July 08, 2020
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_h7047__
HB 7047

1
A bill to be entitled
2An act relating to health care; amending s. 409.911, F.S.;
3revising the method for calculating disproportionate share
4payments to hospitals; amending s. 409.9112, F.S.;
5revising the time period during which the Agency for
6Health Care Administration is prohibited from distributing
7disproportionate share payments to regional perinatal
8intensive care centers; amending s. 409.9113, F.S.;
9revising the time period for distribution of
10disproportionate share payments to teaching hospitals;
11amending s. 409.9117, F.S.; revising the time period
12during which the agency is prohibited from distributing
13certain moneys under the primary care disproportionate
14share program; providing an effective date.
15
16Be It Enacted by the Legislature of the State of Florida:
17
18     Section 1.  Subsection (2) of section 409.911, Florida
19Statutes, is amended to read:
20     409.911  Disproportionate share program.--Subject to
21specific allocations established within the General
22Appropriations Act and any limitations established pursuant to
23chapter 216, the agency shall distribute, pursuant to this
24section, moneys to hospitals providing a disproportionate share
25of Medicaid or charity care services by making quarterly
26Medicaid payments as required. Notwithstanding the provisions of
27s. 409.915, counties are exempt from contributing toward the
28cost of this special reimbursement for hospitals serving a
29disproportionate share of low-income patients.
30     (2)  The Agency for Health Care Administration shall use
31the following actual audited data to determine the Medicaid days
32and charity care to be used in calculating the disproportionate
33share payment:
34     (a)  The average of the 2001, 2002, and 2003 2000, 2001,
35and 2002 audited disproportionate share data to determine each
36hospital's Medicaid days and charity care for the 2007-2008
372006-2007 state fiscal year.
38     (b)  If the Agency for Health Care Administration does not
39have the prescribed 3 years of audited disproportionate share
40data as noted in paragraph (a) for a hospital, the agency shall
41use the average of the years of the audited disproportionate
42share data as noted in paragraph (a) which is available.
43     (c)  In accordance with s. 1923(b) of the Social Security
44Act, a hospital with a Medicaid inpatient utilization rate
45greater than one standard deviation above the statewide mean or
46a hospital with a low-income utilization rate of 25 percent or
47greater shall qualify for reimbursement.
48     Section 2.  Section 409.9112, Florida Statutes, is amended
49to read:
50     409.9112  Disproportionate share program for regional
51perinatal intensive care centers.--In addition to the payments
52made under s. 409.911, the Agency for Health Care Administration
53shall design and implement a system of making disproportionate
54share payments to those hospitals that participate in the
55regional perinatal intensive care center program established
56pursuant to chapter 383. This system of payments shall conform
57with federal requirements and shall distribute funds in each
58fiscal year for which an appropriation is made by making
59quarterly Medicaid payments. Notwithstanding the provisions of
60s. 409.915, counties are exempt from contributing toward the
61cost of this special reimbursement for hospitals serving a
62disproportionate share of low-income patients. For the state
63fiscal year 2007-2008 2005-2006, the agency shall not distribute
64moneys under the regional perinatal intensive care centers
65disproportionate share program.
66     (1)  The following formula shall be used by the agency to
67calculate the total amount earned for hospitals that participate
68in the regional perinatal intensive care center program:
69
70
TAE = HDSP/THDSP
71
72Where:
73     TAE = total amount earned by a regional perinatal intensive
74care center.
75     HDSP = the prior state fiscal year regional perinatal
76intensive care center disproportionate share payment to the
77individual hospital.
78     THDSP = the prior state fiscal year total regional
79perinatal intensive care center disproportionate share payments
80to all hospitals.
81     (2)  The total additional payment for hospitals that
82participate in the regional perinatal intensive care center
83program shall be calculated by the agency as follows:
84
85
TAP = TAE x TA
86
87Where:
88     TAP = total additional payment for a regional perinatal
89intensive care center.
90     TAE = total amount earned by a regional perinatal intensive
91care center.
92     TA = total appropriation for the regional perinatal
93intensive care center disproportionate share program.
94     (3)  In order to receive payments under this section, a
95hospital must be participating in the regional perinatal
96intensive care center program pursuant to chapter 383 and must
97meet the following additional requirements:
98     (a)  Agree to conform to all departmental and agency
99requirements to ensure high quality in the provision of
100services, including criteria adopted by departmental and agency
101rule concerning staffing ratios, medical records, standards of
102care, equipment, space, and such other standards and criteria as
103the department and agency deem appropriate as specified by rule.
104     (b)  Agree to provide information to the department and
105agency, in a form and manner to be prescribed by rule of the
106department and agency, concerning the care provided to all
107patients in neonatal intensive care centers and high-risk
108maternity care.
109     (c)  Agree to accept all patients for neonatal intensive
110care and high-risk maternity care, regardless of ability to pay,
111on a functional space-available basis.
112     (d)  Agree to develop arrangements with other maternity and
113neonatal care providers in the hospital's region for the
114appropriate receipt and transfer of patients in need of
115specialized maternity and neonatal intensive care services.
116     (e)  Agree to establish and provide a developmental
117evaluation and services program for certain high-risk neonates,
118as prescribed and defined by rule of the department.
119     (f)  Agree to sponsor a program of continuing education in
120perinatal care for health care professionals within the region
121of the hospital, as specified by rule.
122     (g)  Agree to provide backup and referral services to the
123department's county health departments and other low-income
124perinatal providers within the hospital's region, including the
125development of written agreements between these organizations
126and the hospital.
127     (h)  Agree to arrange for transportation for high-risk
128obstetrical patients and neonates in need of transfer from the
129community to the hospital or from the hospital to another more
130appropriate facility.
131     (4)  Hospitals which fail to comply with any of the
132conditions in subsection (3) or the applicable rules of the
133department and agency shall not receive any payments under this
134section until full compliance is achieved. A hospital which is
135not in compliance in two or more consecutive quarters shall not
136receive its share of the funds. Any forfeited funds shall be
137distributed by the remaining participating regional perinatal
138intensive care center program hospitals.
139     Section 3.  Section 409.9113, Florida Statutes, is amended
140to read:
141     409.9113  Disproportionate share program for teaching
142hospitals.--In addition to the payments made under ss. 409.911
143and 409.9112, the Agency for Health Care Administration shall
144make disproportionate share payments to statutorily defined
145teaching hospitals for their increased costs associated with
146medical education programs and for tertiary health care services
147provided to the indigent. This system of payments shall conform
148with federal requirements and shall distribute funds in each
149fiscal year for which an appropriation is made by making
150quarterly Medicaid payments. Notwithstanding s. 409.915,
151counties are exempt from contributing toward the cost of this
152special reimbursement for hospitals serving a disproportionate
153share of low-income patients. For the state fiscal year 2007-
1542008 2006-2007, the agency shall distribute the moneys provided
155in the General Appropriations Act to statutorily defined
156teaching hospitals and family practice teaching hospitals under
157the teaching hospital disproportionate share program. The funds
158provided for statutorily defined teaching hospitals shall be
159distributed in the same proportion as the state fiscal year
1602003-2004 teaching hospital disproportionate share funds were
161distributed. The funds provided for family practice teaching
162hospitals shall be distributed equally among family practice
163teaching hospitals.
164     (1)  On or before September 15 of each year, the Agency for
165Health Care Administration shall calculate an allocation
166fraction to be used for distributing funds to state statutory
167teaching hospitals. Subsequent to the end of each quarter of the
168state fiscal year, the agency shall distribute to each statutory
169teaching hospital, as defined in s. 408.07, an amount determined
170by multiplying one-fourth of the funds appropriated for this
171purpose by the Legislature times such hospital's allocation
172fraction. The allocation fraction for each such hospital shall
173be determined by the sum of three primary factors, divided by
174three. The primary factors are:
175     (a)  The number of nationally accredited graduate medical
176education programs offered by the hospital, including programs
177accredited by the Accreditation Council for Graduate Medical
178Education and the combined Internal Medicine and Pediatrics
179programs acceptable to both the American Board of Internal
180Medicine and the American Board of Pediatrics at the beginning
181of the state fiscal year preceding the date on which the
182allocation fraction is calculated. The numerical value of this
183factor is the fraction that the hospital represents of the total
184number of programs, where the total is computed for all state
185statutory teaching hospitals.
186     (b)  The number of full-time equivalent trainees in the
187hospital, which comprises two components:
188     1.  The number of trainees enrolled in nationally
189accredited graduate medical education programs, as defined in
190paragraph (a). Full-time equivalents are computed using the
191fraction of the year during which each trainee is primarily
192assigned to the given institution, over the state fiscal year
193preceding the date on which the allocation fraction is
194calculated. The numerical value of this factor is the fraction
195that the hospital represents of the total number of full-time
196equivalent trainees enrolled in accredited graduate programs,
197where the total is computed for all state statutory teaching
198hospitals.
199     2.  The number of medical students enrolled in accredited
200colleges of medicine and engaged in clinical activities,
201including required clinical clerkships and clinical electives.
202Full-time equivalents are computed using the fraction of the
203year during which each trainee is primarily assigned to the
204given institution, over the course of the state fiscal year
205preceding the date on which the allocation fraction is
206calculated. The numerical value of this factor is the fraction
207that the given hospital represents of the total number of full-
208time equivalent students enrolled in accredited colleges of
209medicine, where the total is computed for all state statutory
210teaching hospitals.
211
212The primary factor for full-time equivalent trainees is computed
213as the sum of these two components, divided by two.
214     (c)  A service index that comprises three components:
215     1.  The Agency for Health Care Administration Service
216Index, computed by applying the standard Service Inventory
217Scores established by the Agency for Health Care Administration
218to services offered by the given hospital, as reported on
219Worksheet A-2 for the last fiscal year reported to the agency
220before the date on which the allocation fraction is calculated.
221The numerical value of this factor is the fraction that the
222given hospital represents of the total Agency for Health Care
223Administration Service Index values, where the total is computed
224for all state statutory teaching hospitals.
225     2.  A volume-weighted service index, computed by applying
226the standard Service Inventory Scores established by the Agency
227for Health Care Administration to the volume of each service,
228expressed in terms of the standard units of measure reported on
229Worksheet A-2 for the last fiscal year reported to the agency
230before the date on which the allocation factor is calculated.
231The numerical value of this factor is the fraction that the
232given hospital represents of the total volume-weighted service
233index values, where the total is computed for all state
234statutory teaching hospitals.
235     3.  Total Medicaid payments to each hospital for direct
236inpatient and outpatient services during the fiscal year
237preceding the date on which the allocation factor is calculated.
238This includes payments made to each hospital for such services
239by Medicaid prepaid health plans, whether the plan was
240administered by the hospital or not. The numerical value of this
241factor is the fraction that each hospital represents of the
242total of such Medicaid payments, where the total is computed for
243all state statutory teaching hospitals.
244
245The primary factor for the service index is computed as the sum
246of these three components, divided by three.
247     (2)  By October 1 of each year, the agency shall use the
248following formula to calculate the maximum additional
249disproportionate share payment for statutorily defined teaching
250hospitals:
251
252
TAP = THAF x A
253
254Where:
255     TAP = total additional payment.
256     THAF = teaching hospital allocation factor.
257     A = amount appropriated for a teaching hospital
258disproportionate share program.
259     Section 4.  Section 409.9117, Florida Statutes, is amended
260to read:
261     409.9117  Primary care disproportionate share program.--For
262the state fiscal year 2007-2008 2006-2007, the agency shall not
263distribute moneys under the primary care disproportionate share
264program.
265     (1)  If federal funds are available for disproportionate
266share programs in addition to those otherwise provided by law,
267there shall be created a primary care disproportionate share
268program.
269     (2)  The following formula shall be used by the agency to
270calculate the total amount earned for hospitals that participate
271in the primary care disproportionate share program:
272
273
TAE = HDSP/THDSP
274
275Where:
276     TAE = total amount earned by a hospital participating in
277the primary care disproportionate share program.
278     HDSP = the prior state fiscal year primary care
279disproportionate share payment to the individual hospital.
280     THDSP = the prior state fiscal year total primary care
281disproportionate share payments to all hospitals.
282     (3)  The total additional payment for hospitals that
283participate in the primary care disproportionate share program
284shall be calculated by the agency as follows:
285
286
TAP = TAE x TA
287
288Where:
289     TAP = total additional payment for a primary care hospital.
290     TAE = total amount earned by a primary care hospital.
291     TA = total appropriation for the primary care
292disproportionate share program.
293     (4)  In the establishment and funding of this program, the
294agency shall use the following criteria in addition to those
295specified in s. 409.911, payments may not be made to a hospital
296unless the hospital agrees to:
297     (a)  Cooperate with a Medicaid prepaid health plan, if one
298exists in the community.
299     (b)  Ensure the availability of primary and specialty care
300physicians to Medicaid recipients who are not enrolled in a
301prepaid capitated arrangement and who are in need of access to
302such physicians.
303     (c)  Coordinate and provide primary care services free of
304charge, except copayments, to all persons with incomes up to 100
305percent of the federal poverty level who are not otherwise
306covered by Medicaid or another program administered by a
307governmental entity, and to provide such services based on a
308sliding fee scale to all persons with incomes up to 200 percent
309of the federal poverty level who are not otherwise covered by
310Medicaid or another program administered by a governmental
311entity, except that eligibility may be limited to persons who
312reside within a more limited area, as agreed to by the agency
313and the hospital.
314     (d)  Contract with any federally qualified health center,
315if one exists within the agreed geopolitical boundaries,
316concerning the provision of primary care services, in order to
317guarantee delivery of services in a nonduplicative fashion, and
318to provide for referral arrangements, privileges, and
319admissions, as appropriate. The hospital shall agree to provide
320at an onsite or offsite facility primary care services within 24
321hours to which all Medicaid recipients and persons eligible
322under this paragraph who do not require emergency room services
323are referred during normal daylight hours.
324     (e)  Cooperate with the agency, the county, and other
325entities to ensure the provision of certain public health
326services, case management, referral and acceptance of patients,
327and sharing of epidemiological data, as the agency and the
328hospital find mutually necessary and desirable to promote and
329protect the public health within the agreed geopolitical
330boundaries.
331     (f)  In cooperation with the county in which the hospital
332resides, develop a low-cost, outpatient, prepaid health care
333program to persons who are not eligible for the Medicaid
334program, and who reside within the area.
335     (g)  Provide inpatient services to residents within the
336area who are not eligible for Medicaid or Medicare, and who do
337not have private health insurance, regardless of ability to pay,
338on the basis of available space, except that nothing shall
339prevent the hospital from establishing bill collection programs
340based on ability to pay.
341     (h)  Work with the Florida Healthy Kids Corporation, the
342Florida Health Care Purchasing Cooperative, and business health
343coalitions, as appropriate, to develop a feasibility study and
344plan to provide a low-cost comprehensive health insurance plan
345to persons who reside within the area and who do not have access
346to such a plan.
347     (i)  Work with public health officials and other experts to
348provide community health education and prevention activities
349designed to promote healthy lifestyles and appropriate use of
350health services.
351     (j)  Work with the local health council to develop a plan
352for promoting access to affordable health care services for all
353persons who reside within the area, including, but not limited
354to, public health services, primary care services, inpatient
355services, and affordable health insurance generally.
356
357Any hospital that fails to comply with any of the provisions of
358this subsection, or any other contractual condition, may not
359receive payments under this section until full compliance is
360achieved.
361     Section 5.  This act shall take effect July 1, 2007.


CODING: Words stricken are deletions; words underlined are additions.
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