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Court Backs Hospitals In Outpatient Rate Dispute

Dec 1, 2017
Originally published on December 1, 2017 8:17 am

Siding with dozens of hospitals across the state, an appeals court Thursday said the Florida Agency for Health Care Administration improperly dismissed challenges dealing with Medicaid reimbursement rates for outpatient care.

A three-judge panel of the 1st District Court of Appeal ordered formal administrative hearings to be held on the hospitals' rate challenges. The ruling said 67 petitions were filed seeking administrative hearings after the agency announced outpatient reimbursement rates for the 2016-2017 fiscal year.

Hospitals argued, at least in part, that the agency had made rate reductions that went beyond what the Legislature had authorized. AHCA contended that the rates could only be challenged after requested reimbursements were audited in the future, according to Thursday's ruling. But the appeals court disagreed with that conclusion and the agency's decision to dismiss the petitions.

“In sum, the substantial interest of a party entitled to a Medicaid reimbursement is affected at the time an unsatisfactory rate is announced as that rate takes effect immediately and reimbursements which are made prior to auditing are based on that rate,” said the ruling, written by Judge Ross Bilbrey and joined by judges Clay Roberts and M. Kemmerly Thomas. “The petitioners have alleged … that the methodologies used to set the reimbursement rates are not subject to change during the auditing process, and thus the rate becomes `final' at the time it is announced.”

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