Bill Text: FL S2514 | 2017 | Regular Session | Engrossed
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-Engrossed.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-Engrossed.html
SB 2514 First Engrossed
20172514e1
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.; revising the reporting
18 requirements of the acute care services utilization
19 database; requiring the Department of Children and
20 Families to post certain data on its website; creating
21 the Substance Abuse and Mental Health (SAMH) Safety
22 Net Network; providing legislative intent; requiring
23 the Department of Children and Families and the Agency
24 for Health Care Administration to determine the scope
25 of services to be offered through providers contracted
26 with the SAMH Safety Net Network; authorizing the SAMH
27 Safety Net Network to provide Medicaid reimbursable
28 services beyond the limits of the state Medicaid plan
29 under certain circumstances; providing that general
30 revenue matching funds for the services shall be
31 derived from the existing unmatched general revenue
32 funds within the substance abuse and mental health
33 program and documented through general revenue
34 expenditure submissions by the department; requiring
35 the agency, in consultation with the department, to
36 seek federal authorization for administrative claiming
37 pursuant to a specified federal program to fund
38 certain interventions, case managers, and facility
39 services; requiring the department, in collaboration
40 with the agency, to document local funding of
41 behavioral health services; requiring the agency to
42 seek certain federal matching funds; amending s.
43 395.602, F.S.; revising the definition of the term
44 “rural hospital” to include a hospital classified as a
45 sole community hospital, regardless of the number of
46 licensed beds; amending s. 400.179, F.S.; providing
47 that certain fees deposited into the Medicaid nursing
48 home overpayment account in the Grants and Donations
49 Trust Fund may be used by the agency for enhanced
50 payments to nursing facilities as specified in the
51 General Appropriations Act or other law; amending s.
52 409.904, F.S.; authorizing the agency to make payments
53 for medical assistance and related services on behalf
54 of a person diagnosed with acquired immune deficiency
55 syndrome who meets certain criteria, subject to the
56 availability of moneys and specified limitations;
57 amending s. 409.908, F.S.; revising requirements
58 related to the long-term care reimbursement plan and
59 cost reporting system; requiring the calculation of
60 separate prices for each patient care subcomponent
61 based on specified cost reports; providing that
62 certain ceilings and targets apply only to providers
63 being reimbursed on a cost-based system; expanding the
64 direct care subcomponent to include allowable therapy
65 and dietary costs; specifying that allowable ancillary
66 costs are included in the indirect care cost
67 subcomponent; requiring the agency to establish, by a
68 specified date, a technical advisory council to assist
69 in ongoing development and refining of quality
70 measures used in the nursing home prospective payment
71 system; providing for membership; requiring that
72 nursing home prospective payment rates be rebased at a
73 specified interval; authorizing the payment of a
74 direct care supplemental payment to certain providers;
75 specifying the amount providers will be reimbursed for
76 a specified period of time, which may be a cost-based
77 rate or a prospective payment rate; providing for
78 expiration of this reimbursement mechanism on a
79 specified date; requiring the agency to reimburse
80 providers on a cost-based rate or a rebased
81 prospective payment rate, beginning on a specified
82 date; requiring that Medicaid pay deductibles and
83 coinsurance for certain X-ray services provided in an
84 assisted living facility or in the patient’s home;
85 amending s. 409.909, F.S.; providing that the agency
86 shall make payments and distribute funds to qualifying
87 institutions in addition to hospitals under the
88 Statewide Medicaid Residency Program; amending s.
89 409.9082, F.S.; revising the uses of quality
90 assessment and federal matching funds to include the
91 partial funding of the quality incentive payment
92 program for nursing facilities that exceed quality
93 benchmarks; amending s. 409.911, F.S.; updating
94 obsolete language; amending s. 409.9119, F.S.;
95 revising criteria for the participation of hospitals
96 in the disproportionate share program for specialty
97 hospitals for children; amending s. 409.913, F.S.;
98 removing a requirement that the agency provide each
99 Medicaid recipient with an explanation of benefits;
100 authorizing the agency to provide an explanation of
101 benefits to a sample of Medicaid recipients or their
102 representatives; amending s. 409.975, F.S.;
103 authorizing, rather than requiring, a managed care
104 plan to offer a network contract to certain medical
105 equipment and supplies providers in the region;
106 requiring the agency to contract with the SAMH Safety
107 Net Network; specifying that the contract must require
108 managing entities to provide specified services to
109 certain individuals; requiring the agency to conduct a
110 comprehensive readiness assessment before contracting
111 with the SAMH Safety Net Network; requiring the agency
112 and the department to develop performance measures for
113 the SAMH Safety Net Network; requiring the agency and
114 the department to develop performance measures to
115 evaluate the SAMH Safety Net Network and its services;
116 requiring the agency, in consultation with the
117 department and managing entities, to determine the
118 rates for services added to the state Medicaid plan;
119 amending s. 409.979, F.S.; expanding eligibility for
120 long-term care services to include hospital level of
121 care for certain individuals diagnosed with cystic
122 fibrosis; revising eligibility for certain Medicaid
123 recipients in the long-term care managed care program;
124 amending s. 409.983, F.S.; eliminating the requirement
125 that the agency consider facility costs adjusted for
126 inflation in the establishment of certain payment
127 rates for nursing homes; requiring the agency to
128 contract with an additional, not-for-profit
129 organization that meets certain conditions and offers
130 specified services to frail elders who reside in
131 Miami-Dade County, subject to federal approval;
132 exempting the organization from ch. 641, F.S.,
133 relating to health care service programs; requiring
134 the agency, in consultation with the Department of
135 Elderly Affairs, to approve a certain number of
136 initial enrollees in the Program of All-inclusive Care
137 for the Elderly (PACE); requiring the agency to
138 contract with a specified not-for-profit organization,
139 a not-for-profit agency serving elders, and a not-for
140 profit hospice in Leon County to be a site for PACE,
141 subject to federal approval; authorizing PACE to serve
142 eligible enrollees in Gadsden, Jefferson, Leon, and
143 Wakulla Counties; requiring the agency, in
144 consultation with the department, to approve a certain
145 number of initial enrollees in PACE at the new site,
146 subject to an appropriation; amending s. 17 of chapter
147 2011-61, Laws of Florida; requiring the agency, in
148 consultation with the department, to approve a certain
149 number of initial enrollees in PACE to serve frail
150 elders who reside in certain counties; amending s. 9
151 of chapter 2016-65, Laws of Florida; revising an
152 effective date; revising the date that rates for
153 hospital outpatient services must take effect;
154 amending s. 29 of chapter 2016-65, Laws of Florida;
155 requiring the agency, in consultation with the
156 department, to approve a certain number of enrollees
157 in the PACE established to serve frail elders who
158 reside in Hospice Service Area 7; requiring the agency
159 to contract with a not-for-profit organization that
160 meets certain criteria to offer specified services to
161 frail elders who reside in Alachua County, subject to
162 federal approval; exempting the organization from ch.
163 641, F.S., relating to health care service programs;
164 requiring the agency, in consultation with the
165 department, to approve a certain number of initial
166 enrollees in PACE at the new site, subject to certain
167 conditions; requiring the agency to contract with an
168 organization that meets certain criteria to offer
169 specified services to frail elders who reside in
170 certain counties, subject to federal approval;
171 exempting the organization from ch. 641, F.S.,
172 relating to health care service programs; requiring
173 the agency, in consultation with the department, to
174 approve a certain number of initial enrollees in PACE
175 at the new site, subject to certain conditions;
176 providing that the agency may seek any necessary
177 waiver or state plan amendments to serve a certain
178 purpose; providing effective dates.
179
180 Be It Enacted by the Legislature of the State of Florida:
181
182 Section 1. Paragraph (c) of subsection (2) of section
183 210.20, Florida Statutes, is amended to read:
184 210.20 Employees and assistants; distribution of funds.—
185 (2) As collections are received by the division from such
186 cigarette taxes, it shall pay the same into a trust fund in the
187 State Treasury designated “Cigarette Tax Collection Trust Fund”
188 which shall be paid and distributed as follows:
189 (c) Beginning July 1, 2017 2013, and continuing through
190 June 30, 2033, the division shall from month to month certify to
191 the Chief Financial Officer the amount derived from the
192 cigarette tax imposed by s. 210.02, less the service charges
193 provided for in s. 215.20 and less 0.9 percent of the amount
194 derived from the cigarette tax imposed by s. 210.02, which shall
195 be deposited into the Alcoholic Beverage and Tobacco Trust Fund,
196 specifying an amount equal to 1 percent of the net collections,
197 not to exceed $3 million annually, and that amount shall be
198 deposited into the Biomedical Research Trust Fund in the
199 Department of Health. These funds are appropriated annually in
200 an amount not to exceed $3 million from the Biomedical Research
201 Trust Fund for the advancement of cures for cancers afflicting
202 pediatric populations through basic or applied research,
203 including, but not limited to, clinical trials and nontoxic drug
204 discovery. These funds are not included in the calculation for
205 the distribution of funds pursuant to s. 381.915; however, these
206 funds shall be distributed to cancer centers participating in
207 the Florida Consortium of National Cancer Institute Centers
208 Program in the same proportion as is allocated to each cancer
209 center in accordance with s. 381.915 and are in addition to any
210 funds distributed pursuant to that section Department of Health
211 and the Sanford-Burnham Medical Research Institute to work in
212 conjunction for the purpose of establishing activities and grant
213 opportunities in relation to biomedical research.
214 Section 2. Subsection (2) of section 381.922, Florida
215 Statutes, is amended to read:
216 381.922 William G. “Bill” Bankhead, Jr., and David Coley
217 Cancer Research Program.—
218 (2) The program shall provide grants for cancer research to
219 further the search for cures for cancer.
220 (a) Emphasis shall be given to the following goals, as
221 those goals support the advancement of such cures:
222 1. Efforts to significantly expand cancer research capacity
223 in the state by:
224 a. Identifying ways to attract new research talent and
225 attendant national grant-producing researchers to cancer
226 research facilities in this state;
227 b. Implementing a peer-reviewed, competitive process to
228 identify and fund the best proposals to expand cancer research
229 institutes in this state;
230 c. Funding through available resources for those proposals
231 that demonstrate the greatest opportunity to attract federal
232 research grants and private financial support;
233 d. Encouraging the employment of bioinformatics in order to
234 create a cancer informatics infrastructure that enhances
235 information and resource exchange and integration through
236 researchers working in diverse disciplines, to facilitate the
237 full spectrum of cancer investigations;
238 e. Facilitating the technical coordination, business
239 development, and support of intellectual property as it relates
240 to the advancement of cancer research; and
241 f. Aiding in other multidisciplinary research-support
242 activities as they inure to the advancement of cancer research.
243 2. Efforts to improve both research and treatment through
244 greater participation in clinical trials networks by:
245 a. Identifying ways to increase pediatric and adult
246 enrollment in cancer clinical trials;
247 b. Supporting public and private professional education
248 programs designed to increase the awareness and knowledge about
249 cancer clinical trials;
250 c. Providing tools to cancer patients and community-based
251 oncologists to aid in the identification of cancer clinical
252 trials available in the state; and
253 d. Creating opportunities for the state’s academic cancer
254 centers to collaborate with community-based oncologists in
255 cancer clinical trials networks.
256 3. Efforts to reduce the impact of cancer on disparate
257 groups by:
258 a. Identifying those cancers that disproportionately impact
259 certain demographic groups; and
260 b. Building collaborations designed to reduce health
261 disparities as they relate to cancer.
262 (b) Preference may be given to grant proposals that foster
263 collaborations among institutions, researchers, and community
264 practitioners, as such proposals support the advancement of
265 cures through basic or applied research, including clinical
266 trials involving cancer patients and related networks.
267 (c) There is established within the program the Live Like
268 Bella Initiative. The purpose of the initiative is to advance
269 progress toward curing pediatric cancer by awarding grants
270 through the peer-reviewed, competitive process established under
271 subsection (3). This paragraph is subject to the annual
272 appropriation of funds by the Legislature.
273 Section 3. Paragraph (a) of subsection (10) of section
274 394.9082, Florida Statutes, is republished, paragraph (b) of
275 that subsection is amended, paragraph (f) is added to that
276 subsection, and subsection (11) is added to that section, to
277 read:
278 394.9082 Behavioral health managing entities.—
279 (10) ACUTE CARE SERVICES UTILIZATION DATABASE.—The
280 department shall develop, implement, and maintain standards
281 under which a managing entity shall collect utilization data
282 from all public receiving facilities situated within its
283 geographical service area and all detoxification and addictions
284 receiving facilities under contract with the managing entity. As
285 used in this subsection, the term “public receiving facility”
286 means an entity that meets the licensure requirements of, and is
287 designated by, the department to operate as a public receiving
288 facility under s. 394.875 and that is operating as a licensed
289 crisis stabilization unit.
290 (a) The department shall develop standards and protocols to
291 be used for data collection, storage, transmittal, and analysis.
292 The standards and protocols shall allow for compatibility of
293 data and data transmittal between public receiving facilities,
294 detoxification facilities, addictions receiving facilities,
295 managing entities, and the department for the implementation,
296 and to meet the requirements, of this subsection.
297 (b) A managing entity shall require providers specified in
298 paragraph (a) to submit data, in real time or at least daily, to
299 the managing entity for:
300 1. All admissions and discharges of clients receiving
301 public receiving facility services who qualify as indigent, as
302 defined in s. 394.4787.
303 2. All admissions and discharges of clients receiving
304 substance abuse services in an addictions receiving facility or
305 detoxification facility pursuant to parts IV and V of chapter
306 397 who qualify as indigent.
307 3. The current active census of total licensed and utilized
308 beds, the number of beds purchased by the department, the number
309 of clients qualifying as indigent occupying who occupy any of
310 those beds, and the total number of unoccupied licensed beds,
311 regardless of funding, and the number in excess of licensed
312 capacity. Crisis units licensed for both adult and child use
313 will report as a single unit.
314 (f) The department shall post on its website, by facility,
315 the data collected pursuant to this subsection and update such
316 posting monthly.
317 (11) SUBSTANCE ABUSE AND MENTAL HEALTH (SAMH) SAFETY NET
318 NETWORK.—
319 (a) It is the intent of the Legislature to create the
320 Substance Abuse and Mental Health (SAMH) Safety Net Network to
321 support and enhance the community mental health and substance
322 abuse services currently provided by managing entities. The SAMH
323 Safety Net Network as used in this section means the managing
324 entities and their contracted network of providers. Contracted
325 providers are considered vendors and not subrecipients, as
326 defined in s. 215.97. Managing entities and their contracted
327 providers are not public employees for purposes of chapter 112.
328 (b) The department and the agency shall establish the SAMH
329 Safety Net Network by adding specific behavioral health services
330 currently provided by managing entities to the state Medicaid
331 plan and adjusting the amount of units of services for specific
332 Medicaid services to better serve Medicaid-eligible individuals
333 with severe and persistent mental health or substance use
334 disorders, and their families, who are currently served by
335 managing entities. It is the intent of the Legislature to have
336 the department submit documentation of general revenue
337 expenditures to the agency for the state match for the services
338 and for the agency to pay managing entities the federal Medicaid
339 portion for services provided.
340 1. Behavioral health services currently funded by managing
341 entities through the substance abuse and mental health program
342 shall be added by the agency to the state Medicaid plan through
343 a state plan amendment. These services shall be provided
344 exclusively through the providers contracted with the SAMH
345 Safety Net Network. The department and the agency shall
346 determine which services are essential for individuals served by
347 managing entities through coordinated systems of care and which
348 services will most efficiently use state and federal resources.
349 2. The state Medicaid plan currently limits the amount of
350 behavioral health services that may be provided to a covered
351 individual. However, the SAMH Safety Net Network is authorized
352 to provide Medicaid reimbursable services beyond these limits
353 when providing services, including, but not limited to,
354 assessment, group therapy, individual therapy, psychosocial
355 rehabilitation, day treatment, medication management,
356 therapeutic onsite services, substance abuse inpatient or
357 residential detoxification, inpatient hospital services, and
358 crisis stabilization unit or as appropriate in lieu of services.
359 (c) The required general revenue matching funds for the
360 services shall be derived from the existing unmatched general
361 revenue funds within the substance abuse and mental health
362 program and documented through general revenue expenditure
363 submissions by the department. The Medicaid reimbursement for
364 services provided by the SAMH Safety Net Network shall be
365 limited to the availability of general revenue matching funds
366 within the substance abuse and mental health program for such
367 purpose.
368 (d) Except as otherwise provided in this part, the state
369 share of funds sufficient to implement the provisions of this
370 act shall be redirected from existing general revenue funds in
371 the department which are used for funding mental health and
372 substance abuse services, excluding funding for residential
373 services. The need for these state-only funds must be offset by
374 the infusion of federal funds made available to the SAMH Safety
375 Net Network under the provisions of this act.
376 Section 4. The Agency for Health Care Administration, in
377 consultation with the Department of Children and Families, shall
378 seek federal authorization for administrative claiming pursuant
379 to the Medicaid Administrative Claiming program to fund:
380 (1) The department’s team-based interventions, including,
381 but not limited to, community action treatment teams and family
382 intervention treatment teams, which focus on the entire family
383 to prevent out-of-home placements in the child welfare,
384 behavioral health, and criminal justice systems.
385 (2) Case managers employed by the department’s child
386 welfare community-based care lead agency who are responsible for
387 locating, coordinating, and monitoring necessary and appropriate
388 services extending beyond direct services for Medicaid-eligible
389 children, including, but not limited to, outreach, referral,
390 eligibility determination, and case management.
391 (3) Central receiving facility services for individuals
392 with mental health or substance use disorders.
393 Section 5. The Department of Children and Families, in
394 collaboration with the Agency for Health Care Administration,
395 shall document the extent to which behavioral health services
396 are funded with contributions from units of local government.
397 The agency shall seek federal authority to have these funds
398 qualify for federal matching funds as certified public
399 expenditures.
400 Section 6. Paragraph (e) of subsection (2) of section
401 395.602, Florida Statutes, is amended to read:
402 395.602 Rural hospitals.—
403 (2) DEFINITIONS.—As used in this part, the term:
404 (e) “Rural hospital” means an acute care hospital licensed
405 under this chapter, having 100 or fewer licensed beds and an
406 emergency room, which is:
407 1. The sole provider within a county with a population
408 density of up to 100 persons per square mile;
409 2. An acute care hospital, in a county with a population
410 density of up to 100 persons per square mile, which is at least
411 30 minutes of travel time, on normally traveled roads under
412 normal traffic conditions, from any other acute care hospital
413 within the same county;
414 3. A hospital supported by a tax district or subdistrict
415 whose boundaries encompass a population of up to 100 persons per
416 square mile;
417 4. A hospital classified as a sole community hospital under
418 42 C.F.R. s. 412.92, regardless of the number of which has up to
419 175 licensed beds;
420 5. A hospital with a service area that has a population of
421 up to 100 persons per square mile. As used in this subparagraph,
422 the term “service area” means the fewest number of zip codes
423 that account for 75 percent of the hospital’s discharges for the
424 most recent 5-year period, based on information available from
425 the hospital inpatient discharge database in the Florida Center
426 for Health Information and Transparency at the agency; or
427 6. A hospital designated as a critical access hospital, as
428 defined in s. 408.07.
429
430 Population densities used in this paragraph must be based upon
431 the most recently completed United States census. A hospital
432 that received funds under s. 409.9116 for a quarter beginning no
433 later than July 1, 2002, is deemed to have been and shall
434 continue to be a rural hospital from that date through June 30,
435 2021, if the hospital continues to have up to 100 licensed beds
436 and an emergency room. An acute care hospital that has not
437 previously been designated as a rural hospital and that meets
438 the criteria of this paragraph shall be granted such designation
439 upon application, including supporting documentation, to the
440 agency. A hospital that was licensed as a rural hospital during
441 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
442 rural hospital from the date of designation through June 30,
443 2021, if the hospital continues to have up to 100 licensed beds
444 and an emergency room.
445 Section 7. Paragraph (d) of subsection (2) of section
446 400.179, Florida Statutes, is amended to read:
447 400.179 Liability for Medicaid underpayments and
448 overpayments.—
449 (2) Because any transfer of a nursing facility may expose
450 the fact that Medicaid may have underpaid or overpaid the
451 transferor, and because in most instances, any such underpayment
452 or overpayment can only be determined following a formal field
453 audit, the liabilities for any such underpayments or
454 overpayments shall be as follows:
455 (d) Where the transfer involves a facility that has been
456 leased by the transferor:
457 1. The transferee shall, as a condition to being issued a
458 license by the agency, acquire, maintain, and provide proof to
459 the agency of a bond with a term of 30 months, renewable
460 annually, in an amount not less than the total of 3 months’
461 Medicaid payments to the facility computed on the basis of the
462 preceding 12-month average Medicaid payments to the facility.
463 2. A leasehold licensee may meet the requirements of
464 subparagraph 1. by payment of a nonrefundable fee, paid at
465 initial licensure, paid at the time of any subsequent change of
466 ownership, and paid annually thereafter, in the amount of 1
467 percent of the total of 3 months’ Medicaid payments to the
468 facility computed on the basis of the preceding 12-month average
469 Medicaid payments to the facility. If a preceding 12-month
470 average is not available, projected Medicaid payments may be
471 used. The fee shall be deposited into the Grants and Donations
472 Trust Fund and shall be accounted for separately as a Medicaid
473 nursing home overpayment account. These fees shall be used at
474 the sole discretion of the agency to repay nursing home Medicaid
475 overpayments or for enhanced payments to nursing facilities as
476 specified in the General Appropriations Act or other law.
477 Payment of this fee shall not release the licensee from any
478 liability for any Medicaid overpayments, nor shall payment bar
479 the agency from seeking to recoup overpayments from the licensee
480 and any other liable party. As a condition of exercising this
481 lease bond alternative, licensees paying this fee must maintain
482 an existing lease bond through the end of the 30-month term
483 period of that bond. The agency is herein granted specific
484 authority to promulgate all rules pertaining to the
485 administration and management of this account, including
486 withdrawals from the account, subject to federal review and
487 approval. This provision shall take effect upon becoming law and
488 shall apply to any leasehold license application. The financial
489 viability of the Medicaid nursing home overpayment account shall
490 be determined by the agency through annual review of the account
491 balance and the amount of total outstanding, unpaid Medicaid
492 overpayments owing from leasehold licensees to the agency as
493 determined by final agency audits. By March 31 of each year, the
494 agency shall assess the cumulative fees collected under this
495 subparagraph, minus any amounts used to repay nursing home
496 Medicaid overpayments and amounts transferred to contribute to
497 the General Revenue Fund pursuant to s. 215.20. If the net
498 cumulative collections, minus amounts utilized to repay nursing
499 home Medicaid overpayments, exceed $25 million, the provisions
500 of this subparagraph shall not apply for the subsequent fiscal
501 year.
502 3. The leasehold licensee may meet the bond requirement
503 through other arrangements acceptable to the agency. The agency
504 is herein granted specific authority to promulgate rules
505 pertaining to lease bond arrangements.
506 4. All existing nursing facility licensees, operating the
507 facility as a leasehold, shall acquire, maintain, and provide
508 proof to the agency of the 30-month bond required in
509 subparagraph 1., above, on and after July 1, 1993, for each
510 license renewal.
511 5. It shall be the responsibility of all nursing facility
512 operators, operating the facility as a leasehold, to renew the
513 30-month bond and to provide proof of such renewal to the agency
514 annually.
515 6. Any failure of the nursing facility operator to acquire,
516 maintain, renew annually, or provide proof to the agency shall
517 be grounds for the agency to deny, revoke, and suspend the
518 facility license to operate such facility and to take any
519 further action, including, but not limited to, enjoining the
520 facility, asserting a moratorium pursuant to part II of chapter
521 408, or applying for a receiver, deemed necessary to ensure
522 compliance with this section and to safeguard and protect the
523 health, safety, and welfare of the facility’s residents. A lease
524 agreement required as a condition of bond financing or
525 refinancing under s. 154.213 by a health facilities authority or
526 required under s. 159.30 by a county or municipality is not a
527 leasehold for purposes of this paragraph and is not subject to
528 the bond requirement of this paragraph.
529 Section 8. Subsection (11) is added to section 409.904,
530 Florida Statutes, to read:
531 409.904 Optional payments for eligible persons.—The agency
532 may make payments for medical assistance and related services on
533 behalf of the following persons who are determined to be
534 eligible subject to the income, assets, and categorical
535 eligibility tests set forth in federal and state law. Payment on
536 behalf of these Medicaid eligible persons is subject to the
537 availability of moneys and any limitations established by the
538 General Appropriations Act or chapter 216.
539 (11) Subject to federal waiver approval, a person diagnosed
540 with acquired immune deficiency syndrome (AIDS) who has an AIDS
541 related opportunistic infection and is at risk of
542 hospitalization as determined by the agency and whose income is
543 at or below 300 percent of the Federal Benefit Rate.
544 Section 9. Subsections (2) and (14) of section 409.908,
545 Florida Statutes, are amended to read:
546 409.908 Reimbursement of Medicaid providers.—Subject to
547 specific appropriations, the agency shall reimburse Medicaid
548 providers, in accordance with state and federal law, according
549 to methodologies set forth in the rules of the agency and in
550 policy manuals and handbooks incorporated by reference therein.
551 These methodologies may include fee schedules, reimbursement
552 methods based on cost reporting, negotiated fees, competitive
553 bidding pursuant to s. 287.057, and other mechanisms the agency
554 considers efficient and effective for purchasing services or
555 goods on behalf of recipients. If a provider is reimbursed based
556 on cost reporting and submits a cost report late and that cost
557 report would have been used to set a lower reimbursement rate
558 for a rate semester, then the provider’s rate for that semester
559 shall be retroactively calculated using the new cost report, and
560 full payment at the recalculated rate shall be effected
561 retroactively. Medicare-granted extensions for filing cost
562 reports, if applicable, shall also apply to Medicaid cost
563 reports. Payment for Medicaid compensable services made on
564 behalf of Medicaid eligible persons is subject to the
565 availability of moneys and any limitations or directions
566 provided for in the General Appropriations Act or chapter 216.
567 Further, nothing in this section shall be construed to prevent
568 or limit the agency from adjusting fees, reimbursement rates,
569 lengths of stay, number of visits, or number of services, or
570 making any other adjustments necessary to comply with the
571 availability of moneys and any limitations or directions
572 provided for in the General Appropriations Act, provided the
573 adjustment is consistent with legislative intent.
574 (2)(a)1. Reimbursement to nursing homes licensed under part
575 II of chapter 400 and state-owned-and-operated intermediate care
576 facilities for the developmentally disabled licensed under part
577 VIII of chapter 400 must be made prospectively.
578 2. Unless otherwise limited or directed in the General
579 Appropriations Act, reimbursement to hospitals licensed under
580 part I of chapter 395 for the provision of swing-bed nursing
581 home services must be made on the basis of the average statewide
582 nursing home payment, and reimbursement to a hospital licensed
583 under part I of chapter 395 for the provision of skilled nursing
584 services must be made on the basis of the average nursing home
585 payment for those services in the county in which the hospital
586 is located. When a hospital is located in a county that does not
587 have any community nursing homes, reimbursement shall be
588 determined by averaging the nursing home payments in counties
589 that surround the county in which the hospital is located.
590 Reimbursement to hospitals, including Medicaid payment of
591 Medicare copayments, for skilled nursing services shall be
592 limited to 30 days, unless a prior authorization has been
593 obtained from the agency. Medicaid reimbursement may be extended
594 by the agency beyond 30 days, and approval must be based upon
595 verification by the patient’s physician that the patient
596 requires short-term rehabilitative and recuperative services
597 only, in which case an extension of no more than 15 days may be
598 approved. Reimbursement to a hospital licensed under part I of
599 chapter 395 for the temporary provision of skilled nursing
600 services to nursing home residents who have been displaced as
601 the result of a natural disaster or other emergency may not
602 exceed the average county nursing home payment for those
603 services in the county in which the hospital is located and is
604 limited to the period of time which the agency considers
605 necessary for continued placement of the nursing home residents
606 in the hospital.
607 (b) Subject to any limitations or directions in the General
608 Appropriations Act, the agency shall establish and implement a
609 state Title XIX Long-Term Care Reimbursement Plan for nursing
610 home care in order to provide care and services in conformance
611 with the applicable state and federal laws, rules, regulations,
612 and quality and safety standards and to ensure that individuals
613 eligible for medical assistance have reasonable geographic
614 access to such care.
615 1. The agency shall amend the long-term care reimbursement
616 plan and cost reporting system to create direct care and
617 indirect care subcomponents of the patient care component of the
618 per diem rate. These two subcomponents together shall equal the
619 patient care component of the per diem rate. Separate prices
620 cost-based ceilings shall be calculated for each patient care
621 subcomponent, initially based on the September 2016 rate setting
622 cost reports and subsequently based on the most recently audited
623 cost report used during a rebasing year. The direct care
624 subcomponent of the per diem rate for any providers still being
625 reimbursed on a cost basis shall be limited by the cost-based
626 class ceiling, and the indirect care subcomponent may be limited
627 by the lower of the cost-based class ceiling, the target rate
628 class ceiling, or the individual provider target. The ceilings
629 and targets apply only to providers being reimbursed on a cost
630 based system.
631 2. The direct care subcomponent shall include salaries and
632 benefits of direct care staff providing nursing services
633 including registered nurses, licensed practical nurses, and
634 certified nursing assistants who deliver care directly to
635 residents in the nursing home facility, allowable therapy costs,
636 and dietary costs. This excludes nursing administration, staff
637 development, the staffing coordinator, and the administrative
638 portion of the minimum data set and care plan coordinators. The
639 direct care subcomponent also includes medically necessary
640 dental care, vision care, hearing care, and podiatric care.
641 3. All other patient care costs shall be included in the
642 indirect care cost subcomponent of the patient care per diem
643 rate, including complex medical equipment, medical supplies, and
644 other allowable ancillary costs. Costs may not be allocated
645 directly or indirectly to the direct care subcomponent from a
646 home office or management company.
647 4. On July 1 of each year, the agency shall report to the
648 Legislature direct and indirect care costs, including average
649 direct and indirect care costs per resident per facility and
650 direct care and indirect care salaries and benefits per category
651 of staff member per facility.
652 5. Before December 31, 2017, the agency must establish a
653 technical advisory council to assist in ongoing development and
654 refining of the quality measures used in the nursing home
655 prospective payment system. The advisory council must include,
656 but need not be limited to, representatives of nursing home
657 providers and other interested stakeholders. In order to offset
658 the cost of general and professional liability insurance, the
659 agency shall amend the plan to allow for interim rate
660 adjustments to reflect increases in the cost of general or
661 professional liability insurance for nursing homes. This
662 provision shall be implemented to the extent existing
663 appropriations are available.
664 6. Every fourth year, the agency shall rebase nursing home
665 prospective payment rates to reflect changes in cost based on
666 the most recently audited cost report for each participating
667 provider.
668 7. A direct care supplemental payment may be made to
669 providers whose direct care hours per patient day are above the
670 80th percentile and who provide Medicaid services to a larger
671 percentage of Medicaid patients than the state average.
672 8. For the period beginning on October 1, 2017, and ending
673 on September 30, 2020, the agency shall reimburse providers the
674 greater of their September 2016 cost-based rate or their
675 prospective payment rate. Effective October 1, 2020, the agency
676 shall reimburse providers the greater of 95 percent of their
677 cost-based rate or their rebased prospective payment rate, using
678 the most recently audited cost report for each facility. This
679 subsection shall expire September 30, 2022.
680 9. Pediatric, Florida Department of Veterans Affairs, and
681 government-owned facilities are exempt from the pricing model
682 established in this subsection and shall remain on a cost-based
683 prospective payment system. Effective October 1, 2018, the
684 agency shall set rates for all facilities remaining on a cost
685 based prospective payment system using each facility’s most
686 recently audited cost report, eliminating retroactive
687 settlements.
688
689 It is the intent of the Legislature that the reimbursement plan
690 achieve the goal of providing access to health care for nursing
691 home residents who require large amounts of care while
692 encouraging diversion services as an alternative to nursing home
693 care for residents who can be served within the community. The
694 agency shall base the establishment of any maximum rate of
695 payment, whether overall or component, on the available moneys
696 as provided for in the General Appropriations Act. The agency
697 may base the maximum rate of payment on the results of
698 scientifically valid analysis and conclusions derived from
699 objective statistical data pertinent to the particular maximum
700 rate of payment.
701 (14) Medicare premiums for persons eligible for both
702 Medicare and Medicaid coverage shall be paid at the rates
703 established by Title XVIII of the Social Security Act. For
704 Medicare services rendered to Medicaid-eligible persons,
705 Medicaid shall pay Medicare deductibles and coinsurance as
706 follows:
707 (a) Medicaid’s financial obligation for deductibles and
708 coinsurance payments shall be based on Medicare allowable fees,
709 not on a provider’s billed charges.
710 (b) Medicaid will pay no portion of Medicare deductibles
711 and coinsurance when payment that Medicare has made for the
712 service equals or exceeds what Medicaid would have paid if it
713 had been the sole payor. The combined payment of Medicare and
714 Medicaid shall not exceed the amount Medicaid would have paid
715 had it been the sole payor. The Legislature finds that there has
716 been confusion regarding the reimbursement for services rendered
717 to dually eligible Medicare beneficiaries. Accordingly, the
718 Legislature clarifies that it has always been the intent of the
719 Legislature before and after 1991 that, in reimbursing in
720 accordance with fees established by Title XVIII for premiums,
721 deductibles, and coinsurance for Medicare services rendered by
722 physicians to Medicaid eligible persons, physicians be
723 reimbursed at the lesser of the amount billed by the physician
724 or the Medicaid maximum allowable fee established by the Agency
725 for Health Care Administration, as is permitted by federal law.
726 It has never been the intent of the Legislature with regard to
727 such services rendered by physicians that Medicaid be required
728 to provide any payment for deductibles, coinsurance, or
729 copayments for Medicare cost sharing, or any expenses incurred
730 relating thereto, in excess of the payment amount provided for
731 under the State Medicaid plan for such service. This payment
732 methodology is applicable even in those situations in which the
733 payment for Medicare cost sharing for a qualified Medicare
734 beneficiary with respect to an item or service is reduced or
735 eliminated. This expression of the Legislature is in
736 clarification of existing law and shall apply to payment for,
737 and with respect to provider agreements with respect to, items
738 or services furnished on or after the effective date of this
739 act. This paragraph applies to payment by Medicaid for items and
740 services furnished before the effective date of this act if such
741 payment is the subject of a lawsuit that is based on the
742 provisions of this section, and that is pending as of, or is
743 initiated after, the effective date of this act.
744 (c) Notwithstanding paragraphs (a) and (b):
745 1. Medicaid payments for Nursing Home Medicare part A
746 coinsurance are limited to the Medicaid nursing home per diem
747 rate less any amounts paid by Medicare, but only up to the
748 amount of Medicare coinsurance. The Medicaid per diem rate shall
749 be the rate in effect for the dates of service of the crossover
750 claims and may not be subsequently adjusted due to subsequent
751 per diem rate adjustments.
752 2. Medicaid shall pay all deductibles and coinsurance for
753 Medicare-eligible recipients receiving freestanding end stage
754 renal dialysis center services.
755 3. Medicaid payments for general and specialty hospital
756 inpatient services are limited to the Medicare deductible and
757 coinsurance per spell of illness. Medicaid payments for hospital
758 Medicare Part A coinsurance shall be limited to the Medicaid
759 hospital per diem rate less any amounts paid by Medicare, but
760 only up to the amount of Medicare coinsurance. Medicaid payments
761 for coinsurance shall be limited to the Medicaid per diem rate
762 in effect for the dates of service of the crossover claims and
763 may not be subsequently adjusted due to subsequent per diem
764 adjustments.
765 4. Medicaid shall pay all deductibles and coinsurance for
766 Medicare emergency transportation services provided by
767 ambulances licensed pursuant to chapter 401.
768 5. Medicaid shall pay all deductibles and coinsurance for
769 portable X-ray Medicare Part B services provided in a nursing
770 home, in an assisted living facility, or in the patient’s home.
771 Section 10. Subsection (4) of section 409.9082, Florida
772 Statutes, is amended to read:
773 409.9082 Quality assessment on nursing home facility
774 providers; exemptions; purpose; federal approval required;
775 remedies.—
776 (4) The purpose of the nursing home facility quality
777 assessment is to ensure continued quality of care. Collected
778 assessment funds shall be used to obtain federal financial
779 participation through the Medicaid program to make Medicaid
780 payments for nursing home facility services up to the amount of
781 nursing home facility Medicaid rates as calculated in accordance
782 with the approved state Medicaid plan in effect on December 31,
783 2007. The quality assessment and federal matching funds shall be
784 used exclusively for the following purposes and in the following
785 order of priority:
786 (a) To reimburse the Medicaid share of the quality
787 assessment as a pass-through, Medicaid-allowable cost;
788 (b) To increase to each nursing home facility’s Medicaid
789 rate, as needed, an amount that restores rate reductions
790 effective on or after January 1, 2008, as provided in the
791 General Appropriations Act; and
792 (c) To partially fund the quality incentive payment program
793 for nursing facilities that exceed quality benchmarks increase
794 each nursing home facility’s Medicaid rate that accounts for the
795 portion of the total assessment not included in paragraphs (a)
796 and (b) which begins a phase-in to a pricing model for the
797 operating cost component.
798 Section 11. Section 409.909, Florida Statutes, is amended
799 to read:
800 409.909 Statewide Medicaid Residency Program.—
801 (1) The Statewide Medicaid Residency Program is established
802 to improve the quality of care and access to care for Medicaid
803 recipients, expand graduate medical education on an equitable
804 basis, and increase the supply of highly trained physicians
805 statewide. The agency shall make payments to hospitals licensed
806 under part I of chapter 395 and to qualifying institutions as
807 defined in paragraph (2)(c) for graduate medical education
808 associated with the Medicaid program. This system of payments is
809 designed to generate federal matching funds under Medicaid and
810 distribute the resulting funds to participating hospitals on a
811 quarterly basis in each fiscal year for which an appropriation
812 is made.
813 (2) On or before September 15 of each year, the agency
814 shall calculate an allocation fraction to be used for
815 distributing funds to participating hospitals and to qualifying
816 institutions as defined in paragraph (2)(c). On or before the
817 final business day of each quarter of a state fiscal year, the
818 agency shall distribute to each participating hospital one
819 fourth of that hospital’s annual allocation calculated under
820 subsection (4). The allocation fraction for each participating
821 hospital is based on the hospital’s number of full-time
822 equivalent residents and the amount of its Medicaid payments. As
823 used in this section, the term:
824 (a) “Full-time equivalent,” or “FTE,” means a resident who
825 is in his or her residency period, with the initial residency
826 period defined as the minimum number of years of training
827 required before the resident may become eligible for board
828 certification by the American Osteopathic Association Bureau of
829 Osteopathic Specialists or the American Board of Medical
830 Specialties in the specialty in which he or she first began
831 training, not to exceed 5 years. The residency specialty is
832 defined as reported using the current residency type codes in
833 the Intern and Resident Information System (IRIS), required by
834 Medicare. A resident training beyond the initial residency
835 period is counted as 0.5 FTE, unless his or her chosen specialty
836 is in primary care, in which case the resident is counted as 1.0
837 FTE. For the purposes of this section, primary care specialties
838 include:
839 1. Family medicine;
840 2. General internal medicine;
841 3. General pediatrics;
842 4. Preventive medicine;
843 5. Geriatric medicine;
844 6. Osteopathic general practice;
845 7. Obstetrics and gynecology;
846 8. Emergency medicine;
847 9. General surgery; and
848 10. Psychiatry.
849 (b) “Medicaid payments” means the estimated total payments
850 for reimbursing a hospital for direct inpatient services for the
851 fiscal year in which the allocation fraction is calculated based
852 on the hospital inpatient appropriation and the parameters for
853 the inpatient diagnosis-related group base rate, including
854 applicable intergovernmental transfers, specified in the General
855 Appropriations Act, as determined by the agency. Effective July
856 1, 2017, the term “Medicaid payments” means the estimated total
857 payments for reimbursing a hospital and qualifying institutions
858 as defined in paragraph (2)(c) for direct inpatient and
859 outpatient services for the fiscal year in which the allocation
860 fraction is calculated based on the hospital inpatient
861 appropriation and outpatient appropriation and the parameters
862 for the inpatient diagnosis-related group base rate, including
863 applicable intergovernmental transfers, specified in the General
864 Appropriations Act, as determined by the agency.
865 (c) “Qualifying institution” means a federally Qualified
866 Health Center holding an Accreditation Council for Graduate
867 Medical Education institutional accreditation.
868 (d) “Resident” means a medical intern, fellow, or resident
869 enrolled in a program accredited by the Accreditation Council
870 for Graduate Medical Education, the American Association of
871 Colleges of Osteopathic Medicine, or the American Osteopathic
872 Association at the beginning of the state fiscal year during
873 which the allocation fraction is calculated, as reported by the
874 hospital to the agency.
875 (3) The agency shall use the following formula to calculate
876 a participating hospital’s and qualifying institution’s
877 allocation fraction:
878
879 HAF=[0.9 x (HFTE/TFTE)] + [0.1 x (HMP/TMP)]
880
881 Where:
882 HAF=A hospital’s and qualifying institution’s allocation
883 fraction.
884 HFTE=A hospital’s and qualifying institution’s total number
885 of FTE residents.
886 TFTE=The total FTE residents for all participating
887 hospitals and qualifying institutions.
888 HMP=A hospital’s and qualifying institution’s Medicaid
889 payments.
890 TMP=The total Medicaid payments for all participating
891 hospitals and qualifying institutions.
892
893 (4) A hospital’s and qualifying institution’s annual
894 allocation shall be calculated by multiplying the funds
895 appropriated for the Statewide Medicaid Residency Program in the
896 General Appropriations Act by that hospital’s and qualifying
897 institution’s allocation fraction. If the calculation results in
898 an annual allocation that exceeds two times the average per FTE
899 resident amount for all hospitals and qualifying institutions,
900 the hospital’s and qualifying institution’s annual allocation
901 shall be reduced to a sum equaling no more than two times the
902 average per FTE resident. The funds calculated for that hospital
903 and qualifying institution in excess of two times the average
904 per FTE resident amount for all hospitals and qualifying
905 institutions shall be redistributed to participating hospitals
906 and qualifying institutions whose annual allocation does not
907 exceed two times the average per FTE resident amount for all
908 hospitals and qualifying institutions, using the same
909 methodology and payment schedule specified in this section.
910 (5) The Graduate Medical Education Startup Bonus Program is
911 established to provide resources for the education and training
912 of physicians in specialties which are in a statewide supply
913 and-demand deficit. Hospitals and qualifying institutions as
914 defined in paragraph (2)(c) eligible for participation in
915 subsection (1) are eligible to participate in the Graduate
916 Medical Education Startup Bonus Program established under this
917 subsection. Notwithstanding subsection (4) or an FTE’s residency
918 period, and in any state fiscal year in which funds are
919 appropriated for the startup bonus program, the agency shall
920 allocate a $100,000 startup bonus for each newly created
921 resident position that is authorized by the Accreditation
922 Council for Graduate Medical Education or Osteopathic
923 Postdoctoral Training Institution in an initial or established
924 accredited training program that is in a physician specialty in
925 statewide supply-and-demand deficit. In any year in which
926 funding is not sufficient to provide $100,000 for each newly
927 created resident position, funding shall be reduced pro rata
928 across all newly created resident positions in physician
929 specialties in statewide supply-and-demand deficit.
930 (a) Hospitals and qualifying institutions as defined in
931 paragraph (2)(c) applying for a startup bonus must submit to the
932 agency by March 1 their Accreditation Council for Graduate
933 Medical Education or Osteopathic Postdoctoral Training
934 Institution approval validating the new resident positions
935 approved on or after March 2 of the prior fiscal year through
936 March 1 of the current fiscal year for the physician specialties
937 identified in a statewide supply-and-demand deficit as provided
938 in the current fiscal year’s General Appropriations Act. An
939 applicant hospital or qualifying institution as defined in
940 paragraph (2)(c) may validate a change in the number of
941 residents by comparing the number in the prior period
942 Accreditation Council for Graduate Medical Education or
943 Osteopathic Postdoctoral Training Institution approval to the
944 number in the current year.
945 (b) Any unobligated startup bonus funds on April 15 of each
946 fiscal year shall be proportionally allocated to hospitals and
947 to qualifying institutions as defined in paragraph (2)(c)
948 participating under subsection (3) for existing FTE residents in
949 the physician specialties in statewide supply-and-demand
950 deficit. This nonrecurring allocation shall be in addition to
951 the funds allocated in subsection (4). Notwithstanding
952 subsection (4), the allocation under this subsection may not
953 exceed $100,000 per FTE resident.
954 (c) For purposes of this subsection, physician specialties
955 and subspecialties, both adult and pediatric, in statewide
956 supply-and-demand deficit are those identified in the General
957 Appropriations Act.
958 (d) The agency shall distribute all funds authorized under
959 the Graduate Medical Education Startup Bonus Program on or
960 before the final business day of the fourth quarter of a state
961 fiscal year.
962 (6) Beginning in the 2015-2016 state fiscal year, the
963 agency shall reconcile each participating hospital’s total
964 number of FTE residents calculated for the state fiscal year 2
965 years before with its most recently available Medicare cost
966 reports covering the same time period. Reconciled FTE counts
967 shall be prorated according to the portion of the state fiscal
968 year covered by a Medicare cost report. Using the same
969 definitions, methodology, and payment schedule specified in this
970 section, the reconciliation shall apply any differences in
971 annual allocations calculated under subsection (4) to the
972 current year’s annual allocations.
973 (7) The agency may adopt rules to administer this section.
974 Section 12. Paragraph (a) of subsection (2) of section
975 409.911, Florida Statutes, is amended, and paragraph (b) of that
976 subsection is republished, to read:
977 409.911 Disproportionate share program.—Subject to specific
978 allocations established within the General Appropriations Act
979 and any limitations established pursuant to chapter 216, the
980 agency shall distribute, pursuant to this section, moneys to
981 hospitals providing a disproportionate share of Medicaid or
982 charity care services by making quarterly Medicaid payments as
983 required. Notwithstanding the provisions of s. 409.915, counties
984 are exempt from contributing toward the cost of this special
985 reimbursement for hospitals serving a disproportionate share of
986 low-income patients.
987 (2) The Agency for Health Care Administration shall use the
988 following actual audited data to determine the Medicaid days and
989 charity care to be used in calculating the disproportionate
990 share payment:
991 (a) The average of the 2009, 2010, and 2011 2007, 2008, and
992 2009 audited disproportionate share data to determine each
993 hospital’s Medicaid days and charity care for the 2017-2018
994 2015-2016 state fiscal year.
995 (b) If the Agency for Health Care Administration does not
996 have the prescribed 3 years of audited disproportionate share
997 data as noted in paragraph (a) for a hospital, the agency shall
998 use the average of the years of the audited disproportionate
999 share data as noted in paragraph (a) which is available.
1000 Section 13. Section 409.9119, Florida Statutes, is amended
1001 to read:
1002 409.9119 Disproportionate share program for specialty
1003 hospitals for children.—In addition to the payments made under
1004 s. 409.911, the Agency for Health Care Administration shall
1005 develop and implement a system under which disproportionate
1006 share payments are made to those hospitals that are separately
1007 licensed by the state as specialty hospitals for children, have
1008 a federal Centers for Medicare and Medicaid Services
1009 certification number in the 3300-3399 range, have Medicaid days
1010 that exceed 55 percent of their total days and Medicare days
1011 that are less than 5 percent of their total days, and were
1012 licensed on January 1, 2012 January 1, 2000, as specialty
1013 hospitals for children. This system of payments must conform to
1014 federal requirements and must distribute funds in each fiscal
1015 year for which an appropriation is made by making quarterly
1016 Medicaid payments. Notwithstanding s. 409.915, counties are
1017 exempt from contributing toward the cost of this special
1018 reimbursement for hospitals that serve a disproportionate share
1019 of low-income patients. The agency may make disproportionate
1020 share payments to specialty hospitals for children as provided
1021 for in the General Appropriations Act.
1022 (1) Unless specified in the General Appropriations Act, the
1023 agency shall use the following formula to calculate the total
1024 amount earned for hospitals that participate in the specialty
1025 hospital for children disproportionate share program:
1026
1027 TAE = DSR x BMPD x MD
1028
1029 Where:
1030 TAE = total amount earned by a specialty hospital for
1031 children.
1032 DSR = disproportionate share rate.
1033 BMPD = base Medicaid per diem.
1034 MD = Medicaid days.
1035
1036 (2) The agency shall calculate the total additional payment
1037 for hospitals that participate in the specialty hospital for
1038 children disproportionate share program as follows:
1039
1040 TAP = (TAE x TA) ÷ STAE
1041
1042 Where:
1043 TAP = total additional payment for a specialty hospital for
1044 children.
1045 TAE = total amount earned by a specialty hospital for
1046 children.
1047 TA = total appropriation for the specialty hospital for
1048 children disproportionate share program.
1049 STAE = sum of total amount earned by each hospital that
1050 participates in the specialty hospital for children
1051 disproportionate share program.
1052
1053 (3) A hospital may not receive any payments under this
1054 section until it achieves full compliance with the applicable
1055 rules of the agency. A hospital that is not in compliance for
1056 two or more consecutive quarters may not receive its share of
1057 the funds. Any forfeited funds must be distributed to the
1058 remaining participating specialty hospitals for children that
1059 are in compliance.
1060 (4) Notwithstanding any provision of this section to the
1061 contrary, for the 2017-2018 2016-2017 state fiscal year, for
1062 hospitals achieving full compliance under subsection (3), the
1063 agency shall make disproportionate share payments to specialty
1064 hospitals for children as provided in the 2017-2018 2016-2017
1065 General Appropriations Act. This subsection expires July 1, 2018
1066 2017.
1067 Section 14. Subsection (36) of section 409.913, Florida
1068 Statutes, is amended to read:
1069 409.913 Oversight of the integrity of the Medicaid
1070 program.—The agency shall operate a program to oversee the
1071 activities of Florida Medicaid recipients, and providers and
1072 their representatives, to ensure that fraudulent and abusive
1073 behavior and neglect of recipients occur to the minimum extent
1074 possible, and to recover overpayments and impose sanctions as
1075 appropriate. Beginning January 1, 2003, and each year
1076 thereafter, the agency and the Medicaid Fraud Control Unit of
1077 the Department of Legal Affairs shall submit a joint report to
1078 the Legislature documenting the effectiveness of the state’s
1079 efforts to control Medicaid fraud and abuse and to recover
1080 Medicaid overpayments during the previous fiscal year. The
1081 report must describe the number of cases opened and investigated
1082 each year; the sources of the cases opened; the disposition of
1083 the cases closed each year; the amount of overpayments alleged
1084 in preliminary and final audit letters; the number and amount of
1085 fines or penalties imposed; any reductions in overpayment
1086 amounts negotiated in settlement agreements or by other means;
1087 the amount of final agency determinations of overpayments; the
1088 amount deducted from federal claiming as a result of
1089 overpayments; the amount of overpayments recovered each year;
1090 the amount of cost of investigation recovered each year; the
1091 average length of time to collect from the time the case was
1092 opened until the overpayment is paid in full; the amount
1093 determined as uncollectible and the portion of the uncollectible
1094 amount subsequently reclaimed from the Federal Government; the
1095 number of providers, by type, that are terminated from
1096 participation in the Medicaid program as a result of fraud and
1097 abuse; and all costs associated with discovering and prosecuting
1098 cases of Medicaid overpayments and making recoveries in such
1099 cases. The report must also document actions taken to prevent
1100 overpayments and the number of providers prevented from
1101 enrolling in or reenrolling in the Medicaid program as a result
1102 of documented Medicaid fraud and abuse and must include policy
1103 recommendations necessary to prevent or recover overpayments and
1104 changes necessary to prevent and detect Medicaid fraud. All
1105 policy recommendations in the report must include a detailed
1106 fiscal analysis, including, but not limited to, implementation
1107 costs, estimated savings to the Medicaid program, and the return
1108 on investment. The agency must submit the policy recommendations
1109 and fiscal analyses in the report to the appropriate estimating
1110 conference, pursuant to s. 216.137, by February 15 of each year.
1111 The agency and the Medicaid Fraud Control Unit of the Department
1112 of Legal Affairs each must include detailed unit-specific
1113 performance standards, benchmarks, and metrics in the report,
1114 including projected cost savings to the state Medicaid program
1115 during the following fiscal year.
1116 (36) At least three times a year, The agency may shall
1117 provide to a sample of each Medicaid recipients recipient or
1118 their representatives through the distribution of explanations
1119 his or her representative an explanation of benefits information
1120 about services reimbursed by the Medicaid program for goods and
1121 services to such recipients, including in the form of a letter
1122 that is mailed to the most recent address of the recipient on
1123 the record with the Department of Children and Families. The
1124 explanation of benefits must include the patient’s name, the
1125 name of the health care provider and the address of the location
1126 where the service was provided, a description of all services
1127 billed to Medicaid in terminology that should be understood by a
1128 reasonable person, and information on how to report
1129 inappropriate or incorrect billing to the agency or other law
1130 enforcement entities for review or investigation. At least once
1131 a year, the letter also must include information on how to
1132 report criminal Medicaid fraud to, the Medicaid Fraud Control
1133 Unit’s toll-free hotline number, and information about the
1134 rewards available under s. 409.9203. The explanation of benefits
1135 may not be mailed for Medicaid independent laboratory services
1136 as described in s. 409.905(7) or for Medicaid certified match
1137 services as described in ss. 409.9071 and 1011.70.
1138 Section 15. Paragraph (e) of subsection (1) of section
1139 409.975, Florida Statutes, is amended, and subsection (7) is
1140 added to that section, to read:
1141 409.975 Managed care plan accountability.—In addition to
1142 the requirements of s. 409.967, plans and providers
1143 participating in the managed medical assistance program shall
1144 comply with the requirements of this section.
1145 (1) PROVIDER NETWORKS.—Managed care plans must develop and
1146 maintain provider networks that meet the medical needs of their
1147 enrollees in accordance with standards established pursuant to
1148 s. 409.967(2)(c). Except as provided in this section, managed
1149 care plans may limit the providers in their networks based on
1150 credentials, quality indicators, and price.
1151 (e) Each managed care plan may must offer a network
1152 contract to each home medical equipment and supplies provider in
1153 the region which meets quality and fraud prevention and
1154 detection standards established by the plan and which agrees to
1155 accept the lowest price previously negotiated between the plan
1156 and another such provider.
1157 (7) SUBSTANCE ABUSE AND MENTAL HEALTH (SAMH) SAFETY NET
1158 NETWORK.—
1159 (a) The agency shall contract with the Substance Abuse and
1160 Mental Health (SAMH) Safety Net Network, established under s.
1161 394.9082(11), to plan, coordinate, and contract for delivering
1162 certain community mental health and substance abuse services,
1163 thereby improving access to behavioral health care, promoting
1164 the continuity of such services, and supporting efficient and
1165 effective delivery of such services under this section. The
1166 contract must require managing entities to provide specified
1167 services to Medicaid-eligible individuals with specified
1168 behaviors, diagnoses, or addictions.
1169 (b) Before contracting, the agency must conduct a
1170 comprehensive readiness assessment to ensure that the SAMH
1171 Safety Net Network has the necessary infrastructure, financial
1172 resources, and relevant experience to implement the contract.
1173 The agency and the department shall develop performance measures
1174 to evaluate the impact of the SAMH Safety Net Network and to
1175 determine the adequacy, timeliness, and quality of the services
1176 provided for specified target populations and the efficiency of
1177 the services in addressing mental health and substance use
1178 disorders within a community.
1179 (c) The agency, in consultation with the department and
1180 managing entities, shall determine the rates for services added
1181 to the state Medicaid plan. The rates shall be developed based
1182 on the full cost of the services and reasonable administrative
1183 costs for providers and managing entities.
1184 Section 16. Subsections (1) and (2) of section 409.979,
1185 Florida Statutes, are amended to read:
1186 409.979 Eligibility.—
1187 (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid
1188 recipients who meet all of the following criteria are eligible
1189 to receive long-term care services and must receive long-term
1190 care services by participating in the long-term care managed
1191 care program. The recipient must be:
1192 (a) Sixty-five years of age or older, or age 18 or older
1193 and eligible for Medicaid by reason of a disability.
1194 (b) Determined by the Comprehensive Assessment Review and
1195 Evaluation for Long-Term Care Services (CARES) preadmission
1196 screening program to require:
1197 1. Nursing facility care as defined in s. 409.985(3); or
1198 2. Hospital level of care for individuals diagnosed with
1199 cystic fibrosis.
1200 (2) ENROLLMENT OFFERS.—Subject to the availability of
1201 funds, the Department of Elderly Affairs shall make offers for
1202 enrollment to eligible individuals based on a wait-list
1203 prioritization. Before making enrollment offers, the agency and
1204 the Department of Elderly Affairs shall determine that
1205 sufficient funds exist to support additional enrollment into
1206 plans.
1207 (a) A Medicaid recipient enrolled in one of the following
1208 Medicaid home and community-based services waiver programs who
1209 meets the eligibility criteria established in subsection (1) is
1210 eligible to participate in the long-term care managed care
1211 program and must be transitioned into the long-term care managed
1212 care program by January 1, 2018:
1213 1. Traumatic Brain and Spinal Cord Injury Waiver.
1214 2. Adult Cystic Fibrosis Waiver.
1215 3. Project AIDS Care Waiver.
1216 (b) The agency shall seek federal approval to terminate the
1217 Traumatic Brain and Spinal Cord Injury Waiver, the Adult Cystic
1218 Fibrosis Waiver, and the Project AIDS Care Waiver once all
1219 eligible Medicaid recipients have transitioned into the long
1220 term care managed care program.
1221 Section 17. Subsection (6) of section 409.983, Florida
1222 Statutes, is amended to read:
1223 409.983 Long-term care managed care plan payment.—In
1224 addition to the payment provisions of s. 409.968, the agency
1225 shall provide payment to plans in the long-term care managed
1226 care program pursuant to this section.
1227 (6) The agency shall establish nursing-facility-specific
1228 payment rates for each licensed nursing home based on facility
1229 costs adjusted for inflation and other factors as authorized in
1230 the General Appropriations Act. Payments to long-term care
1231 managed care plans shall be reconciled, as necessary, to
1232 reimburse actual payments to nursing facilities resulting from
1233 changes in nursing home per diem rates, but may not be
1234 reconciled to actual days experienced by the long-term care
1235 managed care plans.
1236 Section 18. Subject to federal approval of the application
1237 to be a site for the Program of All-inclusive Care for the
1238 Elderly (PACE), the Agency for Health Care Administration shall
1239 contract with an additional not-for-profit organization to serve
1240 individuals and families in Miami-Dade County. The not-for
1241 profit organization must have a history of serving primarily the
1242 Hispanic population by providing primary care services,
1243 nutrition, meals, and adult day care to senior citizens. The
1244 not-for-profit organization shall leverage existing community
1245 based care providers and health care organizations to provide
1246 PACE services to frail elders who reside in Miami-Dade County.
1247 The organization is exempt from the requirements of chapter 641,
1248 Florida Statutes. The agency, in consultation with the
1249 Department of Elderly Affairs and subject to an appropriation,
1250 shall approve up to 250 initial enrollees in the additional PACE
1251 site established by this organization to serve frail elders who
1252 reside in Miami-Dade County.
1253 Section 19. Notwithstanding section 27 of chapter 2016-65,
1254 Laws of Florida, and subject to federal approval of the
1255 application to be a site for the Program of All-inclusive Care
1256 for the Elderly (PACE), the Agency for Health Care
1257 Administration shall contract with a not-for-profit
1258 organization, formed by a partnership with a not-for-profit
1259 hospital, a not-for-profit agency serving elders, and a not-for
1260 profit hospice in Leon County. The not-for-profit PACE shall
1261 serve eligible PACE enrollees in Gadsden, Jefferson, Leon, and
1262 Wakulla Counties. The Agency for Health Care Administration, in
1263 consultation with the Department of Elderly Affairs and subject
1264 to an appropriation, shall approve up to 300 initial enrollees
1265 for the additional PACE site.
1266 Section 20. Section 17 of chapter 2011-61, Laws of Florida,
1267 is amended to read:
1268 Section 17. Notwithstanding s. 430.707, Florida Statutes,
1269 and subject to federal approval of the application to be a site
1270 for the Program of All-inclusive Care for the Elderly, the
1271 Agency for Health Care Administration shall contract with one
1272 private health care organization, the sole member of which is a
1273 private, not-for-profit corporation that owns and manages health
1274 care organizations which provide comprehensive long-term care
1275 services, including nursing home, assisted living, independent
1276 housing, home care, adult day care, and care management, with a
1277 board-certified, trained geriatrician as the medical director.
1278 This organization shall provide these services to frail and
1279 elderly persons who reside in Indian River, Martin, Okeechobee,
1280 Palm Beach, and St. Lucie Counties County. The organization is
1281 exempt from the requirements of chapter 641, Florida Statutes.
1282 The agency, in consultation with the Department of Elderly
1283 Affairs and subject to an appropriation, shall approve up to 150
1284 initial enrollees who reside in Palm Beach County and up to 150
1285 initial enrollees who reside in Martin County in the Program of
1286 All-inclusive Care for the Elderly established by this
1287 organization to serve elderly persons who reside in Palm Beach
1288 County.
1289 Section 21. Effective June 30, 2017, section 9 of chapter
1290 2016-65, Laws of Florida, is amended to read:
1291 Section 9. Effective July 1, 2018 2017, paragraph (b) of
1292 subsection (6) of section 409.905, Florida Statutes, is amended
1293 to read:
1294 409.905 Mandatory Medicaid services.—The agency may make
1295 payments for the following services, which are required of the
1296 state by Title XIX of the Social Security Act, furnished by
1297 Medicaid providers to recipients who are determined to be
1298 eligible on the dates on which the services were provided. Any
1299 service under this section shall be provided only when medically
1300 necessary and in accordance with state and federal law.
1301 Mandatory services rendered by providers in mobile units to
1302 Medicaid recipients may be restricted by the agency. Nothing in
1303 this section shall be construed to prevent or limit the agency
1304 from adjusting fees, reimbursement rates, lengths of stay,
1305 number of visits, number of services, or any other adjustments
1306 necessary to comply with the availability of moneys and any
1307 limitations or directions provided for in the General
1308 Appropriations Act or chapter 216.
1309 (6) HOSPITAL OUTPATIENT SERVICES.—
1310 (b) The agency shall implement a prospective payment
1311 methodology for establishing reimbursement rates for outpatient
1312 hospital services. Rates shall be calculated annually and take
1313 effect July 1, 2018 2017, and July 1 of each year thereafter.
1314 The methodology shall categorize the amount and type of services
1315 used in various ambulatory visits which group together
1316 procedures and medical visits that share similar characteristics
1317 and resource utilization.
1318 1. Adjustments may not be made to the rates after July 31
1319 of the state fiscal year in which the rates take effect.
1320 2. Errors in source data or calculations discovered after
1321 July 31 of each state fiscal year must be reconciled in a
1322 subsequent rate period. However, the agency may not make any
1323 adjustment to a hospital’s reimbursement more than 5 years after
1324 a hospital is notified of an audited rate established by the
1325 agency. The prohibition against adjustments more than 5 years
1326 after notification is remedial and applies to actions by
1327 providers involving Medicaid claims for hospital services.
1328 Hospital reimbursement is subject to such limits or ceilings as
1329 may be established in law or described in the agency’s hospital
1330 reimbursement plan. Specific exemptions to the limits or
1331 ceilings may be provided in the General Appropriations Act.
1332 Section 22. Section 29 of chapter 2016-65, Laws of Florida,
1333 is amended to read:
1334 Section 29. Subject to federal approval of the application
1335 to be a site for the Program of All-inclusive Care for the
1336 Elderly (PACE), the Agency for Health Care Administration shall
1337 contract with one private, not-for-profit hospice organization
1338 located in Lake County which operates health care organizations
1339 licensed in Hospice Areas 7B and 3E and which provides
1340 comprehensive services, including hospice and palliative care,
1341 to frail elders who reside in these service areas. The
1342 organization is exempt from the requirements of chapter 641,
1343 Florida Statutes. The agency, in consultation with the
1344 Department of Elderly Affairs and subject to the appropriation
1345 of funds by the Legislature, shall approve up to 150 initial
1346 enrollees in the Program of All-inclusive Care for the Elderly
1347 established by the organization to serve frail elders who reside
1348 in Hospice Service Areas 7B and 3E. The agency, in consultation
1349 with the department and subject to an appropriation, shall
1350 approve up to 150 enrollees in the Program of All-inclusive Care
1351 for the Elderly established by this organization to serve frail
1352 elders who reside in Hospice Service Area 7C.
1353 Section 23. Subject to federal approval of the application
1354 to be a site for the Program of All-inclusive Care for the
1355 Elderly (PACE), the Agency for Health Care Administration shall
1356 contract with one not-for-profit organization that satisfies
1357 each of the following conditions:
1358 (1) The organization is exempt from federal income taxation
1359 as an entity described in s. 501(c)(3) of the Internal Revenue
1360 Code of 1986, as amended;
1361 (2) The organization is licensed pursuant to part IV of
1362 chapter 400, Florida Statutes, to provide hospice services in
1363 the Agency for Health Care Administration Areas 3 and 4 and
1364 operates inpatient hospice care centers in each of the following
1365 counties within those regions: Alachua, Citrus, Clay, Columbia,
1366 and Putnam;
1367 (3) The organization has more than 30 years of experience
1368 as a licensed hospice provider in this state; and
1369 (4) The organization is affiliated, through common
1370 ownership or control, with other not-for-profit organizations
1371 licensed by the agency to provide home health services, to
1372 operate a nursing home, and to operate an assisted living
1373 facility.
1374
1375 The approved not-for-profit organization shall provide PACE
1376 services to frail and elderly persons who reside in Alachua
1377 County. The organization is exempt from the requirements of
1378 chapter 641, Florida Statutes. The agency, in consultation with
1379 the Department of Elder Affairs and subject to an appropriation,
1380 shall approve up to 150 initial enrollees in the PACE site
1381 established by this organization to serve frail and elderly
1382 persons who reside in Alachua County.
1383 Section 24. Subject to federal approval of the application
1384 to be a site for the Program of All-inclusive Care for the
1385 Elderly (PACE), the Agency for Health Care Administration shall
1386 contract with an organization located in Miami-Dade County that
1387 owns and operates primary care medical centers in South Florida.
1388 The organization shall leverage its existing community-based
1389 care providers to provide PACE services to frail elders who
1390 reside in Broward, Miami-Dade, and Palm Beach Counties. The
1391 organization is exempt from the requirements of chapter 641,
1392 Florida Statutes. The agency, in consultation with the
1393 Department of Elderly Affairs and subject to an appropriation of
1394 funds by the Legislature, shall approve up to 300 initial
1395 enrollees in the PACE site established by the organization for
1396 frail elders who reside in Broward, Miami-Dade, and Palm Beach
1397 Counties. The agency may seek any necessary waiver or state plan
1398 amendments to implement this section.
1399 Section 25. Except as otherwise expressly provided in this
1400 act and except for this section, which shall take effect upon
1401 becoming a law, this act shall take effect July 1, 2017.
