Inpatient Hospital Medical Services
There are currently 233 acute care hospitals enrolled as Medicaid providers
in the state of Florida. Medicaid reimburses hospital services prospectively.
This is done by establishing per-diem rates based on cost reports from the hospitals.
The rates are subject to caps. Medicaid reimbursement for inpatient hospital
care for adults age 21 and older is limited to 45 days per fiscal year. The
only exception to the 45 day cap is when a patient requires inpatient care due
to an emergency condition. There is no limit on the number of days that Medicaid
can reimburse for recipients under age 21. There were 246,716 unduplicated admissions
over the 12-month period from July 1, 1999 through June 30, 2000, with an average
length of stay of 4.65 days.
The agency has contracted with federally designated peer review organizations
to perform utilization review oversight of Medicaid hospital admissions since
1985. Currently, the agency is under contract with Keystone Peer Review Organization
(KePRO) to perform prior authorization and concurrent review of specified categories
of fee-for-service recipients. KePRO is the federally designated peer review
organization for Medicare in the State of Pennsylvania and has held that designation
since 1985. KePRO, known as KePRO South in Florida, is under contract with the
agency from January 1, 2002 until June 30, 2005. Additional information on KePRO
South may be found at www.keprosouth.com.
Click here to send your comments
or questions to Diane Weller, Registered Nurse Consultant or mail them to
her at Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 20,
Tallahassee, Florida 32308-5403.
For further information on the State of Florida Medicaid utilization review
program, click on the links noted below.
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