12/17/2019 (3) - Laserfiche WebLink

Home Browse Search

12/6/2019 Statutes & Constitution :View Statutes : Online Sunshine Select Year: 2019 • I Go J The 2019 Florida Statutes Title XXX Chap er 409 View Entire Chapter SOCIAL WELFARE SOCIAL AND ECONOMIC ASSISTANCE 409.908 Reimbursement of Medicaid providers.—Subject to specific appropriations, the agency shall reimburse Medicaid providers, in accordance with state and federal taw, according to methodologies set forth in the rules of the agency and in policy manuals and handbooks incorporated by reference therein. These methodologies may include fee schedules, reimbursement methods based on cost reporting, negotiated fees, competitive bidding pursuant to s. 287.057. and other mechanisms the agency considers efficient and effective for purchasing services or goods on behalf of recipients. If a provider is reimbursed based on cost reporting and submits a cost report late and that cost report would have been used to set a lower reimbursement rate for a rate semester, then the provider's rate for that semester shall be retroactively calculated using the new cost report, and full payment at the recalculated rate shalt be effected retroactively. Medicare -granted extensions for filing cost reports, if applicable, shalt also apply to Medicaid cost reports. Payment for Medicaid compensable services made on behalf of Medicaid eligible persons is subject to the availability of moneys and any limitations or directions provided for in the General Appropriations Act or chapter 216. Further, nothing in this section shall be construed to prevent or limit the agency from adjusting fees, reimbursement rates, lengths of stay, number of visits, or number of services, or making any other adjustments necessary to comply with the availability of moneys and any limitations or directions provided for in the General Appropriations Act, provided the adjustment is consistent with legistative intent. (1) Reimbursement to hospitals licensed under part I of chapter 395 must be made prospectively or on the basis of negotiation. (a) Reimbursement for inpatient care is limited as provided in s. 409.905(5), except as otherwise provided in this subsection. 1. If authorized. by the General Appropriations Act, the agency may modify reimbursement for specific types of services or diagnoses, recipient ages, and hospital provider types. 2. The agency may establish an alternative methodology to the DRG -based prospective payment system to set reimbursement rates for: a. State-owned psychiatric hospitals. b. Newborn hearing screening services. c. Transplant services for which the agency has established a global fee. d. Recipients who have tuberculosis that is resistant to therapy who are in need of long-term, hospital-based treatment pursuant to s. 392.62. e. Class IIi psychiatric hospitals. 3. The agency shall modify reimbursement according to other methodologies recognized in the General Appropriations Act. The agency may receive funds from state entities, including, but not limited to, the Department of Health, local governments, and other local political subdivisions, for the purpose of making special exception payments, including federal matching funds, through the Medicaid inpatient reimbursement methodologies. Funds received for this purpose shall be separately accounted for and may not be commingled with other state or local funds in any manner. The agency may certify all local governmental funds used as state match under Title XIX of Wociat www.leg.state.fl.uslstatutesrindex.cfm?App_mode=Display_Statute&URL=0400-0499/0409/Sections/0409.908.html 1112