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12/6/2019 Statutes & Constitution :View Statutes : Online Sunshine 2. The direct care subcomponent shalt include salaries and benefits of direct care staff providing nursing services including registered nurses, licensed practical nurses, and certified nursing assistants who deliver care directly to residents in the nursing home facility, allowable therapy costs, and dietary costs. This excludes nursing administration, staff development, the staffing coordinator, and the administrative portion of the minimum data set and care plan coordinators. The direct care subcomponent also includes medically necessary dental care, vision care, hearing care, and podiatric care. 3. All other patient care costs shalt be included in the indirect care cost subcomponent of the patient care per diem rate, including complex medical equipment, medical supplies, and other allowable ancillary costs. Costs may not be allocated directly or indirectly to the direct care subcomponent from a home office or management company. 4. On Juty 1 of each year, the agency shall report to the Legislature direct and indirect care costs, including average direct and indirect care costs per resident per facility and direct care and indirect care salaries and benefits per category of staff member per facility. 5. Every fourth year, the agency shalt rebase nursing home prospective payment rates to reflect changes in cost based on the most recently audited cost report for each participating provider. 6. A direct care supplemental payment may be made to providers whose direct care hours per patient day are above the 80th percentile and who provide Medicaid services to a larger percentage of Medicaid patients than the state average. 7. For the period beginning on October 1, 2018, and ending on September 30, 2021, the agency shalt reimburse providers the greater of their September 2016 cost -based rate or their prospective payment rate. Effective October 1, 2021, the agency shall reimburse providers the greater of 95 percent of their cost -based rate or their rebased prospective payment rate, using the most recently audited cost report for each facility. This subparagraph shalt expire September 30, 2023. 8. Pediatric, Florida Department of Veterans Affairs, and government-owned facilities are exempt from the pricing model established in this subsection and shalt remain on a cost -based prospective payment system. Effective October 1, 2018, the agency shalt set rates for all facilities remaining on a cost -based prospective payment system using each facility's most recently audited cost report, eliminating retroactive settlements. It is the intent of the Legislature that the reimbursement plan achieve the goal of providing access to health care for nursing home residents who require large amounts of care white encouraging diversion services as an alternative to nursing home care for residents who can be served within the community. The agency shall base the establishment of any maximum rate of payment, whether overall or component, on the available moneys as provided for in the General Appropriations Act. The agency may base the maximum rate of payment on the results of scientifically valid analysis and conclusions derived from objective statistical data pertinent to the particular maximum rate of payment. (3) Subject to any limitations or directions provided for in the General Appropriations Act, the following Medicaid services and goods may be reimbursed on a fee-for-service basis. For each allowable service or goods furnished in accordance with Medicaid rules, policy manuals, handbooks, and state and federat taw, the payment shalt be the amount bitted by the provider, the provider's usual and customary charge, or the maximum attowabte fee established by the agency, whichever amount is less, with the exception of those services or goods for which the agency makes payment using a methodology based on capitation rates, average costs, or negotiated fees. (a) Advanced practice registered nurse services. (b) Birth center services. (c) Chiropractic services. (d) Community mental health services. (e) Dental services, including oral and .maxillofacial surgery. (f) Durable medical equipment. (g) Hearing services. (h) Occupational therapy for Medicaid recipients under age 21. 220 www.leg.state:fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-049910409/Sections/0409.908.html 5/12