J. Ross Nobles
2727 Mahan Drive
Mail Stop #23
Tallahassee, FL 32308
The Bureau of Medicaid Program Finance (MPF) is responsible for the fiscal planning of the $28.3 billion Florida Medicaid Services budget. The Bureau administers the Low Income Pool and Disproportionate Share programs and sets reimbursement rates for inpatient/outpatient hospitals, County Health Departments, Federally Qualified Health Centers, Intermediate Care Facilities, and nursing homes. MPF also monitors the financial performance and health of Medicaid managed care health plans.
The Budget and Fiscal Planning unit is responsible for estimating, implementing and tracking the Florida Medicaid budget.
This bureau section is responsible for overseeing the management and monitoring of the financial and banking functions of the Fiscal Agent to ensure appropriate payment of Medicaid claims, including coordinating all federal IRS tax reporting efforts for payments made to providers.
The Financial Monitoring unit oversees the financial reporting of contracted Medicaid Health Maintenance Organizations (HMOs) and Provider Service Networks (PSNs) as well as reviewing the reporting of the Medical Loss Ratio and the Achieved Savings Rebate.
The Cost Reimbursement unit calculates the Medicaid reimbursement rates for institutional providers. These providers include inpatient and outpatient hospitals, ambulatory surgical centers (ASCs), Skilled Nursing Units (SNUs), Swing Beds, Hospices, Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), County Health Departments (CHDs), Intermediate Care Facilities (ICFs), and Statewide Inpatient Psychiatric Program (SIPP) providers.
The LIP/DSH/GME Operation Unit manages supplemental payment funding distributions and monitors state and federal compliance for the Low Income Pool (LIP) program, Disproportionate Share Hospital (DSH) program, Graduate Medical Education (GME) program, Medicaid School Faculty Physicians payments, Public Emergency Medical Transportation (PEMT) program, and the Florida Cancer Hospital (FCHP) program.
The Nursing Home unit calculates reimbursement rates for nursing home Medicaid providers. Audit Services is responsible for the collection and review of nursing home cost reports based on Medicaid and cost reporting requirements.
The Third Party Liability (TPL) Unit is responsible for identifying, managing and recovering funds for claims paid for by Florida Medicaid for which a third party was liable, thereby ensuring Medicaid is the payer of last resort. TPL recovery services are contracted with Health Management Systems (HMS), Inc. Some examples of liable third parties include: Medicare and other insurance companies, tort/casualty settlements, recipient estates, and trust and annuity recovery. New or updated third party insurance information is also added to the Florida Medicaid Management Information System (FMMIS) in order to cost avoid claims that are submitted by Medicaid providers. When a provider submits a claim and a recipient has other insurance, the provider is instructed to bill the other insurance company prior to billing Medicaid. In addition, the TPL Unit also works in conjunction with the Agency's Bureau of Medicaid Program Integrity to conduct other Medicaid recoupment projects such as: overpayments, duplicate payments, provider audits, and overutilization.
Notices regarding any third-party benefit, including trust, annuity, or estate probate actions, must be submitted in accordance with sections 409.910, 409.9101, and 733.2121, Florida Statutes (F.S.), to the appropriate address located below.Florida Medicaid TPL Recovery Program
For additional information about the Florida Medicaid Third Party Liability Recovery Program, please call our vendor at 1-877-357-3268 or visit our website at www.flmedicaidtplrecovery.com.