Bill Text: FL S1370 | 2016 | Regular Session | Comm Sub
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
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 verifytelephonicallyvisits 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 servicesvoice66biometrics. 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.