End-Stage Renal Disease pharmaceuticals subject to coverage and
limitations policy. All pharmaceutical claims for this purpose must
include National Drug Codes (NDC) to permit the invoicing for federal
and/or state supplemental rebates from manufacturers. Claims for drug
products that do not include NDC information are not payable by Florida
Medicaid unless the drug product is exempt from federal rebate
requirements.
From the funds in Specific Appropriation 220, the Agency for Health
Care Administration shall work with dialysis providers, managed care
organizations, and physicians to ensure that all Medicaid patients with
End Stage Renal Disease (ESRD) are educated and assessed by their
physician and dialysis provider to determine their suitability for all
types of home modalities. Further, the agency shall consult with the
dialysis community concerning suitable voluntary reporting to the state
Medicaid program on members' home modality suitability.
From the funds in Specific Appropriation 220, the Agency for Health
Care Administration shall apply a recurring methodology to establish
clinic services rates taking into consideration the reductions imposed
on or after October 1, 2008, in the following manner: (1) the agency
shall divide the total amount of each recurring reduction imposed by the
number of visits originally used in the rate calculation for each rate
setting period on or after October 1, 2008, which will yield a rate
reduction per diem for each rate period; (2) the agency shall multiply
the resulting rate reduction per diem for each rate setting period on or
after October 1, 2008, by the projected number of visits used in
establishing the current budget estimate which will yield the total
current reduction amount to be applied to current rates; and (3) in the
event the total current reduction amount is greater than the historical
reduction amount, the agency shall hold the rate reduction to the
historical reduction amount.
From the funds in Specific Appropriations 220 and 223, $400,000 from
the Grants and Donations Trust Fund and $537,481 from the Medical Care
Trust Fund are provided to buy back clinic services rate adjustments,
effective on or after July 1, 2008, and are contingent on the nonfederal
share being provided through grants and donations from state, county or
other governmental funds. Authority is granted to buy back rate
reductions up to, but not higher than, the amounts available under the
authority appropriated in this Specific Appropriation. In the event that
the funds are not available in the Grants and Donations Trust Fund, the
State of Florida is not obligated to continue reimbursements at the
higher amount.
From the funds in Specific Appropriations 220 and 235, $21,086,619
from the Grants and Donations Trust Fund and $28,334,179 from the
Medical Care Trust Fund are provided to buy back hospice rate
reductions, effective on or after January 1, 2008, and are contingent on
the nonfederal share being provided through nursing home quality
assessments. Authority is granted to buy back rate reductions up to, but
no higher than, the amounts available under the budgeted authority in
this Specific Appropriation. In the event that the funds are not
available in the Grants and Donations Trust Fund, the State of Florida
is not obligated to continue reimbursements at the higher amount.
From the funds in Specific Appropriation 220, $24,990,000 from the
Medical Care Trust Fund is provided for the Florida Assertive Community
Treatment (FACT) Team Services as a Medicaid state plan covered service.
Medicaid coverage for the FACT Team Services is contingent on the
availability of state matching funds of $10,662,608 from the Medical
Care Trust Fund being provided in Specific Appropriation 390.
The Agency for Health Care Administration is authorized to seek federal
authority to expend funds from the Grants and Donations Trust and
Medical Care Trust Fund to implement fee-for-service inpatient and
outpatient supplement payments for specialty hospitals providing
comprehensive acute care services to children that as of January 1,
2022, are (i) separately licensed by the state pursuant to section
395.002(28), Florida Statutes,(ii) are in Medicaid Regions I or E, and
(iii) are defined as IPPS Exempt CHG ME children's hospitals by the
federal government. The Agency is authorized to submit a budget
amendment requesting the spending authority to implement the FFS
supplemental payment program, which will be excluded from the
calculation of the prepaid plan per member per month payments. The
budget amendment must include a proposed distribution model by entity
and a proposed listing of entities contributing intergovernmental