Bill Text: FL S2518 | 2021 | Regular Session | Enrolled
Bill Title: Health Care
Spectrum: Committee Bill
Status: (Passed) 2021-06-03 - Chapter No. 2021-41, companion bill(s) passed, see SB 2500 (Ch. 2021-36) [S2518 Detail]
Download: Florida-2021-S2518-Enrolled.html
ENROLLED 2021 Legislature SB 2518, 1st Engrossed 20212518er 1 2 An act relating to health care; amending s. 296.37, 3 F.S.; revising the amount of money residents of a 4 veterans’ nursing home must receive monthly before 5 being required to contribute to their maintenance and 6 support; reenacting s. 400.179(2)(d), F.S., relating 7 to liability for Medicaid underpayments and 8 overpayments; amending s. 408.061, F.S.; requiring 9 nursing homes and their home offices to annually 10 submit to the Agency for Health Care Administration 11 certain information within a specified timeframe; 12 amending s. 408.07, F.S.; defining the terms “FNHURS” 13 and “home office”; amending s. 409.903, F.S.; revising 14 the postpartum Medicaid eligibility period for 15 pregnant women; amending s. 409.904, F.S.; deleting 16 the effective date and the expiration date of a 17 provision requiring the agency to make payments to 18 Medicaid-covered services; reenacting s. 409.908(23), 19 F.S., relating to reimbursement of Medicaid providers; 20 amending s. 409.908, F.S.; authorizing the agency to 21 receive funds to be used for Low Income Pool Program 22 payments; requiring certain essential providers to 23 offer to contract with certain managed care plans to 24 be eligible for low-income pool funding; requiring the 25 agency to evaluate contract negotiations and withhold 26 supplemental payments under certain circumstances; 27 requiring the agency to notify and afford hearing 28 rights to providers under certain circumstances; 29 amending s. 409.911, F.S.; revising the years of 30 audited disproportionate share data the agency must 31 use for calculating an average for purposes of 32 calculating disproportionate share payments; 33 authorizing the agency to use data available for a 34 hospital; conforming provisions to changes made by the 35 act; revising the requirement that the agency 36 distribute moneys to hospitals providing a 37 disproportionate share of Medicaid or charity care 38 services, as provided in the General Appropriations 39 Act, to apply to each fiscal year, rather than a 40 specified fiscal year; deleting the expiration date of 41 such requirement; amending s. 409.9113, F.S.; revising 42 the requirement that the agency make disproportionate 43 share payments to teaching hospitals, as provided in 44 the General Appropriations Act, to apply to each 45 fiscal year, rather than a specified fiscal year; 46 deleting the expiration date of such requirement; 47 amending s. 409.9119, F.S.; revising the requirement 48 that the agency make disproportionate share payments 49 to certain specialty hospitals for children to apply 50 to each fiscal year, rather than a specified fiscal 51 year; deleting the expiration date of such 52 requirement; amending s. 409.975, F.S.; conforming a 53 cross-reference; amending s. 430.502, F.S.; revising 54 the name of a memory disorder clinic in Pensacola; 55 reenacting s. 624.91(5)(b), F.S., relating to The 56 Florida Healthy Kids Corporation Act; amending s. 57 1011.52, F.S.; conforming a cross-reference; requiring 58 the agency to contract with organizations for the 59 provision of elder care services in specified counties 60 if certain conditions are met; requiring the agency to 61 contract with hospitals for the provision of elder 62 care services in specified counties if certain 63 conditions are met; authorizing an organization 64 providing elder care services in specified counties to 65 provide elder care services in additional specified 66 counties if certain conditions are met; authorizing 67 the consolidation of organizations providing elder 68 care services in specified counties; authorizing an 69 organization to provide elder care services with the 70 consolidation if certain criteria are met; authorizing 71 an organization to provide elder care services in 72 specified counties if certain criteria are met; 73 providing an effective date. 74 75 Be It Enacted by the Legislature of the State of Florida: 76 77 Section 1. Subsections (1) and (3) of section 296.37, 78 Florida Statutes, are amended to read: 79 296.37 Residents; contribution to support.— 80 (1) Every resident of the home who receives a pension, 81 compensation, or gratuity from the United States Government, or 82 income from any other source of more than $130$105per month, 83 shall contribute to his or her maintenance and support while a 84 resident of the home in accordance with a schedule of payment 85 determined by the administrator and approved by the director. 86 The total amount of such contributions shall be to the fullest 87 extent possible but mayshallnot exceed the actual cost of 88 operating and maintaining the home. 89(3) Notwithstanding subsection (1), each resident of the90home who receives a pension, compensation, or gratuity from the91United States Government, or income from any other source, of92more than $130 per month shall contribute to his or her93maintenance and support while a resident of the home in94accordance with a payment schedule determined by the95administrator and approved by the director. The total amount of96such contributions shall be to the fullest extent possible, but,97in no case, shall exceed the actual cost of operating and98maintaining the home. This subsection expires July 1, 2021.99 Section 2. Notwithstanding the expiration date in section 100 51 of chapter 2020-114, Laws of Florida, paragraph (d) of 101 subsection (2) of section 400.179, Florida Statutes, is 102 reenacted to read: 103 400.179 Liability for Medicaid underpayments and 104 overpayments.— 105 (2) Because any transfer of a nursing facility may expose 106 the fact that Medicaid may have underpaid or overpaid the 107 transferor, and because in most instances, any such underpayment 108 or overpayment can only be determined following a formal field 109 audit, the liabilities for any such underpayments or 110 overpayments shall be as follows: 111 (d) Where the transfer involves a facility that has been 112 leased by the transferor: 113 1. The transferee shall, as a condition to being issued a 114 license by the agency, acquire, maintain, and provide proof to 115 the agency of a bond with a term of 30 months, renewable 116 annually, in an amount not less than the total of 3 months’ 117 Medicaid payments to the facility computed on the basis of the 118 preceding 12-month average Medicaid payments to the facility. 119 2. A leasehold licensee may meet the requirements of 120 subparagraph 1. by payment of a nonrefundable fee, paid at 121 initial licensure, paid at the time of any subsequent change of 122 ownership, and paid annually thereafter, in the amount of 1 123 percent of the total of 3 months’ Medicaid payments to the 124 facility computed on the basis of the preceding 12-month average 125 Medicaid payments to the facility. If a preceding 12-month 126 average is not available, projected Medicaid payments may be 127 used. The fee shall be deposited into the Grants and Donations 128 Trust Fund and shall be accounted for separately as a Medicaid 129 nursing home overpayment account. These fees shall be used at 130 the sole discretion of the agency to repay nursing home Medicaid 131 overpayments or for enhanced payments to nursing facilities as 132 specified in the General Appropriations Act or other law. 133 Payment of this fee shall not release the licensee from any 134 liability for any Medicaid overpayments, nor shall payment bar 135 the agency from seeking to recoup overpayments from the licensee 136 and any other liable party. As a condition of exercising this 137 lease bond alternative, licensees paying this fee must maintain 138 an existing lease bond through the end of the 30-month term 139 period of that bond. The agency is herein granted specific 140 authority to promulgate all rules pertaining to the 141 administration and management of this account, including 142 withdrawals from the account, subject to federal review and 143 approval. This provision shall take effect upon becoming law and 144 shall apply to any leasehold license application. The financial 145 viability of the Medicaid nursing home overpayment account shall 146 be determined by the agency through annual review of the account 147 balance and the amount of total outstanding, unpaid Medicaid 148 overpayments owing from leasehold licensees to the agency as 149 determined by final agency audits. By March 31 of each year, the 150 agency shall assess the cumulative fees collected under this 151 subparagraph, minus any amounts used to repay nursing home 152 Medicaid overpayments and amounts transferred to contribute to 153 the General Revenue Fund pursuant to s. 215.20. If the net 154 cumulative collections, minus amounts utilized to repay nursing 155 home Medicaid overpayments, exceed $10 million, the provisions 156 of this subparagraph shall not apply for the subsequent fiscal 157 year. 158 3. The leasehold licensee may meet the bond requirement 159 through other arrangements acceptable to the agency. The agency 160 is herein granted specific authority to promulgate rules 161 pertaining to lease bond arrangements. 162 4. All existing nursing facility licensees, operating the 163 facility as a leasehold, shall acquire, maintain, and provide 164 proof to the agency of the 30-month bond required in 165 subparagraph 1., above, on and after July 1, 1993, for each 166 license renewal. 167 5. It shall be the responsibility of all nursing facility 168 operators, operating the facility as a leasehold, to renew the 169 30-month bond and to provide proof of such renewal to the agency 170 annually. 171 6. Any failure of the nursing facility operator to acquire, 172 maintain, renew annually, or provide proof to the agency shall 173 be grounds for the agency to deny, revoke, and suspend the 174 facility license to operate such facility and to take any 175 further action, including, but not limited to, enjoining the 176 facility, asserting a moratorium pursuant to part II of chapter 177 408, or applying for a receiver, deemed necessary to ensure 178 compliance with this section and to safeguard and protect the 179 health, safety, and welfare of the facility’s residents. A lease 180 agreement required as a condition of bond financing or 181 refinancing under s. 154.213 by a health facilities authority or 182 required under s. 159.30 by a county or municipality is not a 183 leasehold for purposes of this paragraph and is not subject to 184 the bond requirement of this paragraph. 185 Section 3. Present subsections (5) through (13) of section 186 408.061, Florida Statutes, are redesignated as subsections (7) 187 through (15), respectively, subsection (4) is amended, and new 188 subsections (5) and (6) are added to that section, to read: 189 408.061 Data collection; uniform systems of financial 190 reporting; information relating to physician charges; 191 confidential information; immunity.— 192 (4) Within 120 days after the end of its fiscal year, each 193 health care facility, excluding continuing care facilities,and 194 hospitals operated by state agencies, and nursing homesas those 195 terms are defined in s. 408.07, shall file with the agency, on 196 forms adopted by the agency and based on the uniform system of 197 financial reporting, its actual financial experience for that 198 fiscal year, including expenditures, revenues, and statistical 199 measures. Such data may be based on internal financial reports 200 which are certified to be complete and accurate by the provider. 201 However, hospitals’ actual financial experience shall be their 202 audited actual experience. Every nursing home shall submit to 203 the agency, in a format designated by the agency, a statistical 204 profile of the nursing home residents. The agency, in 205 conjunction with the Department of Elderly Affairs and the 206 Department of Health, shall review these statistical profiles 207 and develop recommendations for the types of residents who might 208 more appropriately be placed in their homes or other 209 noninstitutional settings. 210 (5) Within 120 days after the end of its fiscal year, each 211 nursing home as defined in s. 408.07 shall file with the agency, 212 on forms adopted by the agency and based on the uniform system 213 of financial reporting, its actual financial experience for that 214 fiscal year, including expenditures, revenues, and statistical 215 measures. Such data may be based on internal financial reports 216 that are certified to be complete and accurate by the chief 217 financial officer of the nursing home. This actual experience 218 must include the fiscal year-end balance sheet, income 219 statement, statement of cash flow, and statement of retained 220 earnings and must be submitted to the agency in addition to the 221 information filed in the uniform system of financial reporting. 222 The financial statements must tie to the information submitted 223 in the uniform system of financial reporting, and a crosswalk 224 must be submitted along with the financial statements. 225 (6) Within 120 days after the end of its fiscal year, the 226 home office of each nursing home as defined in s. 408.07 shall 227 file with the agency, on forms adopted by the agency and based 228 on the uniform system of financial reporting, its actual 229 financial experience for that fiscal year, including 230 expenditures, revenues, and statistical measures. Such data may 231 be based on internal financial reports that are certified to be 232 complete and accurate by the chief financial officer of the 233 nursing home. This actual experience must include the fiscal 234 year-end balance sheet, income statement, statement of cash 235 flow, and statement of retained earnings and must be submitted 236 to the agency in addition to the information filed in the 237 uniform system of financial reporting. The financial statements 238 must tie to the information submitted in the uniform system of 239 financial reporting, and a crosswalk must be submitted along 240 with the audited financial statements. 241 Section 4. Present subsections (19) through (27) of section 242 408.07, Florida Statutes, are redesignated as subsections (20) 243 through (28), respectively, and present subsections (28) through 244 (44) are redesignated as subsections (30) through (46), 245 respectively, and new subsections (19) and (29) are added to 246 that section, to read: 247 408.07 Definitions.—As used in this chapter, with the 248 exception of ss. 408.031-408.045, the term: 249 (19) “FNHURS” means the Florida Nursing Home Uniform 250 Reporting System developed by the agency. 251 (29) “Home office” has the same meaning as provided in the 252 Provider Reimbursement Manual, Part 1 (Centers for Medicare and 253 Medicaid Services, Pub. 15-1), as that definition exists on the 254 effective date of this act. 255 Section 5. Subsection (5) of section 409.903, Florida 256 Statutes, is amended to read: 257 409.903 Mandatory payments for eligible persons.—The agency 258 shall make payments for medical assistance and related services 259 on behalf of the following persons who the department, or the 260 Social Security Administration by contract with the Department 261 of Children and Families, determines to be eligible, subject to 262 the income, assets, and categorical eligibility tests set forth 263 in federal and state law. Payment on behalf of these Medicaid 264 eligible persons is subject to the availability of moneys and 265 any limitations established by the General Appropriations Act or 266 chapter 216. 267 (5) A pregnant woman for the duration of her pregnancy and 268 for the postpartum period consisting of the 12-month period 269 beginning on the last day of her pregnancyas defined in federal270law and rule, or a child under age 1, if either is living in a 271 family that has an income thatwhichis at orbelow 150 percent272of the most current federal poverty level, or, effective January2731, 1992, that has an income which is at orbelow 185 percent of 274 the most current federal poverty level. Such a person is not 275 subject to an assets test. Further, a pregnant woman who applies 276 for eligibility for the Medicaid program through a qualified 277 Medicaid provider must be offered the opportunity, subject to 278 federal rules, to be made presumptively eligible for the 279 Medicaid program. 280 Section 6. Subsection (12) of section 409.904, Florida 281 Statutes, is amended to read: 282 409.904 Optional payments for eligible persons.—The agency 283 may make payments for medical assistance and related services on 284 behalf of the following persons who are determined to be 285 eligible subject to the income, assets, and categorical 286 eligibility tests set forth in federal and state law. Payment on 287 behalf of these Medicaid eligible persons is subject to the 288 availability of moneys and any limitations established by the 289 General Appropriations Act or chapter 216. 290 (12)Effective July 1, 2020,The agency shall make payments 291 to Medicaid-covered services: 292 (a) For eligible children and pregnant women, retroactive 293 for a period of no more than 90 days before the month in which 294 an application for Medicaid is submitted. 295 (b) For eligible nonpregnant adults, retroactive to the 296 first day of the month in which an application for Medicaid is 297 submitted. 298 299This subsection expires July 1, 2021.300 Section 7. Notwithstanding the expiration date in section 301 13 of chapter 2020-114, Laws of Florida, subsection (23) of 302 section 409.908, Florida Statutes, is reenacted to read: 303 409.908 Reimbursement of Medicaid providers.—Subject to 304 specific appropriations, the agency shall reimburse Medicaid 305 providers, in accordance with state and federal law, according 306 to methodologies set forth in the rules of the agency and in 307 policy manuals and handbooks incorporated by reference therein. 308 These methodologies may include fee schedules, reimbursement 309 methods based on cost reporting, negotiated fees, competitive 310 bidding pursuant to s. 287.057, and other mechanisms the agency 311 considers efficient and effective for purchasing services or 312 goods on behalf of recipients. If a provider is reimbursed based 313 on cost reporting and submits a cost report late and that cost 314 report would have been used to set a lower reimbursement rate 315 for a rate semester, then the provider’s rate for that semester 316 shall be retroactively calculated using the new cost report, and 317 full payment at the recalculated rate shall be effected 318 retroactively. Medicare-granted extensions for filing cost 319 reports, if applicable, shall also apply to Medicaid cost 320 reports. Payment for Medicaid compensable services made on 321 behalf of Medicaid eligible persons is subject to the 322 availability of moneys and any limitations or directions 323 provided for in the General Appropriations Act or chapter 216. 324 Further, nothing in this section shall be construed to prevent 325 or limit the agency from adjusting fees, reimbursement rates, 326 lengths of stay, number of visits, or number of services, or 327 making any other adjustments necessary to comply with the 328 availability of moneys and any limitations or directions 329 provided for in the General Appropriations Act, provided the 330 adjustment is consistent with legislative intent. 331 (23)(a) The agency shall establish rates at a level that 332 ensures no increase in statewide expenditures resulting from a 333 change in unit costs for county health departments effective 334 July 1, 2011. Reimbursement rates shall be as provided in the 335 General Appropriations Act. 336 (b)1. Base rate reimbursement for inpatient services under 337 a diagnosis-related group payment methodology shall be provided 338 in the General Appropriations Act. 339 2. Base rate reimbursement for outpatient services under an 340 enhanced ambulatory payment group methodology shall be provided 341 in the General Appropriations Act. 342 3. Prospective payment system reimbursement for nursing 343 home services shall be as provided in subsection (2) and in the 344 General Appropriations Act. 345 Section 8. Upon the expiration and reversion of the 346 amendments made to section 409.908, Florida Statutes, pursuant 347 to section 15 of chapter 2020-114, Laws of Florida, subsection 348 (26) of section 409.908, Florida Statutes, is amended to read: 349 409.908 Reimbursement of Medicaid providers.—Subject to 350 specific appropriations, the agency shall reimburse Medicaid 351 providers, in accordance with state and federal law, according 352 to methodologies set forth in the rules of the agency and in 353 policy manuals and handbooks incorporated by reference therein. 354 These methodologies may include fee schedules, reimbursement 355 methods based on cost reporting, negotiated fees, competitive 356 bidding pursuant to s. 287.057, and other mechanisms the agency 357 considers efficient and effective for purchasing services or 358 goods on behalf of recipients. If a provider is reimbursed based 359 on cost reporting and submits a cost report late and that cost 360 report would have been used to set a lower reimbursement rate 361 for a rate semester, then the provider’s rate for that semester 362 shall be retroactively calculated using the new cost report, and 363 full payment at the recalculated rate shall be effected 364 retroactively. Medicare-granted extensions for filing cost 365 reports, if applicable, shall also apply to Medicaid cost 366 reports. Payment for Medicaid compensable services made on 367 behalf of Medicaid eligible persons is subject to the 368 availability of moneys and any limitations or directions 369 provided for in the General Appropriations Act or chapter 216. 370 Further, nothing in this section shall be construed to prevent 371 or limit the agency from adjusting fees, reimbursement rates, 372 lengths of stay, number of visits, or number of services, or 373 making any other adjustments necessary to comply with the 374 availability of moneys and any limitations or directions 375 provided for in the General Appropriations Act, provided the 376 adjustment is consistent with legislative intent. 377 (26) The agency may receive funds from state entities, 378 including, but not limited to, the Department of Health, local 379 governments, and other local political subdivisions, for the 380 purpose of making special exception payments and Low Income Pool 381 Program payments, including federal matching funds. Funds 382 received for this purpose shall be separately accounted for and 383 may not be commingled with other state or local funds in any 384 manner. The agency may certify all local governmental funds used 385 as state match under Title XIX of the Social Security Act to the 386 extent and in the manner authorized under the General 387 Appropriations Act and pursuant to an agreement between the 388 agency and the local governmental entity. In order for the 389 agency to certify such local governmental funds, a local 390 governmental entity must submit a final, executed letter of 391 agreement to the agency, which must be received by October 1 of 392 each fiscal year and provide the total amount of local 393 governmental funds authorized by the entity for that fiscal year 394 under the General Appropriations Act. The local governmental 395 entity shall use a certification form prescribed by the agency. 396 At a minimum, the certification form must identify the amount 397 being certified and describe the relationship between the 398 certifying local governmental entity and the local health care 399 provider. Local governmental funds outlined in the letters of 400 agreement must be received by the agency no later than October 401 31 of each fiscal year in which such funds are pledged, unless 402 an alternative plan is specifically approved by the agency. To 403 be eligible for low-income pool funding or other forms of 404 supplemental payments funded by intergovernmental transfers, and 405 in addition to any other applicable requirements, essential 406 providers identified in s. 409.975(1)(a)2. must offer to 407 contract with each managed care plan in their region and 408 essential providers identified in s. 409.975(1)(b)1. and 3. must 409 offer to contract with each managed care plan in the state. 410 Before releasing such supplemental payments, in the event the 411 parties have not executed network contracts, the agency shall 412 evaluate the parties’ efforts to complete negotiations. If such 413 efforts continue to fail, the agency must withhold such 414 supplemental payments beginning in the third quarter of the 415 fiscal year if it determines that, based upon the totality of 416 the circumstances, the essential provider has negotiated with 417 the managed care plan in bad faith. If the agency determines 418 that an essential provider has negotiated in bad faith, it must 419 notify the essential provider at least 90 days in advance of the 420 start of the third quarter of the fiscal year and afford the 421 essential provider hearing rights in accordance with chapter 422 120. 423 Section 9. Subsections (2), (3), and (10) of section 424 409.911, Florida Statutes, are amended to read: 425 409.911 Disproportionate share program.—Subject to specific 426 allocations established within the General Appropriations Act 427 and any limitations established pursuant to chapter 216, the 428 agency shall distribute, pursuant to this section, moneys to 429 hospitals providing a disproportionate share of Medicaid or 430 charity care services by making quarterly Medicaid payments as 431 required. Notwithstanding the provisions of s. 409.915, counties 432 are exempt from contributing toward the cost of this special 433 reimbursement for hospitals serving a disproportionate share of 434 low-income patients. 435 (2) The Agency for Health Care Administration shall use the 436 following actual audited data to determine the Medicaid days and 437 charity care to be used in calculating the disproportionate 438 share payment: 439 (a) The average of the 3 most recent years of2012, 2013,440and 2014audited disproportionate share data available for a 441 hospital to determine each hospital’s Medicaid days and charity 442 care for eachthe 2020-2021state fiscal year. 443 (b)If the Agency for Health Care Administration does not444have the prescribed 3 years of audited disproportionate share445data as noted in paragraph (a) for a hospital, the agency shall446use the average of the years of the audited disproportionate447share data as noted in paragraph (a) which is available.448(c)In accordance with s. 1923(b) of the Social Security 449 Act, a hospital with a Medicaid inpatient utilization rate 450 greater than one standard deviation above the statewide mean or 451 a hospital with a low-income utilization rate of 25 percent or 452 greater shall qualify for reimbursement. 453 (3) Hospitals that qualify for a disproportionate share 454 payment solely under paragraph (2)(b)(2)(c)shall have their 455 payment calculated in accordance with the following formulas: 456 457 DSHP = (HMD/TMSD) x $1 million 458 459 Where: 460 DSHP = disproportionate share hospital payment. 461 HMD = hospital Medicaid days. 462 TSD = total state Medicaid days. 463 464 Any funds not allocated to hospitals qualifying under this 465 section shall be redistributed to the non-state government owned 466 or operated hospitals with greater than 3,100 Medicaid days. 467 (10) Notwithstanding any provision of this section to the 468 contrary, for eachthe 2020-2021state fiscal year, the agency 469 shall distribute moneys to hospitals providing a 470 disproportionate share of Medicaid or charity care services as 471 provided in the2020-2021General Appropriations Act.This472subsection expires July 1, 2021.473 Section 10. Subsection (3) of section 409.9113, Florida 474 Statutes, is amended to read: 475 409.9113 Disproportionate share program for teaching 476 hospitals.—In addition to the payments made under s. 409.911, 477 the agency shall make disproportionate share payments to 478 teaching hospitals, as defined in s. 408.07, for their increased 479 costs associated with medical education programs and for 480 tertiary health care services provided to the indigent. This 481 system of payments must conform to federal requirements and 482 distribute funds in each fiscal year for which an appropriation 483 is made by making quarterly Medicaid payments. Notwithstanding 484 s. 409.915, counties are exempt from contributing toward the 485 cost of this special reimbursement for hospitals serving a 486 disproportionate share of low-income patients. The agency shall 487 distribute the moneys provided in the General Appropriations Act 488 to statutorily defined teaching hospitals and family practice 489 teaching hospitals, as defined in s. 395.805, pursuant to this 490 section. The funds provided for statutorily defined teaching 491 hospitals shall be distributed as provided in the General 492 Appropriations Act. The funds provided for family practice 493 teaching hospitals shall be distributed equally among family 494 practice teaching hospitals. 495 (3) Notwithstanding any provision of this section to the 496 contrary, for eachthe 2020-2021state fiscal year, the agency 497 shall make disproportionate share payments to teaching 498 hospitals, as defined in s. 408.07, as provided in the2020-2021499 General Appropriations Act.This subsection expires July 1,5002021.501 Section 11. Subsection (4) of section 409.9119, Florida 502 Statutes, is amended to read: 503 409.9119 Disproportionate share program for specialty 504 hospitals for children.—In addition to the payments made under 505 s. 409.911, the Agency for Health Care Administration shall 506 develop and implement a system under which disproportionate 507 share payments are made to those hospitals that are separately 508 licensed by the state as specialty hospitals for children, have 509 a federal Centers for Medicare and Medicaid Services 510 certification number in the 3300-3399 range, have Medicaid days 511 that exceed 55 percent of their total days and Medicare days 512 that are less than 5 percent of their total days, and were 513 licensed on January 1, 2013, as specialty hospitals for 514 children. This system of payments must conform to federal 515 requirements and must distribute funds in each fiscal year for 516 which an appropriation is made by making quarterly Medicaid 517 payments. Notwithstanding s. 409.915, counties are exempt from 518 contributing toward the cost of this special reimbursement for 519 hospitals that serve a disproportionate share of low-income 520 patients. The agency may make disproportionate share payments to 521 specialty hospitals for children as provided for in the General 522 Appropriations Act. 523 (4) Notwithstanding any provision of this section to the 524 contrary, for eachthe 2020-2021state fiscal year, for 525 hospitals achieving full compliance under subsection (3), the 526 agency shall make disproportionate share payments to specialty 527 hospitals for children as provided in the2020-2021General 528 Appropriations Act.This subsection expires July 1, 2021.529 Section 12. Paragraph (a) of subsection (1) of section 530 409.975, Florida Statutes, is amended to read: 531 409.975 Managed care plan accountability.—In addition to 532 the requirements of s. 409.967, plans and providers 533 participating in the managed medical assistance program shall 534 comply with the requirements of this section. 535 (1) PROVIDER NETWORKS.—Managed care plans must develop and 536 maintain provider networks that meet the medical needs of their 537 enrollees in accordance with standards established pursuant to 538 s. 409.967(2)(c). Except as provided in this section, managed 539 care plans may limit the providers in their networks based on 540 credentials, quality indicators, and price. 541 (a) Plans must include all providers in the region that are 542 classified by the agency as essential Medicaid providers, unless 543 the agency approves, in writing, an alternative arrangement for 544 securing the types of services offered by the essential 545 providers. Providers are essential for serving Medicaid 546 enrollees if they offer services that are not available from any 547 other provider within a reasonable access standard, or if they 548 provided a substantial share of the total units of a particular 549 service used by Medicaid patients within the region during the 550 last 3 years and the combined capacity of other service 551 providers in the region is insufficient to meet the total needs 552 of the Medicaid patients. The agency may not classify physicians 553 and other practitioners as essential providers. The agency, at a 554 minimum, shall determine which providers in the following 555 categories are essential Medicaid providers: 556 1. Federally qualified health centers. 557 2. Statutory teaching hospitals as defined in s. 408.07(46) 558s. 408.07(44). 559 3. Hospitals that are trauma centers as defined in s. 560 395.4001(15). 561 4. Hospitals located at least 25 miles from any other 562 hospital with similar services. 563 564 Managed care plans that have not contracted with all essential 565 providers in the region as of the first date of recipient 566 enrollment, or with whom an essential provider has terminated 567 its contract, must negotiate in good faith with such essential 568 providers for 1 year or until an agreement is reached, whichever 569 is first. Payments for services rendered by a nonparticipating 570 essential provider shall be made at the applicable Medicaid rate 571 as of the first day of the contract between the agency and the 572 plan. A rate schedule for all essential providers shall be 573 attached to the contract between the agency and the plan. After 574 1 year, managed care plans that are unable to contract with 575 essential providers shall notify the agency and propose an 576 alternative arrangement for securing the essential services for 577 Medicaid enrollees. The arrangement must rely on contracts with 578 other participating providers, regardless of whether those 579 providers are located within the same region as the 580 nonparticipating essential service provider. If the alternative 581 arrangement is approved by the agency, payments to 582 nonparticipating essential providers after the date of the 583 agency’s approval shall equal 90 percent of the applicable 584 Medicaid rate. Except for payment for emergency services, if the 585 alternative arrangement is not approved by the agency, payment 586 to nonparticipating essential providers shall equal 110 percent 587 of the applicable Medicaid rate. 588 Section 13. Subsection (1) of section 430.502, Florida 589 Statutes, is amended to read: 590 430.502 Alzheimer’s disease; memory disorder clinics and 591 day care and respite care programs.— 592 (1) There is established: 593 (a) A memory disorder clinic at each of the three medical 594 schools in this state; 595 (b) A memory disorder clinic at a major private nonprofit 596 research-oriented teaching hospital, and may fund a memory 597 disorder clinic at any of the other affiliated teaching 598 hospitals; 599 (c) A memory disorder clinic at the Mayo Clinic in 600 Jacksonville; 601 (d) A memory disorder clinic at theWest Florida Regional602 Medical Center Clinic in Pensacola; 603 (e) A memory disorder clinic operated by Health First in 604 Brevard County; 605 (f) A memory disorder clinic at the Orlando Regional 606 Healthcare System, Inc.; 607 (g) A memory disorder center located in a public hospital 608 that is operated by an independent special hospital taxing 609 district that governs multiple hospitals and is located in a 610 county with a population greater than 800,000 persons; 611 (h) A memory disorder clinic at St. Mary’s Medical Center 612 in Palm Beach County; 613 (i) A memory disorder clinic at Tallahassee Memorial 614 Healthcare; 615 (j) A memory disorder clinic at Lee Memorial Hospital 616 created by chapter 63-1552, Laws of Florida, as amended; 617 (k) A memory disorder clinic at Sarasota Memorial Hospital 618 in Sarasota County; 619 (l) A memory disorder clinic at Morton Plant Hospital, 620 Clearwater, in Pinellas County; 621 (m) A memory disorder clinic at Florida Atlantic 622 University, Boca Raton, in Palm Beach County; 623 (n) A memory disorder clinic at AdventHealth in Orange 624 County; and 625 (o) A memory disorder clinic at Miami Jewish Health System 626 in Miami-Dade County, 627 628 for the purpose of conducting research and training in a 629 diagnostic and therapeutic setting for persons suffering from 630 Alzheimer’s disease and related memory disorders. However, 631 memory disorder clinics mayshallnot receive decreased funding 632 due solely to subsequent additions of memory disorder clinics in 633 this subsection. 634 Section 14. Notwithstanding the expiration date in section 635 19 of chapter 2020-114, Laws of Florida, paragraph (b) of 636 subsection (5) of section 624.91, Florida Statutes, is reenacted 637 to read: 638 624.91 The Florida Healthy Kids Corporation Act.— 639 (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.— 640 (b) The Florida Healthy Kids Corporation shall: 641 1. Arrange for the collection of any family, local 642 contributions, or employer payment or premium, in an amount to 643 be determined by the board of directors, to provide for payment 644 of premiums for comprehensive insurance coverage and for the 645 actual or estimated administrative expenses. 646 2. Arrange for the collection of any voluntary 647 contributions to provide for payment of Florida Kidcare program 648 premiums for children who are not eligible for medical 649 assistance under Title XIX or Title XXI of the Social Security 650 Act. 651 3. Subject to the provisions of s. 409.8134, accept 652 voluntary supplemental local match contributions that comply 653 with the requirements of Title XXI of the Social Security Act 654 for the purpose of providing additional Florida Kidcare coverage 655 in contributing counties under Title XXI. 656 4. Establish the administrative and accounting procedures 657 for the operation of the corporation. 658 5. Establish, with consultation from appropriate 659 professional organizations, standards for preventive health 660 services and providers and comprehensive insurance benefits 661 appropriate to children, provided that such standards for rural 662 areas shall not limit primary care providers to board-certified 663 pediatricians. 664 6. Determine eligibility for children seeking to 665 participate in the Title XXI-funded components of the Florida 666 Kidcare program consistent with the requirements specified in s. 667 409.814, as well as the non-Title-XXI-eligible children as 668 provided in subsection (3). 669 7. Establish procedures under which providers of local 670 match to, applicants to and participants in the program may have 671 grievances reviewed by an impartial body and reported to the 672 board of directors of the corporation. 673 8. Establish participation criteria and, if appropriate, 674 contract with an authorized insurer, health maintenance 675 organization, or third-party administrator to provide 676 administrative services to the corporation. 677 9. Establish enrollment criteria that include penalties or 678 waiting periods of 30 days for reinstatement of coverage upon 679 voluntary cancellation for nonpayment of family premiums. 680 10. Contract with authorized insurers or any provider of 681 health care services, meeting standards established by the 682 corporation, for the provision of comprehensive insurance 683 coverage to participants. Such standards shall include criteria 684 under which the corporation may contract with more than one 685 provider of health care services in program sites. Health plans 686 shall be selected through a competitive bid process. The Florida 687 Healthy Kids Corporation shall purchase goods and services in 688 the most cost-effective manner consistent with the delivery of 689 quality medical care. The maximum administrative cost for a 690 Florida Healthy Kids Corporation contract shall be 15 percent. 691 For health care contracts, the minimum medical loss ratio for a 692 Florida Healthy Kids Corporation contract shall be 85 percent. 693 For dental contracts, the remaining compensation to be paid to 694 the authorized insurer or provider under a Florida Healthy Kids 695 Corporation contract shall be no less than an amount which is 85 696 percent of premium; to the extent any contract provision does 697 not provide for this minimum compensation, this section shall 698 prevail. For an insurer or any provider of health care services 699 which achieves an annual medical loss ratio below 85 percent, 700 the Florida Healthy Kids Corporation shall validate the medical 701 loss ratio and calculate an amount to be refunded by the insurer 702 or any provider of health care services to the state which shall 703 be deposited into the General Revenue Fund unallocated. The 704 health plan selection criteria and scoring system, and the 705 scoring results, shall be available upon request for inspection 706 after the bids have been awarded. 707 11. Establish disenrollment criteria in the event local 708 matching funds are insufficient to cover enrollments. 709 12. Develop and implement a plan to publicize the Florida 710 Kidcare program, the eligibility requirements of the program, 711 and the procedures for enrollment in the program and to maintain 712 public awareness of the corporation and the program. 713 13. Secure staff necessary to properly administer the 714 corporation. Staff costs shall be funded from state and local 715 matching funds and such other private or public funds as become 716 available. The board of directors shall determine the number of 717 staff members necessary to administer the corporation. 718 14. In consultation with the partner agencies, provide a 719 report on the Florida Kidcare program annually to the Governor, 720 the Chief Financial Officer, the Commissioner of Education, the 721 President of the Senate, the Speaker of the House of 722 Representatives, and the Minority Leaders of the Senate and the 723 House of Representatives. 724 15. Provide information on a quarterly basis to the 725 Legislature and the Governor which compares the costs and 726 utilization of the full-pay enrolled population and the Title 727 XXI-subsidized enrolled population in the Florida Kidcare 728 program. The information, at a minimum, must include: 729 a. The monthly enrollment and expenditure for full-pay 730 enrollees in the Medikids and Florida Healthy Kids programs 731 compared to the Title XXI-subsidized enrolled population; and 732 b. The costs and utilization by service of the full-pay 733 enrollees in the Medikids and Florida Healthy Kids programs and 734 the Title XXI-subsidized enrolled population. 735 16. Establish benefit packages that conform to the 736 provisions of the Florida Kidcare program, as created in ss. 737 409.810-409.821. 738 Section 15. Subsection (2) of section 1011.52, Florida 739 Statutes, is amended to read: 740 1011.52 Appropriation to first accredited medical school.— 741 (2) In order for a medical school to qualify under this 742 section and to be entitled to the benefits herein, such medical 743 school: 744 (a) Must be primarily operated and established to offer, 745 afford, and render a medical education to residents of the state 746 qualifying for admission to such institution; 747 (b) Must be operated by a municipality or county of this 748 state, or by a nonprofit organization heretofore or hereafter 749 established exclusively for educational purposes; 750 (c) Must, upon the formation and establishment of an 751 accredited medical school, transmit and file with the Department 752 of Education documentary proof evidencing the facts that such 753 institution has been certified and approved by the council on 754 medical education and hospitals of the American Medical 755 Association and has adequately met the requirements of that 756 council in regard to its administrative facilities, 757 administrative plant, clinical facilities, curriculum, and all 758 other such requirements as may be necessary to qualify with the 759 council as a recognized, approved, and accredited medical 760 school; 761 (d) Must certify to the Department of Education the name, 762 address, and educational history of each student approved and 763 accepted for enrollment in such institution for the ensuing 764 school year; and 765 (e) Must have in place an operating agreement with a 766 government-owned hospital that is located in the same county as 767 the medical school and that is a statutory teaching hospital as 768 defined in s. 408.07(46)s. 408.07(44). The operating agreement 769 must provide for the medical school to maintain the same level 770 of affiliation with the hospital, including the level of 771 services to indigent and charity care patients served by the 772 hospital, which was in place in the prior fiscal year. Each 773 year, documentation demonstrating that an operating agreement is 774 in effect shall be submitted jointly to the Department of 775 Education by the hospital and the medical school prior to the 776 payment of moneys from the annual appropriation. 777 Section 16. Subject to federal approval of the application 778 to be a site for the Program of All-inclusive Care for the 779 Elderly (PACE), the Agency for Health Care Administration shall 780 contract with one private health care organization, the sole 781 member of which is a private, not-for-profit corporation that 782 owns and manages health care organizations that provide 783 comprehensive long-term care services, including nursing home, 784 assisted living, independent housing, home care, adult day care, 785 and care management. This organization shall provide these 786 services to frail and elderly persons who reside in Escambia, 787 Okaloosa, and Santa Rosa Counties. The organization is exempt 788 from the requirements of chapter 641, Florida Statutes. The 789 agency, in consultation with the Department of Elderly Affairs 790 and subject to an appropriation, shall approve up to 200 initial 791 enrollees in the PACE program established by this organization 792 to serve elderly persons who reside in Escambia, Okaloosa, and 793 Santa Rosa Counties. 794 Section 17. Subject to federal approval of the application 795 to be a site for the Program of All-inclusive Care for the 796 Elderly (PACE), the Agency for Health Care Administration shall 797 contract with one private, not-for-profit hospital located in 798 Miami-Dade County to provide comprehensive services to frail and 799 elderly persons residing in Northwest Miami-Dade County, as 800 defined by the agency. The hospital is exempt from the 801 requirements of chapter 641, Florida Statutes. The agency, in 802 consultation with the Department of Elderly Affairs and subject 803 to appropriation, shall approve up to 100 initial enrollees in 804 the PACE program established by this hospital to serve persons 805 in Northwest Miami-Dade County. 806 Section 18. Subject to federal approval of an application 807 to be a provider of the Program of All-inclusive Care for the 808 Elderly (PACE), the Agency for Health Care Administration shall 809 contract with a private organization that has demonstrated the 810 ability to operate PACE centers in more than one state and that 811 serves more than 500 eligible PACE participants, to provide PACE 812 services to frail and elderly persons who reside in 813 Hillsborough, Hernando, or Pasco Counties. The organization is 814 exempt from the requirements of chapter 641, Florida Statutes. 815 The agency, in consultation with the Department of Elderly 816 Affairs and subject to the appropriation of funds by the 817 Legislature, shall approve up to 500 initial enrollees in the 818 PACE program established by the organization to serve frail and 819 elderly persons who reside in Hillsborough, Hernando, or Pasco 820 Counties. 821 Section 19. Subject to federal approval of an application 822 to be a provider of the Program of All-inclusive Care for the 823 Elderly (PACE), the Agency for Health Care Administration shall 824 contract with a private organization that has demonstrated the 825 ability to service high-risk, frail elderly residents in either 826 nursing homes or in the community in Florida through its 827 operation of long-term care facilities, as well as approved 828 special needs plans for institutionalized Medicare residents. 829 This organization shall provide these services to frail and 830 elderly persons who reside in Broward County. The organization 831 is exempt from the requirements of chapter 641, Florida 832 Statutes. The agency, in consultation with the Department of 833 Elderly Affairs and subject to the appropriation of funds by the 834 Legislature, shall approve up to 300 initial enrollees in the 835 PACE program established by the organization to serve frail and 836 elderly persons who reside in Broward County. 837 Section 20. Subject to federal approval, a current Program 838 of All-inclusive Care for the Elderly (PACE) organization that 839 is authorized to provide PACE services in Northeast Florida and 840 that is granted authority under section 28 of Chapter 2016-65, 841 Laws of Florida, for up to 300 enrollee slots to serve frail and 842 elderly persons residing in Baker, Clay, Duval, Nassau, and St. 843 Johns Counties, may also use those PACE slots for enrollees 844 residing in Alachua and Putnam Counties, subject to a contract 845 amendment with the Agency for Health Care Administration. 846 Section 21. The Program of All-inclusive Care for the 847 Elderly (PACE) organization that is authorized as of July 1, 848 2021 to provide PACE services for up to 150 enrollee slots to 849 serve frail and elderly persons residing in Hospice Service 850 Areas 7B (Orange and Osceola Counties) and 3E (Lake and Sumter 851 Counties), as previously authorized by section 29 of Chapter 852 2016-65, Laws of Florida, and the PACE organization that is 853 authorized as of July 1, 2021 to provide PACE services for up to 854 150 initial enrollee slots to serve frail and elderly persons 855 who reside in Hospice Services Area 7C (Seminole County), as 856 previously authorized by section 22 of Chapter 2017-129, Laws of 857 Florida, may be consolidated. With the consolidation, the PACE 858 organization that has demonstrated the ability to operate PACE 859 centers in more than one state and that serves more than 500 860 eligible PACE participants is authorized to provide PACE 861 services for up to 300 initial enrollee slots to serve frail and 862 elderly persons who reside in Orange, Osceola, Lake, Sumter, or 863 Seminole Counties. 864 Section 22. Subject to federal approval, a private 865 organization that owns and manages a health care organization 866 that provides comprehensive long-term care services, including 867 acute care services, independent living through federally 868 approved affordable housing, and care management, and has 869 demonstrated the ability to operate Program of All-inclusive 870 Care for the Elderly (PACE) centers in more than one state is 871 authorized to provide PACE services to frail and elderly persons 872 who reside in Seminole, Volusia, or Flagler Counties. The 873 organization is exempt from the requirements of chapter 641, 874 Florida Statutes. The agency, in consultation with the 875 Department of Elderly Affairs, and subject to an appropriation, 876 shall approve up to 500 initial enrollee slots to serve frail 877 and elderly persons residing in Seminole, Volusia, or Flagler 878 Counties. 879 Section 23. Subject to federal approval of the application 880 to be a site for the Program of All-inclusive Care for the 881 Elderly (PACE), the Agency for Health Care Administration shall 882 contract with one public hospital system operating in the 883 northern two-thirds of Broward County to provide comprehensive 884 services to frail and elderly persons residing in the northern 885 two-thirds of Broward County. The public hospital system is 886 exempt from the requirements of chapter 641, Florida Statutes. 887 The agency, in consultation with the Department of Elderly 888 Affairs, and subject to an appropriation, shall approve up to 889 200 initial enrollee slots in the PACE program established by 890 the public hospital system to serve frail and elderly persons 891 residing in the northern two-thirds of Broward County. 892 Section 24. This act shall take effect July 1, 2021.