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12(612019
<br />Statutes & Constitution :View Statutes: Online Sunshine
<br />6. A direct care supplemental payment may be made to providers whose direct care hours per patient day are above the 80th
<br />percentile and who provide Medicaid services to a larger percentage of Medicaid patients than the state average.
<br />7. For the period beginning on October 1, 2018, and ending on September 30, 2021, the agency shall reimburse providers the greater of
<br />their September 2016 cost -based rate or their prospective payment rate. Effective October 1, 2021, the agency shall reimburse providers
<br />the greater of 95 percent of their cost -based rate or their rebased prospective payment rate, using the most recently audited cost report
<br />for each facility. This subparagraph shall expire September 30, 2023.
<br />8. Pediatric, Florida Department of Veterans Affairs, and government-owned facilities are exempt from the pricing model established
<br />in this subsection and shall remain on a cost -based prospective payment system. Effective October 1, 2018, the agency shall set rates for
<br />all facilities remaining on a cost -based prospective payment system using each facility's most recently audited cost report, eliminating
<br />retroactive settlements.
<br />It is the intent of the Legislature that the reimbursement plan achieve the goal of providing access to health care for nursing home
<br />residents who require large amounts of care while encouraging diversion services as an alternative to nursing home care for residents who
<br />can be served within the community. The agency shall base the establishment of any maximum rate of payment, whether overall or
<br />component, on the available moneys as provided for in the General Appropriations Act. The agency may base the maximum rate of
<br />payment on the results of scientifically valid analysis and conclusions derived from objective statistical data pertinent to the particular
<br />maximum rate of payment.
<br />2Note.-
<br />A. Section 18, ch. 2019-116, amended subsection (23) "[ijn order to implement Specific Appropriations 221 and 222 of the 2019-2020
<br />General Appropriations Act."
<br />B. Section 19, ch. 2019-116, provides that "[t]he text of s. 409.908(23), Florida Statutes, as carried forward from chapter 2018-10,
<br />Laws of Florida, by this act, expires July 1, 2020, and the text of that subsection shall revert to that in existence on October 1, 2018, not
<br />including any amendments made by chapter 2018-10, Laws of Florida, except that any amendments to such text enacted other than by this
<br />act and chapter 2018-10, Laws of Florida, shall be preserved and continue to operate to the extent that such amendments are not
<br />dependent upon the portions of text which expire pursuant to this section." Effective July 1, 2020, subsection (23), as amended by s. 19,
<br />ch. 2019-116, will read:
<br />(23)(a) The agency shaft establish rates at a levet that ensures no increase in statewide expenditures resulting from a change in unit
<br />costs effective July 1, 2011. Reimbursement rates shaft be as provided in the General Appropriations Act.
<br />(b) Base rate reimbursement for inpatient services under a diagnosis-related group payment methodology shall be provided in the
<br />General Appropriations Act.
<br />(c) Base rate reimbursement for outpatient services under an enhanced ambulatory payment group methodology shalt be provided in
<br />the General Appropriations Act.
<br />(d) This subsection applies to the following provider types:
<br />1. Nursing homes.
<br />2. County health departments.
<br />(e) The agency shall apply the effect of this subsection to the reimbursement rates for nursing home diversion programs.
<br />3Note.-
<br />A. Section 20, ch. 2019-116, amended subsection (26) "[i]n order to implement Specific Appropriation 205 of the 2019-2020 General
<br />Appropriations Act."
<br />B. Section 21, ch. 2019-116, provides that "[t]he amendment to s. 409.908(26), Florida Statutes, by this act expires July 1, 2020, and
<br />the text of that subsection shall revert to that in existence on June 30, 2019, except that any amendments to such text enacted other
<br />than by this act shall be preserved and continue to operate to the extent that such amendments are not dependent upon the portions of
<br />text which expire pursuant to this section." Effective July 1, 2020, subsection (26), as amended by s. 21, ch. 2019-116, will read:
<br />(26) The agency may receive funds from state entities, including, but not limited to, the Department of Health, total governments,
<br />and other local political subdivisions, for the purpose of making special exception payments, including federal matching funds. Funds
<br />received for this purpose shall be separately accounted for and may not be commingled with other state or local funds in any manner. The
<br />agency may certify all local governmental funds used as state match under Title XIX of the Social Security Act to the extent and in the
<br />manner authorized under the General Appropriations Act and pursuant to an agreement between the agency and the local governmental
<br />entity. In order for the agency to certify such local governmental funds, a local governmental entity must submit a final, executed letter
<br />of agreement to the agency, which must be received by October 1 of each fiscal year and provide the total amount of local governmental
<br />funds authorized by the entity for that fiscal year under the General Appropriations Act. The local governmental entity shalt use a
<br />certification form prescribed by the agency. At a minimum, the certification form must identify the amount being certified and describe
<br />the relationship between the certifying local governmental entity and the local health care provider. Local governmental funds outlined in
<br />the letters of agreement must be received by the agency no later than October 31 of each fiscal year in which such funds are pledged,
<br />unless an alternative plan is specifically approved by the agency.
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