Florida Senate - 2016                                    SB 7056
       
       
        
       By the Committee on Health Policy
       
       588-02608-16                                          20167056__
    1                        A bill to be entitled                      
    2         An act relating to long-term care managed care
    3         prioritization; amending s. 409.962, F.S.; defining
    4         terms; amending s. 409.979, F.S.; requiring the
    5         Department of Elderly Affairs to maintain a statewide
    6         wait list for enrollment for home and community-based
    7         services through the Medicaid long-term care managed
    8         care program; requiring the department to prioritize
    9         individuals for potential enrollment using a frailty
   10         based screening tool that provides a priority score;
   11         providing for determinations regarding offers of
   12         enrollment; requiring screening and certain
   13         rescreening by Aging Resource Center personnel of
   14         individuals requesting long-term care services from
   15         the program; requiring the department to adopt by rule
   16         a screening tool; requiring the department to make a
   17         specified methodology available on its website;
   18         requiring the department to notify applicants if they
   19         are placed on the wait list; requiring the department
   20         to conduct prerelease assessments upon notification by
   21         the agency of available capacity; authorizing certain
   22         individuals to enroll in the long-term care managed
   23         care program; requiring the department to terminate an
   24         individual from the wait list under certain
   25         circumstances; providing for priority enrollment for
   26         home and community-based services; authorizing the
   27         department and the Agency for Health Care
   28         Administration to adopt rules; deleting obsolete
   29         language; providing an effective date.
   30          
   31  Be It Enacted by the Legislature of the State of Florida:
   32  
   33         Section 1. Present subsections (4) through (13) of section
   34  409.962, Florida Statutes, are redesignated as subsections (5)
   35  through and (14), respectively, present subsection (14) of that
   36  section is redesignated as subsection (18), and new subsection
   37  (4) and subsections (15), (16), and (17) are added to that
   38  section, to read:
   39         409.962 Definitions.—As used in this part, except as
   40  otherwise specifically provided, the term:
   41         (4) “Authorized representative” means an individual who has
   42  the legal authority to make decisions on behalf of a Medicaid
   43  recipient or potential Medicaid recipient in matters related to
   44  the managed care plan or the screening or eligibility process.
   45         (15) “Rescreening” means the use of a screening tool to
   46  conduct annual screenings or screenings due to a significant
   47  change which determine an individual’s placement and
   48  continuation on the wait list.
   49         (16) “Screening” means the use of an information-collection
   50  tool to determine a priority score for placement on the wait
   51  list.
   52         (17) “Significant change” means change in an individual’s
   53  health status after an accident or illness; an actual or
   54  anticipated change in the individual’s living situation; a
   55  change in the caregiver relationship; loss of or damage to the
   56  individual’s home or deterioration of his or her home
   57  environment; or loss of the individual’s spouse or caregiver.
   58         Section 2. Section 409.979, Florida Statutes, is amended to
   59  read:
   60         409.979 Eligibility.—
   61         (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid
   62  recipients who meet all of the following criteria are eligible
   63  to receive long-term care services and must receive long-term
   64  care services by participating in the long-term care managed
   65  care program. The recipient must be:
   66         (a) Sixty-five years of age or older, or age 18 or older
   67  and eligible for Medicaid by reason of a disability.
   68         (b) Determined by the Comprehensive Assessment Review and
   69  Evaluation for Long-Term Care Services (CARES) preadmission
   70  screening program to require nursing facility care as defined in
   71  s. 409.985(3).
   72         (2) ENROLLMENT OFFERS.—Medicaid recipients who, on the date
   73  long-term care managed care plans become available in their
   74  region, reside in a nursing home facility or are enrolled in one
   75  of the following long-term care Medicaid waiver programs are
   76  eligible to participate in the long-term care managed care
   77  program for up to 12 months without being reevaluated for their
   78  need for nursing facility care as defined in s. 409.985(3):
   79         (a) The Assisted Living for the Frail Elderly Waiver.
   80         (b) The Aged and Disabled Adult Waiver.
   81         (c) The Consumer-Directed Care Plus Program as described in
   82  s. 409.221.
   83         (d) The Program of All-inclusive Care for the Elderly.
   84         (e) The Channeling Services Waiver for Frail Elders.
   85         (3)Subject to availability of funds, the Department of
   86  Elderly Affairs shall make offers for enrollment to eligible
   87  individuals based on a wait-list prioritization and subject to
   88  availability of funds. Before making enrollment offers, the
   89  agency and the Department of Elderly Affairs department shall
   90  determine that sufficient funds exist to support additional
   91  enrollment into plans.
   92         (3) WAIT LIST, RELEASE, AND OFFER PROCESS.The Department
   93  of Elderly Affairs shall maintain a statewide wait list for
   94  enrollment for home and community-based services through the
   95  long-term care managed care program.
   96         (a) The Department of Elderly Affairs shall prioritize
   97  individuals for potential enrollment for home and community
   98  based services through the long-term care managed care program
   99  using a frailty-based screening tool that results in a priority
  100  score. The priority score is used to set an order for releasing
  101  individuals from the wait list for potential enrollment in the
  102  long-term care managed care program. If capacity is limited for
  103  individuals with identical priority scores, the individual with
  104  the oldest date of placement on the wait list shall receive
  105  priority for release.
  106         1. Pursuant to s. 430.2053, Aging Resource Center personnel
  107  certified by the Department of Elderly Affairs shall perform the
  108  screening for each individual requesting enrollment for home and
  109  community-based services through the long-term care managed care
  110  program.
  111         2. The individual requesting the long-term care services,
  112  or the individual’s authorized representative, must participate
  113  in an initial screening or rescreening for placement on the wait
  114  list. The screening or rescreening must be completed in its
  115  entirety before placement on the wait list.
  116         3. Pursuant to s. 430.2053, Aging Resource Center personnel
  117  shall administer rescreening annually or upon notification of a
  118  significant change in an individual’s circumstances.
  119         4. The Department of Elderly Affairs shall adopt by rule a
  120  screening tool that generates the priority score, and shall make
  121  publicly available on its website the specific methodology used
  122  to calculate an individual’s priority score.
  123         (b) Upon completion of the screening or rescreening
  124  process, the Department of Elderly Affairs shall notify the
  125  individual or the individual’s authorized representative that
  126  the individual has been placed on the wait list.
  127         (c) If the Department of Elderly Affairs is unable to
  128  contact the individual or the individual’s authorized
  129  representative to schedule an initial screening or rescreening,
  130  it shall send a letter to the last documented address of the
  131  individual or the individual’s authorized representative. The
  132  letter must advise the individual or his or her authorized
  133  representative that he or she must contact the Department of
  134  Elderly Affairs within 30 calendar days after the date of the
  135  notice to schedule a screening or rescreening and must notify
  136  the individual that failure to complete the screening or
  137  rescreening will result in his or her termination from the
  138  screening process and the wait list.
  139         (d) After notification by the agency of available capacity,
  140  the CARES program shall conduct a prerelease assessment. The
  141  Department of Elderly Affairs shall release individuals from the
  142  wait list based on the priority scoring process and prerelease
  143  assessment results. Upon release, individuals who also are
  144  determined by the department to be financially eligible and by
  145  the Department of Elderly Affairs to be clinically eligible may
  146  enroll in the long-term care managed care program.
  147         (e) The Department of Elderly Affairs shall terminate an
  148  individual’s inclusion on the wait list if the individual:
  149         1. Does not have a current priority score due to the
  150  individual’s action or inaction;
  151         2. Requests to be removed from the wait list;
  152         3. Does not keep an appointment to complete the rescreening
  153  without scheduling another appointment;
  154         4. Receives an offer to begin the eligibility determination
  155  process for the long-term care managed care program; or
  156         5. Begins receiving services through the long-term care
  157  managed care program.
  158  
  159  An individual whose inclusion on the wait list is terminated
  160  must initiate a new request for placement on the wait list, and
  161  any previous priority considerations must be disregarded.
  162         (f) Notwithstanding this subsection, the following
  163  individuals are afforded priority enrollment for home and
  164  community-based services through the long-term care managed care
  165  program and do not have to complete the screening or wait-list
  166  process if all other long-term care managed care program
  167  eligibility requirements are met:
  168         1. Individuals who are 18, 19, or 20 years of age who have
  169  chronic debilitating diseases or conditions of one or more
  170  physiological or organ systems which generally make the
  171  individual dependent upon 24-hour-per-day medical, nursing, or
  172  health supervision or intervention.
  173         2. Nursing facility residents requesting to transition into
  174  the community who have resided in a Florida-licensed skilled
  175  nursing facility for at least 60 consecutive days.
  176         (g) The Department of Elderly Affairs and the agency may
  177  adopt rules to implement this subsection.
  178         Section 3. This act shall take effect July 1, 2016.