Bill Text: FL S1370 | 2016 | Regular Session | Comm Sub

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Bill Title: Medicaid Provider Overpayments

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2016-03-03 - Laid on Table, companion bill(s) passed, see CS/HB 1245 (Ch. 2016-103) [S1370 Detail]

Download: Florida-2016-S1370-Comm_Sub.html

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       Florida Senate - 2016                             CS for SB 1370
       
       
        
       By the Committee on Health Policy; and Senator Grimsley
       
       588-03252-16                                          20161370c1
    1                        A bill to be entitled                      
    2         An act relating to Medicaid provider overpayments;
    3         amending s. 409.908, F.S.; authorizing the Agency for
    4         Health Care Administration to certify that a Medicaid
    5         provider is out of business and that overpayments made
    6         to a provider cannot be collected under state law;
    7         amending s. 409.9132, F.S.; revising the manner in
    8         which the Medicaid program verifies a vendor’s visits
    9         for the delivery of home health services; reenacting
   10         s. 409.8132(4), F.S., to incorporate the amendment
   11         made to s. 409.908, F.S., in a reference thereto;
   12         providing an effective date.
   13          
   14  Be It Enacted by the Legislature of the State of Florida:
   15  
   16         Section 1. Subsection (25) is added to section 409.908,
   17  Florida Statutes, to read:
   18         409.908 Reimbursement of Medicaid providers.—Subject to
   19  specific appropriations, the agency shall reimburse Medicaid
   20  providers, in accordance with state and federal law, according
   21  to methodologies set forth in the rules of the agency and in
   22  policy manuals and handbooks incorporated by reference therein.
   23  These methodologies may include fee schedules, reimbursement
   24  methods based on cost reporting, negotiated fees, competitive
   25  bidding pursuant to s. 287.057, and other mechanisms the agency
   26  considers efficient and effective for purchasing services or
   27  goods on behalf of recipients. If a provider is reimbursed based
   28  on cost reporting and submits a cost report late and that cost
   29  report would have been used to set a lower reimbursement rate
   30  for a rate semester, then the provider’s rate for that semester
   31  shall be retroactively calculated using the new cost report, and
   32  full payment at the recalculated rate shall be effected
   33  retroactively. Medicare-granted extensions for filing cost
   34  reports, if applicable, shall also apply to Medicaid cost
   35  reports. Payment for Medicaid compensable services made on
   36  behalf of Medicaid eligible persons is subject to the
   37  availability of moneys and any limitations or directions
   38  provided for in the General Appropriations Act or chapter 216.
   39  Further, nothing in this section shall be construed to prevent
   40  or limit the agency from adjusting fees, reimbursement rates,
   41  lengths of stay, number of visits, or number of services, or
   42  making any other adjustments necessary to comply with the
   43  availability of moneys and any limitations or directions
   44  provided for in the General Appropriations Act, provided the
   45  adjustment is consistent with legislative intent.
   46         (25) In accordance with 42 C.F.R. s. 433.318(d), the agency
   47  may certify that a Medicaid provider is out of business and that
   48  any overpayments made to the provider cannot be collected under
   49  state law and procedures.
   50         Section 2. Section 409.9132, Florida Statutes, is amended
   51  to read:
   52         409.9132 Pilot project to monitor home health services.—The
   53  Agency for Health Care Administration shall expand the home
   54  health agency monitoring pilot project in Miami-Dade County on a
   55  statewide basis effective July 1, 2012, except in counties in
   56  which the program is not cost-effective, as determined by the
   57  agency. The agency shall contract with a vendor to verify the
   58  utilization and delivery of home health services and provide an
   59  electronic billing interface for home health services. The
   60  contract must require the creation of a program to submit claims
   61  electronically for the delivery of home health services. The
   62  program must verify telephonically visits for the delivery of
   63  home health services by using technology that is effective for
   64  identifying delivery of the home health services and deterring
   65  fraudulent or abusive billing for these services voice
   66  biometrics. The agency may seek amendments to the Medicaid state
   67  plan and waivers of federal laws, as necessary, to implement or
   68  expand the pilot project. Notwithstanding s. 287.057(3)(e), the
   69  agency must award the contract through the competitive
   70  solicitation process and may use the current contract to expand
   71  the home health agency monitoring pilot project to include
   72  additional counties as authorized under this section.
   73         Section 3. Subsection (4) of s. 409.8132, Florida Statutes,
   74  is reenacted for the purpose of incorporating the amendment made
   75  by this act to s. 409.908, Florida Statutes, in a reference
   76  thereto.
   77         Section 4. This act shall take effect July 1, 2016.