Fla. Admin. Code R. 59H-1.012

Current through Reg. 50, No. 235-239, December 10, 2024

Section 59H-1.012 - State Comptroller Responsibilities

(1) If a hospital has not received payment from the responsible county for an eligible individual within 90 days of receipt of a claim, or if the claim is disputed and payment is not received from the county determined to be responsible within 60 days after all legal and administrative remedies under Chapter 120, F.S., have been exhausted, the hospital shall certify to the Comptroller the amount owed by the responsible county. The certification shall include the name of the patient, patient ID number, the amount of the claim and the documented date the claim was received by the county. A copy of the invoice as submitted to the county, a copy of the final order for disputed claims pursuant to Chapter 120, F.S., and such other documentation as the Comptroller might require that would support payment of the claim shall be filed with the certification submitted by the hospital.

(2) Section 154.314, F.S., requires the Comptroller to forward the amount delinquent to the hospital from any funds due the county under any tax-sharing or revenue-sharing fund established by the state, except as otherwise provided by the state constitution, within 45 days of the date of receiving the hospital's certified notice.

(3) Section 154.314, F.S., requires the Comptroller to provide reports quarterly to the Governor, appropriations and finance and tax committees in the House of Representatives and the Senate and to the agency the amount certified by the hospitals as owed by counties and the amounts paid to hospitals out of any revenue or tax sharing funds due to the county.

(4) Hospitals shall be reimbursed not less than 100 percent of the Medicaid per diem rate unless the hospital or county provides the Comptroller:

(a) Evidence that the county is not a spend-down provision eligible county,

(b) Evidence of a different rate negotiated pursuant to subsection 59H-1.0045(4), F.A.C., or

(c) The order of a hearing officer providing for a different rate of reimbursement.

(5) The Comptroller shall reimburse hospitals for counties that are not eligible for the spend-down provision at a rate not less than 80% percent of the Medicaid per diem rate, minus the applicant's share of cost, unless the hospital or county provides the Comptroller:

(a) Evidence of a different rate negotiated pursuant to subsection 59H-1.0045(5), F.A.C., or

(b) The order of a hearing officer providing for a different rate of reimbursement.

Fla. Admin. Code Ann. R. 59H-1.012

Rulemaking Authority 154.3105 FS. Law Implemented 154.314 FS.

New 3-29-89, Amended 12-24-90, 2-24-92, Formerly 10C-26.012, Amended 6-7-00.