In addition to the payments made under s. 409.911, the Agency for Health Care Administration shall administer a federally matched disproportionate share program and a state-funded financial assistance program for statutory rural hospitals. The agency shall make disproportionate share payments to statutory rural hospitals that qualify for such payments and financial assistance payments to statutory rural hospitals that do not qualify for disproportionate share payments. The disproportionate share program payments shall be limited by and conform with federal requirements. Funds shall be distributed quarterly in each fiscal year for which an appropriation is made. Notwithstanding the provisions of s. 409.915, counties are exempt from contributing toward the cost of this special reimbursement for hospitals serving a disproportionate share of low-income patients.(1) The following formula shall be used by the agency to calculate the total amount earned for hospitals that participate in the rural hospital disproportionate share program or the financial assistance program:TAERH = (CCD + MDD)/TPD
Where:
CCD = total charity care-other, plus charity care-Hill-Burton, minus 50 percent of unrestricted tax revenue from local governments, and restricted funds for indigent care, divided by gross revenue per adjusted patient day; however, if CCD is less than zero, then zero shall be used for CCD.
MDD = Medicaid inpatient days plus Medicaid HMO inpatient days.
TPD = total inpatient days.
TAERH = total amount earned by each rural hospital.
In computing the total amount earned by each rural hospital, the agency must use the average of the 3 most recent years of actual data reported in accordance with s. 408.061(4). The agency shall provide a preliminary estimate of the payments under the rural disproportionate share and financial assistance programs to the rural hospitals by August 31 of each state fiscal year for review. Each rural hospital shall have 30 days to review the preliminary estimates of payments and report any errors to the agency. The agency shall make any corrections deemed necessary and compute the rural disproportionate share and financial assistance program payments.
(2) The agency shall use the following formula for distribution of funds for the disproportionate share/financial assistance program for rural hospitals.(a) The agency shall first determine a preliminary payment amount for each rural hospital by allocating all available state funds using the following formula:PDAER = (TAERH x TARH)/STAERH
Where:
PDAER = preliminary distribution amount for each rural hospital.
TAERH = total amount earned by each rural hospital.
TARH = total amount appropriated or distributed under this section.
STAERH = sum of total amount earned by each rural hospital.
(b) Federal matching funds for the disproportionate share program shall then be calculated for those hospitals that qualify for disproportionate share in paragraph (a).
(c) The state-funds-only payment amount shall then be calculated for each hospital using the formula:SFOER = Maximum value of (1) SFOL - PDAER or (2) 0
Where:
SFOER = state-funds-only payment amount for each rural hospital.
SFOL = state-funds-only payment level, which is set at 4 percent of TARH.
In calculating the SFOER, PDAER includes federal matching funds from paragraph (b).
(d) The adjusted total amount allocated to the rural disproportionate share program shall then be calculated using the following formula:ATARH = (TARH - SSFOER)
Where:
ATARH = adjusted total amount appropriated or distributed under this section.
SSFOER = sum of the state-funds-only payment amount calculated under paragraph (c) for all rural hospitals.
(e) The distribution of the adjusted total amount of rural disproportionate share hospital funds shall then be calculated using the following formula:DAERH = [(TAERH x ATARH)/STAERH]
Where:
DAERH = distribution amount for each rural hospital.
(f) Federal matching funds for the disproportionate share program shall then be calculated for those hospitals that qualify for disproportionate share in paragraph (e).
(g) State-funds-only payment amounts calculated under paragraph (c) and corresponding federal matching funds are then added to the results of paragraph (f) to determine the total distribution amount for each rural hospital.
(3) The Agency for Health Care Administration may recommend to the Legislature a formula to be used in subsequent fiscal years to distribute funds appropriated for this section that includes charity care, uncompensated care to medically indigent patients, and Medicaid inpatient days.
(4) In the event that federal matching funds for the rural hospital disproportionate share program are not available, state matching funds appropriated for the program may be utilized for the Rural Hospital Financial Assistance Program and shall be allocated to rural hospitals based on the formulas in subsections (1) and (2).
(5) In order to receive payments under this section, a hospital must be a rural hospital as defined in s. 395.602 and must meet the following additional requirements:(a) Agree to conform to all agency requirements to ensure high quality in the provision of services, including criteria adopted by agency rule concerning staffing ratios, medical records, standards of care, equipment, space, and such other standards and criteria as the agency deems appropriate as specified by rule.
(b) Agree to accept all patients, regardless of ability to pay, on a functional space-available basis.
(c) Agree to provide backup and referral services to the county public health departments and other low-income providers within the hospital’s service area, including the development of written agreements between these organizations and the hospital.
(d) For any hospital owned by a county government which is leased to a management company, agree to submit on a quarterly basis a report to the agency, in a format specified by the agency, which provides a specific accounting of how all funds dispersed under this act are spent.
(6) This section applies only to hospitals that were defined as statutory rural hospitals, or their successor-in-interest hospital, prior to January 1, 2001. Any additional hospital that is defined as a statutory rural hospital, or its successor-in-interest hospital, on or after January 1, 2001, is not eligible for programs under this section unless additional funds are appropriated each fiscal year specifically to the rural hospital disproportionate share and financial assistance programs in an amount necessary to prevent any hospital, or its successor-in-interest hospital, eligible for the programs prior to January 1, 2001, from incurring a reduction in payments because of the eligibility of an additional hospital to participate in the programs. A hospital, or its successor-in-interest hospital, which received funds pursuant to this section before January 1, 2001, and which qualifies under s. 395.602(2)(b), shall be included in the programs under this section and is not required to seek additional appropriations under this subsection. 
