$314,375 and $50,607; adult heart transplants $207,406 and $41,406;
adult liver $146,606 and $41,406; and intestinal/multi-visceral
transplants $690,092 and $76,677. The payments shall be used to pay
approved transplant facilities global facility and physician fees for
providing these transplant services to Medicaid beneficiaries. The
agency is authorized to seek any federal waiver or state plan amendment
necessary to implement this provision.
From the funds in Specific Appropriations 204 and 207, the criteria
for the High Medicaid Provider Adjustor shall be hospitals with Medicaid
utilization equal to or greater than 50 percent.
From the funds in Specific Appropriation 204, the Agency for Health
Care Administration shall continue a Diagnosis Related Grouping (DRG)
reimbursement methodology for hospital inpatient services as directed in
section 409.905(5)(c), Florida Statutes.
Base Rate............................................ 3,551.33
Neonates Service Adjustor Severity Level 1 .......... 1.0
Neonates Service Adjustor Severity Level 2 .......... 1.52
Neonates Service Adjustor Severity Level 3 .......... 2.310
Neonates Service Adjustor Severity Level 4 .......... 2.310
Neonatal, Pediatric, Transplant Pediatric, Mental
Health and Rehab DRGs:
Severity Level 1 ............................ 1.0
Severity Level 2 ............................ 1.52
Severity Level 3 ............................ 2.310
Severity Level 4 ............................ 2.310
Normal Newborn DRGs:
Severity Level 1 ............................ 1.419
Severity Level 2 ............................ 1.419
Severity Level 3 ............................ 2.049
Severity Level 4 ............................ 2.363
Obstetrics DRGs:
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 ...... 3.082
Rural Provider Adjustor ............................. 2.373
Long Term Acute Care (LTAC) Provider Adjustor ....... 2.319
High Medicaid Provider Adjustor ..................... 1.916
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 204, 207, and 211,
$37,078,489 from the General Revenue Fund and $47,808,161 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, 2025, for a term of
the entire fiscal year at a minimum.
205 SPECIAL CATEGORIES
REGULAR DISPROPORTIONATE SHARE
FROM GENERAL REVENUE FUND . . . . . 6,545,351
The funds in Specific Appropriation 205 are provided to the Agency