(1) As used in this section, the term:(a) “Health care provider” means:1. A hospital licensed under chapter 395.
2. A physician or physician assistant licensed under chapter 458.
3. An osteopathic physician or physician assistant licensed under chapter 459.
4. A podiatric physician licensed under chapter 461.
5. A health maintenance organization certificated under part I of chapter 641.
6. An ambulatory surgical center licensed under chapter 395.
7. A professional association, partnership, corporation, joint venture, or other association established by the individuals set forth in subparagraphs 2.-4. for professional activity.
8. An other medical facility.a. As used in this subparagraph, the term “other medical facility” means:(I) A facility the primary purpose of which is to provide human medical diagnostic services, or a facility providing nonsurgical human medical treatment which discharges patients on the same working day that the patients are admitted; and
(II) A facility that is not part of a hospital.
b. The term does not include a facility existing for the primary purpose of performing terminations of pregnancy, or an office maintained by a physician or dentist for the practice of medicine.
(b) “Hospital” means a hospital licensed under chapter 395.
(2) When compensating health care providers, the department must comply with the following reimbursement limitations:(a) Payments to a hospital or a health care provider may not exceed 110 percent of the Medicare allowable rate for any health care services provided if there is no contract between the department and the hospital or the health care provider providing services at a hospital.
(b)1. The department may continue to make payments for health care services at the contracted rates for contracts executed before July 1, 2014, through the current term of the contract if a contract has been executed between the department and a hospital or a health care provider providing services at a hospital.
2. Payments may not exceed 110 percent of the Medicare allowable rate after the current term of the contract expires or after the contract is renewed during the 2013-2014 fiscal year.
(c) Payments may not exceed 110 percent of the Medicare allowable rate under a contract executed on or after July 1, 2014, between the department and a hospital or a health care provider providing services at a hospital.
(d) Notwithstanding paragraphs (a)-(c), the department may pay up to 125 percent of the Medicare allowable rate for health care services at a hospital that reports, or has reported, a negative operating margin for the previous fiscal year to the Agency for Health Care Administration through hospital-audited financial data.
