Health Care Administration shall establish a global fee for these transplant procedures and the payments shall be used to pay approved multi visceral transplant and intestine transplant facilities a global fee for providing these transplant services to Medicaid beneficiaries. Payment of the global fee is contingent upon the non-federal share being provided through grants and donations from state, county or other governmental funds. The agency is authorized to seek any federal waiver or state plan amendment necessary to implement this provision. From the funds in Specific Appropriation 198, the Agency for Health Care Administration shall continue a Diagnosis Related Grouping (DRG) reimbursement methodology for hospital inpatient services as directed in section 409.905 (5)(c), Florida Statutes. Base Rate-$3,485.82 $3,310.98 Neonates Service Adjustor Severity Level-1.0 Neonates Service Adjustor Severity Level-1.52 Neonates Service Adjustor Severity Level-1.8 Neonates Service Adjustor Severity Level-2.0 Neonatal, Pediatric, Transplant Pediatric, Mental Health and Rehab DRGs: Severity Level-1.0 Severity Level-1.52 Severity Level-1.8 Severity Level-2.0 Free Standing Rehabilitation Provider Adjustor-2.840 2.843 Rural Provider Adjustor-2.115 2.116 Long Term Acute Care (LTAC) Provider Adjustor-2.218 2.199 High Medicaid and High Outlier Provider Adjustor-2.504 2.548 Outlier Threshold-$60,000 Marginal Cost Percentage-60% Marginal Cost Percentage for Pediatric Claims Severity Levels or-80% Marginal Cost Percentage for Neonates Claims Severity Levels or-80% Marginal Cost Percentage for Transplant Pediatric Claims Severity Levels or-80% Documentation and Coding Adjustment-1/3 of 1% Level I Trauma Add On-17% Level II or Level II and Pediatric Add On-11% Pediatric Trauma Add On-4% Funds in Specific Appropriation reflect an increase of $2,668,209 $2,480,485 in nonrecurring funds from the General Revenue Fund and $4,283,872 $3,982,478 in nonrecurring funds from the Medical Care Trust Fund for sole community hospitals that meet the definition of  rural hospital  under section 395.602 (2) (e), Florida Statutes, to be recognized as rural hospitals in the Agency for Health Care Administration s Diagnosis Related Group (DRG) reimbursement methodology for hospital inpatient services (HB 3791). Funds in Specific Appropriation reflect an increase of $9,421,726 in the General Revenue Fund, of which, $804,168 is nonrecurring, and $15,126,804 in the Medical Care Trust Fund, of which, $1,291,111 is nonrecurring, to increase the High Medicaid and High Outlier Provider Adjustor for the Agency for Health Care Administration s Diagnosis Related Group (DRG) reimbursement methodology for hospital inpatient services. Funds in Specific Appropriations and reflect a reduction of $58,284,811 from the General Revenue Fund and $93,577,645 from the Medical Care Trust Fund based on a reduction to the Diagnosis Related Grouping Base Rate. Funds in Specific Appropriations and reflect a reduction of $160,882,696 $160,401,653 from the General Revenue Fund and $258,300,982 $257,528,657 from the Medical Care Trust Fund as a result of reducing Hospital Inpatient Automatic Rate Enhancements. The calculations of the Medicaid Hospital Funding Programs for the 2017-2018 fiscal year are incorporated by reference in Senate Bill 2502. The calculations are the basis for the appropriations made in the General Appropriations Act. From the funds in Specific Appropriations,and 203, and 207, $50,000,000 in nonrecurring funds from the General Revenue Fund and $80,276,186 in nonrecurring funds from the Medical Care Trust Fund are provided to partially restore reductions applied to DRG base rates and Hospital Inpatient and Hospital Outpatient exemption payments. From the funds in Specific Appropriations 198, 203, and 207, $100,000,000 in nonrecurring funds from the General Revenue Fund and $160,552,371 in nonrecurring funds from the Medical Care Trust Fund are provided to restore reductions applied to DRG base rates and Hospital Inpatient and Hospital Outpatient exemption payments. Section 2. Specific Appropriation of Chapter 2017-70, Laws of Florida, is amended to read: SECTION-HUMAN SERVICES SPECIFIC APPROPRIATION The moneys contained herein are appropriated from the named funds to the Agency for Health Care Administration, Agency for Persons with Disabilities, Department of Children and Families, Department of Elder Affairs, Department of Health, and the Department of Veterans  Affairs as the amounts to be used to pay the salaries, other operational expenditures and fixed capital outlay of the named agencies. AGENCY FOR HEALTH CARE ADMINISTRATION From the funds provided in Specific Appropriations through 232, the Agency for Health Care Administration shall submit quarterly reports on all travel related to training, seminars, workshops, conferences, or similarly purposed travel that was completed by senior management employees or division or program directors. Each quarterly report shall include the following information: (a) employee name, (b) position title, (c) purpose of travel, (d) dates and location of travel, (e) confirmation of agency head authorization if required by SB 2502, and (f) total travel cost. The report shall be submitted to the chair of the Senate Appropriations Committee, the chair of the House of Representatives Appropriations Committee, and the Executive Office of the Governor. The first report shall be submitted on July 15, 2017, for the period of April 1, 2017, through June 30, 2017, and quarterly thereafter. PROGRAM: HEALTH CARE SERVICES MEDICAID SERVICES TO INDIVIDUALS From the funds in Specific Appropriations through 220A, the Agency for Health Care Administration shall provide a quarterly reconciliation report of all Medicaid service appropriation expenditures and fund sources. The reconciliation shall compare actual expenditures paid through each specific appropriation category by fund either through the Florida Medicaid Management Information System (FMMIS) or the Agency for Health Care Administration to expenditure estimates forecasted through the Social Services Estimating Conference Medicaid services forecasting model, as directed in section 216.136(6), Florida Statutes. The comparison shall include fund source detail for each comparison. For any category where a variance is identified, the Agency for Health Care Administration shall submit a written corrective action plan to address each variance by category and fund source. The reconciliation shall be submitted to the Office of the Governor, the President of the Senate, and the Speaker of the House of Representatives no later than days after the close of each quarter. The Agency for Health Care Administration may submit budget amendments to the Legislative Budget Commission to realign appropriation categories based on the reconciliation pursuant to the provisions of chapter 216, Florida Statutes. SPECIAL CATEGORIES HOSPITAL OUTPATIENT SERVICES FROM GENERAL REVENUE FUND 54,208,290 62,253,217 FROM GRANTS AND DONATIONS TRUST FUND 5,047,647 FROM MEDICAL CARE TRUST FUND 129,294,879 142,211,200 FROM PUBLIC MEDICAL ASSISTANCE TRUST FUND 20,768,022 FROM REFUGEE ASSISTANCE TRUST FUND 948,222 From the funds in Specific Appropriation 203, the calculations of the Medicaid Hospital Funding Programs for the 2017-2018 fiscal year are incorporated by reference in Senate Bill 2502. The calculations are the basis for the appropriations made in the General Appropriations Act. From the funds in Specific Appropriations and 207, $22,767,278 from the Grants and Donations Trust Fund and $36,553,405 from the Medical Care Trust Fund are provided to increase the outpatient cap for adults from $500 to $1,500 per year. Payments to increase outpatient caps are contingent upon the non-federal share being provided through intergovernmental transfers in the Grants and Donations Trust Fund. In the event the funds are not available in the Grants and Donations Trust Fund, the State of Florida is not obligated to continue reimbursements at the higher amount. From the funds in Specific Appropriation 203, $400,000 from the General Revenue Fund and $642,209 from the Medical Care Trust Fund is provided to Nemours Children s Hospital as a Hospital Outpatient exemption payment. From the funds in Specific Appropriation 203, the Agency for Health Care Administration shall implement an Enhanced Ambulatory Patient Grouping (EAPG) reimbursement methodology for hospital outpatient services as directed in section 409.905(6)(b), Florida Statutes. Ambulatory Surgical Center Base Rate-$276.66 Hospital Outpatient Base Rate-$267.82 Rural Hospital Provider Adjustor-1.4736 High Medicaid and High Outlier Hospital Adjustor-2.0182 Documentation and Coding Adjustment-2% From the funds in Specific Appropriation 203, the Agency for Health Care Administration shall apply a transition methodology that will limit provider gains and losses in a budget neutral manner resulting from the implementation of EAPG payment methodologies. The agency shall cap provider losses from EAPG payment at 5% for any in-state hospital with at least 1,000 annual Medicaid outpatient visits and a payment decrease projected to be greater than 5%. For each applicable hospital, the hospital s EAPG base rate shall be set to a value that models EAPG payment to be 95% of the hospital s current baseline payment. The agency shall cap gains from EAPG payment at a percentage to ensure budget neutrality. Both EAPG and current baseline payments shall be values independent of rate enhancements. EAPG base rate adjustments shall be applied after the impact related to Graduate Medical Education funding has been transferred to the Graduate Medical Education category. Funds in Specific Appropriations and reflect a reduction of $30,832,608 $31,313,536 from the General Revenue Fund and $49,502,484 $50,274,625 from the Medical Care Trust Fund as a result of reducing Hospital Outpatient Automatic Rate Enhancements. The calculations of the Medicaid Hospital Funding Programs for the 2017-2018 fiscal year are incorporated by reference in Senate Bill 2502. The calculations are the basis for the appropriations made in the General Appropriations Act. Section 3. Specific Appropriation of Chapter 2017-70, Laws of Florida, is amended to read: SECTION-HUMAN SERVICES SPECIFIC APPROPRIATION The moneys contained herein are appropriated from the named funds to the Agency for Health Care Administration, Agency for Persons with Disabilities, Department of Children and Families, Department of Elder Affairs, Department of Health, and the Department of Veterans  Affairs as the amounts to be used to pay the salaries, other operational expenditures and fixed capital outlay of the named agencies. AGENCY FOR HEALTH CARE ADMINISTRATION From the funds provided in Specific Appropriations through 232, the Agency for Health Care Administration shall submit quarterly reports on all travel related to training, seminars, workshops, conferences, or similarly purposed travel that was completed by senior management employees or division or program directors. Each quarterly report shall include the following information: (a) employee name, (b) position title, (c) purpose of travel, (d) dates and location of travel, (e) confirmation of agency head authorization if required by SB 2502, and (f) total travel cost. The report shall be submitted to the chair of the Senate Appropriations Committee, the chair of the House of Representatives Appropriations Committee, and the Executive Office of the Governor. The first report shall be submitted on July 15, 2017, for the period of April 1, 2017, through June 30, 2017, and quarterly thereafter. PROGRAM: HEALTH CARE SERVICES MEDICAID SERVICES TO INDIVIDUALS From the funds in Specific Appropriations through 220A, the Agency for Health Care Administration shall provide a quarterly reconciliation report of all Medicaid service appropriation expenditures and fund sources. The reconciliation shall compare actual expenditures paid through each specific appropriation category by fund either through the Florida Medicaid Management Information System (FMMIS) or the Agency for Health Care Administration to expenditure estimates forecasted through the Social Services Estimating Conference Medicaid services forecasting model, as directed in section 216.136(6), Florida Statutes. The comparison shall include fund source detail for each comparison. For any category where a variance is identified, the Agency for Health Care Administration shall submit a written corrective action plan to address each variance by category and fund source. The reconciliation shall be submitted to the Office of the Governor, the President of the Senate, and the Speaker of the House of Representatives no later than days after the close of each quarter. The Agency for Health Care Administration may submit budget amendments to the Legislative Budget Commission to realign appropriation categories based on the reconciliation pursuant to the provisions of chapter 216, Florida Statutes. SPECIAL CATEGORIES PREPAID HEALTH PLANS FROM GENERAL REVENUE FUND 3,259,771,877 3,125,225,879 FROM HEALTH CARE TRUST FUND 388,170,046 FROM TOBACCO SETTLEMENT TRUST FUND 283,209,096 FROM GRANTS AND DONATIONS TRUST FUND 1,409,122,479 FROM MEDICAL CARE TRUST FUND 7,521,165,423 7,305,709,389 FROM PUBLIC MEDICAL ASSISTANCE TRUST FUND 692,598,885 FROM REFUGEE ASSISTANCE TRUST FUND 57,759,492 Section 4.  For the purposes of Specific Appropriations 198, 199, 203, and of the 2017-2018 General Appropriations Act, the calculations for the Medicaid Disproportionate Share Hospital and Hospital Reimbursement programs for the 2017-2018 fiscal year contained in the document titled  Medicaid Hospital Funding Programs,  dated June,2017, and filed with the Secretary of the Senate, are incorporated by reference for the purpose of displaying the calculations used by the Legislature, consistent with the requirements of state law, in making appropriations for the Medicaid Disproportionate Share Hospital and Hospital Reimbursement programs. This section expires July 1, 2018. Section 5. This act shall take effect July 1, 2017; or, if this act fails to become a law until after that date, it shall take effect upon becoming a law and shall operate retroactively to July 1, 2017.