Florida Senate - 2016                        COMMITTEE AMENDMENT
       Bill No. SB 1144
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: FAV            .                                
                  02/17/2016           .                                

       Appropriations Subcommittee on Health and Human Services
       (Richter) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Present paragraphs (a) through (t) of subsection
    6  (3) of section 408.036, Florida Statutes, are redesignated as
    7  paragraphs (c) through (v), respectively, new paragraphs (a) and
    8  (b) are added to that subsection, present subsections (4) and
    9  (5) of that section are redesignated as subsections (5) and (6),
   10  respectively, and a new subsection (4) is added to that section,
   11  to read:
   12         408.036 Projects subject to review; exemptions.—
   13         (3) EXEMPTIONS.—Upon request, the following projects are
   14  subject to exemption from the provisions of subsection (1):
   15         (a) Except for projects described in paragraphs (b) and
   16  (c), any project conditioned upon a significant, active, and
   17  continuing commitment to improved access to care for uninsured
   18  and low-income residents of the applicable service district.
   19  Such commitment is demonstrated by compliance with the following
   20  conditions and requirements which the project applicant must
   21  accept in a signed agreement with the agency:
   22         1. The project licensee must contribute, once the project
   23  is operational and at the end of each of the first four calendar
   24  quarters of the project’s operations, an amount equal to 1.5
   25  percent of the gross revenues earned by the exempt project.
   26  Contributions shall be made to the agency and deposited in the
   27  Public Medical Assistance Trust Fund.
   28         2.a. Beginning in the fifth calendar quarter of the exempt
   29  project’s operations, the licensee must provide charity care in
   30  an amount equal to twice the applicable district average among
   31  licensed providers of similar services. For purposes of this
   32  section, the term “charity care” means uncompensated care
   33  delivered to uninsured patients having incomes at or below 200
   34  percent of the federal poverty level when such services are
   35  preauthorized by the licensee and not subject to collection
   36  procedures. The valuation of charity care must be based on
   37  Medicaid reimbursement rates.
   38         b. Alternatively, if the licensee provides less charity
   39  care than is required by sub-subparagraph a., the licensee must
   40  donate:
   41         (I) Pursuant to a written agreement with a charity care
   42  provider in the service district, payments for charity care
   43  provided to residents of the service district in total amounts
   44  equal to or greater than the difference between the value of the
   45  charity care provided in sub-subparagraph a. and the applicable
   46  district average among licensed providers of similar services;
   47  or
   48         (II) Payments to Florida Health Choices for health care
   49  coverage financial assistance in total amounts equal to or
   50  greater than the difference between the value of the charity
   51  care provided in sub-subparagraph a. and the applicable district
   52  average among licensed providers of similar services. The
   53  payments for financial assistance must be made in increments
   54  sufficient to purchase silver-level health care coverage for an
   55  individual for at least 1 year. The individual receiving this
   56  assistance must have been uninsured during the previous 12
   57  months. The licensee and Florida Health Choices shall cooperate
   58  to identify individuals from the service district who are
   59  qualified to receive the available assistance.
   60         c. The agreement between the agency and the applicant for
   61  an exemption must require the licensee to submit reports and
   62  data necessary to monitor compliance with the charity care
   63  threshold.
   64         (b) Any project to construct or establish a new skilled
   65  nursing facility or increase the licensed bed capacity of an
   66  existing skilled nursing facility conditioned on a significant,
   67  active, and continuing commitment by the facility to improved
   68  access to Medicaid long-term care services. Such commitment is
   69  demonstrated by an applicant by compliance with a signed
   70  agreement between the applicant and the agency which, upon the
   71  project becoming operational, requires the project licensee to
   72  contribute an amount equal to the state share of one-fourth of
   73  the cost of enrolling a person in the long-term care waiver
   74  program established pursuant to Part IV of Chapter 409 times
   75  twice the number of new beds included in the project. The
   76  contribution shall be paid by the project licensee to the agency
   77  at the end of each calendar quarter that the project is
   78  operational and deposited in the Public Medical Assistance Trust
   79  Fund. The agreement between the agency and the applicant must
   80  require the licensee to submit reports and data necessary to
   81  monitor compliance with the charity care threshold.
   82         (4) PENALTIES.—A facility licensed based on the exemption
   83  established in subsection (3)(a)-(b) is subject to the following
   84  penalties for noncompliance with its specific commitment to
   85  improve access to care for uninsured and low-income persons in
   86  the service district:
   87         (a) For the first quarter in which the value of services,
   88  donations, and financial assistance falls below the specified
   89  threshold, the fine is equal to twice the amount of the
   90  shortfall. The fine is doubled in each subsequent quarter of
   91  noncompliance up to a maximum of four quarters.
   92         (b) Following a fifth quarter of noncompliance, the exempt
   93  license shall be suspended until the licensee implements a
   94  corrective action plan that the agency has approved.
   95         (c) Failure by the facility to maintain compliance
   96  following the implementation of a corrective action plan shall
   97  result in revocation of the exempt license.
   98         Section 2. This act shall take effect July 1, 2016.
  100  ================= T I T L E  A M E N D M E N T ================
  101  And the title is amended as follows:
  102         Delete everything before the enacting clause
  103  and insert:
  104                        A bill to be entitled                      
  105         An act relating to certificates of need for health
  106         care-related projects; amending s. 408.036, F.S.;
  107         providing an exemption from certificate of need review
  108         for certain health care-related projects; specifying
  109         conditions and requirements for the exemption;
  110         requiring that project applicants enter into an
  111         agreement with the Agency for Health Care
  112         Administration as a condition of eligibility for the
  113         exemption; requiring specified monetary contributions;
  114         providing penalties for failure to comply with the
  115         terms of the agreement; providing an effective date.