Bill Text: FL S1748 | 2013 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Medicaid Eligibility

Spectrum: Bipartisan Bill

Status: (Failed) 2013-05-03 - Died in Appropriations [S1748 Detail]

Download: Florida-2013-S1748-Introduced.html

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       Florida Senate - 2013                                    SB 1748
       
       
       
       By Senator Evers
       
       
       
       
       2-01397-13                                            20131748__
    1                        A bill to be entitled                      
    2         An act relating to Medicaid nursing home eligibility;
    3         amending s. 409.902, F.S.; specifying limitations and
    4         sanctions on persons transferring assets in order to
    5         become eligible for Medicaid nursing facility
    6         services; making technical corrections; requiring the
    7         Department of Children and Families to adopt rules;
    8         providing an effective date.
    9  
   10  Be It Enacted by the Legislature of the State of Florida:
   11  
   12         Section 1. Section 409.902, Florida Statutes, is amended to
   13  read:
   14         409.902 Designated single state agency; eligibility
   15  determinations payment requirements; program title; release of
   16  medical records; Internet eligibility system; rules.—
   17         (1) SINGLE STATE MEDICAID AGENCY.—The Agency for Health
   18  Care Administration is designated as the single state agency
   19  authorized to make payments for medical assistance and related
   20  services under Title XIX of the Social Security Act. These
   21  payments shall be made, subject to any limitations or directions
   22  provided for in the General Appropriations Act, only for
   23  services included in the Medicaid program, shall be made only on
   24  behalf of eligible individuals, and shall be made only to
   25  qualified providers in accordance with federal requirements
   26  under for Title XIX of the Social Security Act and the
   27  provisions of state law. This program of medical assistance is
   28  designated the “Medicaid program.”
   29         (2) ELIGIBILITY DETERMINATIONS.—The Department of Children
   30  and Families Family Services is responsible for determining
   31  Medicaid eligibility determinations, including, but not limited
   32  to, policy, rules, and the agreement with the Social Security
   33  Administration for Medicaid eligibility determinations for
   34  Supplemental Security Income recipients, as well as the actual
   35  determination of eligibility.
   36         (a) As a condition of Medicaid eligibility, subject to
   37  federal approval, the agency for Health Care Administration and
   38  the department of Children and Family Services shall ensure that
   39  each Medicaid recipient of Medicaid consents to the release of
   40  her or his medical records to the agency for Health Care
   41  Administration and the Medicaid Fraud Control Unit of the
   42  Department of Legal Affairs.
   43         (b)(2) Eligibility is restricted to United States citizens
   44  and to lawfully admitted noncitizens who meet the criteria
   45  provided in s. 414.095(3).
   46         1.(a) Citizenship or immigration status must be verified.
   47  For noncitizens, this includes verification of the validity of
   48  documents with the United States Citizenship and Immigration
   49  Services using the federal SAVE verification process.
   50         2.(b) State funds may not be used to provide medical
   51  services to individuals who do not meet the requirements of this
   52  subsection unless the services are necessary to treat an
   53  emergency medical condition or are for pregnant women. Such
   54  services are authorized only to the extent provided under
   55  federal law and in accordance with federal regulations as
   56  provided in 42 C.F.R. s. 440.255.
   57         (3) ELIGIBILITY FOR NURSING FACILITY SERVICES.—In
   58  determining eligibility for nursing facility services, including
   59  institutional hospice services and services provided through a
   60  home and community-based waiver, under the Medicaid program, the
   61  Department of Children and Families shall apply the following
   62  limitations and sanctions on asset transfers made after July 1,
   63  2013.
   64         (a) Individuals who enter into a personal services contract
   65  with a relative shall be considered to have transferred assets
   66  without fair compensation to qualify for Medicaid if any of the
   67  following occurs:
   68         1. The contracted services duplicate services available
   69  through other sources or providers, such as Medicaid, Medicare,
   70  private insurance, or another legally obligated third party.
   71         2. The contracted services do not directly benefit the
   72  individual or are services normally provided out of
   73  consideration for the individual;
   74         3. The actual cost to deliver services is not computed in a
   75  manner that clearly reflects the actual number of hours to be
   76  expended and the contract does not clearly identify each
   77  specific service and the average number of hours required to
   78  deliver each service each month.
   79         4. The hourly rate for each contracted service is computed
   80  at more than minimum wage, except if the provider is a
   81  professional in the field for the specific service or services,
   82  in which case the hourly rate is more than the amount normally
   83  charged by a professional who traditionally provides the same or
   84  similar services in the same geographical area.
   85         5. The contracted services are not provided on a
   86  prospective basis only and are for services provided before July
   87  1, 2013.
   88         6. The contract does not provide fair compensation to the
   89  individual in her or his lifetime as set forth in the life
   90  expectancy tables published by the Office of the Chief Actuary
   91  of the Social Security Administration.
   92         (b) If an applicant for services has a nonapplicant spouse,
   93  the applicant spouse shall be determined ineligible for Medicaid
   94  if she or he, or the person acting on her or his behalf, refuses
   95  to provide information about the nonapplicant spouse or
   96  cooperate in the pursuit of court-ordered medical support or the
   97  recovery of Medicaid expenses paid by the state on her or his
   98  behalf.
   99         (c) The agency shall seek recovery of all Medicaid-covered
  100  expenses and pursue court-ordered medical support for a
  101  recipient from the nonrecipient spouse if she or he refuses to
  102  make her or his assets available to the recipient spouse and the
  103  recipient spouse has assigned his or her right to support to the
  104  state.
  105         (4)(3) INTERNET ELIGIBILITY SYSTEM.—To the extent that
  106  funds are appropriated, the Department of Children and Families
  107  shall collaborate with the agency for Health Care Administration
  108  to develop an Internet-based system that is modular,
  109  interoperable, and scalable for eligibility determination for
  110  Medicaid and the Children’s Health Insurance Program (CHIP)
  111  which that complies with all applicable federal and state laws
  112  and requirements.
  113         (a)(4) The system shall accomplish the following primary
  114  business objectives:
  115         1.(a) Provide individuals and families with a single point
  116  of access to information that explains benefits, premiums, and
  117  cost sharing available through Medicaid, the Children’s Health
  118  Insurance Program, or any other state or federal health
  119  insurance exchange.
  120         2.(b) Enable timely, accurate, and efficient enrollment of
  121  eligible persons into available assistance programs.
  122         3.(c) Prevent eligibility fraud.
  123         4.(d) Allow for detailed financial analysis of eligibility
  124  based cost drivers.
  125         (b)(5) The system shall include, but is not limited to, the
  126  following business and functional requirements:
  127         1.(a) Allow for the completion and submission of an online
  128  application for eligibility determination that accepts the use
  129  of electronic signatures.
  130         2.(b) Include a process that enables automatic enrollment
  131  of qualified individuals in Medicaid, the Children’s Health
  132  Insurance Program, or any other state or federal exchange that
  133  offers cost-sharing benefits for the purchase of health
  134  insurance.
  135         3.(c) Allow for the determination of Medicaid eligibility
  136  based on modified adjusted gross income by using information
  137  submitted in the application and information accessed and
  138  verified through automated and secure interfaces with authorized
  139  databases.
  140         4.(d) Include the ability to determine specific categories
  141  of Medicaid eligibility and interfaces with the Florida Medicaid
  142  Management Information System to support a determination, using
  143  federally approved assessment methodologies, of state and
  144  federal financial participation rates for persons in each
  145  eligibility category.
  146         5.(e) Allow for the accurate and timely processing of
  147  eligibility claims and adjudications.
  148         6.(f) Align with and incorporate all applicable state and
  149  federal laws, requirements, and standards to include the
  150  information technology security requirements established
  151  pursuant to s. 282.318 and the accessibility standards
  152  established under part II of chapter 282.
  153         7.(g) Produce transaction data, reports, and performance
  154  information that contribute to an evaluation of the program,
  155  continuous improvement in business operations, and increased
  156  transparency and accountability.
  157         (c)(6) The department shall develop the system, subject to
  158  the approval by the Legislative Budget Commission and as
  159  required by the General Appropriations Act for the 2012-2013
  160  fiscal year.
  161         (d)(7) The system must be completed by October 1, 2013, and
  162  ready for implementation by January 1, 2014.
  163         (e)(8) The department shall implement the following project
  164  governance structure until the system is implemented:
  165         1.(a) The Secretary of Children and Family Services shall
  166  have overall responsibility for the project.
  167         2.(b) The project shall be governed by an executive
  168  steering committee composed of three department staff members
  169  appointed by the Secretary of Children and Family Services;
  170  three agency staff members, including at least two state
  171  Medicaid program staff members, appointed by the Secretary of
  172  the Agency for Health Care Administration; one staff member from
  173  Children’s Medical Services within the Department of Health
  174  appointed by the Surgeon General; and a representative from the
  175  Florida Healthy Kids Corporation.
  176         3.(c) The executive steering committee shall have the
  177  overall responsibility for ensuring that the project meets its
  178  primary business objectives and shall:
  179         a.1. Provide management direction and support to the
  180  project management team.
  181         b.2. Review and approve any changes to the project’s scope,
  182  schedule, and budget.
  183         c.3. Review, approve, and determine whether to proceed with
  184  any major deliverable project.
  185         d.4. Recommend suspension or termination of the project to
  186  the Governor, the President of the Senate, and the Speaker of
  187  the House of Representatives if the committee determines that
  188  the primary business objectives cannot be achieved.
  189         4.(d) A project management team shall be appointed by and
  190  work under the direction of the executive steering committee.
  191  The project management team shall:
  192         a.1. Provide planning, management, and oversight of the
  193  project.
  194         b.2. Submit an operational work plan and provide quarterly
  195  updates to the plan to the executive steering committee. The
  196  plan must specify project milestones, deliverables, and
  197  expenditures.
  198         c.3. Submit written monthly project status reports to the
  199  executive steering committee.
  200         (5) RULES.—The Department of Children and Families shall
  201  adopt any rules necessary to carry out its statutory duties
  202  under this section for receiving and processing Medicaid
  203  applications and determining Medicaid eligibility, and any other
  204  statutory provisions related to responsibility for the
  205  determination of Medicaid eligibility.
  206         Section 2. This act shall take effect July 1, 2013.