Bill Text: FL S2514 | 2017 | Regular Session | Prefiled
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health Care
Spectrum: Committee Bill
Status: (Passed) 2017-06-19 - Chapter No. 2017-129, companion bill(s) passed, see SB 2500 (Ch. 2017-70) [S2514 Detail]
Download: Florida-2017-S2514-Prefiled.html
Bill Title: Health Care
Spectrum: Committee Bill
Status: (Passed) 2017-06-19 - Chapter No. 2017-129, companion bill(s) passed, see SB 2500 (Ch. 2017-70) [S2514 Detail]
Download: Florida-2017-S2514-Prefiled.html
Florida Senate - 2017 (PROPOSED BILL) SPB 2514
FOR CONSIDERATION By the Committee on Appropriations
576-02557C-17 20172514pb
1 A bill to be entitled
2 An act relating to health care; amending s. 210.20,
3 F.S.; providing that a specified percentage of the
4 cigarette tax, up to a specified amount, be paid
5 annually to the Florida Consortium of National Cancer
6 Institute Centers Program, rather than the Sanford
7 Burnham Medical Research Institute; requiring that the
8 funds be used to advance cures for cancers afflicting
9 pediatric populations through basic or applied
10 research; amending s. 381.922, F.S.; revising the
11 goals of the William G. “Bill” Bankhead, Jr., and
12 David Coley Cancer Research Program to include
13 identifying ways to increase pediatric enrollment in
14 cancer clinical trials; establishing the Live Like
15 Bella Initiative to advance progress toward curing
16 pediatric cancer, subject to an appropriation;
17 amending s. 394.9082, F.S.; creating the Substance
18 Abuse and Mental Health (SAMH) Safety Net Network;
19 providing legislative intent; requiring the Department
20 of Children and Families and the Agency for Health
21 Care Administration to determine the scope of services
22 to be offered through providers contracted with the
23 SAMH Safety Net Network; authorizing the SAMH Safety
24 Net Network to provide Medicaid reimbursable services
25 beyond the limits of the state Medicaid plan under
26 certain circumstances; providing that general revenue
27 matching funds for the services shall be derived from
28 the existing unmatched general revenue funds within
29 the substance abuse and mental health program and
30 documented through general revenue expenditure
31 submissions by the department; requiring the agency,
32 in consultation with the department, to seek federal
33 authorization for administrative claiming pursuant to
34 a specified federal program to fund certain
35 interventions, case managers, and facility services;
36 requiring the department, in collaboration with the
37 agency, to document local funding of behavioral health
38 services; requiring the agency to seek certain federal
39 matching funds; amending s. 395.602, F.S.; revising
40 the definition of the term “rural hospital” to include
41 a hospital classified as a sole community hospital,
42 regardless of the number of licensed beds; amending s.
43 409.904, F.S.; authorizing the agency to make payments
44 for medical assistance and related services on behalf
45 of a person diagnosed with acquired immune deficiency
46 syndrome who meets certain criteria, subject to the
47 availability of moneys and specified limitations;
48 amending s. 409.908, F.S.; revising requirements
49 related to the long-term care reimbursement plan and
50 cost reporting system; requiring the calculation of
51 separate prices for each patient care subcomponent
52 based on specified cost reports; providing that
53 certain ceilings and targets apply only to providers
54 being reimbursed on a cost-based system; expanding the
55 direct care subcomponent to include allowable therapy
56 and dietary costs; specifying that allowable ancillary
57 costs are included in the indirect care cost
58 subcomponent; requiring the agency to establish, by a
59 specified date, a technical advisory council to assist
60 in ongoing development and refining of quality
61 measures used in the nursing home prospective payment
62 system; providing for membership; requiring that
63 nursing home prospective payment rates be rebased at a
64 specified interval; authorizing the payment of a
65 direct care supplemental payment to certain providers;
66 specifying the amount providers will be reimbursed for
67 a specified period of time, which may be a cost-based
68 rate or a prospective payment rate; providing for
69 expiration of this reimbursement mechanism on a
70 specified date; requiring the agency to reimburse
71 providers on a cost-based rate or a rebased
72 prospective payment rate, beginning on a specified
73 date; requiring that Medicaid pay deductibles and
74 coinsurance for certain X-ray services provided in an
75 assisted living facility or in the patient’s home;
76 amending s. 409.909, F.S.; providing that the agency
77 shall make payments and distribute funds to qualifying
78 institutions in addition to hospitals under the
79 Statewide Medicaid Residency Program; amending s.
80 409.9082; revising the uses of quality assessment and
81 federal matching funds to include the partial funding
82 of the quality incentive payment program for nursing
83 facilities that exceed quality benchmarks; amending s.
84 409.911, F.S.; updating obsolete language; amending s.
85 409.9119, F.S.; revising criteria for the
86 participation of hospitals in the disproportionate
87 share program for specialty hospitals for children;
88 amending s. 409.913, F.S.; removing a requirement that
89 the agency provide each Medicaid recipient with an
90 explanation of benefits; authorizing the agency to
91 provide an explanation of benefits to a sample of
92 Medicaid recipients or their representatives; amending
93 s. 409.975, F.S.; authorizing, rather than requiring,
94 a managed care plan to offer a network contract to
95 certain medical equipment and supplies providers in
96 the region; requiring the agency to contract with the
97 SAMH Safety Net Network; specifying that the contract
98 must require managing entities to provide specified
99 services to certain individuals; requiring the agency
100 to conduct a comprehensive readiness assessment before
101 contracting with the SAMH Safety Net Network;
102 requiring the agency and the department to develop
103 performance measures for the SAMH Safety Net Network;
104 requiring the agency and the department to develop
105 performance measures to evaluate the SAMH Safety Net
106 Network and its services; requiring the agency, in
107 consultation with the department and managing
108 entities, to determine the rates for services added to
109 the state Medicaid plan; amending s. 409.979, F.S.;
110 expanding eligibility for long-term care services to
111 include hospital level of care for certain individuals
112 diagnosed with cystic fibrosis; revising eligibility
113 for certain Medicaid recipients in the long-term care
114 managed care program; requiring the agency to contract
115 with an additional, not-for-profit organization that
116 meets certain conditions and offers specified services
117 to frail elders who reside in Miami-Dade County,
118 subject to federal approval; exempting the
119 organization from ch. 641, F.S., relating to health
120 care service programs; requiring the agency, in
121 consultation with the Department of Elderly Affairs,
122 to approve a certain number of initial enrollees in
123 the Program of All-inclusive Care for the Elderly
124 (PACE); requiring the agency to contract with a
125 specified not-for-profit organization, a not-for
126 profit agency serving elders, and a not-for-profit
127 hospice in Leon County to be a site for PACE, subject
128 to federal approval; authorizing PACE to serve
129 eligible enrollees in Gadsden, Jefferson, Leon, and
130 Wakulla Counties; requiring the agency, in
131 consultation with the department, to approve a certain
132 number of initial enrollees in PACE at the new site,
133 subject to an appropriation; amending s. 17 of chapter
134 2011-61, Laws of Florida; requiring the agency, in
135 consultation with the department, to approve a certain
136 number of initial enrollees in PACE to serve frail
137 elders who reside in certain counties; amending s. 9
138 of chapter 2016-65, Laws of Florida; revising an
139 effective date; revising the date that rates for
140 hospital outpatient services must take effect;
141 amending s. 29 of chapter 2016-65, Laws of Florida;
142 requiring the agency, in consultation with the
143 department, to approve a certain number of enrollees
144 in the PACE established to serve frail elders who
145 reside in Hospice Service Area 7; requiring the agency
146 to contract with a not-for-profit organization that
147 meets certain criteria to offer specified services to
148 frail elders who reside in Alachua County, subject to
149 federal approval; exempting the organization from ch.
150 641, F.S., relating to health care service programs;
151 requiring the agency, in consultation with the
152 department, to approve a certain number of initial
153 enrollees in PACE at the new site, subject to certain
154 conditions; providing effective dates.
155
156 Be It Enacted by the Legislature of the State of Florida:
157
158 Section 1. Paragraph (c) of subsection (2) of section
159 210.20, Florida Statutes, is amended to read:
160 210.20 Employees and assistants; distribution of funds.—
161 (2) As collections are received by the division from such
162 cigarette taxes, it shall pay the same into a trust fund in the
163 State Treasury designated “Cigarette Tax Collection Trust Fund”
164 which shall be paid and distributed as follows:
165 (c) Beginning July 1, 2017 2013, and continuing through
166 June 30, 2033, the division shall from month to month certify to
167 the Chief Financial Officer the amount derived from the
168 cigarette tax imposed by s. 210.02, less the service charges
169 provided for in s. 215.20 and less 0.9 percent of the amount
170 derived from the cigarette tax imposed by s. 210.02, which shall
171 be deposited into the Alcoholic Beverage and Tobacco Trust Fund,
172 specifying an amount equal to 1 percent of the net collections,
173 not to exceed $3 million annually, and that amount shall be
174 deposited into the Biomedical Research Trust Fund in the
175 Department of Health. These funds are appropriated annually in
176 an amount not to exceed $3 million from the Biomedical Research
177 Trust Fund and distributed pursuant to s. 381.915 for the
178 advancement of cures for cancers afflicting pediatric
179 populations through basic or applied research, including, but
180 not limited to, clinical trials and nontoxic drug discovery
181 Department of Health and the Sanford-Burnham Medical Research
182 Institute to work in conjunction for the purpose of establishing
183 activities and grant opportunities in relation to biomedical
184 research.
185 Section 2. Subsection (2) of section 381.922, Florida
186 Statutes, is amended to read:
187 381.922 William G. “Bill” Bankhead, Jr., and David Coley
188 Cancer Research Program.—
189 (2) The program shall provide grants for cancer research to
190 further the search for cures for cancer.
191 (a) Emphasis shall be given to the following goals, as
192 those goals support the advancement of such cures:
193 1. Efforts to significantly expand cancer research capacity
194 in the state by:
195 a. Identifying ways to attract new research talent and
196 attendant national grant-producing researchers to cancer
197 research facilities in this state;
198 b. Implementing a peer-reviewed, competitive process to
199 identify and fund the best proposals to expand cancer research
200 institutes in this state;
201 c. Funding through available resources for those proposals
202 that demonstrate the greatest opportunity to attract federal
203 research grants and private financial support;
204 d. Encouraging the employment of bioinformatics in order to
205 create a cancer informatics infrastructure that enhances
206 information and resource exchange and integration through
207 researchers working in diverse disciplines, to facilitate the
208 full spectrum of cancer investigations;
209 e. Facilitating the technical coordination, business
210 development, and support of intellectual property as it relates
211 to the advancement of cancer research; and
212 f. Aiding in other multidisciplinary research-support
213 activities as they inure to the advancement of cancer research.
214 2. Efforts to improve both research and treatment through
215 greater participation in clinical trials networks by:
216 a. Identifying ways to increase pediatric and adult
217 enrollment in cancer clinical trials;
218 b. Supporting public and private professional education
219 programs designed to increase the awareness and knowledge about
220 cancer clinical trials;
221 c. Providing tools to cancer patients and community-based
222 oncologists to aid in the identification of cancer clinical
223 trials available in the state; and
224 d. Creating opportunities for the state’s academic cancer
225 centers to collaborate with community-based oncologists in
226 cancer clinical trials networks.
227 3. Efforts to reduce the impact of cancer on disparate
228 groups by:
229 a. Identifying those cancers that disproportionately impact
230 certain demographic groups; and
231 b. Building collaborations designed to reduce health
232 disparities as they relate to cancer.
233 (b) Preference may be given to grant proposals that foster
234 collaborations among institutions, researchers, and community
235 practitioners, as such proposals support the advancement of
236 cures through basic or applied research, including clinical
237 trials involving cancer patients and related networks.
238 (c) There is established within the program the Live Like
239 Bella Initiative. The purpose of the initiative is to advance
240 progress toward curing pediatric cancer by awarding grants
241 through the peer-reviewed, competitive process established under
242 subsection (3). This paragraph is subject to the annual
243 appropriation of funds by the Legislature.
244 Section 3. Subsection (11) is added to section 394.9082,
245 Florida Statutes, to read:
246 394.9082 Behavioral health managing entities.—
247 (11) SUBSTANCE ABUSE AND MENTAL HEALTH (SAMH) SAFETY NET
248 NETWORK.—
249 (a) It is the intent of the Legislature to create the
250 Substance Abuse and Mental Health (SAMH) Safety Net Network to
251 support and enhance the community mental health and substance
252 abuse services currently provided by managing entities. The SAMH
253 Safety Net Network as used in this section means the managing
254 entities and their contracted network of providers. Contracted
255 providers are considered vendors and not subrecipients, as
256 defined in s. 215.97. Managing entities and their contracted
257 providers are not public employees for purposes of chapter 112.
258 (b) The department and the agency shall establish the SAMH
259 Safety Net Network by adding specific behavioral health services
260 currently provided by managing entities to the state Medicaid
261 plan and adjusting the amount of units of services for specific
262 Medicaid services to better serve Medicaid-eligible individuals
263 with severe and persistent mental health or substance use
264 disorders, and their families, who are currently served by
265 managing entities. It is the intent of the Legislature to have
266 the department submit documentation of general revenue
267 expenditures to the agency for the state match for the services
268 and for the agency to pay managing entities the federal Medicaid
269 portion for services provided.
270 1. Behavioral health services currently funded by managing
271 entities through the substance abuse and mental health program
272 shall be added by the agency to the state Medicaid plan through
273 a state plan amendment. These services shall be provided
274 exclusively through the providers contracted with the SAMH
275 Safety Net Network. The department and the agency shall
276 determine which services are essential for individuals served by
277 managing entities through coordinated systems of care and which
278 services will most efficiently use state and federal resources.
279 2. The state Medicaid plan currently limits the amount of
280 behavioral health services that may be provided to a covered
281 individual. However, the SAMH Safety Net Network is authorized
282 to provide Medicaid reimbursable services beyond these limits
283 when providing services, including, but not limited to,
284 assessment, group therapy, individual therapy, psychosocial
285 rehabilitation, day treatment, medication management,
286 therapeutic onsite services, substance abuse inpatient or
287 residential detoxification, inpatient hospital services, and
288 crisis stabilization unit or as appropriate in lieu of services.
289 (c) The required general revenue matching funds for the
290 services shall be derived from the existing unmatched general
291 revenue funds within the substance abuse and mental health
292 program and documented through general revenue expenditure
293 submissions by the department. The Medicaid reimbursement for
294 services provided by the SAMH Safety Net Network shall be
295 limited to the availability of general revenue matching funds
296 within the substance abuse and mental health program for such
297 purpose.
298 (d) Except as otherwise provided in this part, the state
299 share of funds sufficient to implement the provisions of this
300 act shall be redirected from existing general revenue funds in
301 the department which are used for funding mental health and
302 substance abuse services, excluding funding for residential
303 services. The need for these state-only funds must be offset by
304 the infusion of federal funds made available to the SAMH Safety
305 Net Network under the provisions of this act.
306 Section 4. The Agency for Health Care Administration, in
307 consultation with the Department of Children and Families, shall
308 seek federal authorization for administrative claiming pursuant
309 to the Medicaid Administrative Claiming program to fund:
310 (1) The department’s team-based interventions, including,
311 but not limited to, community action treatment teams and family
312 intervention treatment teams, which focus on the entire family
313 to prevent out-of-home placements in the child welfare,
314 behavioral health, and criminal justice systems.
315 (2) Case managers employed by the department’s child
316 welfare community-based care lead agency who are responsible for
317 locating, coordinating, and monitoring necessary and appropriate
318 services extending beyond direct services for Medicaid-eligible
319 children, including, but not limited to, outreach, referral,
320 eligibility determination, and case management.
321 (3) Central receiving facility services for individuals
322 with mental health or substance use disorders.
323 Section 5. The Department of Children and Families, in
324 collaboration with the Agency for Health Care Administration,
325 shall document the extent to which behavioral health services
326 are funded with contributions from units of local government.
327 The agency shall seek federal authority to have these funds
328 qualify for federal matching funds as certified public
329 expenditures.
330 Section 6. Paragraph (e) of subsection (2) of section
331 395.602, Florida Statutes, is amended to read:
332 395.602 Rural hospitals.—
333 (2) DEFINITIONS.—As used in this part, the term:
334 (e) “Rural hospital” means an acute care hospital licensed
335 under this chapter, having 100 or fewer licensed beds and an
336 emergency room, which is:
337 1. The sole provider within a county with a population
338 density of up to 100 persons per square mile;
339 2. An acute care hospital, in a county with a population
340 density of up to 100 persons per square mile, which is at least
341 30 minutes of travel time, on normally traveled roads under
342 normal traffic conditions, from any other acute care hospital
343 within the same county;
344 3. A hospital supported by a tax district or subdistrict
345 whose boundaries encompass a population of up to 100 persons per
346 square mile;
347 4. A hospital classified as a sole community hospital under
348 42 C.F.R. s. 412.92, regardless of the number of which has up to
349 175 licensed beds;
350 5. A hospital with a service area that has a population of
351 up to 100 persons per square mile. As used in this subparagraph,
352 the term “service area” means the fewest number of zip codes
353 that account for 75 percent of the hospital’s discharges for the
354 most recent 5-year period, based on information available from
355 the hospital inpatient discharge database in the Florida Center
356 for Health Information and Transparency at the agency; or
357 6. A hospital designated as a critical access hospital, as
358 defined in s. 408.07.
359
360 Population densities used in this paragraph must be based upon
361 the most recently completed United States census. A hospital
362 that received funds under s. 409.9116 for a quarter beginning no
363 later than July 1, 2002, is deemed to have been and shall
364 continue to be a rural hospital from that date through June 30,
365 2021, if the hospital continues to have up to 100 licensed beds
366 and an emergency room. An acute care hospital that has not
367 previously been designated as a rural hospital and that meets
368 the criteria of this paragraph shall be granted such designation
369 upon application, including supporting documentation, to the
370 agency. A hospital that was licensed as a rural hospital during
371 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
372 rural hospital from the date of designation through June 30,
373 2021, if the hospital continues to have up to 100 licensed beds
374 and an emergency room.
375 Section 7. Subsection (11) is added to section 409.904,
376 Florida Statutes, to read:
377 409.904 Optional payments for eligible persons.—The agency
378 may make payments for medical assistance and related services on
379 behalf of the following persons who are determined to be
380 eligible subject to the income, assets, and categorical
381 eligibility tests set forth in federal and state law. Payment on
382 behalf of these Medicaid eligible persons is subject to the
383 availability of moneys and any limitations established by the
384 General Appropriations Act or chapter 216.
385 (11) Subject to federal waiver approval, a person diagnosed
386 with acquired immune deficiency syndrome (AIDS) who has an AIDS
387 related opportunistic infection and is at risk of
388 hospitalization as determined by the agency and whose income is
389 at or below 300 percent of the Federal Benefit Rate.
390 Section 8. Subsections (2) and (14) of section 409.908,
391 Florida Statutes, are amended to read:
392 409.908 Reimbursement of Medicaid providers.—Subject to
393 specific appropriations, the agency shall reimburse Medicaid
394 providers, in accordance with state and federal law, according
395 to methodologies set forth in the rules of the agency and in
396 policy manuals and handbooks incorporated by reference therein.
397 These methodologies may include fee schedules, reimbursement
398 methods based on cost reporting, negotiated fees, competitive
399 bidding pursuant to s. 287.057, and other mechanisms the agency
400 considers efficient and effective for purchasing services or
401 goods on behalf of recipients. If a provider is reimbursed based
402 on cost reporting and submits a cost report late and that cost
403 report would have been used to set a lower reimbursement rate
404 for a rate semester, then the provider’s rate for that semester
405 shall be retroactively calculated using the new cost report, and
406 full payment at the recalculated rate shall be effected
407 retroactively. Medicare-granted extensions for filing cost
408 reports, if applicable, shall also apply to Medicaid cost
409 reports. Payment for Medicaid compensable services made on
410 behalf of Medicaid eligible persons is subject to the
411 availability of moneys and any limitations or directions
412 provided for in the General Appropriations Act or chapter 216.
413 Further, nothing in this section shall be construed to prevent
414 or limit the agency from adjusting fees, reimbursement rates,
415 lengths of stay, number of visits, or number of services, or
416 making any other adjustments necessary to comply with the
417 availability of moneys and any limitations or directions
418 provided for in the General Appropriations Act, provided the
419 adjustment is consistent with legislative intent.
420 (2)(a)1. Reimbursement to nursing homes licensed under part
421 II of chapter 400 and state-owned-and-operated intermediate care
422 facilities for the developmentally disabled licensed under part
423 VIII of chapter 400 must be made prospectively.
424 2. Unless otherwise limited or directed in the General
425 Appropriations Act, reimbursement to hospitals licensed under
426 part I of chapter 395 for the provision of swing-bed nursing
427 home services must be made on the basis of the average statewide
428 nursing home payment, and reimbursement to a hospital licensed
429 under part I of chapter 395 for the provision of skilled nursing
430 services must be made on the basis of the average nursing home
431 payment for those services in the county in which the hospital
432 is located. When a hospital is located in a county that does not
433 have any community nursing homes, reimbursement shall be
434 determined by averaging the nursing home payments in counties
435 that surround the county in which the hospital is located.
436 Reimbursement to hospitals, including Medicaid payment of
437 Medicare copayments, for skilled nursing services shall be
438 limited to 30 days, unless a prior authorization has been
439 obtained from the agency. Medicaid reimbursement may be extended
440 by the agency beyond 30 days, and approval must be based upon
441 verification by the patient’s physician that the patient
442 requires short-term rehabilitative and recuperative services
443 only, in which case an extension of no more than 15 days may be
444 approved. Reimbursement to a hospital licensed under part I of
445 chapter 395 for the temporary provision of skilled nursing
446 services to nursing home residents who have been displaced as
447 the result of a natural disaster or other emergency may not
448 exceed the average county nursing home payment for those
449 services in the county in which the hospital is located and is
450 limited to the period of time which the agency considers
451 necessary for continued placement of the nursing home residents
452 in the hospital.
453 (b) Subject to any limitations or directions in the General
454 Appropriations Act, the agency shall establish and implement a
455 state Title XIX Long-Term Care Reimbursement Plan for nursing
456 home care in order to provide care and services in conformance
457 with the applicable state and federal laws, rules, regulations,
458 and quality and safety standards and to ensure that individuals
459 eligible for medical assistance have reasonable geographic
460 access to such care.
461 1. The agency shall amend the long-term care reimbursement
462 plan and cost reporting system to create direct care and
463 indirect care subcomponents of the patient care component of the
464 per diem rate. These two subcomponents together shall equal the
465 patient care component of the per diem rate. Separate prices
466 cost-based ceilings shall be calculated for each patient care
467 subcomponent, initially based on the September 2016 rate setting
468 cost reports and subsequently based on the most recently audited
469 cost report used during a rebasing year. The direct care
470 subcomponent of the per diem rate for any providers still being
471 reimbursed on a cost basis shall be limited by the cost-based
472 class ceiling, and the indirect care subcomponent may be limited
473 by the lower of the cost-based class ceiling, the target rate
474 class ceiling, or the individual provider target. The ceilings
475 and targets apply only to providers being reimbursed on a cost
476 based system.
477 2. The direct care subcomponent shall include salaries and
478 benefits of direct care staff providing nursing services
479 including registered nurses, licensed practical nurses, and
480 certified nursing assistants who deliver care directly to
481 residents in the nursing home facility, allowable therapy costs,
482 and dietary costs. This excludes nursing administration, staff
483 development, the staffing coordinator, and the administrative
484 portion of the minimum data set and care plan coordinators. The
485 direct care subcomponent also includes medically necessary
486 dental care, vision care, hearing care, and podiatric care.
487 3. All other patient care costs shall be included in the
488 indirect care cost subcomponent of the patient care per diem
489 rate, including complex medical equipment, medical supplies, and
490 other allowable ancillary costs. Costs may not be allocated
491 directly or indirectly to the direct care subcomponent from a
492 home office or management company.
493 4. On July 1 of each year, the agency shall report to the
494 Legislature direct and indirect care costs, including average
495 direct and indirect care costs per resident per facility and
496 direct care and indirect care salaries and benefits per category
497 of staff member per facility.
498 5. Before December 31, 2017, the agency must establish a
499 technical advisory council to assist in ongoing development and
500 refining of the quality measures used in the nursing home
501 prospective payment system. The advisory council must include,
502 but need not be limited to, representatives of nursing home
503 providers and other interested stakeholders. In order to offset
504 the cost of general and professional liability insurance, the
505 agency shall amend the plan to allow for interim rate
506 adjustments to reflect increases in the cost of general or
507 professional liability insurance for nursing homes. This
508 provision shall be implemented to the extent existing
509 appropriations are available.
510 6. Every fourth year, the agency shall rebase nursing home
511 prospective payment rates to reflect changes in cost based on
512 the most recently audited cost report for each participating
513 provider.
514 7. A direct care supplemental payment may be made to
515 providers whose direct care hours per patient day are above the
516 80th percentile and who provide Medicaid services to a larger
517 percentage of Medicaid patients than the state average.
518 8. For the period beginning on October 1, 2017, and ending
519 on September 30, 2020, the agency shall reimburse providers the
520 greater of their September 2016 cost-based rate or their
521 prospective payment rate. Effective October 1, 2020, the agency
522 shall reimburse providers the greater of 95 percent of their
523 cost-based rate or their rebased prospective payment rate, using
524 the most recently audited cost report for each facility. This
525 subsection shall expire September 30, 2022.
526 9. Pediatric, Florida Department of Veterans Affairs, and
527 government-owned facilities are exempt from the pricing model
528 established in this subsection and shall remain on a cost-based
529 prospective payment system. Effective October 1, 2018, the
530 agency shall set rates for all facilities remaining on a cost
531 based prospective payment system using each facility’s most
532 recently audited cost report, eliminating retroactive
533 settlements.
534
535 It is the intent of the Legislature that the reimbursement plan
536 achieve the goal of providing access to health care for nursing
537 home residents who require large amounts of care while
538 encouraging diversion services as an alternative to nursing home
539 care for residents who can be served within the community. The
540 agency shall base the establishment of any maximum rate of
541 payment, whether overall or component, on the available moneys
542 as provided for in the General Appropriations Act. The agency
543 may base the maximum rate of payment on the results of
544 scientifically valid analysis and conclusions derived from
545 objective statistical data pertinent to the particular maximum
546 rate of payment.
547 (14) Medicare premiums for persons eligible for both
548 Medicare and Medicaid coverage shall be paid at the rates
549 established by Title XVIII of the Social Security Act. For
550 Medicare services rendered to Medicaid-eligible persons,
551 Medicaid shall pay Medicare deductibles and coinsurance as
552 follows:
553 (a) Medicaid’s financial obligation for deductibles and
554 coinsurance payments shall be based on Medicare allowable fees,
555 not on a provider’s billed charges.
556 (b) Medicaid will pay no portion of Medicare deductibles
557 and coinsurance when payment that Medicare has made for the
558 service equals or exceeds what Medicaid would have paid if it
559 had been the sole payor. The combined payment of Medicare and
560 Medicaid shall not exceed the amount Medicaid would have paid
561 had it been the sole payor. The Legislature finds that there has
562 been confusion regarding the reimbursement for services rendered
563 to dually eligible Medicare beneficiaries. Accordingly, the
564 Legislature clarifies that it has always been the intent of the
565 Legislature before and after 1991 that, in reimbursing in
566 accordance with fees established by Title XVIII for premiums,
567 deductibles, and coinsurance for Medicare services rendered by
568 physicians to Medicaid eligible persons, physicians be
569 reimbursed at the lesser of the amount billed by the physician
570 or the Medicaid maximum allowable fee established by the Agency
571 for Health Care Administration, as is permitted by federal law.
572 It has never been the intent of the Legislature with regard to
573 such services rendered by physicians that Medicaid be required
574 to provide any payment for deductibles, coinsurance, or
575 copayments for Medicare cost sharing, or any expenses incurred
576 relating thereto, in excess of the payment amount provided for
577 under the State Medicaid plan for such service. This payment
578 methodology is applicable even in those situations in which the
579 payment for Medicare cost sharing for a qualified Medicare
580 beneficiary with respect to an item or service is reduced or
581 eliminated. This expression of the Legislature is in
582 clarification of existing law and shall apply to payment for,
583 and with respect to provider agreements with respect to, items
584 or services furnished on or after the effective date of this
585 act. This paragraph applies to payment by Medicaid for items and
586 services furnished before the effective date of this act if such
587 payment is the subject of a lawsuit that is based on the
588 provisions of this section, and that is pending as of, or is
589 initiated after, the effective date of this act.
590 (c) Notwithstanding paragraphs (a) and (b):
591 1. Medicaid payments for Nursing Home Medicare part A
592 coinsurance are limited to the Medicaid nursing home per diem
593 rate less any amounts paid by Medicare, but only up to the
594 amount of Medicare coinsurance. The Medicaid per diem rate shall
595 be the rate in effect for the dates of service of the crossover
596 claims and may not be subsequently adjusted due to subsequent
597 per diem rate adjustments.
598 2. Medicaid shall pay all deductibles and coinsurance for
599 Medicare-eligible recipients receiving freestanding end stage
600 renal dialysis center services.
601 3. Medicaid payments for general and specialty hospital
602 inpatient services are limited to the Medicare deductible and
603 coinsurance per spell of illness. Medicaid payments for hospital
604 Medicare Part A coinsurance shall be limited to the Medicaid
605 hospital per diem rate less any amounts paid by Medicare, but
606 only up to the amount of Medicare coinsurance. Medicaid payments
607 for coinsurance shall be limited to the Medicaid per diem rate
608 in effect for the dates of service of the crossover claims and
609 may not be subsequently adjusted due to subsequent per diem
610 adjustments.
611 4. Medicaid shall pay all deductibles and coinsurance for
612 Medicare emergency transportation services provided by
613 ambulances licensed pursuant to chapter 401.
614 5. Medicaid shall pay all deductibles and coinsurance for
615 portable X-ray Medicare Part B services provided in a nursing
616 home, in an assisted living facility, or in the patient’s home.
617 Section 9. Subsection (4) of section 409.9082, Florida
618 Statutes, is amended to read:
619 409.9082 Quality assessment on nursing home facility
620 providers; exemptions; purpose; federal approval required;
621 remedies.—
622 (4) The purpose of the nursing home facility quality
623 assessment is to ensure continued quality of care. Collected
624 assessment funds shall be used to obtain federal financial
625 participation through the Medicaid program to make Medicaid
626 payments for nursing home facility services up to the amount of
627 nursing home facility Medicaid rates as calculated in accordance
628 with the approved state Medicaid plan in effect on December 31,
629 2007. The quality assessment and federal matching funds shall be
630 used exclusively for the following purposes and in the following
631 order of priority:
632 (a) To reimburse the Medicaid share of the quality
633 assessment as a pass-through, Medicaid-allowable cost;
634 (b) To increase to each nursing home facility’s Medicaid
635 rate, as needed, an amount that restores rate reductions
636 effective on or after January 1, 2008, as provided in the
637 General Appropriations Act; and
638 (c) To partially fund the quality incentive payment program
639 for nursing facilities that exceed quality benchmarks increase
640 each nursing home facility’s Medicaid rate that accounts for the
641 portion of the total assessment not included in paragraphs (a)
642 and (b) which begins a phase-in to a pricing model for the
643 operating cost component.
644 Section 10. Section 409.909, Florida Statutes, is amended
645 to read:
646 409.909 Statewide Medicaid Residency Program.—
647 (1) The Statewide Medicaid Residency Program is established
648 to improve the quality of care and access to care for Medicaid
649 recipients, expand graduate medical education on an equitable
650 basis, and increase the supply of highly trained physicians
651 statewide. The agency shall make payments to hospitals licensed
652 under part I of chapter 395 and to qualifying institutions as
653 defined in paragraph (2)(c) for graduate medical education
654 associated with the Medicaid program. This system of payments is
655 designed to generate federal matching funds under Medicaid and
656 distribute the resulting funds to participating hospitals on a
657 quarterly basis in each fiscal year for which an appropriation
658 is made.
659 (2) On or before September 15 of each year, the agency
660 shall calculate an allocation fraction to be used for
661 distributing funds to participating hospitals and to qualifying
662 institutions as defined in paragraph (2)(c). On or before the
663 final business day of each quarter of a state fiscal year, the
664 agency shall distribute to each participating hospital one
665 fourth of that hospital’s annual allocation calculated under
666 subsection (4). The allocation fraction for each participating
667 hospital is based on the hospital’s number of full-time
668 equivalent residents and the amount of its Medicaid payments. As
669 used in this section, the term:
670 (a) “Full-time equivalent,” or “FTE,” means a resident who
671 is in his or her residency period, with the initial residency
672 period defined as the minimum number of years of training
673 required before the resident may become eligible for board
674 certification by the American Osteopathic Association Bureau of
675 Osteopathic Specialists or the American Board of Medical
676 Specialties in the specialty in which he or she first began
677 training, not to exceed 5 years. The residency specialty is
678 defined as reported using the current residency type codes in
679 the Intern and Resident Information System (IRIS), required by
680 Medicare. A resident training beyond the initial residency
681 period is counted as 0.5 FTE, unless his or her chosen specialty
682 is in primary care, in which case the resident is counted as 1.0
683 FTE. For the purposes of this section, primary care specialties
684 include:
685 1. Family medicine;
686 2. General internal medicine;
687 3. General pediatrics;
688 4. Preventive medicine;
689 5. Geriatric medicine;
690 6. Osteopathic general practice;
691 7. Obstetrics and gynecology;
692 8. Emergency medicine;
693 9. General surgery; and
694 10. Psychiatry.
695 (b) “Medicaid payments” means the estimated total payments
696 for reimbursing a hospital for direct inpatient services for the
697 fiscal year in which the allocation fraction is calculated based
698 on the hospital inpatient appropriation and the parameters for
699 the inpatient diagnosis-related group base rate, including
700 applicable intergovernmental transfers, specified in the General
701 Appropriations Act, as determined by the agency. Effective July
702 1, 2017, the term “Medicaid payments” means the estimated total
703 payments for reimbursing a hospital and qualifying institutions
704 as defined in paragraph (2)(c) for direct inpatient and
705 outpatient services for the fiscal year in which the allocation
706 fraction is calculated based on the hospital inpatient
707 appropriation and outpatient appropriation and the parameters
708 for the inpatient diagnosis-related group base rate, including
709 applicable intergovernmental transfers, specified in the General
710 Appropriations Act, as determined by the agency.
711 (c) “Qualifying institution” means a federally Qualified
712 Health Center holding an Accreditation Council for Graduate
713 Medical Education institutional accreditation.
714 (d) “Resident” means a medical intern, fellow, or resident
715 enrolled in a program accredited by the Accreditation Council
716 for Graduate Medical Education, the American Association of
717 Colleges of Osteopathic Medicine, or the American Osteopathic
718 Association at the beginning of the state fiscal year during
719 which the allocation fraction is calculated, as reported by the
720 hospital to the agency.
721 (3) The agency shall use the following formula to calculate
722 a participating hospital’s and qualifying institution’s
723 allocation fraction:
724
725 HAF=[0.9 x (HFTE/TFTE)] + [0.1 x (HMP/TMP)]
726
727 Where:
728 HAF=A hospital’s and qualifying institution’s allocation
729 fraction.
730 HFTE=A hospital’s and qualifying institution’s total number
731 of FTE residents.
732 TFTE=The total FTE residents for all participating
733 hospitals and qualifying institutions.
734 HMP=A hospital’s and qualifying institution’s Medicaid
735 payments.
736 TMP=The total Medicaid payments for all participating
737 hospitals and qualifying institutions.
738
739 (4) A hospital’s and qualifying institution’s annual
740 allocation shall be calculated by multiplying the funds
741 appropriated for the Statewide Medicaid Residency Program in the
742 General Appropriations Act by that hospital’s and qualifying
743 institution’s allocation fraction. If the calculation results in
744 an annual allocation that exceeds two times the average per FTE
745 resident amount for all hospitals and qualifying institutions,
746 the hospital’s and qualifying institution’s annual allocation
747 shall be reduced to a sum equaling no more than two times the
748 average per FTE resident. The funds calculated for that hospital
749 and qualifying institution in excess of two times the average
750 per FTE resident amount for all hospitals and qualifying
751 institutions shall be redistributed to participating hospitals
752 and qualifying institutions whose annual allocation does not
753 exceed two times the average per FTE resident amount for all
754 hospitals and qualifying institutions, using the same
755 methodology and payment schedule specified in this section.
756 (5) The Graduate Medical Education Startup Bonus Program is
757 established to provide resources for the education and training
758 of physicians in specialties which are in a statewide supply
759 and-demand deficit. Hospitals and qualifying institutions as
760 defined in paragraph (2)(c) eligible for participation in
761 subsection (1) are eligible to participate in the Graduate
762 Medical Education Startup Bonus Program established under this
763 subsection. Notwithstanding subsection (4) or an FTE’s residency
764 period, and in any state fiscal year in which funds are
765 appropriated for the startup bonus program, the agency shall
766 allocate a $100,000 startup bonus for each newly created
767 resident position that is authorized by the Accreditation
768 Council for Graduate Medical Education or Osteopathic
769 Postdoctoral Training Institution in an initial or established
770 accredited training program that is in a physician specialty in
771 statewide supply-and-demand deficit. In any year in which
772 funding is not sufficient to provide $100,000 for each newly
773 created resident position, funding shall be reduced pro rata
774 across all newly created resident positions in physician
775 specialties in statewide supply-and-demand deficit.
776 (a) Hospitals and qualifying institutions as defined in
777 paragraph (2)(c) applying for a startup bonus must submit to the
778 agency by March 1 their Accreditation Council for Graduate
779 Medical Education or Osteopathic Postdoctoral Training
780 Institution approval validating the new resident positions
781 approved on or after March 2 of the prior fiscal year through
782 March 1 of the current fiscal year for the physician specialties
783 identified in a statewide supply-and-demand deficit as provided
784 in the current fiscal year’s General Appropriations Act. An
785 applicant hospital or qualifying institution as defined in
786 paragraph (2)(c) may validate a change in the number of
787 residents by comparing the number in the prior period
788 Accreditation Council for Graduate Medical Education or
789 Osteopathic Postdoctoral Training Institution approval to the
790 number in the current year.
791 (b) Any unobligated startup bonus funds on April 15 of each
792 fiscal year shall be proportionally allocated to hospitals and
793 to qualifying institutions as defined in paragraph (2)(c)
794 participating under subsection (3) for existing FTE residents in
795 the physician specialties in statewide supply-and-demand
796 deficit. This nonrecurring allocation shall be in addition to
797 the funds allocated in subsection (4). Notwithstanding
798 subsection (4), the allocation under this subsection may not
799 exceed $100,000 per FTE resident.
800 (c) For purposes of this subsection, physician specialties
801 and subspecialties, both adult and pediatric, in statewide
802 supply-and-demand deficit are those identified in the General
803 Appropriations Act.
804 (d) The agency shall distribute all funds authorized under
805 the Graduate Medical Education Startup Bonus Program on or
806 before the final business day of the fourth quarter of a state
807 fiscal year.
808 (6) Beginning in the 2015-2016 state fiscal year, the
809 agency shall reconcile each participating hospital’s total
810 number of FTE residents calculated for the state fiscal year 2
811 years before with its most recently available Medicare cost
812 reports covering the same time period. Reconciled FTE counts
813 shall be prorated according to the portion of the state fiscal
814 year covered by a Medicare cost report. Using the same
815 definitions, methodology, and payment schedule specified in this
816 section, the reconciliation shall apply any differences in
817 annual allocations calculated under subsection (4) to the
818 current year’s annual allocations.
819 (7) The agency may adopt rules to administer this section.
820 Section 11. Paragraph (a) of subsection (2) of section
821 409.911, Florida Statutes, is amended, and paragraph (b) of that
822 subsection is republished, to read:
823 409.911 Disproportionate share program.—Subject to specific
824 allocations established within the General Appropriations Act
825 and any limitations established pursuant to chapter 216, the
826 agency shall distribute, pursuant to this section, moneys to
827 hospitals providing a disproportionate share of Medicaid or
828 charity care services by making quarterly Medicaid payments as
829 required. Notwithstanding the provisions of s. 409.915, counties
830 are exempt from contributing toward the cost of this special
831 reimbursement for hospitals serving a disproportionate share of
832 low-income patients.
833 (2) The Agency for Health Care Administration shall use the
834 following actual audited data to determine the Medicaid days and
835 charity care to be used in calculating the disproportionate
836 share payment:
837 (a) The average of the 2009, 2010, and 2011 2007, 2008, and
838 2009 audited disproportionate share data to determine each
839 hospital’s Medicaid days and charity care for the 2017-2018
840 2015-2016 state fiscal year.
841 (b) If the Agency for Health Care Administration does not
842 have the prescribed 3 years of audited disproportionate share
843 data as noted in paragraph (a) for a hospital, the agency shall
844 use the average of the years of the audited disproportionate
845 share data as noted in paragraph (a) which is available.
846 Section 12. Section 409.9119, Florida Statutes, is amended
847 to read:
848 409.9119 Disproportionate share program for specialty
849 hospitals for children.—In addition to the payments made under
850 s. 409.911, the Agency for Health Care Administration shall
851 develop and implement a system under which disproportionate
852 share payments are made to those hospitals that are separately
853 licensed by the state as specialty hospitals for children, have
854 a federal Centers for Medicare and Medicaid Services
855 certification number in the 3300-3399 range, have Medicaid days
856 that exceed 55 percent of their total days and Medicare days
857 that are less than 5 percent of their total days, and were
858 licensed on January 1, 2012 January 1, 2000, as specialty
859 hospitals for children. This system of payments must conform to
860 federal requirements and must distribute funds in each fiscal
861 year for which an appropriation is made by making quarterly
862 Medicaid payments. Notwithstanding s. 409.915, counties are
863 exempt from contributing toward the cost of this special
864 reimbursement for hospitals that serve a disproportionate share
865 of low-income patients. The agency may make disproportionate
866 share payments to specialty hospitals for children as provided
867 for in the General Appropriations Act.
868 (1) Unless specified in the General Appropriations Act, the
869 agency shall use the following formula to calculate the total
870 amount earned for hospitals that participate in the specialty
871 hospital for children disproportionate share program:
872
873 TAE = DSR x BMPD x MD
874
875 Where:
876 TAE = total amount earned by a specialty hospital for
877 children.
878 DSR = disproportionate share rate.
879 BMPD = base Medicaid per diem.
880 MD = Medicaid days.
881
882 (2) The agency shall calculate the total additional payment
883 for hospitals that participate in the specialty hospital for
884 children disproportionate share program as follows:
885
886 TAP = (TAE x TA) ÷ STAE
887
888 Where:
889 TAP = total additional payment for a specialty hospital for
890 children.
891 TAE = total amount earned by a specialty hospital for
892 children.
893 TA = total appropriation for the specialty hospital for
894 children disproportionate share program.
895 STAE = sum of total amount earned by each hospital that
896 participates in the specialty hospital for children
897 disproportionate share program.
898
899 (3) A hospital may not receive any payments under this
900 section until it achieves full compliance with the applicable
901 rules of the agency. A hospital that is not in compliance for
902 two or more consecutive quarters may not receive its share of
903 the funds. Any forfeited funds must be distributed to the
904 remaining participating specialty hospitals for children that
905 are in compliance.
906 (4) Notwithstanding any provision of this section to the
907 contrary, for the 2017-2018 2016-2017 state fiscal year, for
908 hospitals achieving full compliance under subsection (3), the
909 agency shall make disproportionate share payments to specialty
910 hospitals for children as provided in the 2017-2018 2016-2017
911 General Appropriations Act. This subsection expires July 1, 2018
912 2017.
913 Section 13. Subsection (36) of section 409.913, Florida
914 Statutes, is amended to read:
915 409.913 Oversight of the integrity of the Medicaid
916 program.—The agency shall operate a program to oversee the
917 activities of Florida Medicaid recipients, and providers and
918 their representatives, to ensure that fraudulent and abusive
919 behavior and neglect of recipients occur to the minimum extent
920 possible, and to recover overpayments and impose sanctions as
921 appropriate. Beginning January 1, 2003, and each year
922 thereafter, the agency and the Medicaid Fraud Control Unit of
923 the Department of Legal Affairs shall submit a joint report to
924 the Legislature documenting the effectiveness of the state’s
925 efforts to control Medicaid fraud and abuse and to recover
926 Medicaid overpayments during the previous fiscal year. The
927 report must describe the number of cases opened and investigated
928 each year; the sources of the cases opened; the disposition of
929 the cases closed each year; the amount of overpayments alleged
930 in preliminary and final audit letters; the number and amount of
931 fines or penalties imposed; any reductions in overpayment
932 amounts negotiated in settlement agreements or by other means;
933 the amount of final agency determinations of overpayments; the
934 amount deducted from federal claiming as a result of
935 overpayments; the amount of overpayments recovered each year;
936 the amount of cost of investigation recovered each year; the
937 average length of time to collect from the time the case was
938 opened until the overpayment is paid in full; the amount
939 determined as uncollectible and the portion of the uncollectible
940 amount subsequently reclaimed from the Federal Government; the
941 number of providers, by type, that are terminated from
942 participation in the Medicaid program as a result of fraud and
943 abuse; and all costs associated with discovering and prosecuting
944 cases of Medicaid overpayments and making recoveries in such
945 cases. The report must also document actions taken to prevent
946 overpayments and the number of providers prevented from
947 enrolling in or reenrolling in the Medicaid program as a result
948 of documented Medicaid fraud and abuse and must include policy
949 recommendations necessary to prevent or recover overpayments and
950 changes necessary to prevent and detect Medicaid fraud. All
951 policy recommendations in the report must include a detailed
952 fiscal analysis, including, but not limited to, implementation
953 costs, estimated savings to the Medicaid program, and the return
954 on investment. The agency must submit the policy recommendations
955 and fiscal analyses in the report to the appropriate estimating
956 conference, pursuant to s. 216.137, by February 15 of each year.
957 The agency and the Medicaid Fraud Control Unit of the Department
958 of Legal Affairs each must include detailed unit-specific
959 performance standards, benchmarks, and metrics in the report,
960 including projected cost savings to the state Medicaid program
961 during the following fiscal year.
962 (36) At least three times a year, The agency may shall
963 provide to a sample of each Medicaid recipients recipient or
964 their representatives through the distribution of explanations
965 his or her representative an explanation of benefits information
966 about services reimbursed by the Medicaid program for goods and
967 services to such recipients, including in the form of a letter
968 that is mailed to the most recent address of the recipient on
969 the record with the Department of Children and Families. The
970 explanation of benefits must include the patient’s name, the
971 name of the health care provider and the address of the location
972 where the service was provided, a description of all services
973 billed to Medicaid in terminology that should be understood by a
974 reasonable person, and information on how to report
975 inappropriate or incorrect billing to the agency or other law
976 enforcement entities for review or investigation. At least once
977 a year, the letter also must include information on how to
978 report criminal Medicaid fraud to, the Medicaid Fraud Control
979 Unit’s toll-free hotline number, and information about the
980 rewards available under s. 409.9203. The explanation of benefits
981 may not be mailed for Medicaid independent laboratory services
982 as described in s. 409.905(7) or for Medicaid certified match
983 services as described in ss. 409.9071 and 1011.70.
984 Section 14. Paragraph (e) of subsection (1) of section
985 409.975, Florida Statutes, is amended, and subsection (7) is
986 added to that section, to read:
987 409.975 Managed care plan accountability.—In addition to
988 the requirements of s. 409.967, plans and providers
989 participating in the managed medical assistance program shall
990 comply with the requirements of this section.
991 (1) PROVIDER NETWORKS.—Managed care plans must develop and
992 maintain provider networks that meet the medical needs of their
993 enrollees in accordance with standards established pursuant to
994 s. 409.967(2)(c). Except as provided in this section, managed
995 care plans may limit the providers in their networks based on
996 credentials, quality indicators, and price.
997 (e) Each managed care plan may must offer a network
998 contract to each home medical equipment and supplies provider in
999 the region which meets quality and fraud prevention and
1000 detection standards established by the plan and which agrees to
1001 accept the lowest price previously negotiated between the plan
1002 and another such provider.
1003 (7) SUBSTANCE ABUSE AND MENTAL HEALTH (SAMH) SAFETY NET
1004 NETWORK.—
1005 (a) The agency shall contract with the Substance Abuse and
1006 Mental Health (SAMH) Safety Net Network, established under s.
1007 394.9082(11), to plan, coordinate, and contract for delivering
1008 certain community mental health and substance abuse services,
1009 thereby improving access to behavioral health care, promoting
1010 the continuity of such services, and supporting efficient and
1011 effective delivery of such services under this section. The
1012 contract must require managing entities to provide specified
1013 services to Medicaid-eligible individuals with specified
1014 behaviors, diagnoses, or addictions.
1015 (b) Before contracting, the agency must conduct a
1016 comprehensive readiness assessment to ensure that the SAMH
1017 Safety Net Network has the necessary infrastructure, financial
1018 resources, and relevant experience to implement the contract.
1019 The agency and the department shall develop performance measures
1020 to evaluate the impact of the SAMH Safety Net Network and to
1021 determine the adequacy, timeliness, and quality of the services
1022 provided for specified target populations and the efficiency of
1023 the services in addressing mental health and substance use
1024 disorders within a community.
1025 (c) The agency, in consultation with the department and
1026 managing entities, shall determine the rates for services added
1027 to the state Medicaid plan. The rates shall be developed based
1028 on the full cost of the services and reasonable administrative
1029 costs for providers and managing entities.
1030 Section 15. Subsection (1) and (2) of section 409.979,
1031 Florida Statutes, are amended to read:
1032 409.979 Eligibility.—
1033 (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid
1034 recipients who meet all of the following criteria are eligible
1035 to receive long-term care services and must receive long-term
1036 care services by participating in the long-term care managed
1037 care program. The recipient must be:
1038 (a) Sixty-five years of age or older, or age 18 or older
1039 and eligible for Medicaid by reason of a disability.
1040 (b) Determined by the Comprehensive Assessment Review and
1041 Evaluation for Long-Term Care Services (CARES) preadmission
1042 screening program to require:
1043 1. Nursing facility care as defined in s. 409.985(3); or
1044 2. Hospital level of care for individuals diagnosed with
1045 cystic fibrosis.
1046 (2) ENROLLMENT OFFERS.—Subject to the availability of
1047 funds, the Department of Elderly Affairs shall make offers for
1048 enrollment to eligible individuals based on a wait-list
1049 prioritization. Before making enrollment offers, the agency and
1050 the Department of Elderly Affairs shall determine that
1051 sufficient funds exist to support additional enrollment into
1052 plans.
1053 (a) A Medicaid recipient enrolled in one of the following
1054 Medicaid home and community-based services waiver programs who
1055 meets the eligibility criteria established in subsection (1) is
1056 eligible to participate in the long-term care managed care
1057 program and must be transitioned into the long-term care managed
1058 care program by January 1, 2018:
1059 1. Traumatic Brain and Spinal Cord Injury Waiver.
1060 2. Adult Cystic Fibrosis Waiver.
1061 3. Project AIDS Care Waiver.
1062 (b) The agency shall seek federal approval to terminate the
1063 Traumatic Brain and Spinal Cord Injury Waiver, the Adult Cystic
1064 Fibrosis Waiver, and the Project AIDS Care Waiver once all
1065 eligible Medicaid recipients have transitioned into the long
1066 term care managed care program.
1067 Section 16. Subject to federal approval of the application
1068 to be a site for the Program of All-inclusive Care for the
1069 Elderly (PACE), the Agency for Health Care Administration shall
1070 contract with an additional not-for-profit organization to serve
1071 individuals and families in Miami-Dade County. The not-for
1072 profit organization must have a history of serving primarily the
1073 Hispanic population by providing primary care services,
1074 nutrition, meals, and adult day care to senior citizens. The
1075 not-for-profit organization shall leverage existing community
1076 based care providers and health care organizations to provide
1077 PACE services to frail elders who reside in Miami-Dade County.
1078 The organization is exempt from the requirements of chapter 641,
1079 Florida Statutes. The agency, in consultation with the
1080 Department of Elderly Affairs and subject to an appropriation,
1081 shall approve up to 250 initial enrollees in the additional PACE
1082 site established by this organization to serve frail elders who
1083 reside in Miami-Dade County.
1084 Section 17. Notwithstanding section 27 of chapter 2016-65,
1085 Laws of Florida, and subject to federal approval of the
1086 application to be a site for the Program of All-inclusive Care
1087 for the Elderly (PACE), the Agency for Health Care
1088 Administration shall contract with a not-for-profit
1089 organization, formed by a partnership with a not-for-profit
1090 hospital, a not-for-profit agency serving elders, and a not-for
1091 profit hospice in Leon County. The not-for-profit PACE shall
1092 serve eligible PACE enrollees in Gadsden, Jefferson, Leon, and
1093 Wakulla Counties. The Agency for Health Care Administration, in
1094 consultation with the Department of Elderly Affairs and subject
1095 to an appropriation, shall approve up to 300 initial enrollees
1096 for the additional PACE site.
1097 Section 18. Section 17 of chapter 2011-61, Laws of Florida,
1098 is amended to read:
1099 Section 17. Notwithstanding s. 430.707, Florida Statutes,
1100 and subject to federal approval of the application to be a site
1101 for the Program of All-inclusive Care for the Elderly, the
1102 Agency for Health Care Administration shall contract with one
1103 private health care organization, the sole member of which is a
1104 private, not-for-profit corporation that owns and manages health
1105 care organizations which provide comprehensive long-term care
1106 services, including nursing home, assisted living, independent
1107 housing, home care, adult day care, and care management, with a
1108 board-certified, trained geriatrician as the medical director.
1109 This organization shall provide these services to frail and
1110 elderly persons who reside in Indian River, Martin, Okeechobee,
1111 Palm Beach, and St. Lucie Counties County. The organization is
1112 exempt from the requirements of chapter 641, Florida Statutes.
1113 The agency, in consultation with the Department of Elderly
1114 Affairs and subject to an appropriation, shall approve up to 150
1115 initial enrollees who reside in Palm Beach County and up to 150
1116 initial enrollees who reside in Martin County in the Program of
1117 All-inclusive Care for the Elderly established by this
1118 organization to serve elderly persons who reside in Palm Beach
1119 County.
1120 Section 19. Effective June 30, 2017, section 9 of chapter
1121 2016-65, Laws of Florida, is amended to read:
1122 Section 9. Effective July 1, 2018 2017, paragraph (b) of
1123 subsection (6) of section 409.905, Florida Statutes, is amended
1124 to read:
1125 409.905 Mandatory Medicaid services.—The agency may make
1126 payments for the following services, which are required of the
1127 state by Title XIX of the Social Security Act, furnished by
1128 Medicaid providers to recipients who are determined to be
1129 eligible on the dates on which the services were provided. Any
1130 service under this section shall be provided only when medically
1131 necessary and in accordance with state and federal law.
1132 Mandatory services rendered by providers in mobile units to
1133 Medicaid recipients may be restricted by the agency. Nothing in
1134 this section shall be construed to prevent or limit the agency
1135 from adjusting fees, reimbursement rates, lengths of stay,
1136 number of visits, number of services, or any other adjustments
1137 necessary to comply with the availability of moneys and any
1138 limitations or directions provided for in the General
1139 Appropriations Act or chapter 216.
1140 (6) HOSPITAL OUTPATIENT SERVICES.—
1141 (b) The agency shall implement a prospective payment
1142 methodology for establishing reimbursement rates for outpatient
1143 hospital services. Rates shall be calculated annually and take
1144 effect July 1, 2018 2017, and July 1 of each year thereafter.
1145 The methodology shall categorize the amount and type of services
1146 used in various ambulatory visits which group together
1147 procedures and medical visits that share similar characteristics
1148 and resource utilization.
1149 1. Adjustments may not be made to the rates after July 31
1150 of the state fiscal year in which the rates take effect.
1151 2. Errors in source data or calculations discovered after
1152 July 31 of each state fiscal year must be reconciled in a
1153 subsequent rate period. However, the agency may not make any
1154 adjustment to a hospital’s reimbursement more than 5 years after
1155 a hospital is notified of an audited rate established by the
1156 agency. The prohibition against adjustments more than 5 years
1157 after notification is remedial and applies to actions by
1158 providers involving Medicaid claims for hospital services.
1159 Hospital reimbursement is subject to such limits or ceilings as
1160 may be established in law or described in the agency’s hospital
1161 reimbursement plan. Specific exemptions to the limits or
1162 ceilings may be provided in the General Appropriations Act.
1163 Section 20. Section 29 of chapter 2016-65, Laws of Florida,
1164 is amended to read:
1165 Section 29. Subject to federal approval of the application
1166 to be a site for the Program of All-inclusive Care for the
1167 Elderly (PACE), the Agency for Health Care Administration shall
1168 contract with one private, not-for-profit hospice organization
1169 located in Lake County which operates health care organizations
1170 licensed in Hospice Areas 7B and 3E and which provides
1171 comprehensive services, including hospice and palliative care,
1172 to frail elders who reside in these service areas. The
1173 organization is exempt from the requirements of chapter 641,
1174 Florida Statutes. The agency, in consultation with the
1175 Department of Elderly Affairs and subject to the appropriation
1176 of funds by the Legislature, shall approve up to 150 initial
1177 enrollees in the Program of All-inclusive Care for the Elderly
1178 established by the organization to serve frail elders who reside
1179 in Hospice Service Areas 7B and 3E. The agency, in consultation
1180 with the department and subject to an appropriation, shall
1181 approve up to 150 enrollees in the Program of All-inclusive Care
1182 for the Elderly established by this organization to serve frail
1183 elders who reside in Hospice Service Area 7C.
1184 Section 21. Subject to federal approval of the application
1185 to be a site for the Program of All-inclusive Care for the
1186 Elderly (PACE), the Agency for Health Care Administration shall
1187 contract with one not-for-profit organization that satisfies
1188 each of the following conditions:
1189 (1) The organization is exempt from federal income taxation
1190 as an entity described in s. 501(c)(3) of the Internal Revenue
1191 Code of 1986, as amended;
1192 (2) The organization is licensed pursuant to part IV of
1193 chapter 400, Florida Statutes, to provide hospice services in
1194 the Agency for Health Care Administration Areas 3 and 4 and
1195 operates inpatient hospice care centers in each of the following
1196 counties within those regions: Alachua, Citrus, Clay, Columbia,
1197 and Putnam;
1198 (3) The organization has more than 30 years of experience
1199 as a licensed hospice provider in this state; and
1200 (4) The organization is affiliated, through common
1201 ownership or control, with other not-for-profit organizations
1202 licensed by the agency to provide home health services, to
1203 operate a nursing home, and to operate an assisted living
1204 facility.
1205
1206 The approved not-for-profit organization shall provide PACE
1207 services to frail and elderly persons who reside in Alachua
1208 County. The organization is exempt from the requirements of
1209 chapter 641, Florida Statutes. The agency, in consultation with
1210 the Department of Elder Affairs and subject to an appropriation,
1211 shall approve up to 150 initial enrollees in the PACE site
1212 established by this organization to serve frail and elderly
1213 persons who reside in Alachua County.
1214 Section 22. Except as otherwise expressly provided in this
1215 act and except for this section, which shall take effect upon
1216 becoming a law, this act shall take effect July 1, 2017.
