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12/6/2019 Statutes & Constitution :View Statutes : Online Sunshine Medicaid reimbursement may be extended by the agency beyond 30 days, and approval must be based upon verification by the patient's physician that the patient requires short-term rehabilitative and recuperative services only, in which case an extension of no more than 15 days may be approved. Reimbursement to a hospital licensed under part I of chapter 395 for the temporary provision of skilled nursing services to nursing home residents who have been displaced as the result of a natural disaster or other emergency may not exceed the average county nursing home payment for those services in the county in which the hospital is located and is limited to the period of time which the agency considers necessary for continued placement of the nursing home residents in the hospital. (b) Subject to any limitations or directions in the General Appropriations Act, the agency shalt establish and implement a state Title XIX tong -Term Care Reimbursement Pian for nursing home care in order to provide care and services in conformance with the applicabie state and federal laws, rules, regulations, and quality and safety standards and to ensure that individuals eligible for medical assistance have reasonable geographic access to such care. 1. The agency shalt amend the long-term care reimbursement plan and cost reporting system to create direct care and indirect care subcomponents of the patient care component of the per diem rate. These two subcomponents together shall equal the patient care component of the per diem rate. Separate prices shall be calculated for each patient care subcomponent, initially based on the September 2016 rate setting cost reports and subsequently based on the most recently audited cost report used during a rebasing year. The direct care subcomponent of the per diem rate for any providers still being reimbursed on a cost basis shall be limited by the cost -based class ceiling, and the indirect care subcomponent may be limited by the lower of the cost -based class ceiling, the target rate class ceiling, or the individual provider target. The ceilings and targets apply only to providers being reimbursed on a cost -based system. Effective October 1, 2018, a prospective payment methodology shalt be implemented for rate setting purposes with the following parameters: a. Peer Groups, inctuding: (1) North-SMMC Regions 1-9, less Palm Beach and Okeechobee Counties; and (11) South-SMMC Regions 10-11, plus Palm Beach and Okeechobee Counties. b. Percentage of Median Costs based on the cost reports used for September 2016 rate setting: (1) Direct Care Costs. . . . . . . . . . 100 percent. (11) Indirect Care Costs. . . . . . . . . . 92 percent. (III) Operating Costs. . . . . . . . . . 86 percent. c. Floors: (1) Direct Care Component. . . . . . . . . . 95 percent. (II) Indirect Care Component. . . . . . . . . . 92.5 percent. (III) Operating Component. . . . . . . . . . None. d. Pass-through Payments. . . . . . . . . . Real Estate and Personal Property Taxes and Property Insurance. e. Quality Incentive Program Payment Pool. . . . . . . . . 6 percent of September 2016 non -property related payments of included facilities. f. Quality Score Threshold to Quality for Quality Incentive Payment. . . . . . . . . . 20th percentile of included facilities. g. Fair Rentat Value System Payment Parameters: (1) Building Value per Square Foot based on 2018 RS Means. (11) Land Valuation. . . . . . . . . . 10 percent of Gross Building value. (111) Facility Square Footage. . . . . . . . . . Actual Square Footage. (IV) Moveable Equipment Allowance. . . . . . . . . . $8,000 per bed. (V) Obsolescence Factor. . . . . . . . . . 1.5 percent. (Vi) Fair Rental Rate of Return. . . . . . . . . . 8 percent. (VII) Minimum Occupancy. . . . . . . . . 90 percent. (Vill) Maximum Facility Age. . . . . . . . . . 40 years. (IX) Minimum Square Footage per Bed. . . . . . . . . . 350. (X) Maximum Square Footage for Bed. . . . . . . . . . 500. (XI) Minimum Cost of a renovation/replacements. . . . . . . . . . $500 per bed. h. Ventilator Supplemental payment of $200 per Medicaid day of 40,000 ventilator Medicaid days per fiscal year. 2. The direct care subcomponent shall 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, attowable 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. Alt other patient care costs shall be included in the indirect care cost subcomponent of the patient care per diem rate, including complex medical equipment, medical supplies, and other attowable 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 shalt 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. 226 www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0409/Sections/0409.908.html 11/12