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Hospitals Challenge State On Outpatient Rates

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Dozens of hospitals across Florida have filed legal challenges against the state in a dispute about payments for outpatient care in the Medicaid program.

The challenges have been posted during the past week on the state Division of Administrative Hearings website and involve major players in the hospital industry from various areas of Florida. Among the challengers: hospitals in the Tenet health system; hospitals in the HCA health system; hospitals in the Adventist health system; hospitals in the Bayfront health system in the Tampa Bay area; hospitals in the St. Vincent's and Baptist health systems in Jacksonville; hospitals in the Sacred Heart health system in Pensacola; Jackson Health System in Miami; UF Health Shands in Gainesville; Orlando Health; and Lee Memorial Hospital in Fort Myers.

The challenges, which raise similar arguments and were consolidated in a single case Wednesday, deal with a complicated process in which the state Agency for Health Care Administration determines payment rates for hospitals in the Medicaid program. Changes proposed last year by the agency would reduce outpatient rates for the hospitals. The challengers argue, in part, that the agency overstepped its authority and that a proposed rule and a related plan involved in the dispute are invalid.

In its challenge, the Public Health Trust of Miami-Dade County, which operates the Jackson Health System, said the state agency posted what are known as Medicaid "rate sheets" in July that raised concerns. "The calculated outpatient reimbursement rates were significantly lower than prior years, and significantly less than what was anticipated by petitioners based upon their data and the fact that the Legislature had not implemented an outpatient rate decrease for 2016," the Jackson challenge said.

The Division of Administrative Hearings website, as of Wednesdaymorning, did not include a response from the state agency. Administrative Law Judge J. Lawrence Johnston has been assigned to hear the consolidated case.