409.9117 Primary care disproportionate share program.
409.9117 Primary care disproportionate share program.
For the 2010-2011 state fiscal year, the agency shall not distribute moneys under the primary care disproportionate share program.
(1) If federal funds are available for disproportionate share programs in addition to those otherwise provided by law, there shall be created a primary care disproportionate share program.
(2) The following formula shall be used by the agency to calculate the total amount earned for hospitals that participate in the primary care disproportionate share program:
TAE = HDSP/THDSP
Where:
TAE = total amount earned by a hospital participating in the primary care disproportionate share program.
HDSP = the prior state fiscal year primary care disproportionate share payment to the individual hospital.
THDSP = the prior state fiscal year total primary care disproportionate share payments to all hospitals.
(3) The total additional payment for hospitals that participate in the primary care disproportionate share program shall be calculated by the agency as follows:
TAP = TAE x TA
Where:
TAP = total additional payment for a primary care hospital.
TAE = total amount earned by a primary care hospital.
TA = total appropriation for the primary care disproportionate share program.
(4) In the establishment and funding of this program, the agency shall use the following criteria in addition to those specified in s. 409.911, and payments may not be made to a hospital unless the hospital agrees to:
(a) Cooperate with a Medicaid prepaid health plan, if one exists in the community.
(b) Ensure the availability of primary and specialty care physicians to Medicaid recipients who are not enrolled in a prepaid capitated arrangement and who are in need of access to such physicians.
(c) Coordinate and provide primary care services free of charge, except copayments, to all persons with incomes up to 100 percent of the federal poverty level who are not otherwise covered by Medicaid or another program administered by a governmental entity, and to provide such services based on a sliding fee scale to all persons with incomes up to 200 percent of the federal poverty level who are not otherwise covered by Medicaid or another program administered by a governmental entity, except that eligibility may be limited to persons who reside within a more limited area, as agreed to by the agency and the hospital.
(d) Contract with any federally qualified health center, if one exists within the agreed geopolitical boundaries, concerning the provision of primary care services, in order to guarantee delivery of services in a nonduplicative fashion, and to provide for referral arrangements, privileges, and admissions, as appropriate. The hospital shall agree to provide at an onsite or offsite facility primary care services within 24 hours to which all Medicaid recipients and persons eligible under this paragraph who do not require emergency room services are referred during normal daylight hours.
(e) Cooperate with the agency, the county, and other entities to ensure the provision of certain public health services, case management, referral and acceptance of patients, and sharing of epidemiological data, as the agency and the hospital find mutually necessary and desirable to promote and protect the public health within the agreed geopolitical boundaries.
(f) In cooperation with the county in which the hospital resides, develop a low-cost, outpatient, prepaid health care program to persons who are not eligible for the Medicaid program, and who reside within the area.
(g) Provide inpatient services to residents within the area who are not eligible for Medicaid or Medicare, and who do not have private health insurance, regardless of ability to pay, on the basis of available space, except that hospitals may not be prevented from establishing bill collection programs based on ability to pay.
(h) Work with the Florida Healthy Kids Corporation, the Florida Health Care Purchasing Cooperative, and business health coalitions, as appropriate, to develop a feasibility study and plan to provide a low-cost comprehensive health insurance plan to persons who reside within the area and who do not have access to such a plan.
(i) Work with public health officials and other experts to provide community health education and prevention activities designed to promote healthy lifestyles and appropriate use of health services.
(j) Work with the local health council to develop a plan for promoting access to affordable health care services for all persons who reside within the area, including, but not limited to, public health services, primary care services, inpatient services, and affordable health insurance generally.
Any hospital that fails to comply with any of the provisions of this subsection, or any other contractual condition, may not receive payments under this section until full compliance is achieved.
History. s. 49, ch. 93-129; s. 9, ch. 2000-209; s. 6, ch. 2001-222; s. 69, ch. 2002-1; s. 16, ch. 2003-405; s. 16, ch. 2004-270; s. 14, ch. 2005-60; s. 17, ch. 2006-28; s. 9, ch. 2008-143; s. 12, ch. 2009-55; s. 13, ch. 2010-156.