Subject:
Title
Ordinance amending the Brevard County Local Provider Participation Fund Non-Ad Valorem Assessment to address waiver exemptions and allow for the opportunity for local hospitals to participate in managed care quality incentive program
End
Fiscal Impact:
None.
Dept/Office:
County Attorney’s Office
Requested Action:
Recommendation
Hold a public hearing and consider the adoption of the proposed ordinance amending the Brevard County Local Provider Participation Fund Non-Ad Valorem Assessment to address waiver exemptions and allow for the opportunity for local hospitals to participate in managed care quality incentive program.End
Summary Explanation and Background:
This ordinance was requested by local hospitals that are subject to the Brevard County Local Provider Participation Fund Non-Ad Valorem Assessment. Brevard County levies this assessment to fund Medicaid payments for hospitals who provide in-patient and out-patient services to low income and Medicaid eligible Floridians. Hospitals pay assessments to Brevard County, which then transfers the funds to the state where they qualify for federal match.
The Local Provider Participation Fund Non-Ad Valorem Assessment costs nothing to local taxpayers. The benefits of the Local Provider Participation Fund Non-Ad Valorem Assessment program flow to the hospitals, increasing reimbursement for Medicaid services and charitable care.
In 2025, Congress passed the One Big Beautiful Bill Act (“OBBA”), which affected how states can finance Medicaid programs and what opportunities remain available in the future. OBBA changes, Centers for Medicare & Medicaid (CMS) guidance, and protracted negotiations over program approvals now leave Florida in a position to update its assessment structure.
This year, Florida is seeking waivers to exempt certain facilities from the provider taxes in jurisdictions across the state. The assessments must be broad-based and uniform to comply with federal requirements. In April, Florida submitted 33 waiver requests seeking to waive the federal provider tax broad-based requirement, which waivers would apply to hospitals in 19 local jurisdictions and, if granted, would render the newly exempt facilities no longer subject to the assessment. While the state and CMS continue to negotiate these waiver requests, local jurisdictions can take steps to prepare for the possible exemptions.
This ordinance will amend the Brevard County Local Provider Participation Fund Non-Ad Valorem Assessment to incorporate the waiver exemptions and ensure that it is levied in compliance with the requirements of federal law. Local hospitals understand the state’s desire to ensure equitable outcomes for all assessment payers, and hospitals not included in the waiver request remain supportive of the assessment and understand the assessment obligation will continue to apply. Hospitals subject to the annual assessment will receive notice in advance of the assessment rate being set, including notice of the proposed assessment amount.
Further, Florida’s Agency for Health Care Administration (ACHA) is advocating for the legislature to open the door for a new program to reward managed care plans that meet specific health quality, efficiency, and outcome goals, furthering state quality objectives. Managed care plans often partner with hospitals to achieve designated program goals and objectives. In a managed care quality incentive program (“MCO”), benefits flow to partnering hospitals as managed care plans make payments to hospitals for their contribution to program objectives.
In jurisdictions with a local provider participation fund non-ad valorem assessment, the assessment may generate sufficient dollars to provide an intergovernmental transfer for this new MCO program, in addition to the existing Medicaid payment programs already funded by the assessment. To allow for the opportunity to participate in this new MCO program, participating jurisdictions must amend existing ordinance to ensure that funds may be applied toward the MCO incentive program, in addition to the Medicaid payment programs already funded.
Clerk to the Board Instructions:
Upon approval by the Board, execution by the Chair, and attestation by the Clerk, file the ordinance with the Department of State as required by law within the 10-day deadline. Please return a copy of the executed ordinance with the Department of State’s official acknowledgment of filing to the County Attorney’s Office.