Severity Level 1 ............................ 1.419
Severity Level 2 ............................ 1.419
Severity Level 3 ............................ 2.049
Severity Level 4 ............................ 2.363
Outlier Threshold ................................... $60,000
Free Standing Rehabilitation Provider Adjustor ...... 3.068
Rural Provider Adjustor ............................. 2.387
Long Term Acute Care (LTAC) Provider Adjustor ....... 2.159
High Medicaid Provider Adjustor ..................... 1.555
Marginal Cost Percentage ........................... 60%
Marginal Cost Percentage for Pediatric Claims
Severity Levels 3 or 4 ............................. 80%
Marginal Cost Percentage for Neonates Claims
Severity Levels 3 or 4 ............................. 80%
Marginal Cost Percentage for Transplant Pediatric
Claims Severity Levels 3 or 4 ...................... 80%
Documentation and Coding Adjustment (per year)....... 1/3 of 1%
Level I Trauma Add On ............................... 17%
Level II or Level II and Pediatric Add On ........... 11%
Pediatric Trauma Add On ............................. 4%
From the funds in Specific Appropriations 217, 219, and 223,
$36,221,134 from the General Revenue Fund and $48,665,516 from the
Medical Care Trust Fund are provided to nonprofit hospitals that as of
January 1, 2022, are separately licensed by the state as specialty
hospitals providing comprehensive acute care services to children
pursuant to section 395.002(28), Florida Statutes, as of the date of
enactment of this bill into law, and remain so licensed and qualify for
the High-Medicaid DRG and EAPG Policy Adjustor. Payments to these
hospitals must be distributed to qualifying hospitals proportionately
via average per claim (per discharge) amounts through the DRG and EAPG
payment method based on each hospital's total of Simulated DRG and
Trauma Add-On Payments plus Simulated EAPG payments to the total of
these payments for all qualifying hospitals. Payment of these funds to
an individual qualifying specialty hospital is contingent on that
hospital entering into full network contracts with each applicable
Medicaid managed care plan in the state by July 30, 2026, for a term of
the entire fiscal year at a minimum.
218 SPECIAL CATEGORIES
HOSPITAL INSURANCE BENEFITS
FROM GENERAL REVENUE FUND . . . . . 914,602
FROM MEDICAL CARE TRUST FUND . . . . 1,308,581
219 SPECIAL CATEGORIES
HOSPITAL OUTPATIENT SERVICES
FROM GENERAL REVENUE FUND . . . . . 23,825,303
FROM MEDICAL CARE TRUST FUND . . . . 56,991,368
FROM PUBLIC MEDICAL ASSISTANCE
TRUST FUND . . . . . . . . . . . . 20,768,022
FROM REFUGEE ASSISTANCE TRUST FUND . 4,712,489
From the funds in Specific Appropriation 219, the Agency for Health
Care Administration shall implement an Enhanced Ambulatory Patient
Grouping (EAPG) reimbursement methodology for hospital outpatient
services as directed in section 409.905(6)(b), Florida Statutes.
Ambulatory Surgical Center Base Rate......$233.77
Hospital Outpatient Base Rate.............$385.22
Rural Hospital Provider Adjustor...........1.5254
High Medicaid Provider Adjustor............2.0951
Documentation and Coding Adjustment............0%
220 SPECIAL CATEGORIES
OTHER FEE FOR SERVICE
FROM GENERAL REVENUE FUND . . . . . 170,383,331
FROM HEALTH CARE TRUST FUND . . . . 4,840,597
FROM GRANTS AND DONATIONS TRUST
FUND . . . . . . . . . . . . . . . 1,743,862
FROM MEDICAL CARE TRUST FUND . . . . 284,974,891
FROM REFUGEE ASSISTANCE TRUST FUND . 132,352,401
Funds in Specific Appropriation 220 are for the inclusion of
freestanding dialysis clinics in the Medicaid program. The Agency for
Health Care Administration shall limit payment to $125.00 per visit for
each dialysis treatment. Freestanding dialysis facilities may obtain,
administer and submit claims directly to the Medicaid program for