Bill Summary – FastDemocracy

HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #:     HB 5305      PCB HCA 23-03 Medicaid Reimbursement for Nursing Home Care
SPONSOR(S): Health Care Appropriations Subcommittee, Garrison
TIED BILLS:       IDEN./SIM. BILLS:
  REFERENCE                                                   ACTION                  ANALYST            STAFF DIRECTOR or
                                                                                                         BUDGET/POLICY CHIEF
  Orig. Comm.: Health Care Appropriations                     13 Y, 0 N               Smith              Clark
     Subcommittee
  1) Appropriations Committee                                 26 Y, 0 N               Smith              Pridgeon
                                             SUMMARY ANALYSIS
The bill conforms statutes to the funding decisions related to Health Care included in the House proposed
General Appropriations Act (GAA) for Fiscal Year 2023-2024.
On October 1, 2018, Florida Medicaid nursing homes transitioned from facility-specific cost based rates to the
prospective rate reimbursement methodology, which determines rates in advance of payment. The
methodology includes a parameter for Quality Incentive Payment for providers of up to 6 percent of the
September 2016 non-property related payments of included facilities.
The bill modifies the parameters governing the nursing home prospective payment methodology for Medicaid
provider reimbursement to increase the quality incentive payment pool parameter from 6 percent to 9 percent.
The bill has an effective date of October 1, 2023.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h5305a.APC
DATE: 3/28/2023
                                                              FULL ANALYSIS
                                                      I. SUBSTANTIVE ANALYSIS
    A. EFFECT OF PROPOSED CHANGES:
          Background
          Nursing Home Prospective Payment System
          On October 1, 2018, Florida Medicaid nursing homes transitioned from facility-specific cost based rates
          to the prospective rate reimbursement methodology, which determines rates in advance of payment.
          Section 409.908, F.S., provides the methodology1 and parameters for rate setting including
          reimbursement rates for direct care, indirect care, and operating costs.
          The methodology includes a parameter for a Quality Incentive Payment, in which a provider is awarded
          points for process, outcome, structural and credentialing measures using most recently reported data
          on May 31 of the rate period year.2
          The Quality Incentive Payment calculation3 is as follows:
             Facility Annualized           Quality Points with
               Medicaid Days                  Lower Limit                  Total Quality Budget
                                       X                           X
             Average Annualized           Sum of Total Points               Facility Annualized
               Medicaid Days             Awarded to All Facilities            Medicaid Days
          Payment amounts are limited to 6 percent of the September 2016 non-property related payments of
          included facilities.4
          Effect of the Bill
          The bill modifies the parameters governing the nursing home prospective payment methodology for
          Medicaid provider reimbursement to increase the quality incentive payment pool from 6 percent to 9
          percent.
          The bill has an effective date of October 1, 2023.
    B. SECTION DIRECTORY:
         Section 1:          Amends s. 409.908, F.S., relating to reimbursement of Medicaid providers.
         Section 2:          Providing an effective date of October 1, 2023.
                                II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
    A. FISCAL IMPACT ON STATE GOVERNMENT:
         1. Revenues:
              None.
         2. Expenditures:
1
  Nursing Home Prospective Payment System Calculation: (Operating Price + Direct Care Price - Floor Reduction + Indirect Care Price - Floor Reduction
+ FRVS Rate + Pass Through Payments) * Budget Neutrality Factor + Quality Incentive Payment + Medicaid Share of NFQA + Ventilator Supplemental
Payment + High Medicaid Utilization and High Direct Patient Care Add-On)) + Unit Cost Rate Increase
2
  R. 59G-6.010(2)(y), F.A.C.
3 Id.
4
  S. 409.908(2)(e), F.S. (2022).
STORAGE NAME: h5305a.APC                                                                                                                     PAGE: 2
DATE: 3/28/2023
           The bill conforms to PCB APC 23-01, the proposed Fiscal Year 2023-2024 House of
           Representatives’ General Appropriations Act, which provides $38,699,826 from the General
           Revenue Fund and $56,822,005 from the Medical Care Trust Fund for the Quality Incentive
           Payment Pool parameter percentage increase.
   B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
       1. Revenues:
           None.
       2. Expenditures:
           None.
   C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
       None.
   D. FISCAL COMMENTS:
       None.
                                              III. COMMENTS
   A. CONSTITUTIONAL ISSUES:
       1. Applicability of Municipality/County Mandates Provision:
          None.
       2. Other:
          None.
   B. RULE-MAKING AUTHORITY:
       None.
   C. DRAFTING ISSUES OR OTHER COMMENTS:
       None.
                           IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
               None.
STORAGE NAME: h5305a.APC                                                                              PAGE: 3
DATE: 3/28/2023
Statutes affected: 
H 5305 Filed: 409.908