CopyCited 27 times | Published | Court of Appeals for the Eleventh Circuit | 1997 U.S. App. LEXIS 6506, 1997 WL 131320
...facilities, drugs, nursing care, and all supplies and equipment
necessary to provide care (Pretrial Stipulation, Doc. 89). There
9
See 42 U.S.C. §§ 1396d(a)(16), 1396d(h); Fla.Admin.Code
Ann. r. 59G-4.080 (1994). See generally Fla.Stat. § 409.905(2)
(the state "shall pay for early and periodic screening and
diagnosis of a recipient under age 21 to ascertain ... mental
problems and conditions and provide treatment to correct or
ameliorate these problems and conditions....").
10
See Fla.Stat. § 409.905(1); Fla.Admin.Code Ann....
CopyCited 17 times | Published | District Court, S.D. Florida | 1996 U.S. Dist. LEXIS 16703
...Home health care is an optional service. Id. Florida has elected to cover Home Health Care Services and Early and Periodic Screening, Diagnosis, and Treatment Services, both of which include durable medical equipment, as Mandatory Medical Services. Fla.Stat. § 409.905(4), (2) (1996)....
...Thus, Iowa cannot arbitrarily exclude electronic speech devices from coverage under its Medicaid program." Id. Although Florida Medicaid has not elected to provide "physical therapy and related services," it does provide the optional service of home health care. Fla.Stat. 409.905(4) (1996)....
CopyCited 10 times | Published | Florida 3rd District Court of Appeal | 2004 WL 444154
...§ 1320a-7b(b)(3)(B)(2000) protects employer-employee payments for the provision of covered items or services from criminal prosecution. The federal medicaid statutes require participating states to provide transportation to those eligible for dental services. 42 U.S.C. § 1396a(a)(43)(2000); § 409.905(12), Fla....
CopyCited 7 times | Published | Florida 5th District Court of Appeal | 2005 WL 3555898
...§ 1320a-7b(b)(3)(B)(2000) protects employer-employee payments for the provision of covered items or services from criminal prosecution. The federal medicaid statutes require participating states to provide transportation to those eligible for dental services. 42 U.S.C. *390 § 1396a(a)(43)(2000); § 409.905(12), Fla....
CopyCited 4 times | Published | Florida 1st District Court of Appeal | 1997 WL 402107
...Accordingly, any determination of whether UH was collaterally estopped by reason of its adoption of inconsistent positions is premature, and such issue cannot be correctly decided until after UH is accorded a section
120.57(1) hearing. REVERSED and REMANDED. BENTON, J., and SMITH, Senior Judge, concur. NOTES [1] See §
409.905(5), Fla....
CopyCited 3 times | Published | District Court, S.D. Florida | 1999 U.S. Dist. LEXIS 19622, 1999 WL 1249772
...states to provide motorized or customized wheelchairs to eligible Medicaid recipients. This is so because Florida has voluntarily elected to provide wheelchairs as part of its "home health care," an optional service under the Medicaid Act. Fla.Stat. § 409.905(4) ("[t]he agency shall pay for ......
CopyCited 2 times | Published | Florida 1st District Court of Appeal
...for Medicaid reimbursement. The form and effect of issuance of a single license in these instances are not appropriate subjects for a writ of mandamus. Accordingly, the orders on appeal are quashed. BARFIELD, ALLEN and DAVIS, JJ., concur. NOTES [1] Section 409.905(5), Florida Statutes (Supp....
CopyCited 2 times | Published | Florida 1st District Court of Appeal | 2006 Fla. App. LEXIS 13199, 2006 WL 2251885
...ole or in part, or if an assistance payment is modified or canceled." §
409.285(1). It appears that the resumption in developmental service J.M. sought is precisely the kind of public assistance section
409.285 was designed to address. For example, section
409.905(15), Florida Statutes (2005), provides that the Agency for Health Care Administration "may pay for health-related care and services provided on a 24-hour-a-day basis by a facility licensed and certified as a Medicaid Intermediate Care...
CopyCited 1 times | Published | Florida 1st District Court of Appeal | 1996 Fla. App. LEXIS 2228, 1996 WL 100793
...request of a licensee, issue a single license to a licensee for facilities located on separate premises. Such a license shall specifically state the location of the facilities, the services, and the licensed beds available on each separate premises. Section 409.905(5), Florida Statutes (Supp....
CopyPublished | District Court of Appeal of Florida
(d). The hearing officer also stated that section
409.905(2), Florida Statutes, limits EPSDT services
CopyPublished | Florida 4th District Court of Appeal
...to correct or ameliorate
defects and physical and mental illnesses and conditions . . . .” The
hearing officer stated, however, that “a state may place medical necessity
limitations on EPSDT services,” citing 42 C.F.R. §§ 440.230(a), (b), (d). The
hearing officer also stated that section 409.905(2), Florida Statutes, limits
EPSDT services with a medical necessity standard.
Turning to the instant case, the hearing officer concluded that the child
had not met AHCA’s prior authorization criteria for hormone treatment
becau...
...ion, or amelioration
of these problems and conditions, including personal care,
private duty nursing, durable medical equipment, physical
therapy, occupational therapy, speech therapy, respiratory
therapy, and immunizations.
§ 409.905(2), Fla....
...ing this child’s growth
delay or medical condition as required by the Medicaid program. While
the majority asserts that the hearing officer applied the wrong standard
for medical necessity, the hearing officer cited the correct EPSDT standard
from section 409.905(2), Florida Statutes (2019), and acknowledged that
because the child is under the age of 21, “Florida Medicaid would cover
the request if it were medically necessary.” As reasoned in the seminal
8Prior to the establishment of the U.S....
CopyPublished | District Court of Appeal of Florida
(d). The hearing officer also stated that section
409.905(2), Florida Statutes, limits EPSDT services
CopyPublished | Florida 1st District Court of Appeal | 2007 Fla. App. LEXIS 16856, 2007 WL 3118625
...ailed to meet its burden of proof that the reduction of hours was warranted. As a minor child receiving Medicaid services, Appellant qualifies for Early and Periodic Screening, Diagnosis, and Treatment Services (EPSDT), a mandatory Medicaid service. § 409.905(2), Fla....
CopyPublished | Florida 1st District Court of Appeal
...Statutes
The relevant statutes are part of Florida’s Social Welfare Act,
chapter 409 of the Florida Statutes. In pertinent part, the Act
implements obligations imposed on Florida by Title XIX of the
federal Social Security Act, including the healthcare obligations at
issue here. Portions of sections
409.905 and
409.913, Florida
Statutes, are controlling.
(A) 2019 Version of Section
409.905(5)(a)
In 2019, when we issued Gulf Coast, section
409.905(5)(a)
provided in pertinent part as follows:
(a) The agency may implement reimbursement and
utilization management reforms in order to comply with
any limitations or directions in the General
Appropriations Act,...
...e request.
Authorization procedures must include steps for review
of denials. Upon implementing the prior authorization
program for hospital inpatient services, the agency shall
discontinue its hospital retrospective review program.
§ 409.905(5)(a), Fla. Stat. (2019) (emphasis added).
(B) 2020 Version of Section 409.905(5)(a)4
In 2020, the legislature amended section 409.905(5)(a) to
provide in pertinent part as follows:
Upon implementing the prior authorization program for
hospital inpatient services, the agency shall discontinue
its hospital retrospective review program....
...from conducting retrospective reviews under s.
409.913,
including, but not limited to, reviews in which an
overpayment is suspected due to a mistake or submission
of an improper claim or for other reasons that do not rise
to the level of fraud or abuse.
§
409.905(5)(a)4., Fla....
...d on its own error in
determining the existence or duration of the emergency medical
condition—the very question we resolved adverse to the Agency in
Gulf Coast.
NBH sought summary judgment as to liability, arguing that
the 2020 amendment to section
409.905(5) is consistent with Gulf
Coast and does not abrogate it. NBH advanced three arguments.
First, section
409.905(5)(a) still precludes the Agency from
conducting general retrospective reviews of previously authorized
claims. Second, the legislature did not amend section
409.913 to
give the Agency new authority to conduct general retrospective
reviews of previously authorized claims, but rather clarified that
section
409.905(5)(a) did not limit the Agency’s existing authority
under section
409.913....
...In support, the Agency
relied on the amendment’s legislative history and the close
temporal proximity between issuance of the Gulf Coast opinion
and the statutory amendment.
In the order on appeal, the trial court agreed with the Agency,
concluding that the legislature amended section 409.905(5)(a) to
abrogate Gulf Coast....
...existing law”; (2) the close proximity between the decision in Gulf
Coast and the legislature’s enactment of the clarifying legislation;
and (3) the legislative history, which was “consistent with the plain
language of the amended statute and confirm[ed] that Section
409.905(5)(a) shall not operate to bar [the Agency] ‘from
conducting retrospectives review under s....
...amendments, it should have been far more direct and clear in
doing so. We cannot be left to guess what the legislature intended
but did not say.
The actual legislative changes do not support the Agency’s
statutory-interpretation arguments. In 2019, section 409.905(5)
provided in pertinent part as follows:
The agency may implement reimbursement and
utilization management reforms to comply with any
limitations or directions upon the General
Appropriations Act . . . Upon implementing the prior
authorization program for hospital inpatient services, the
agency shall discontinue its hospital retrospective review
program.
§ 409.905(5)(a), Fla....
...spective reviews
under s.
409.913, including, but not limited to, reviews in
which an overpayment is suspected due to a mistake or
submission of an improper claim or for other reasons that
do not rise to the level of fraud or abuse.
§
409.905(5)(a)1., 4., Fla....
...only
under listed circumstances; i.e., claims not previously reviewed
(not a pre-authorized claim) where fraudulent acts are suspected,
among other reasons.
272 So. 3d at 438–39 (emphasis added). We
explained this point as follows:
[S]ection
409.905’s prohibition only applies to hospital
inpatient services that are subject to prior authorization
review, [and] the ALJ’s interpretation leaves intact the
Agency’s authority to conduct retrospective reviews for
all other...
...nd the Agency’s authority
to conduct retrospective reviews of previously authorized claims to
review issues that did not rise to the level of fraud or abuse. It did
not abrogate Gulf Coast. The amendment incorporated the holding
of Gulf Coast into section 409.905....
...v. Tampa Bay Downs, Inc.,
948 So. 2d 599, 606 (Fla.
2006). Applying the trial court’s interpretation of the amended
statute, the prohibition against the Agency’s conducting general
retrospective reviews of previously authorized claims set out in
section
409.905(5)(a)—which the legislature implemented in 2002
and chose not to repeal in the 2020 amendment—is improperly
rendered meaningless....
...effect to the Legislature’s intent.” Zold v. Zold,
911 So. 2d 1222,
1229–30 (Fla. 2005). In effect, the trial court’s interpretation of the
amended statute renders meaningless the intentional limitations
on the Agency’s authority to conduct retrospective reviews under
sections
409.905(5)(a) and
409.913.
The Agency concedes that the statutory limitations regarding
its retrospective-audit authority remain, and that the amended
statute clarifies that per section
409.913, it may conduct
retrospective reviews on non-pre-authorized claims “in which an
overpayment is suspected ....
...are incorrect is the scope of the Agency’s authority under section
409.913 and, more specifically, whether previously authorized
claims meet the definition of “overpayment.” Gulf Coast held they
did not. The Agency asserts that the legislature’s 2020 amendment
to section
409.905(5)(a), responds to Gulf Coast, where this Court
held that retrospective audits are allowed only “in the context of
claims not previously reviewed and where fraudulent acts are
suspected ....
...abuse and had nothing to do with recipient neglect, the only
remaining authority is where an overpayment is suspected. Gulf
Coast, however, already dealt with the authority to conduct audits
based on overpayment.
The Agency admits that the “Legislature retained the
sentence in section 409.905(5)(a) prohibiting retrospective
reviews” that Gulf Coast relied upon to conclude that it did not
have the authority to conduct general retrospective reviews of
prior-authorized claims. On this concession, the trial court’s ruling
that the amended statute abrogated this Court’s interpretation of
section 409.905(5)(a) cannot be accepted....
...authority, but rather reiterating its limits. §
409.913(1)(e), Fla.
Stat. Importantly, this clarification has no bearing on this case, as
all of the AAP claims were pre-authorized.
The trial court erred in applying an interpretation that is
inconsistent. It concluded that section
409.905(5)(a)(4), as
amended, bars the Agency from conducting a general retrospective
review program for previously authorized claims, but that under
section 409.13, the general authority to do so is given back....
...e not enacted into law
and that are inconsistent with the plain language of the amended
statute. The trial court adopted the Agency’s position, as reflected
in both Legislative Analyses, that Gulf Coast relied “‘on an obsolete
reference’ in [section 409.905(5)(a)]” limiting retroactive audits
that applied to a hospital prepayment review program that no
longer exists” and, because of that, the legislature intended to
abrogate Gulf Coast....
...legislative history to determine legislative intent.” Bautista v.
State,
863 So. 2d 1180, 1185–86 (Fla. 2003) (citing Joshua v. City
of Gainesville,
768 So. 2d 432, 435 (Fla. 2000)).
To the extent the trial court relied upon legislative history to
conclude that section
409.905(5)(a)4. was intended to abrogate
Gulf Coast, it is misplaced. Citing this Court’s decision in Gulf
Coast, the final bill analysis prepared by House of Representatives
staff indicated that “the First District Court of Appeal ruled that
s.
409.905(5)(a), F.S., precludes post-payment audits, including the
Alien Audit Program audits, to determine the appropriateness of
reimbursement, including whether prior authorization was
obtained under false pretenses.” Notably, this statement is
incorrect. In Gulf Coast, we held that section
409.905(5)(a) only
precluded general retrospective audits to determine the
appropriateness of reimbursement for pre-authorized hospital
inpatient services, and that section
409.913 allowed retrospective
audits where prior authorization was obtained under false
pretenses. The final bill analysis then noted that “the directive in
s.
409.905(5)(a), F.S., to discontinue an inpatient retrospective
review program was intended to refer to a specific program
conducted in the Division of Medicaid when the Division shifted to
a prior authorization review.” The analysis then stated,...
...[the Agency] may conduct reviews to determine fraud, abuse and
overpayment in the Medicaid program.” We agree with NBH that
referring is the statutory bar precluding the Agency from
conducting general retrospective reviews of previously authorized
claims, which was added to section 409.905(5)(a) in 2002 and
remains in the amended statute....
...28, 2020).
14
this is another misstatement because the “obsolete” language was
retained in the final bill. Moreover, this analysis was carried over
word-for-word from the staff analyses of prior versions of the bill,
which proposed several amendments to section 409.905(5)(a) that
did not survive to the final bill.
It is even more difficult to give substance to the concluding
sentence of the final bill analysis that “MPI [the Agency’s Bureau
of Medicaid Program Integrity] would be able [to] continue
conducting respective reviews of hospital claims.” We agree with
NBH that alternatively, based on the actual language contained in
the final bill, the trial court erred in entering summary judgment
for the Agency upon concluding that section 409.905(5)(a)4.
abrogated Gulf Coast and allowed the Agency to conduct
retrospective audits of paid Medicaid claims to recover
overpayments for pre-authorized hospital inpatient emergency
services to undocumented immigrants.
IV. Conclusion
The 2020 amendments to section 409.905 did not abrogate
Gulf Coast but serve only to clarify exiting law....
CopyPublished | Florida 1st District Court of Appeal
...did not preclude a challenge on the rates prior to auditing. The Petitioners claimed AHCA’s position could result in a denial of a meaningful point of entry to challenge the rates established. Petitioners maintain that argument here. AHCA filed a Suggestion of Mootness on Nov. 3, 2016, arguing that per section 409.905(6)(b)l., Florida Statutes (2016), the pending petitions were moot....
...* # * Furthermore, even assuming arguen-do Petitioners are entitled to challenge 'the unaudited rates as a substantially affected party under chapter 120,' Florida Statutes, the Agency lacks the jurisdiction and authority to grant Petitioners the relief, they seek, i.e. the adjustment of their rates. Section 409.905(6)(b)l., Florida Statutes, prohibits the , Agency .from making any adjustments to Petitioners’ rates “after October 31 of the state fiscal year in which- the rates- take effect....” For the- rates .at issue, this, date has already passed....
...At the same time, the -statute does not preclude, either explicitly or implicitly, formal administrative challenge to the Medicaid reimbursement rates set by AHCA prior to agency auditing. The statute simply does not speak to pre-audit period. AHCA has argued that section 409.905(6)(b)l, provides that AHCA cannot change its reimbursement rate after October 31 of the fiscal year in which the rates take effect....
...In part, the Final Order states: Even assuming arguendo Petitioners are entitled to challenge the unaudited rates as a substantially affected party under chapter 120, Florida Statutes, the Agency lacks the jurisdiction and authority to grant Petitioners the relief they seek, i.e., the adjustment of their rates. Section 409.905(6)(b)l., Florida Statutes, prohibits the Agency from making any adjustments to Petitioners’ rates ‘after October 31 of the state fiscal year in which the rates take effect ......
...Thus, in the Final Order, AHCA appears to take two incompatible positions with regard to the 2016 legislative scheme: (i) rates can only be challenged after an audit, and (ii) rate challenges can only occur before October 31st. Obviously, such contrary arguments are untenable, and result from a misreading of the statute. Section 409.905(6)(b)l....
...But, it is also true that a reviewing court will not depart from “the contemporaneous construction of a statute by a state agency charged with its enforcement unless the construction is ‘dearly erroneous.’” Id. (quoting PW Ventures, Inc. v. Nichols,
533 So.2d 281, 283 (Fla. 1988)). AHCA’s interpretation of section
409.905(6)(b)l....
CopyPublished | Florida 1st District Court of Appeal
Mootness on Nov. 3, 2016, arguing that per section
409.905(6)(b)1., Florida Statutes (2016), the pending
CopyPublished | District Court, S.D. Florida | 2011 U.S. Dist. LEXIS 151075, 2011 WL 6938381
...42 C.F.R. § 440.230 (d) (2011) (allowing the state agency to “place appropriate limits on a service based on such criteria as medical necessity”). Florida law authorizes AHCA to determine which services are “medically necessary.” Fla. Stat. § 409.905 (2) (2011)....
...mental or investigational.” Fla Admin. Code Ann. r. 59G-1.010(166)(a)3 (2011). Therefore, if AHCA determines that a treatment is “experimental,” the treatment is properly excluded from Medicaid coverage in Florida. See id.; see also Fla. Stat. § 409.905 (2); Rush v....
CopyPublished | District Court of Appeal of Florida | 1996 Fla. App. LEXIS 2233
...gibility for Medicaid reimbursement. The form and effect of issuance of a single license in these instances are not appropriate subjects for a writ of mandamus. Accordingly, the orders on appeal are quashed. BARFIELD, ALLEN and DAVIS, JJ., concur. . Section 409.905(5), Florida Statutes (Supp....
CopyPublished | Florida 3rd District Court of Appeal | 2012 Fla. App. LEXIS 3162, 2012 WL 637911
...Federal and state EPSDT mandates provide “necessary health care, diagnostic services, treatment, and other measures [... ] to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan.” Id. See also § 409.905(2), Fla....
CopyPublished | Florida 1st District Court of Appeal
...Gulf Coast argues the
Agency was without authority to order reimbursement as it was
barred from conducting retrospective audits on claims for
emergency in-patient services that were pre-authorized and paid.
We agree and reverse.
I. FACTS
In 2002, exercising authority under section 409.905(5)(a),
Florida Statutes, the Agency implemented a mandatory pre-
authorization program regarding Medicaid hospital in-patient
services, including emergency services provided to undocumented
alien recipients....
...1st DCA 2009) (“Judicial deference never requires
that courts adopt an agency’s interpretation of a statute or rule
when the agency’s interpretation cannot be reconciled with the
plain language of the statute. . .”).
A. Retrospective Review is Contrary to the Plain Language of
Section 409.905(5)(a), Florida Statutes.
Section 409.905 was amended to provide the Agency, for the
first time, the authority to condition payment for inpatient
hospital services upon a pre-payment review, which was referred
to as prior authorization....
...ly with any
limitations or directions in the General Appropriations
Act . . . Upon implementing the prior authorization
program for hospital inpatient services, the agency shall
discontinue its hospital retrospective review program.
§ 409.905(5), Fla....
...s
referred to its MPI office, which only conducted reviews on claims
that appeared to be outliers or had abnormal billing patterns.
MPI’s function was to investigate possible Medicaid abuse; MPI
did not conduct general retrospective reviews.
Section 409.905, clearly advises that for hospital inpatient
services, upon implementing the new authorization program, “the
agency shall discontinue its hospital retrospective review program.”
§ 409.905(5)(a), Fla....
...ud or abuse
and contrary to the plain reading of the statute.
Thus, the ALJ’s conclusion that the Agency’s retrospective
audit on claims for emergency in-patient services provided to
undocumented aliens was the type of review prohibited by section
409.905(5)(a) is not only supported by a plain reading of the
statute, but is also supported by the record evidence of the
Agency’s claim review history. The Agency acknowledges that the
Project was a review of all inpatient claims for undocumented
aliens, but it opines section 409.905(5)(a) is not controlling because
the retrospective review was conducted by MPI. Yet, the statute
does not distinguish among the Agency’s different offices nor does
4 Of note, the prohibition of section 409.905(5)(a) applies only
to claims for in-patient hospital services....
...audit being conducted. Here, the plain reading of the statute
makes clear that the Agency is barred from conducting general
retrospective reviews of claims, which the Project commanded. 5
We find no ambiguity in the prohibition on retrospective review in
section 409.905(5)(a).
B....
...expected to simultaneously investigate the provider for possible
wrongdoing, such as fraud or misrepresentation. These matters
are clearly distinguishable, and such matters may be explored by
the Agency retrospectively in connection with adjudicated claims.
In that section 409.905’s prohibition only applies to hospital
inpatient services that are subject to prior authorization review,
the ALJ’s interpretation leaves intact the Agency’s authority to
conduct retrospective reviews for all other matters, incl...
...
of an emergency medical condition and deny payment for medical
services falling outside its determined timeline – a determination
not usurping that of DCF under “eligibility” review. This issue
need not be addressed as it is rendered moot by section
409.905(5)(a), which clearly forbids retrospective reviews of paid
inpatient hospital claims for undocumented aliens....
...CONCLUSION
In conclusion, the Agency erroneously relied upon section
409.913 as providing it authority to conduct general retrospective
reviews of claims for emergency in-patient services provided to
undocumented aliens that had previously been authorized and
paid. The plain language of section
409.905(5)(a), as well as the
Agency’s claim review history, specifically bars such retrospective
reviews....
CopyPublished | Florida 1st District Court of Appeal
...Appellant, Lee Memorial Health System, challenges a final order issued by the Agency for Health Care Administration ("AHCA"), finding it was overpaid with Medicaid funds for services provided to undocumented aliens. As AHCA is barred from conducting a retrospective review of prior authorized claims pursuant to section 409.905(5)(a), Florida Statutes, the Final Order is reversed and no overpayment is owed by Appellant....
CopyPublished | Florida 1st District Court of Appeal
review of prior authorized claims pursuant to section
409.905(5)(a), Florida Statutes, the Final Order is
CopyPublished | Florida 1st District Court of Appeal
review of prior authorized claims pursuant to section
409.905(5)(a), Florida Statutes, the Final Order is
CopyPublished | Florida 1st District Court of Appeal
review of prior authorized claims pursuant to section
409.905(5)(a), Florida Statutes, the Final Order is
CopyPublished | District Court of Appeal of Florida
review of prior authorized claims pursuant to section
409.905(5)(a), Florida Statutes, the Final Order is
CopyPublished | Florida 1st District Court of Appeal
...order issued by the Agency for Health Care Administration
(“AHCA”), finding it was overpaid with Medicaid funds for services
provided to undocumented aliens. As AHCA is barred from
conducting a retrospective review of prior authorized claims
pursuant to section 409.905(5)(a), Florida Statutes, the Final
Order is reversed and no overpayment is owed by Appellant....
CopyPublished | Florida 1st District Court of Appeal | 2016 WL 1295045, 2016 Fla. App. LEXIS 5171
...cal care expenses. See 42
U.S.C. § 1396a(r)(1)(A); 42 C.F.R. § 435.725(c)(4)(ii) (2012). See also Fla. Admin
Code R. 65A-1.7141(1)(g). The program then covers the difference between a
beneficiary’s PRA and the facility’s monthly charge. See § 409.905(8), Fla....
CopyPublished | Florida 1st District Court of Appeal
...s, or making any other adjustments necessary to comply with the availability of moneys and any limitations or directions provided for in the General Appropriations Act, provided the adjustment is consistent with legislative intent. (Emphasis added.) Section 409.905, Florida Statutes, also gives the Agency the authority to make any adjustments necessary to comply with the funds allocated and which are consistent with directions set forth in the GAA. Specific to outpatient services, the statute directs, "[t]he agency shall implement a prospective payment methodology for establishing reimbursement rates for outpatient hospital services." § 409.905(6)(b), Fla....
...The language of the implementing statutes and the GAAs is clear and unambiguous. As the Final Order found, the GAAs unambiguously state that the Agency must "implement a recurring methodology in the [Outpatient Plan] ... to achieve the cost savings." Similarly, section
409.905(6)(b) requires the Agency to "implement a methodology" for establishing rates, and section
409.908 requires the Agency to reimburse Medicaid providers "according to methodologies set forth in the rules of the agency and in policy manu...
CopyPublished | Florida 1st District Court of Appeal
...s, or making any other adjustments necessary to comply with the availability of moneys and any limitations or directions provided for in the General Appropriations Act, provided the adjustment is consistent with legislative intent. (Emphasis added.) Section 409.905, Florida Statutes, also gives the Agency the authority to make any adjustments necessary to comply with the funds allocated and which are consistent with directions set forth in the GAA. Specific to outpatient services, the statute directs, "[t]he agency shall implement a prospective payment methodology for establishing reimbursement rates for outpatient hospital services." § 409.905(6)(b), Fla....
...The language of the implementing statutes and the GAAs is clear and unambiguous. As the Final Order found, the GAAs unambiguously state that the Agency must "implement a recurring methodology in the [Outpatient Plan] ... to achieve the cost savings." Similarly, section
409.905(6)(b) requires the Agency to "implement a methodology" for establishing rates, and section
409.908 requires the Agency to reimburse Medicaid providers "according to methodologies set forth in the rules of the agency and in policy manu...
CopyPublished | Florida 1st District Court of Appeal
...ustments
necessary to comply with the availability of moneys and
any limitations or directions provided for in the General
Appropriations Act, provided the adjustment is
consistent with legislative intent. (Emphasis added.)
Section 409.905, Florida Statutes, also gives the Agency the
authority to make any adjustments necessary to comply with the
funds allocated and which are consistent with directions set forth
in the GAA. Specific to outpatient services, the statute directs,
“[t]he agency shall implement a prospective payment methodology
for establishing reimbursement rates for outpatient hospital
services.” § 409.905(6)(b), Fla....
....”).
The language of the implementing statutes and the GAAs is
clear and unambiguous. As the Final Order found, the GAAs
34
unambiguously state that the Agency must “implement a
recurring methodology in the [Outpatient Plan] . . . to achieve the
cost savings.” Similarly, section
409.905(6)(b) requires the Agency
to “implement a methodology” for establishing rates, and section
409.908 requires the Agency to reimburse Medicaid providers
“according to methodologies set forth in the rules of the agency and
in polic...
