Bill Text: FL S1884 | 2013 | Regular Session | Engrossed
Bill Title: County Medicaid Contributions
Spectrum: Committee Bill
Status: (Failed) 2013-05-03 - Died in Messages, companion bill(s) passed, see SB 1520 (Ch. 2013-48) [S1884 Detail]
Download: Florida-2013-S1884-Engrossed.html
CS for SB 1884 First Engrossed 20131884e1 1 A bill to be entitled 2 An act relating to county Medicaid contributions; 3 amending s. 409.915, F.S.; specifying the total 4 contribution for certain years and specifying the 5 method for determining the amount in the following 6 years; revising the method for calculating each 7 county’s contribution; providing tables for 8 calculating county contributions; requiring the Agency 9 for Health Care Administration to annually report the 10 status of county billings to the Legislature; 11 authorizing the Department of Revenue to withhold 12 county distributions for failure to remit Medicaid 13 contributions; deleting provisions specifying the care 14 and services that counties must participate in, 15 obsolete bond provisions, and a process for refund 16 requests; requiring the agency to provide a report to 17 the Florida Association of Counties and the 18 Legislature on the impact on counties of the changes 19 to the methodology for determining county Medicaid 20 contributions and other factors; specifying the method 21 for calculating each county’s contribution for the 22 2013-2014 fiscal year; providing an effective date. 23 24 Be It Enacted by the Legislature of the State of Florida: 25 26 Section 1. Section 409.915, Florida Statutes, is amended to 27 read: 28 409.915 County contributions to Medicaid.—Although the 29 state is responsible for the full portion of the state share of 30 the matching funds required for the Medicaid program,in order31to acquire a certain portion of these funds,the state shall 32 charge the counties an annual contribution in order to acquire a 33 certain portion of these fundsfor certain items of care and34service as provided in this section. 35 (1) As used in this section, the term “state Medicaid 36 expenditures” means those expenditures used as matching funds 37 for the federal Medicaid program. 38 (2)(a) For the 2013-2014 state fiscal year through the 39 2019-2020 state fiscal year, the total amount of the counties’ 40 annual contribution is $269.6 million. For each fiscal year 41 thereafter, the annual amount shall be adjusted by the 42 percentage change in the state Medicaid expenditures as 43 determined by the Social Services Estimating Conference. 44 (b) By March 15, 2020, and each year thereafter, the Social 45 Services Estimating Conference shall determine the percentage 46 change in state Medicaid expenditures by comparing expenditures 47 for the 2 most recent completed state fiscal years. 48 (3)(a)1. The amount of each county’s annual contribution is 49 equal to the product of the amount determined under subsection 50 (2) multiplied by the sum of the percentages calculated in sub 51 subparagraphs a. and b.: 52 a. The enrollment weight provided in subparagraph 2. is 53 multiplied by a fraction, the numerator of which is the number 54 of the county’s Medicaid enrollees as of March 1 of each year, 55 and the denominator of which is the number of all counties’ 56 Medicaid enrollees as of March 1 of each year. The agency shall 57 calculate this amount for each county and provide the 58 information to the Department of Revenue by May 15 of each year. 59 b. The payment weight provided in subparagraph 2. is 60 multiplied by the percentage share of payments provided in 61 subparagraph 3. for each county. 62 2. The weights for each fiscal year are equal to: 63 64 WEIGHTS 65 66 67 FISCAL YEAR ENROLLMENT PAYMENT 68 69 70 71 72 73 74 75 76 3. The percentage share of payments for each county is: 77 78 79 COUNTY SHARE OF PAYMENTS 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 (b)1. The Legislature intends to replace the county 151 percentage share provided in subparagraph (a)3. with percentage 152 shares based upon each county’s proportion of the total 153 statewide amount of county billings made under this section from 154 April 1, 2012, through March 31, 2013, for which the state 155 ultimately receives payment. 156 2. By February 1 of each year and continuing until a 157 certification is made under sub-subparagraph b., the agency 158 shall report to the President of the Senate and the Speaker of 159 the House of Representatives the status of the county billings 160 made under this section from April 1, 2012, through March 31, 161 2013, by county, including: 162 a. The amounts billed to each county which remain unpaid, 163 if any; and 164 b. A certification from the agency of a final accounting of 165 the amount of funds received by the state from such billings, by 166 county, upon the expiration of all appeal rights that counties 167 may have to contest such billings. 168 3. By March 15 of the state fiscal year in which the state 169 receives the certification provided for in sub-subparagraph 170 (b)2.b., the Social Services Estimating Conference shall 171 calculate each county’s percentage share of the total statewide 172 amount of county billings made under this section from April 1, 173 2012, through March 31, 2013, for which the state ultimately 174 receives payment. 175 4. Beginning in the state fiscal year following the receipt 176 by the state of the certification provided in sub-subparagraph 177 (b)2.b., each county’s percentage share under subparagraph (a)3. 178 shall be replaced by the percentage calculated under 179 subparagraph (b)3. 180 5. If the court invalidates the replacement of each 181 county’s share as provided in this paragraph, the county share 182 set forth in subparagraph (a)3. shall continue to apply. 183 (4) By June 1 of each year, the Department of Revenue shall 184 notify each county of its required annual contribution. Each 185 county shall pay its contribution, by check or electronic 186 transfer, in equal monthly installments to the department by the 187 5th day of each month. If a county fails to remit the payment by 188 the 5th day of the month, the department shall reduce the 189 monthly distribution of that county pursuant to s. 218.61 and, 190 if necessary, by the amount of the monthly installment pursuant 191 to s. 218.26. The payments and the amounts by which the 192 distributions are reduced shall be transferred to the General 193 Revenue Fund. 194(1) Each county shall participate in the following items of195care and service:196(a) For both health maintenance members and fee-for-service197beneficiaries, payments for inpatient hospitalization in excess198of 10 days, but not in excess of 45 days, with the exception of199pregnant women and children whose income is in excess of the200federal poverty level and who do not participate in the Medicaid201medically needy program, and for adult lung transplant services.202(b) For both health maintenance members and fee-for-service203beneficiaries, payments for nursing home or intermediate204facilities care in excess of $170 per month, with the exception205of skilled nursing care for children under age 21.206(2) A county’s participation must be 35 percent of the207total cost, or the applicable discounted cost paid by the state208for Medicaid recipients enrolled in health maintenance209organizations or prepaid health plans, of providing the items210listed in subsection (1), except that the payments for items211listed in paragraph (1)(b) may not exceed $55 per month per212person.213(3) Each county shall set aside sufficient funds to pay for214items of care and service provided to the county’s eligible215recipients for which county contributions are required,216regardless of where in the state the care or service is217rendered.218(4) Each county shall contribute its pro rata share of the219total county participation based upon statements rendered by the220agency. The agency shall render such statements monthly based on221each county’s eligible recipients. For purposes of this section,222each county’s eligible recipients shall be determined by the223recipient’s address information contained in the federally224approved Medicaid eligibility system within the Department of225Children and Family Services. A county may use the process226developed under subsection (10) to request a refund if it227determines that the statement rendered by the agency contains228errors.229 (5) In any county in which a special taxing district or 230 authority is located which benefitswill benefitfrom the 231 Medicaid programmedical assistance programs covered by this232section, the board of county commissioners may divide the 233 county’s financial responsibility for this purpose 234 proportionately, and each such district or authority must 235 furnish its share to the board of county commissioners in time 236 for the board to comply with subsection (4)(3). Any appeal of 237 the proration made by the board of county commissioners must be 238 made to the Department of Financial Services, which shallthen239 set the proportionate share forofeach party. 240(6) Counties are exempt from contributing toward the cost241of new exemptions on inpatient ceilings for statutory teaching242hospitals, specialty hospitals, and community hospital education243program hospitals that came into effect July 1, 2000, and for244special Medicaid payments that came into effect on or after July2451, 2000.246 (6)(7)(a) By August 1, 2012, the agency shall certify to 247 each county the amount of such county’s billings from November 248 1, 2001, through April 30, 2012, which remain unpaid. A county 249 may contest the amount certified by filing a petition under the 250 applicable provisions of chapter 120 on or before September 1, 251 2012. This procedure is the exclusive method to challenge the 252 amount certified. In order to successfully challenge the amount 253 certified, a county must show, by a preponderance of the 254 evidence, that a recipient was not an eligible recipient of that 255 county or that the amount certified was otherwise in error. 256 (b) By September 15, 2012, the agency shall certify to the 257 Department of Revenue: 258 1. For each county that files a petition on or before 259 September 1, 2012, the amount certified under paragraph (a); and 260 2. For each county that does not file a petition on or 261 before September 1, 2012, an amount equal to 85 percent of the 262 amount certified under paragraph (a). 263 (c) The filing of a petition under paragraph (a) doesshall264 not stay or stop the Department of Revenue from reducing 265 distributions in accordance with paragraph (b) and subsection 266 (7)(8). If a county that files a petition under paragraph (a) 267 is able to demonstrate that the amount certified should be 268 reduced, the agency shall notify the Department of Revenue of 269 the amount of the reduction. The Department of Revenue shall 270 adjust all future monthly distribution reductions under 271 subsection (7)(8)in a manner that results in the remaining 272 total distribution reduction being applied in equal monthly 273 amounts. 274 (7)(8)(a) Beginning with the October 2012 distribution, the 275 Department of Revenue shall reduce each county’s distributions 276 pursuant to s. 218.26 by one thirty-sixth of the amount 277 certified by the agency under subsection (6)(7)for that 278 county, minus any amount required under paragraph (b). Beginning 279 with the October 2013 distribution, the Department of Revenue 280 shall reduce each county’s distributions pursuant to s. 218.26 281 by one forty-eighth of two-thirds of the amount certified by the 282 agency under subsection (6)(7)for that county, minus any 283 amount required under paragraph (b). However, the amount of the 284 reduction may not exceed 50 percent of each county’s 285 distribution. If, after 60 months, the reductions for any county 286 do not equal the total amount initially certified by the agency, 287 the Department of Revenue shall continue to reduce such county’s 288 distribution by up to 50 percent until the total amount 289 certified is reached. The amounts by which the distributions are 290 reduced shall be transferred to the General Revenue Fund. 291 (b) As an assurance to holders of bonds issued before the 292 effective date of this act to which distributions made pursuant 293 to s. 218.26 are pledged, or bonds issued to refund such bonds 294 which mature no later than the bonds they refunded and which 295 result in a reduction of debt service payable in each fiscal 296 year, the amount available for distribution to a county shall 297 remain as provided by law and continue to be subject to any lien 298 or claim on behalf of the bondholders. The Department of Revenue 299 must ensure, based on information provided by an affected 300 county, that any reduction in amounts distributed pursuant to 301 paragraph (a) does not reduce the amount of distribution to a 302 county below the amount necessary for the timely payment of 303 principal and interest when due on the bonds and the amount 304 necessary to comply with any covenant under the bond resolution 305 or other documents relating to the issuance of the bonds. If a 306 reduction to a county’s monthly distribution must be decreased 307 in order to comply with this paragraph, the Department of 308 Revenue must notify the agency of the amount of the decrease and 309 the agency must send a bill for payment of such amount to the 310 affected county. 311(9)(a) Beginning May 1, 2012, and each month thereafter,312the agency shall certify to the Department of Revenue by the 7th313day of each month the amount of the monthly statement rendered314to each county pursuant to subsection (4). Beginning with the315May 2012 distribution, the Department of Revenue shall reduce316each county’s monthly distribution pursuant to s.218.61by the317amount certified by the agency minus any amount required under318paragraph (b). The amounts by which the distributions are319reduced shall be transferred to the General Revenue Fund.320(b) As an assurance to holders of bonds issued before the321effective date of this act to which distributions made pursuant322to s.218.61are pledged, or bonds issued to refund such bonds323which mature no later than the bonds they refunded and which324result in a reduction of debt service payable in each fiscal325year, the amount available for distribution to a county shall326remain as provided by law and continue to be subject to any lien327or claim on behalf of the bondholders. The Department of Revenue328must ensure, based on information provided by an affected329county, that any reduction in amounts distributed pursuant to330paragraph (a) does not reduce the amount of distribution to a331county below the amount necessary for the timely payment of332principal and interest when due on the bonds and the amount333necessary to comply with any covenant under the bond resolution334or other documents relating to the issuance of the bonds. If a335reduction to a county’s monthly distribution must be decreased336in order to comply with this paragraph, the Department of337Revenue must notify the agency of the amount of the decrease and338the agency must send a bill for payment of such amount to the339affected county.340(10) The agency, in consultation with the Department of341Revenue and the Florida Association of Counties, shall develop a342process for refund requests which:343(a) Allows counties to submit to the agency written344requests for refunds of any amounts by which the distributions345were reduced as provided in subsection (9) and which set forth346the reasons for the refund requests.347(b) Requires the agency to make a determination as to348whether a refund request is appropriate and should be approved,349in which case the agency shall certify the amount of the refund350to the department.351(c) Requires the department to issue the refund for the352certified amount to the county from the General Revenue Fund.353The Department of Revenue may issue the refund in the form of a354credit against reductions to be applied to subsequent monthly355distributions.356 (8)(11)Beginning in the 2013-2014 fiscal year and each 357 year thereafter through the 2020-2021 fiscal year, the Chief 358 Financial Officer shall transfer from the General Revenue Fund 359 to the Lawton Chiles Endowment Fund an amount equal to the 360 amounts transferred to the General Revenue Fund in the previous 361 fiscal year pursuant to subsections (4) and (7)subsections (8)362and (9), reduced by the amount of refunds paid pursuant to363subsection (10),which are in excess of the official estimate 364 for medical hospital fees for such previous fiscal year adopted 365 by the Revenue Estimating Conference on January 12, 2012, as 366 reflected in the conference’s workpapers. By July 20 of each 367 year, the Office of Economic and Demographic Research shall 368 certify the amount to be transferred to the Chief Financial 369 Officer. Such transfers must be made before July 31 of each year 370 until the total transfers for all years equal $350 million. If 371In the event thatsuch transfers do not total $350 million by 372 July 1, 2021, the Legislature shall provide for the transfer of 373 amounts necessary to total $350 million. The Office of Economic 374 and Demographic Research shall publish the official estimates 375 reflected in the conference’s workpapers on its website. 376 (9)(12)The agency may adopt rules to administer this 377 section. 378 Section 2. The Agency for Health Care Administration shall 379 provide a data report to the Florida Association of Counties 380 which includes such information as may be necessary for a 381 comprehensive evaluation of the cost and utilization of health 382 services by Medicaid enrollees in each county by service type. 383 The data report shall be provided at least annually at the 384 request of the association. Copies of the data report shall also 385 be provided to the Governor, the President of the Senate, and 386 the Speaker of the House of Representatives. The agency shall 387 provide other information and assistance requested by the 388 association in order to assess the impact on counties of the 389 changes to the methodology for determining county contributions 390 to Medicaid made by this act and to evaluate the impact of 391 various Medicaid policies, including the use of diagnosis 392 related groups on the reimbursement of hospital inpatient 393 services and the implementation of statewide managed care, 394 including managed long-term care. This section is repealed 395 December 31, 2015. 396 Section 3. Notwithstanding s. 409.915(3) and (4), Florida 397 Statutes, as amended by this act, the amount of each county’s 398 contribution during the 2013-2014 state fiscal year shall be 399 determined and provided to the Department of Revenue by the 400 Agency for Health Care Administration by June 15, 2013. The 401 Department of Revenue shall notify each county of its annual 402 contribution by June 20, 2013. 403 Section 4. This act shall take effect upon becoming a law.