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ENROLLED HB 5001, ENGROSSED 1 2024 LEGISLATURE ______________________________________________________________________________ SECTION 3 - HUMAN SERVICES 208 SPECIAL CATEGORIES HOSPITAL INPATIENT SERVICES FROM GENERAL REVENUE FUND . . . . . 213,538,822 FROM HEALTH CARE TRUST FUND . . . . 42,300,000 FROM GRANTS AND DONATIONS TRUST FUND . . . . . . . . . . . . . . . 13,360,493 FROM MEDICAL CARE TRUST FUND . . . . 426,635,515 FROM PUBLIC MEDICAL ASSISTANCE TRUST FUND . . . . . . . . . . . . 47,450,732 FROM REFUGEE ASSISTANCE TRUST FUND . 4,488,775 From the funds in Specific Appropriation 208, the Agency for Health Care Administration may establish a global fee for bone marrow transplants and the global fee payment shall be paid to approved bone marrow transplant providers that provide bone marrow transplants to Medicaid beneficiaries. From the funds in Specific Appropriations 208 and 214, $3,472,386 from the General Revenue Fund and $4,673,019 from the Medical Care Trust Fund are provided to make Medicaid payments for pediatric lung, adult lung, heart, liver, and adult and pediatric intestinal/multi-visceral transplants in Florida at global rates. The Agency for Health Care Administration shall set the global fee for facilities and physicians that provide these transplant procedures at the respective rates for pediatric lung transplants $429,391 and $62,569; adult lung transplants $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 208 and 211, 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 208 and contingent upon SB 7016, or similar legislation becoming a law, 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............................................ 3,594.67 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 ...... 2.819 Rural Provider Adjustor ............................. 2.402 Long Term Acute Care (LTAC) Provider Adjustor ....... 2.232 High Medicaid Provider Adjustor ..................... 2.113 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% 72