County Medicaid Contributions Heather Wildermuth 3/15/12
Dec 14, 2015
Agenda
• Introduction– Chris Holley
• Explanation of the backlog and HB 5301– Heather Wildermuth
• Medicaid Veto Plan– Cragin Mosteller
• Medicaid Legal Discussion– Ginger Delegal
• Conclusion– John Wayne Smith
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County Medicaid Contributions – SB 1988 and HB 5301
• Medicaid Budget Conforming Bill.
• Adds the children of state employees among those eligible for Florida KidCare.
• Directs the Department of Children and Families and the Agency for Health Care Administration to work cooperatively to develop a new system of eligibility determination for Medicaid and the Children’s Health Insurance Program consistent with federal and state laws.
• Limits payment for emergency room services for non-pregnant Medicaid recipients 21 years of age or older to 6 visits per fiscal year.
• Significantly amends Sec. 409.915, F.S., County Contributions to Medicaid.
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County Medicaid Contributions (Continued)
• Removes the requirement that the state work “in consultation” with the counties to determine who is an “eligible recipient” of that county.
• Stipulates that each county’s eligible recipients will be determined by the address contained in the Medicaid eligibility system maintained by DCF.
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County Medicaid Contributions - Backlog
• By August 1, 2012, AHCA must certify each county’s “backlog” which includes disputed bills occurring between November 1, 2001 – April 30, 2012.
• Each county has 1 month after certification (September 1, 2012) to contest the certified amount.
• This procedure is the exclusive method to challenge the amount certified.
• Burden of proof – A preponderance of the evidence.
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County Medicaid Contributions (Backlog Continued)
• By September 15, 2012, AHCA will certify to the Department of Revenue:
– For each county that files a petition the total amount certified.– For each county that does not file a petition, an amount equal to 85%
of the total amount certified.
• Filing a petition will not stay or stop the DOR from reducing your revenue sharing.
• If you are able to demonstrate that the amount certified should be reduced, AHCA will notify DOR of the amount of the reduction. DOR will adjust all future monthly distributions in a manner that results in the remaining total being applied in equal monthly amounts.
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County Medicaid Contributions (Backlog Continued)
• For 12 months beginning with the October 2012 distribution, DOR will reduce each county’s revenue sharing by a third of the amount certified.
• The remaining two-thirds will be spread over 4 years, beginning with the October 2013 distribution. In total, counties will be paying on the backlog for 5 years.
• The state cannot withhold more than 50% of your revenue sharing due to bonding issues.
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Questions?
The phone will be taken off mute for questions on the backlog.
The prospective payments will be covered in the next section.
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County Medicaid Contributions - Prospective Payments
• Beginning May 1, 2012, AHCA will certify to DOR by the 7th of each month the amount of the monthly Medicaid statement for each county.
• DOR will reduce your ½ cent sales tax distribution by that certified amount.
• Again, there are provisions to ensure that each county can make timely bond payments if that situation exists.
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County Medicaid Contributions – Credits
• AHCA, DOR and FAC will work in consultation to develop a process for “refund” requests which: – Allows counties to submit a written refund request to the
Agency.
– Requires that the Agency determine whether the refund is appropriate and should be approved. Once approved, they will certify the refund to DOR.
– Requires DOR to issue a refund for the certified amount to the county from GR. The “refund” is issued in the form of a credit against reductions to be applied to subsequent monthly distributions.
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County Medicaid Contributions – New Authority
• The Agency is now authorized to adopt rules to administer this section of law.
• New authority in Section 13 of the bill includes the following:
The Agency for Health Care Administration and the Department of Children and Family Services, in consultation with hospitals and nursing homes that serve Medicaid recipients, shall develop a process to update a recipient's address in the Medicaid eligibility system at the time a recipient is admitted to a hospital or nursing home. If a recipient's address information in the Medicaid eligibility system needs to be updated, the update shall be completed within 10 days after the recipient's admission to a hospital or nursing home.
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Medicaid Veto Plan
• Veto letters• Veto video• Veto website• Member support– County resolutions– Sample veto letters
• Op-Ed
• Ongoing media push for editorials– Local reporters
• Action Items– Send sample veto
letter– Talk to reporters
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Questions?
The phone will be taken off mute for questions on public relations attempts to veto bill.
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