Florida Senate - 2017 CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 2514, 1st Eng.
Ì662348=Î662348
LEGISLATIVE ACTION
Senate . House
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Floor: AD/CR . Floor: AD
05/08/2017 04:19 PM . 05/08/2017 07:47 PM
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The Conference Committee on SB 2514, 1st Eng. recommended the
following:
1 Senate Conference Committee Amendment (with title
2 amendment)
3
4 Delete everything after the enacting clause
5 and insert:
6 Section 1. Paragraph (c) of subsection (2) of section
7 210.20, Florida Statutes, is amended to read:
8 210.20 Employees and assistants; distribution of funds.—
9 (2) As collections are received by the division from such
10 cigarette taxes, it shall pay the same into a trust fund in the
11 State Treasury designated “Cigarette Tax Collection Trust Fund”
12 which shall be paid and distributed as follows:
13 (c) Beginning July 1, 2017 2013, and continuing through
14 June 30, 2033, the division shall from month to month certify to
15 the Chief Financial Officer the amount derived from the
16 cigarette tax imposed by s. 210.02, less the service charges
17 provided for in s. 215.20 and less 0.9 percent of the amount
18 derived from the cigarette tax imposed by s. 210.02, which shall
19 be deposited into the Alcoholic Beverage and Tobacco Trust Fund,
20 specifying an amount equal to 1 percent of the net collections,
21 not to exceed $3 million annually, and that amount shall be
22 deposited into the Biomedical Research Trust Fund in the
23 Department of Health. These funds are appropriated annually in
24 an amount not to exceed $3 million from the Biomedical Research
25 Trust Fund for the advancement of cures for cancers afflicting
26 pediatric populations through basic or applied research,
27 including, but not limited to, clinical trials and nontoxic drug
28 discovery. These funds are not included in the calculation for
29 the distribution of funds pursuant to s. 381.915; however, these
30 funds shall be distributed to cancer centers participating in
31 the Florida Consortium of National Cancer Institute Centers
32 Program in the same proportion as is allocated to each cancer
33 center in accordance with s. 381.915 and are in addition to any
34 funds distributed pursuant to that section Department of Health
35 and the Sanford-Burnham Medical Research Institute to work in
36 conjunction for the purpose of establishing activities and grant
37 opportunities in relation to biomedical research.
38 Section 2. Subsection (2) of section 381.922, Florida
39 Statutes, is amended to read:
40 381.922 William G. “Bill” Bankhead, Jr., and David Coley
41 Cancer Research Program.—
42 (2) The program shall provide grants for cancer research to
43 further the search for cures for cancer.
44 (a) Emphasis shall be given to the following goals, as
45 those goals support the advancement of such cures:
46 1. Efforts to significantly expand cancer research capacity
47 in the state by:
48 a. Identifying ways to attract new research talent and
49 attendant national grant-producing researchers to cancer
50 research facilities in this state;
51 b. Implementing a peer-reviewed, competitive process to
52 identify and fund the best proposals to expand cancer research
53 institutes in this state;
54 c. Funding through available resources for those proposals
55 that demonstrate the greatest opportunity to attract federal
56 research grants and private financial support;
57 d. Encouraging the employment of bioinformatics in order to
58 create a cancer informatics infrastructure that enhances
59 information and resource exchange and integration through
60 researchers working in diverse disciplines, to facilitate the
61 full spectrum of cancer investigations;
62 e. Facilitating the technical coordination, business
63 development, and support of intellectual property as it relates
64 to the advancement of cancer research; and
65 f. Aiding in other multidisciplinary research-support
66 activities as they inure to the advancement of cancer research.
67 2. Efforts to improve both research and treatment through
68 greater participation in clinical trials networks by:
69 a. Identifying ways to increase pediatric and adult
70 enrollment in cancer clinical trials;
71 b. Supporting public and private professional education
72 programs designed to increase the awareness and knowledge about
73 cancer clinical trials;
74 c. Providing tools to cancer patients and community-based
75 oncologists to aid in the identification of cancer clinical
76 trials available in the state; and
77 d. Creating opportunities for the state’s academic cancer
78 centers to collaborate with community-based oncologists in
79 cancer clinical trials networks.
80 3. Efforts to reduce the impact of cancer on disparate
81 groups by:
82 a. Identifying those cancers that disproportionately impact
83 certain demographic groups; and
84 b. Building collaborations designed to reduce health
85 disparities as they relate to cancer.
86 (b) Preference may be given to grant proposals that foster
87 collaborations among institutions, researchers, and community
88 practitioners, as such proposals support the advancement of
89 cures through basic or applied research, including clinical
90 trials involving cancer patients and related networks.
91 (c) There is established within the program the Live Like
92 Bella Initiative. The purpose of the initiative is to advance
93 progress toward curing pediatric cancer by awarding grants
94 through the peer-reviewed, competitive process established under
95 subsection (3). This paragraph is subject to the annual
96 appropriation of funds by the Legislature.
97 Section 3. Paragraph (a) of subsection (10) of section
98 394.9082, Florida Statutes, is republished, paragraph (b) of
99 that subsection is amended, and paragraph (f) is added to that
100 subsection, to read:
101 394.9082 Behavioral health managing entities.—
102 (10) ACUTE CARE SERVICES UTILIZATION DATABASE.—The
103 department shall develop, implement, and maintain standards
104 under which a managing entity shall collect utilization data
105 from all public receiving facilities situated within its
106 geographical service area and all detoxification and addictions
107 receiving facilities under contract with the managing entity. As
108 used in this subsection, the term “public receiving facility”
109 means an entity that meets the licensure requirements of, and is
110 designated by, the department to operate as a public receiving
111 facility under s. 394.875 and that is operating as a licensed
112 crisis stabilization unit.
113 (a) The department shall develop standards and protocols to
114 be used for data collection, storage, transmittal, and analysis.
115 The standards and protocols shall allow for compatibility of
116 data and data transmittal between public receiving facilities,
117 detoxification facilities, addictions receiving facilities,
118 managing entities, and the department for the implementation,
119 and to meet the requirements, of this subsection.
120 (b) A managing entity shall require providers specified in
121 paragraph (a) to submit data, in real time or at least daily, to
122 the managing entity for:
123 1. All admissions and discharges of clients receiving
124 public receiving facility services who qualify as indigent, as
125 defined in s. 394.4787.
126 2. All admissions and discharges of clients receiving
127 substance abuse services in an addictions receiving facility or
128 detoxification facility pursuant to parts IV and V of chapter
129 397 who qualify as indigent.
130 3. The current active census of total licensed and utilized
131 beds, the number of beds purchased by the department, the number
132 of clients qualifying as indigent occupying who occupy any of
133 those beds, and the total number of unoccupied licensed beds,
134 regardless of funding, and the number in excess of licensed
135 capacity. Crisis units licensed for both adult and child use
136 will report as a single unit.
137 (f) The department shall post on its website, by facility,
138 the data collected pursuant to this subsection and update such
139 posting monthly.
140 Section 4. Paragraph (e) of subsection (2) of section
141 395.602, Florida Statutes, is amended to read:
142 395.602 Rural hospitals.—
143 (2) DEFINITIONS.—As used in this part, the term:
144 (e) “Rural hospital” means an acute care hospital licensed
145 under this chapter, having 100 or fewer licensed beds and an
146 emergency room, which is:
147 1. The sole provider within a county with a population
148 density of up to 100 persons per square mile;
149 2. An acute care hospital, in a county with a population
150 density of up to 100 persons per square mile, which is at least
151 30 minutes of travel time, on normally traveled roads under
152 normal traffic conditions, from any other acute care hospital
153 within the same county;
154 3. A hospital supported by a tax district or subdistrict
155 whose boundaries encompass a population of up to 100 persons per
156 square mile;
157 4. A hospital classified as a sole community hospital under
158 42 C.F.R. s. 412.92, regardless of the number of which has up to
159 175 licensed beds;
160 5. A hospital with a service area that has a population of
161 up to 100 persons per square mile. As used in this subparagraph,
162 the term “service area” means the fewest number of zip codes
163 that account for 75 percent of the hospital’s discharges for the
164 most recent 5-year period, based on information available from
165 the hospital inpatient discharge database in the Florida Center
166 for Health Information and Transparency at the agency; or
167 6. A hospital designated as a critical access hospital, as
168 defined in s. 408.07.
169
170 Population densities used in this paragraph must be based upon
171 the most recently completed United States census. A hospital
172 that received funds under s. 409.9116 for a quarter beginning no
173 later than July 1, 2002, is deemed to have been and shall
174 continue to be a rural hospital from that date through June 30,
175 2021, if the hospital continues to have up to 100 licensed beds
176 and an emergency room. An acute care hospital that has not
177 previously been designated as a rural hospital and that meets
178 the criteria of this paragraph shall be granted such designation
179 upon application, including supporting documentation, to the
180 agency. A hospital that was licensed as a rural hospital during
181 the 2010-2011 or 2011-2012 fiscal year shall continue to be a
182 rural hospital from the date of designation through June 30,
183 2021, if the hospital continues to have up to 100 licensed beds
184 and an emergency room.
185 Section 5. Effective October 1, 2018, paragraph (d) of
186 subsection (2) of section 400.179, Florida Statutes, is amended
187 to read:
188 400.179 Liability for Medicaid underpayments and
189 overpayments.—
190 (2) Because any transfer of a nursing facility may expose
191 the fact that Medicaid may have underpaid or overpaid the
192 transferor, and because in most instances, any such underpayment
193 or overpayment can only be determined following a formal field
194 audit, the liabilities for any such underpayments or
195 overpayments shall be as follows:
196 (d) Where the transfer involves a facility that has been
197 leased by the transferor:
198 1. The transferee shall, as a condition to being issued a
199 license by the agency, acquire, maintain, and provide proof to
200 the agency of a bond with a term of 30 months, renewable
201 annually, in an amount not less than the total of 3 months’
202 Medicaid payments to the facility computed on the basis of the
203 preceding 12-month average Medicaid payments to the facility.
204 2. A leasehold licensee may meet the requirements of
205 subparagraph 1. by payment of a nonrefundable fee, paid at
206 initial licensure, paid at the time of any subsequent change of
207 ownership, and paid annually thereafter, in the amount of 1
208 percent of the total of 3 months’ Medicaid payments to the
209 facility computed on the basis of the preceding 12-month average
210 Medicaid payments to the facility. If a preceding 12-month
211 average is not available, projected Medicaid payments may be
212 used. The fee shall be deposited into the Grants and Donations
213 Trust Fund and shall be accounted for separately as a Medicaid
214 nursing home overpayment account. These fees shall be used at
215 the sole discretion of the agency to repay nursing home Medicaid
216 overpayments or for enhanced payments to nursing facilities as
217 specified in the General Appropriations Act or other law.
218 Payment of this fee shall not release the licensee from any
219 liability for any Medicaid overpayments, nor shall payment bar
220 the agency from seeking to recoup overpayments from the licensee
221 and any other liable party. As a condition of exercising this
222 lease bond alternative, licensees paying this fee must maintain
223 an existing lease bond through the end of the 30-month term
224 period of that bond. The agency is herein granted specific
225 authority to promulgate all rules pertaining to the
226 administration and management of this account, including
227 withdrawals from the account, subject to federal review and
228 approval. This provision shall take effect upon becoming law and
229 shall apply to any leasehold license application. The financial
230 viability of the Medicaid nursing home overpayment account shall
231 be determined by the agency through annual review of the account
232 balance and the amount of total outstanding, unpaid Medicaid
233 overpayments owing from leasehold licensees to the agency as
234 determined by final agency audits. By March 31 of each year, the
235 agency shall assess the cumulative fees collected under this
236 subparagraph, minus any amounts used to repay nursing home
237 Medicaid overpayments and amounts transferred to contribute to
238 the General Revenue Fund pursuant to s. 215.20. If the net
239 cumulative collections, minus amounts utilized to repay nursing
240 home Medicaid overpayments, exceed $25 million, the provisions
241 of this subparagraph shall not apply for the subsequent fiscal
242 year.
243 3. The leasehold licensee may meet the bond requirement
244 through other arrangements acceptable to the agency. The agency
245 is herein granted specific authority to promulgate rules
246 pertaining to lease bond arrangements.
247 4. All existing nursing facility licensees, operating the
248 facility as a leasehold, shall acquire, maintain, and provide
249 proof to the agency of the 30-month bond required in
250 subparagraph 1., above, on and after July 1, 1993, for each
251 license renewal.
252 5. It shall be the responsibility of all nursing facility
253 operators, operating the facility as a leasehold, to renew the
254 30-month bond and to provide proof of such renewal to the agency
255 annually.
256 6. Any failure of the nursing facility operator to acquire,
257 maintain, renew annually, or provide proof to the agency shall
258 be grounds for the agency to deny, revoke, and suspend the
259 facility license to operate such facility and to take any
260 further action, including, but not limited to, enjoining the
261 facility, asserting a moratorium pursuant to part II of chapter
262 408, or applying for a receiver, deemed necessary to ensure
263 compliance with this section and to safeguard and protect the
264 health, safety, and welfare of the facility’s residents. A lease
265 agreement required as a condition of bond financing or
266 refinancing under s. 154.213 by a health facilities authority or
267 required under s. 159.30 by a county or municipality is not a
268 leasehold for purposes of this paragraph and is not subject to
269 the bond requirement of this paragraph.
270 Section 6. Subsection (11) is added to section 409.904,
271 Florida Statutes, to read:
272 409.904 Optional payments for eligible persons.—The agency
273 may make payments for medical assistance and related services on
274 behalf of the following persons who are determined to be
275 eligible subject to the income, assets, and categorical
276 eligibility tests set forth in federal and state law. Payment on
277 behalf of these Medicaid eligible persons is subject to the
278 availability of moneys and any limitations established by the
279 General Appropriations Act or chapter 216.
280 (11) Subject to federal waiver approval, a person diagnosed
281 with acquired immune deficiency syndrome (AIDS) who has an AIDS
282 related opportunistic infection and is at risk of
283 hospitalization as determined by the agency and whose income is
284 at or below 300 percent of the Federal Benefit Rate.
285 Section 7. Paragraph (b) of subsection (13) of section
286 409.906, Florida Statutes, is amended to read:
287 409.906 Optional Medicaid services.—Subject to specific
288 appropriations, the agency may make payments for services which
289 are optional to the state under Title XIX of the Social Security
290 Act and are furnished by Medicaid providers to recipients who
291 are determined to be eligible on the dates on which the services
292 were provided. Any optional service that is provided shall be
293 provided only when medically necessary and in accordance with
294 state and federal law. Optional services rendered by providers
295 in mobile units to Medicaid recipients may be restricted or
296 prohibited by the agency. Nothing in this section shall be
297 construed to prevent or limit the agency from adjusting fees,
298 reimbursement rates, lengths of stay, number of visits, or
299 number of services, or making any other adjustments necessary to
300 comply with the availability of moneys and any limitations or
301 directions provided for in the General Appropriations Act or
302 chapter 216. If necessary to safeguard the state’s systems of
303 providing services to elderly and disabled persons and subject
304 to the notice and review provisions of s. 216.177, the Governor
305 may direct the Agency for Health Care Administration to amend
306 the Medicaid state plan to delete the optional Medicaid service
307 known as “Intermediate Care Facilities for the Developmentally
308 Disabled.” Optional services may include:
309 (13) HOME AND COMMUNITY-BASED SERVICES.—
310 (b) The agency may consolidate types of services offered in
311 the Aged and Disabled Waiver, the Channeling Waiver, the Project
312 AIDS Care Waiver, and the Traumatic Brain and Spinal Cord Injury
313 Waiver programs in order to group similar services under a
314 single service, or continue a service upon evidence of the need
315 for including a particular service type in a particular waiver.
316 The agency is authorized to seek a Medicaid state plan amendment
317 or federal waiver approval to implement this policy.
318 Section 8. Effective October 1, 2018, subsection (2) of
319 section 409.908, Florida Statutes, is amended to read:
320 409.908 Reimbursement of Medicaid providers.—Subject to
321 specific appropriations, the agency shall reimburse Medicaid
322 providers, in accordance with state and federal law, according
323 to methodologies set forth in the rules of the agency and in
324 policy manuals and handbooks incorporated by reference therein.
325 These methodologies may include fee schedules, reimbursement
326 methods based on cost reporting, negotiated fees, competitive
327 bidding pursuant to s. 287.057, and other mechanisms the agency
328 considers efficient and effective for purchasing services or
329 goods on behalf of recipients. If a provider is reimbursed based
330 on cost reporting and submits a cost report late and that cost
331 report would have been used to set a lower reimbursement rate
332 for a rate semester, then the provider’s rate for that semester
333 shall be retroactively calculated using the new cost report, and
334 full payment at the recalculated rate shall be effected
335 retroactively. Medicare-granted extensions for filing cost
336 reports, if applicable, shall also apply to Medicaid cost
337 reports. Payment for Medicaid compensable services made on
338 behalf of Medicaid eligible persons is subject to the
339 availability of moneys and any limitations or directions
340 provided for in the General Appropriations Act or chapter 216.
341 Further, nothing in this section shall be construed to prevent
342 or limit the agency from adjusting fees, reimbursement rates,
343 lengths of stay, number of visits, or number of services, or
344 making any other adjustments necessary to comply with the
345 availability of moneys and any limitations or directions
346 provided for in the General Appropriations Act, provided the
347 adjustment is consistent with legislative intent.
348 (2)(a)1. Reimbursement to nursing homes licensed under part
349 II of chapter 400 and state-owned-and-operated intermediate care
350 facilities for the developmentally disabled licensed under part
351 VIII of chapter 400 must be made prospectively.
352 2. Unless otherwise limited or directed in the General
353 Appropriations Act, reimbursement to hospitals licensed under
354 part I of chapter 395 for the provision of swing-bed nursing
355 home services must be made on the basis of the average statewide
356 nursing home payment, and reimbursement to a hospital licensed
357 under part I of chapter 395 for the provision of skilled nursing
358 services must be made on the basis of the average nursing home
359 payment for those services in the county in which the hospital
360 is located. When a hospital is located in a county that does not
361 have any community nursing homes, reimbursement shall be
362 determined by averaging the nursing home payments in counties
363 that surround the county in which the hospital is located.
364 Reimbursement to hospitals, including Medicaid payment of
365 Medicare copayments, for skilled nursing services shall be
366 limited to 30 days, unless a prior authorization has been
367 obtained from the agency. Medicaid reimbursement may be extended
368 by the agency beyond 30 days, and approval must be based upon
369 verification by the patient’s physician that the patient
370 requires short-term rehabilitative and recuperative services
371 only, in which case an extension of no more than 15 days may be
372 approved. Reimbursement to a hospital licensed under part I of
373 chapter 395 for the temporary provision of skilled nursing
374 services to nursing home residents who have been displaced as
375 the result of a natural disaster or other emergency may not
376 exceed the average county nursing home payment for those
377 services in the county in which the hospital is located and is
378 limited to the period of time which the agency considers
379 necessary for continued placement of the nursing home residents
380 in the hospital.
381 (b) Subject to any limitations or directions in the General
382 Appropriations Act, the agency shall establish and implement a
383 state Title XIX Long-Term Care Reimbursement Plan for nursing
384 home care in order to provide care and services in conformance
385 with the applicable state and federal laws, rules, regulations,
386 and quality and safety standards and to ensure that individuals
387 eligible for medical assistance have reasonable geographic
388 access to such care.
389 1. The agency shall amend the long-term care reimbursement
390 plan and cost reporting system to create direct care and
391 indirect care subcomponents of the patient care component of the
392 per diem rate. These two subcomponents together shall equal the
393 patient care component of the per diem rate. Separate prices
394 cost-based ceilings shall be calculated for each patient care
395 subcomponent, initially based on the September 2016 rate setting
396 cost reports and subsequently based on the most recently audited
397 cost report used during a rebasing year. The direct care
398 subcomponent of the per diem rate for any providers still being
399 reimbursed on a cost basis shall be limited by the cost-based
400 class ceiling, and the indirect care subcomponent may be limited
401 by the lower of the cost-based class ceiling, the target rate
402 class ceiling, or the individual provider target. The ceilings
403 and targets apply only to providers being reimbursed on a cost
404 based system. Effective October 1, 2018, a prospective payment
405 methodology shall be implemented for rate setting purposes with
406 the following parameters:
407 a. Peer Groups, including:
408 (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
409 Counties; and
410 (II) South-SMMC Regions 10-11, plus Palm Beach and
411 Okeechobee Counties.
412 b. Percentage of Median Costs based on the cost reports
413 used for September 2016 rate setting:
414 (I) Direct Care Costs........................100 percent.
415 (II) Indirect Care Costs......................92 percent.
416 (III) Operating Costs.........................86 percent.
417 c. Floors:
418 (I) Direct Care Component.....................95 percent.
419 (II) Indirect Care Component................92.5 percent.
420 (III) Operating Component...........................None.
421 d. Pass-through PaymentsReal Estate and Personal Property
422 Taxes and Property Insurance.
423 e. Quality Incentive Program Payment Pool....6 percent of
424 September 2016 non-property related payments of included
425 facilities.
426 f. Quality Score Threshold to Quality for Quality Incentive
427 Payment..................20th percentile of included facilities.
428 g. Fair Rental Value System Payment Parameters:
429 (I) Building Value per Square Foot based on 2018 RS Means.
430 (II) Land Valuation...10 percent of Gross Building value.
431 (III) Facility Square Footage......Actual Square Footage.
432 (IV) Moveable Equipment Allowance.........$8,000 per bed.
433 (V) Obsolescence Factor......................1.5 percent.
434 (VI) Fair Rental Rate of Return................8 percent.
435 (VII) Minimum Occupancy.......................90 percent.
436 (VIII) Maximum Facility Age.....................40 years.
437 (IX) Minimum Square Footage per Bed..................350.
438 (X) Maximum Square Footage for Bed...................500.
439 (XI) Minimum Cost of a renovation/replacements$500 per bed.
440 h. Ventilator Supplemental payment of $200 per Medicaid day
441 of 40,000 ventilator Medicaid days per fiscal year.
442 2. The direct care subcomponent shall include salaries and
443 benefits of direct care staff providing nursing services
444 including registered nurses, licensed practical nurses, and
445 certified nursing assistants who deliver care directly to
446 residents in the nursing home facility, allowable therapy costs,
447 and dietary costs. This excludes nursing administration, staff
448 development, the staffing coordinator, and the administrative
449 portion of the minimum data set and care plan coordinators. The
450 direct care subcomponent also includes medically necessary
451 dental care, vision care, hearing care, and podiatric care.
452 3. All other patient care costs shall be included in the
453 indirect care cost subcomponent of the patient care per diem
454 rate, including complex medical equipment, medical supplies, and
455 other allowable ancillary costs. Costs may not be allocated
456 directly or indirectly to the direct care subcomponent from a
457 home office or management company.
458 4. On July 1 of each year, the agency shall report to the
459 Legislature direct and indirect care costs, including average
460 direct and indirect care costs per resident per facility and
461 direct care and indirect care salaries and benefits per category
462 of staff member per facility.
463 5. Every fourth year, the agency shall rebase nursing home
464 prospective payment rates to reflect changes in cost based on
465 the most recently audited cost report for each participating
466 provider In order to offset the cost of general and professional
467 liability insurance, the agency shall amend the plan to allow
468 for interim rate adjustments to reflect increases in the cost of
469 general or professional liability insurance for nursing homes.
470 This provision shall be implemented to the extent existing
471 appropriations are available.
472 6. A direct care supplemental payment may be made to
473 providers whose direct care hours per patient day are above the
474 80th percentile and who provide Medicaid services to a larger
475 percentage of Medicaid patients than the state average.
476 7. For the period beginning on October 1, 2018, and ending
477 on September 30, 2021, the agency shall reimburse providers the
478 greater of their September 2016 cost-based rate or their
479 prospective payment rate. Effective October 1, 2021, the agency
480 shall reimburse providers the greater of 95 percent of their
481 cost-based rate or their rebased prospective payment rate, using
482 the most recently audited cost report for each facility. This
483 subparagraph shall expire September 30, 2023.
484 8. Pediatric, Florida Department of Veterans Affairs, and
485 government-owned facilities are exempt from the pricing model
486 established in this subsection and shall remain on a cost-based
487 prospective payment system. Effective October 1, 2018, the
488 agency shall set rates for all facilities remaining on a cost
489 based prospective payment system using each facility’s most
490 recently audited cost report, eliminating retroactive
491 settlements.
492
493 It is the intent of the Legislature that the reimbursement plan
494 achieve the goal of providing access to health care for nursing
495 home residents who require large amounts of care while
496 encouraging diversion services as an alternative to nursing home
497 care for residents who can be served within the community. The
498 agency shall base the establishment of any maximum rate of
499 payment, whether overall or component, on the available moneys
500 as provided for in the General Appropriations Act. The agency
501 may base the maximum rate of payment on the results of
502 scientifically valid analysis and conclusions derived from
503 objective statistical data pertinent to the particular maximum
504 rate of payment.
505 Section 9. Subsections (6) through (26) of section 409.908,
506 Florida Statutes, are renumbered as subsections (5) through
507 (25), respectively, present subsections (5), (14), and (24) are
508 amended, and a new subsection (26) is added to that section, to
509 read:
510 409.908 Reimbursement of Medicaid providers.—Subject to
511 specific appropriations, the agency shall reimburse Medicaid
512 providers, in accordance with state and federal law, according
513 to methodologies set forth in the rules of the agency and in
514 policy manuals and handbooks incorporated by reference therein.
515 These methodologies may include fee schedules, reimbursement
516 methods based on cost reporting, negotiated fees, competitive
517 bidding pursuant to s. 287.057, and other mechanisms the agency
518 considers efficient and effective for purchasing services or
519 goods on behalf of recipients. If a provider is reimbursed based
520 on cost reporting and submits a cost report late and that cost
521 report would have been used to set a lower reimbursement rate
522 for a rate semester, then the provider’s rate for that semester
523 shall be retroactively calculated using the new cost report, and
524 full payment at the recalculated rate shall be effected
525 retroactively. Medicare-granted extensions for filing cost
526 reports, if applicable, shall also apply to Medicaid cost
527 reports. Payment for Medicaid compensable services made on
528 behalf of Medicaid eligible persons is subject to the
529 availability of moneys and any limitations or directions
530 provided for in the General Appropriations Act or chapter 216.
531 Further, nothing in this section shall be construed to prevent
532 or limit the agency from adjusting fees, reimbursement rates,
533 lengths of stay, number of visits, or number of services, or
534 making any other adjustments necessary to comply with the
535 availability of moneys and any limitations or directions
536 provided for in the General Appropriations Act, provided the
537 adjustment is consistent with legislative intent.
538 (5) An ambulatory surgical center shall be reimbursed the
539 lesser of the amount billed by the provider or the Medicare
540 established allowable amount for the facility.
541 (13)(14) Medicare premiums for persons eligible for both
542 Medicare and Medicaid coverage shall be paid at the rates
543 established by Title XVIII of the Social Security Act. For
544 Medicare services rendered to Medicaid-eligible persons,
545 Medicaid shall pay Medicare deductibles and coinsurance as
546 follows:
547 (a) Medicaid’s financial obligation for deductibles and
548 coinsurance payments shall be based on Medicare allowable fees,
549 not on a provider’s billed charges.
550 (b) Medicaid will pay no portion of Medicare deductibles
551 and coinsurance when payment that Medicare has made for the
552 service equals or exceeds what Medicaid would have paid if it
553 had been the sole payor. The combined payment of Medicare and
554 Medicaid shall not exceed the amount Medicaid would have paid
555 had it been the sole payor. The Legislature finds that there has
556 been confusion regarding the reimbursement for services rendered
557 to dually eligible Medicare beneficiaries. Accordingly, the
558 Legislature clarifies that it has always been the intent of the
559 Legislature before and after 1991 that, in reimbursing in
560 accordance with fees established by Title XVIII for premiums,
561 deductibles, and coinsurance for Medicare services rendered by
562 physicians to Medicaid eligible persons, physicians be
563 reimbursed at the lesser of the amount billed by the physician
564 or the Medicaid maximum allowable fee established by the Agency
565 for Health Care Administration, as is permitted by federal law.
566 It has never been the intent of the Legislature with regard to
567 such services rendered by physicians that Medicaid be required
568 to provide any payment for deductibles, coinsurance, or
569 copayments for Medicare cost sharing, or any expenses incurred
570 relating thereto, in excess of the payment amount provided for
571 under the State Medicaid plan for such service. This payment
572 methodology is applicable even in those situations in which the
573 payment for Medicare cost sharing for a qualified Medicare
574 beneficiary with respect to an item or service is reduced or
575 eliminated. This expression of the Legislature is in
576 clarification of existing law and shall apply to payment for,
577 and with respect to provider agreements with respect to, items
578 or services furnished on or after the effective date of this
579 act. This paragraph applies to payment by Medicaid for items and
580 services furnished before the effective date of this act if such
581 payment is the subject of a lawsuit that is based on the
582 provisions of this section, and that is pending as of, or is
583 initiated after, the effective date of this act.
584 (c) Notwithstanding paragraphs (a) and (b):
585 1. Medicaid payments for Nursing Home Medicare part A
586 coinsurance are limited to the Medicaid nursing home per diem
587 rate less any amounts paid by Medicare, but only up to the
588 amount of Medicare coinsurance. The Medicaid per diem rate shall
589 be the rate in effect for the dates of service of the crossover
590 claims and may not be subsequently adjusted due to subsequent
591 per diem rate adjustments.
592 2. Medicaid shall pay all deductibles and coinsurance for
593 Medicare-eligible recipients receiving freestanding end stage
594 renal dialysis center services.
595 3. Medicaid payments for general and specialty hospital
596 inpatient services are limited to the Medicare deductible and
597 coinsurance per spell of illness. Medicaid payments for hospital
598 Medicare Part A coinsurance shall be limited to the Medicaid
599 hospital per diem rate less any amounts paid by Medicare, but
600 only up to the amount of Medicare coinsurance. Medicaid payments
601 for coinsurance shall be limited to the Medicaid per diem rate
602 in effect for the dates of service of the crossover claims and
603 may not be subsequently adjusted due to subsequent per diem
604 adjustments.
605 4. Medicaid shall pay all deductibles and coinsurance for
606 Medicare emergency transportation services provided by
607 ambulances licensed pursuant to chapter 401.
608 5. Medicaid shall pay all deductibles and coinsurance for
609 portable X-ray Medicare Part B services provided in a nursing
610 home, in an assisted living facility, or in the patient’s home.
611 (23)(24)(a) The agency shall establish rates at a level
612 that ensures no increase in statewide expenditures resulting
613 from a change in unit costs effective July 1, 2011.
614 Reimbursement rates shall be as provided in the General
615 Appropriations Act.
616 (b) Base rate reimbursement for inpatient services under a
617 diagnosis-related group payment methodology shall be provided in
618 the General Appropriations Act.
619 (c) Base rate reimbursement for outpatient services under
620 an enhanced ambulatory payment group methodology shall be
621 provided in the General Appropriations Act.
622 (d)(c) This subsection applies to the following provider
623 types:
624 1. Inpatient hospitals.
625 2. Outpatient hospitals.
626 1.3. Nursing homes.
627 2.4. County health departments.
628 5. Prepaid health plans.
629 (e)(d) The agency shall apply the effect of this subsection
630 to the reimbursement rates for nursing home diversion programs.
631 (26) The agency may receive funds from state entities,
632 including, but not limited to, the Department of Health, local
633 governments, and other local political subdivisions, for the
634 purpose of making special exception payments, including federal
635 matching funds. Funds received for this purpose shall be
636 separately accounted for and may not be commingled with other
637 state or local funds in any manner. The agency may certify all
638 local governmental funds used as state match under Title XIX of
639 the Social Security Act to the extent and in the manner
640 authorized under the General Appropriations Act and pursuant to
641 an agreement between the agency and the local governmental
642 entity. In order for the agency to certify such local
643 governmental funds, a local governmental entity must submit a
644 final, executed letter of agreement to the agency, which must be
645 received by October 1 of each fiscal year and provide the total
646 amount of local governmental funds authorized by the entity for
647 that fiscal year under the General Appropriations Act. The local
648 governmental entity shall use a certification form prescribed by
649 the agency. At a minimum, the certification form must identify
650 the amount being certified and describe the relationship between
651 the certifying local governmental entity and the local health
652 care provider. Local governmental funds outlined in the letters
653 of agreement must be received by the agency no later than
654 October 31 of each fiscal year in which such funds are pledged,
655 unless an alternative plan is specifically approved by the
656 agency.
657 Section 10. Effective October 1, 2018, subsection (4) of
658 section 409.9082, Florida Statutes, is amended to read:
659 409.9082 Quality assessment on nursing home facility
660 providers; exemptions; purpose; federal approval required;
661 remedies.—
662 (4) The purpose of the nursing home facility quality
663 assessment is to ensure continued quality of care. Collected
664 assessment funds shall be used to obtain federal financial
665 participation through the Medicaid program to make Medicaid
666 payments for nursing home facility services up to the amount of
667 nursing home facility Medicaid rates as calculated in accordance
668 with the approved state Medicaid plan in effect on December 31,
669 2007. The quality assessment and federal matching funds shall be
670 used exclusively for the following purposes and in the following
671 order of priority:
672 (a) To reimburse the Medicaid share of the quality
673 assessment as a pass-through, Medicaid-allowable cost;
674 (b) To increase to each nursing home facility’s Medicaid
675 rate, as needed, an amount that restores rate reductions
676 effective on or after January 1, 2008, as provided in the
677 General Appropriations Act; and
678 (c) To partially fund the quality incentive payment program
679 for nursing facilities that exceed quality benchmarks increase
680 each nursing home facility’s Medicaid rate that accounts for the
681 portion of the total assessment not included in paragraphs (a)
682 and (b) which begins a phase-in to a pricing model for the
683 operating cost component.
684 Section 11. Section 409.909, Florida Statutes, is amended
685 to read:
686 409.909 Statewide Medicaid Residency Program.—
687 (1) The Statewide Medicaid Residency Program is established
688 to improve the quality of care and access to care for Medicaid
689 recipients, expand graduate medical education on an equitable
690 basis, and increase the supply of highly trained physicians
691 statewide. The agency shall make payments to hospitals licensed
692 under part I of chapter 395 and to qualifying institutions as
693 defined in paragraph (2)(c) for graduate medical education
694 associated with the Medicaid program. This system of payments is
695 designed to generate federal matching funds under Medicaid and
696 distribute the resulting funds to participating hospitals on a
697 quarterly basis in each fiscal year for which an appropriation
698 is made.
699 (2) On or before September 15 of each year, the agency
700 shall calculate an allocation fraction to be used for
701 distributing funds to participating hospitals and to qualifying
702 institutions as defined in paragraph (2)(c). On or before the
703 final business day of each quarter of a state fiscal year, the
704 agency shall distribute to each participating hospital one
705 fourth of that hospital’s annual allocation calculated under
706 subsection (4). The allocation fraction for each participating
707 hospital is based on the hospital’s number of full-time
708 equivalent residents and the amount of its Medicaid payments. As
709 used in this section, the term:
710 (a) “Full-time equivalent,” or “FTE,” means a resident who
711 is in his or her residency period, with the initial residency
712 period defined as the minimum number of years of training
713 required before the resident may become eligible for board
714 certification by the American Osteopathic Association Bureau of
715 Osteopathic Specialists or the American Board of Medical
716 Specialties in the specialty in which he or she first began
717 training, not to exceed 5 years. The residency specialty is
718 defined as reported using the current residency type codes in
719 the Intern and Resident Information System (IRIS), required by
720 Medicare. A resident training beyond the initial residency
721 period is counted as 0.5 FTE, unless his or her chosen specialty
722 is in primary care, in which case the resident is counted as 1.0
723 FTE. For the purposes of this section, primary care specialties
724 include:
725 1. Family medicine;
726 2. General internal medicine;
727 3. General pediatrics;
728 4. Preventive medicine;
729 5. Geriatric medicine;
730 6. Osteopathic general practice;
731 7. Obstetrics and gynecology;
732 8. Emergency medicine;
733 9. General surgery; and
734 10. Psychiatry.
735 (b) “Medicaid payments” means the estimated total payments
736 for reimbursing a hospital for direct inpatient services for the
737 fiscal year in which the allocation fraction is calculated based
738 on the hospital inpatient appropriation and the parameters for
739 the inpatient diagnosis-related group base rate and the
740 parameters for the outpatient enhanced ambulatory payment group
741 rate, including applicable intergovernmental transfers,
742 specified in the General Appropriations Act, as determined by
743 the agency. Effective July 1, 2017, the term “Medicaid payments”
744 means the estimated total payments for reimbursing a hospital
745 and qualifying institutions as defined in paragraph (2)(c) for
746 direct inpatient and outpatient services for the fiscal year in
747 which the allocation fraction is calculated based on the
748 hospital inpatient appropriation and outpatient appropriation
749 and the parameters for the inpatient diagnosis-related group
750 base rate and the parameters for the outpatient enhanced
751 ambulatory payment group rate, including applicable
752 intergovernmental transfers, specified in the General
753 Appropriations Act, as determined by the agency.
754 (c) “Qualifying institution” means a federally Qualified
755 Health Center holding an Accreditation Council for Graduate
756 Medical Education institutional accreditation.
757 (d) “Resident” means a medical intern, fellow, or resident
758 enrolled in a program accredited by the Accreditation Council
759 for Graduate Medical Education, the American Association of
760 Colleges of Osteopathic Medicine, or the American Osteopathic
761 Association at the beginning of the state fiscal year during
762 which the allocation fraction is calculated, as reported by the
763 hospital to the agency.
764 (3) The agency shall use the following formula to calculate
765 a participating hospital’s and qualifying institution’s
766 allocation fraction:
767
768 HAF=[0.9 x (HFTE/TFTE)] + [0.1 x (HMP/TMP)]
769
770 Where:
771 HAF=A hospital’s and qualifying institution’s allocation
772 fraction.
773 HFTE=A hospital’s and qualifying institution’s total number
774 of FTE residents.
775 TFTE=The total FTE residents for all participating
776 hospitals and qualifying institutions.
777 HMP=A hospital’s and qualifying institution’s Medicaid
778 payments.
779 TMP=The total Medicaid payments for all participating
780 hospitals and qualifying institutions.
781
782 (4) A hospital’s and qualifying institution’s annual
783 allocation shall be calculated by multiplying the funds
784 appropriated for the Statewide Medicaid Residency Program in the
785 General Appropriations Act by that hospital’s and qualifying
786 institution’s allocation fraction. If the calculation results in
787 an annual allocation that exceeds two times the average per FTE
788 resident amount for all hospitals and qualifying institutions,
789 the hospital’s and qualifying institution’s annual allocation
790 shall be reduced to a sum equaling no more than two times the
791 average per FTE resident. The funds calculated for that hospital
792 and qualifying institution in excess of two times the average
793 per FTE resident amount for all hospitals and qualifying
794 institutions shall be redistributed to participating hospitals
795 and qualifying institutions whose annual allocation does not
796 exceed two times the average per FTE resident amount for all
797 hospitals and qualifying institutions, using the same
798 methodology and payment schedule specified in this section.
799 (5) The Graduate Medical Education Startup Bonus Program is
800 established to provide resources for the education and training
801 of physicians in specialties which are in a statewide supply
802 and-demand deficit. Hospitals and qualifying institutions as
803 defined in paragraph (2)(c) eligible for participation in
804 subsection (1) are eligible to participate in the Graduate
805 Medical Education Startup Bonus Program established under this
806 subsection. Notwithstanding subsection (4) or an FTE’s residency
807 period, and in any state fiscal year in which funds are
808 appropriated for the startup bonus program, the agency shall
809 allocate a $100,000 startup bonus for each newly created
810 resident position that is authorized by the Accreditation
811 Council for Graduate Medical Education or Osteopathic
812 Postdoctoral Training Institution in an initial or established
813 accredited training program that is in a physician specialty in
814 statewide supply-and-demand deficit. In any year in which
815 funding is not sufficient to provide $100,000 for each newly
816 created resident position, funding shall be reduced pro rata
817 across all newly created resident positions in physician
818 specialties in statewide supply-and-demand deficit.
819 (a) Hospitals and qualifying institutions as defined in
820 paragraph (2)(c) applying for a startup bonus must submit to the
821 agency by March 1 their Accreditation Council for Graduate
822 Medical Education or Osteopathic Postdoctoral Training
823 Institution approval validating the new resident positions
824 approved on or after March 2 of the prior fiscal year through
825 March 1 of the current fiscal year for the physician specialties
826 identified in a statewide supply-and-demand deficit as provided
827 in the current fiscal year’s General Appropriations Act. An
828 applicant hospital or qualifying institution as defined in
829 paragraph (2)(c) may validate a change in the number of
830 residents by comparing the number in the prior period
831 Accreditation Council for Graduate Medical Education or
832 Osteopathic Postdoctoral Training Institution approval to the
833 number in the current year.
834 (b) Any unobligated startup bonus funds on April 15 of each
835 fiscal year shall be proportionally allocated to hospitals and
836 to qualifying institutions as defined in paragraph (2)(c)
837 participating under subsection (3) for existing FTE residents in
838 the physician specialties in statewide supply-and-demand
839 deficit. This nonrecurring allocation shall be in addition to
840 the funds allocated in subsection (4). Notwithstanding
841 subsection (4), the allocation under this subsection may not
842 exceed $100,000 per FTE resident.
843 (c) For purposes of this subsection, physician specialties
844 and subspecialties, both adult and pediatric, in statewide
845 supply-and-demand deficit are those identified in the General
846 Appropriations Act.
847 (d) The agency shall distribute all funds authorized under
848 the Graduate Medical Education Startup Bonus Program on or
849 before the final business day of the fourth quarter of a state
850 fiscal year.
851 (6) Beginning in the 2015-2016 state fiscal year, the
852 agency shall reconcile each participating hospital’s total
853 number of FTE residents calculated for the state fiscal year 2
854 years before with its most recently available Medicare cost
855 reports covering the same time period. Reconciled FTE counts
856 shall be prorated according to the portion of the state fiscal
857 year covered by a Medicare cost report. Using the same
858 definitions, methodology, and payment schedule specified in this
859 section, the reconciliation shall apply any differences in
860 annual allocations calculated under subsection (4) to the
861 current year’s annual allocations.
862 (7) The agency may adopt rules to administer this section.
863 Section 12. Paragraph (a) of subsection (2) of section
864 409.911, Florida Statutes, is amended, and paragraph (b) of that
865 subsection is republished, to read:
866 409.911 Disproportionate share program.—Subject to specific
867 allocations established within the General Appropriations Act
868 and any limitations established pursuant to chapter 216, the
869 agency shall distribute, pursuant to this section, moneys to
870 hospitals providing a disproportionate share of Medicaid or
871 charity care services by making quarterly Medicaid payments as
872 required. Notwithstanding the provisions of s. 409.915, counties
873 are exempt from contributing toward the cost of this special
874 reimbursement for hospitals serving a disproportionate share of
875 low-income patients.
876 (2) The Agency for Health Care Administration shall use the
877 following actual audited data to determine the Medicaid days and
878 charity care to be used in calculating the disproportionate
879 share payment:
880 (a) The average of the 2009, 2010, and 2011 2007, 2008, and
881 2009 audited disproportionate share data to determine each
882 hospital’s Medicaid days and charity care for the 2017-2018
883 2015-2016 state fiscal year.
884 (b) If the Agency for Health Care Administration does not
885 have the prescribed 3 years of audited disproportionate share
886 data as noted in paragraph (a) for a hospital, the agency shall
887 use the average of the years of the audited disproportionate
888 share data as noted in paragraph (a) which is available.
889 Section 13. Section 409.9119, Florida Statutes, is amended
890 to read:
891 409.9119 Disproportionate share program for specialty
892 hospitals for children.—In addition to the payments made under
893 s. 409.911, the Agency for Health Care Administration shall
894 develop and implement a system under which disproportionate
895 share payments are made to those hospitals that are separately
896 licensed by the state as specialty hospitals for children, have
897 a federal Centers for Medicare and Medicaid Services
898 certification number in the 3300-3399 range, have Medicaid days
899 that exceed 55 percent of their total days and Medicare days
900 that are less than 5 percent of their total days, and were
901 licensed on January 1, 2013 January 1, 2000, as specialty
902 hospitals for children. This system of payments must conform to
903 federal requirements and must distribute funds in each fiscal
904 year for which an appropriation is made by making quarterly
905 Medicaid payments. Notwithstanding s. 409.915, counties are
906 exempt from contributing toward the cost of this special
907 reimbursement for hospitals that serve a disproportionate share
908 of low-income patients. The agency may make disproportionate
909 share payments to specialty hospitals for children as provided
910 for in the General Appropriations Act.
911 (1) Unless specified in the General Appropriations Act, the
912 agency shall use the following formula to calculate the total
913 amount earned for hospitals that participate in the specialty
914 hospital for children disproportionate share program:
915
916 TAE = DSR x BMPD x MD
917
918 Where:
919 TAE = total amount earned by a specialty hospital for
920 children.
921 DSR = disproportionate share rate.
922 BMPD = base Medicaid per diem.
923 MD = Medicaid days.
924
925 (2) The agency shall calculate the total additional payment
926 for hospitals that participate in the specialty hospital for
927 children disproportionate share program as follows:
928
929 TAP = (TAE x TA) ÷ STAE
930
931 Where:
932 TAP = total additional payment for a specialty hospital for
933 children.
934 TAE = total amount earned by a specialty hospital for
935 children.
936 TA = total appropriation for the specialty hospital for
937 children disproportionate share program.
938 STAE = sum of total amount earned by each hospital that
939 participates in the specialty hospital for children
940 disproportionate share program.
941
942 (3) A hospital may not receive any payments under this
943 section until it achieves full compliance with the applicable
944 rules of the agency. A hospital that is not in compliance for
945 two or more consecutive quarters may not receive its share of
946 the funds. Any forfeited funds must be distributed to the
947 remaining participating specialty hospitals for children that
948 are in compliance.
949 (4) Notwithstanding any provision of this section to the
950 contrary, for the 2017-2018 2016-2017 state fiscal year, for
951 hospitals achieving full compliance under subsection (3), the
952 agency shall make disproportionate share payments to specialty
953 hospitals for children as provided in the 2017-2018 2016-2017
954 General Appropriations Act. This subsection expires July 1, 2018
955 2017.
956 Section 14. Subsection (36) of section 409.913, Florida
957 Statutes, is amended to read:
958 409.913 Oversight of the integrity of the Medicaid
959 program.—The agency shall operate a program to oversee the
960 activities of Florida Medicaid recipients, and providers and
961 their representatives, to ensure that fraudulent and abusive
962 behavior and neglect of recipients occur to the minimum extent
963 possible, and to recover overpayments and impose sanctions as
964 appropriate. Beginning January 1, 2003, and each year
965 thereafter, the agency and the Medicaid Fraud Control Unit of
966 the Department of Legal Affairs shall submit a joint report to
967 the Legislature documenting the effectiveness of the state’s
968 efforts to control Medicaid fraud and abuse and to recover
969 Medicaid overpayments during the previous fiscal year. The
970 report must describe the number of cases opened and investigated
971 each year; the sources of the cases opened; the disposition of
972 the cases closed each year; the amount of overpayments alleged
973 in preliminary and final audit letters; the number and amount of
974 fines or penalties imposed; any reductions in overpayment
975 amounts negotiated in settlement agreements or by other means;
976 the amount of final agency determinations of overpayments; the
977 amount deducted from federal claiming as a result of
978 overpayments; the amount of overpayments recovered each year;
979 the amount of cost of investigation recovered each year; the
980 average length of time to collect from the time the case was
981 opened until the overpayment is paid in full; the amount
982 determined as uncollectible and the portion of the uncollectible
983 amount subsequently reclaimed from the Federal Government; the
984 number of providers, by type, that are terminated from
985 participation in the Medicaid program as a result of fraud and
986 abuse; and all costs associated with discovering and prosecuting
987 cases of Medicaid overpayments and making recoveries in such
988 cases. The report must also document actions taken to prevent
989 overpayments and the number of providers prevented from
990 enrolling in or reenrolling in the Medicaid program as a result
991 of documented Medicaid fraud and abuse and must include policy
992 recommendations necessary to prevent or recover overpayments and
993 changes necessary to prevent and detect Medicaid fraud. All
994 policy recommendations in the report must include a detailed
995 fiscal analysis, including, but not limited to, implementation
996 costs, estimated savings to the Medicaid program, and the return
997 on investment. The agency must submit the policy recommendations
998 and fiscal analyses in the report to the appropriate estimating
999 conference, pursuant to s. 216.137, by February 15 of each year.
1000 The agency and the Medicaid Fraud Control Unit of the Department
1001 of Legal Affairs each must include detailed unit-specific
1002 performance standards, benchmarks, and metrics in the report,
1003 including projected cost savings to the state Medicaid program
1004 during the following fiscal year.
1005 (36) At least three times a year, The agency may shall
1006 provide to a sample of each Medicaid recipients recipient or
1007 their representatives through the distribution of explanations
1008 his or her representative an explanation of benefits information
1009 about services reimbursed by the Medicaid program for goods and
1010 services to such recipients, including in the form of a letter
1011 that is mailed to the most recent address of the recipient on
1012 the record with the Department of Children and Families. The
1013 explanation of benefits must include the patient’s name, the
1014 name of the health care provider and the address of the location
1015 where the service was provided, a description of all services
1016 billed to Medicaid in terminology that should be understood by a
1017 reasonable person, and information on how to report
1018 inappropriate or incorrect billing to the agency or other law
1019 enforcement entities for review or investigation. At least once
1020 a year, the letter also must include information on how to
1021 report criminal Medicaid fraud to, the Medicaid Fraud Control
1022 Unit’s toll-free hotline number, and information about the
1023 rewards available under s. 409.9203. The explanation of benefits
1024 may not be mailed for Medicaid independent laboratory services
1025 as described in s. 409.905(7) or for Medicaid certified match
1026 services as described in ss. 409.9071 and 1011.70.
1027 Section 15. Paragraph (e) of subsection (1) of section
1028 409.975, Florida Statutes, is amended, to read:
1029 409.975 Managed care plan accountability.—In addition to
1030 the requirements of s. 409.967, plans and providers
1031 participating in the managed medical assistance program shall
1032 comply with the requirements of this section.
1033 (1) PROVIDER NETWORKS.—Managed care plans must develop and
1034 maintain provider networks that meet the medical needs of their
1035 enrollees in accordance with standards established pursuant to
1036 s. 409.967(2)(c). Except as provided in this section, managed
1037 care plans may limit the providers in their networks based on
1038 credentials, quality indicators, and price.
1039 (e) Each managed care plan may must offer a network
1040 contract to each home medical equipment and supplies provider in
1041 the region which meets quality and fraud prevention and
1042 detection standards established by the plan and which agrees to
1043 accept the lowest price previously negotiated between the plan
1044 and another such provider.
1045 Section 16. Subsections (1) and (2) of section 409.979,
1046 Florida Statutes, are amended to read:
1047 409.979 Eligibility.—
1048 (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid
1049 recipients who meet all of the following criteria are eligible
1050 to receive long-term care services and must receive long-term
1051 care services by participating in the long-term care managed
1052 care program. The recipient must be:
1053 (a) Sixty-five years of age or older, or age 18 or older
1054 and eligible for Medicaid by reason of a disability.
1055 (b) Determined by the Comprehensive Assessment Review and
1056 Evaluation for Long-Term Care Services (CARES) preadmission
1057 screening program to require:
1058 1. Nursing facility care as defined in s. 409.985(3); or
1059 2. Hospital level of care, for individuals diagnosed with
1060 cystic fibrosis.
1061 (2) ENROLLMENT OFFERS.—Subject to the availability of
1062 funds, the Department of Elderly Affairs shall make offers for
1063 enrollment to eligible individuals based on a wait-list
1064 prioritization. Before making enrollment offers, the agency and
1065 the Department of Elderly Affairs shall determine that
1066 sufficient funds exist to support additional enrollment into
1067 plans.
1068 (a) A Medicaid recipient enrolled in one of the following
1069 Medicaid home and community-based services waiver programs who
1070 meets the eligibility criteria established in subsection (1) is
1071 eligible to participate in the long-term care managed care
1072 program and must be transitioned into the long-term care managed
1073 care program by January 1, 2018:
1074 1. Traumatic Brain and Spinal Cord Injury Waiver.
1075 2. Adult Cystic Fibrosis Waiver.
1076 3. Project AIDS Care Waiver.
1077 (b) The agency shall seek federal approval to terminate the
1078 Traumatic Brain and Spinal Cord Injury Waiver, the Adult Cystic
1079 Fibrosis Waiver, and the Project AIDS Care Waiver once all
1080 eligible Medicaid recipients have transitioned into the long
1081 term care managed care program.
1082 Section 17. Effective October 1, 2018, subsection (6) of
1083 section 409.983, Florida Statutes, is amended to read:
1084 409.983 Long-term care managed care plan payment.—In
1085 addition to the payment provisions of s. 409.968, the agency
1086 shall provide payment to plans in the long-term care managed
1087 care program pursuant to this section.
1088 (6) The agency shall establish nursing-facility-specific
1089 payment rates for each licensed nursing home based on facility
1090 costs adjusted for inflation and other factors as authorized in
1091 the General Appropriations Act. Payments to long-term care
1092 managed care plans shall be reconciled, as necessary, to
1093 reimburse actual payments to nursing facilities resulting from
1094 changes in nursing home per diem rates, but may not be
1095 reconciled to actual days experienced by the long-term care
1096 managed care plans.
1097 Section 18. Subsection (27) of section 409.901, Florida
1098 Statutes, is amended to read:
1099 409.901 Definitions; ss. 409.901-409.920.—As used in ss.
1100 409.901-409.920, except as otherwise specifically provided, the
1101 term:
1102 (27) “Third party” means an individual, entity, or program,
1103 excluding Medicaid, that is, may be, could be, should be, or has
1104 been liable for all or part of the cost of medical services
1105 related to any medical assistance covered by Medicaid. A third
1106 party includes a third-party administrator; or a pharmacy
1107 benefits manager; a health insurer; a self-insured plan; a group
1108 health plan, as defined in s. 607(1) of the Employee Retirement
1109 Income Security Act of 1974; a service benefit plan; a managed
1110 care organization; liability insurance, including self
1111 insurance; no-fault insurance; workers’ compensation laws or
1112 plans; or other parties that are, by statute, contract, or
1113 agreement, legally responsible for payment of a claim for a
1114 health care item or service.
1115 Section 19. Subsection (4), paragraph (c) of subsection
1116 (6), paragraph (h) of subsection (11), subsection (16),
1117 paragraph (b) of subsection (17), and subsection (20) of section
1118 409.910, Florida Statutes, are amended to read:
1119 409.910 Responsibility for payments on behalf of Medicaid
1120 eligible persons when other parties are liable.—
1121 (4) After the agency has provided medical assistance under
1122 the Medicaid program, it shall seek recovery of reimbursement
1123 from third-party benefits to the limit of legal liability and
1124 for the full amount of third-party benefits, but not in excess
1125 of the amount of medical assistance paid by Medicaid, as to:
1126 (a) Claims for which the agency has a waiver pursuant to
1127 federal law; or
1128 (b) Situations in which the agency learns of the existence
1129 of a liable third party or in which third-party benefits are
1130 discovered or become available after medical assistance has been
1131 provided by Medicaid.
1132 (6) When the agency provides, pays for, or becomes liable
1133 for medical care under the Medicaid program, it has the
1134 following rights, as to which the agency may assert independent
1135 principles of law, which shall nevertheless be construed
1136 together to provide the greatest recovery from third-party
1137 benefits:
1138 (c) The agency is entitled to, and has, an automatic lien
1139 for the full amount of medical assistance provided by Medicaid
1140 to or on behalf of the recipient for medical care furnished as a
1141 result of any covered injury or illness for which a third party
1142 is or may be liable, upon the collateral, as defined in s.
1143 409.901.
1144 1. The lien attaches automatically when a recipient first
1145 receives treatment for which the agency may be obligated to
1146 provide medical assistance under the Medicaid program. The lien
1147 is perfected automatically at the time of attachment.
1148 2. The agency is authorized to file a verified claim of
1149 lien. The claim of lien shall be signed by an authorized
1150 employee of the agency, and shall be verified as to the
1151 employee’s knowledge and belief. The claim of lien may be filed
1152 and recorded with the clerk of the circuit court in the
1153 recipient’s last known county of residence or in any county
1154 deemed appropriate by the agency. The claim of lien, to the
1155 extent known by the agency, shall contain:
1156 a. The name and last known address of the person to whom
1157 medical care was furnished.
1158 b. The date of injury.
1159 c. The period for which medical assistance was provided.
1160 d. The amount of medical assistance provided or paid, or
1161 for which Medicaid is otherwise liable.
1162 e. The names and addresses of all persons claimed by the
1163 recipient to be liable for the covered injuries or illness.
1164 3. The filing of the claim of lien pursuant to this section
1165 shall be notice thereof to all persons.
1166 4. If the claim of lien is filed within 3 years 1 year
1167 after the later of the date when the last item of medical care
1168 relative to a specific covered injury or illness was paid, or
1169 the date of discovery by the agency of the liability of any
1170 third party, or the date of discovery of a cause of action
1171 against a third party brought by a recipient or his or her legal
1172 representative, record notice shall relate back to the time of
1173 attachment of the lien.
1174 5. If the claim of lien is filed after 3 years 1 year after
1175 the later of the events specified in subparagraph 4., notice
1176 shall be effective as of the date of filing.
1177 6. Only one claim of lien need be filed to provide notice
1178 as set forth in this paragraph and shall provide sufficient
1179 notice as to any additional or after-paid amount of medical
1180 assistance provided by Medicaid for any specific covered injury
1181 or illness. The agency may, in its discretion, file additional,
1182 amended, or substitute claims of lien at any time after the
1183 initial filing, until the agency has been repaid the full amount
1184 of medical assistance provided by Medicaid or otherwise has
1185 released the liable parties and recipient.
1186 7. No release or satisfaction of any cause of action, suit,
1187 claim, counterclaim, demand, judgment, settlement, or settlement
1188 agreement shall be valid or effectual as against a lien created
1189 under this paragraph, unless the agency joins in the release or
1190 satisfaction or executes a release of the lien. An acceptance of
1191 a release or satisfaction of any cause of action, suit, claim,
1192 counterclaim, demand, or judgment and any settlement of any of
1193 the foregoing in the absence of a release or satisfaction of a
1194 lien created under this paragraph shall prima facie constitute
1195 an impairment of the lien, and the agency is entitled to recover
1196 damages on account of such impairment. In an action on account
1197 of impairment of a lien, the agency may recover from the person
1198 accepting the release or satisfaction or making the settlement
1199 the full amount of medical assistance provided by Medicaid.
1200 Nothing in this section shall be construed as creating a lien or
1201 other obligation on the part of an insurer which in good faith
1202 has paid a claim pursuant to its contract without knowledge or
1203 actual notice that the agency has provided medical assistance
1204 for the recipient related to a particular covered injury or
1205 illness. However, notice or knowledge that an insured is, or has
1206 been a Medicaid recipient within 1 year from the date of service
1207 for which a claim is being paid creates a duty to inquire on the
1208 part of the insurer as to any injury or illness for which the
1209 insurer intends or is otherwise required to pay benefits.
1210 8. The lack of a properly filed claim of lien shall not
1211 affect the agency’s assignment or subrogation rights provided in
1212 this subsection, nor shall it affect the existence of the lien,
1213 but only the effective date of notice as provided in
1214 subparagraph 5.
1215 9. The lien created by this paragraph is a first lien and
1216 superior to the liens and charges of any provider, and shall
1217 exist for a period of 7 years, if recorded, after the date of
1218 recording; and shall exist for a period of 7 years after the
1219 date of attachment, if not recorded. If recorded, the lien may
1220 be extended for one additional period of 7 years by rerecording
1221 the claim of lien within the 90-day period preceding the
1222 expiration of the lien.
1223 10. The clerk of the circuit court for each county in the
1224 state shall endorse on a claim of lien filed under this
1225 paragraph the date and hour of filing and shall record the claim
1226 of lien in the official records of the county as for other
1227 records received for filing. The clerk shall receive as his or
1228 her fee for filing and recording any claim of lien or release of
1229 lien under this paragraph the total sum of $2. Any fee required
1230 to be paid by the agency shall not be required to be paid in
1231 advance of filing and recording, but may be billed to the agency
1232 after filing and recording of the claim of lien or release of
1233 lien.
1234 11. After satisfaction of any lien recorded under this
1235 paragraph, the agency shall, within 60 days after satisfaction,
1236 either file with the appropriate clerk of the circuit court or
1237 mail to any appropriate party, or counsel representing such
1238 party, if represented, a satisfaction of lien in a form
1239 acceptable for filing in Florida.
1240 (11) The agency may, as a matter of right, in order to
1241 enforce its rights under this section, institute, intervene in,
1242 or join any legal or administrative proceeding in its own name
1243 in one or more of the following capacities: individually, as
1244 subrogee of the recipient, as assignee of the recipient, or as
1245 lienholder of the collateral.
1246 (h) Except as otherwise provided in this section, actions
1247 to enforce the rights of the agency under this section shall be
1248 commenced within 6 5 years after the date a cause of action
1249 accrues, with the period running from the later of the date of
1250 discovery by the agency of a case filed by a recipient or his or
1251 her legal representative, or of discovery of any judgment,
1252 award, or settlement contemplated in this section, or of
1253 discovery of facts giving rise to a cause of action under this
1254 section. Nothing in this paragraph affects or prevents a
1255 proceeding to enforce a lien during the existence of the lien as
1256 set forth in subparagraph (6)(c)9.
1257 (16) Any transfer or encumbrance of any right, title, or
1258 interest to which the agency has a right pursuant to this
1259 section, with the intent, likelihood, or practical effect of
1260 defeating, hindering, or reducing reimbursement to recovery by
1261 the agency for reimbursement of medical assistance provided by
1262 Medicaid, shall be deemed to be a fraudulent conveyance, and
1263 such transfer or encumbrance shall be void and of no effect
1264 against the claim of the agency, unless the transfer was for
1265 adequate consideration and the proceeds of the transfer are
1266 reimbursed in full to the agency, but not in excess of the
1267 amount of medical assistance provided by Medicaid.
1268 (17)
1269 (b) If federal law limits the agency to reimbursement from
1270 the recovered medical expense damages, a recipient, or his or
1271 her legal representative, may contest the amount designated as
1272 recovered medical expense damages payable to the agency pursuant
1273 to the formula specified in paragraph (11)(f) by filing a
1274 petition under chapter 120 within 21 days after the date of
1275 payment of funds to the agency or after the date of placing the
1276 full amount of the third-party benefits in the trust account for
1277 the benefit of the agency pursuant to paragraph (a). The
1278 petition shall be filed with the Division of Administrative
1279 Hearings. For purposes of chapter 120, the payment of funds to
1280 the agency or the placement of the full amount of the third
1281 party benefits in the trust account for the benefit of the
1282 agency constitutes final agency action and notice thereof. Final
1283 order authority for the proceedings specified in this subsection
1284 rests with the Division of Administrative Hearings. This
1285 procedure is the exclusive method for challenging the amount of
1286 third-party benefits payable to the agency. In order to
1287 successfully challenge the amount designated as recovered
1288 medical expenses payable to the agency, the recipient must
1289 prove, by clear and convincing evidence, that the a lesser
1290 portion of the total recovery which should be allocated as
1291 reimbursement for past and future medical expenses is less than
1292 the amount calculated by the agency pursuant to the formula set
1293 forth in paragraph (11)(f). Alternatively, the recipient must
1294 prove by clear and convincing evidence or that Medicaid provided
1295 a lesser amount of medical assistance than that asserted by the
1296 agency.
1297 (20)(a) Entities providing health insurance as defined in
1298 s. 624.603, health maintenance organizations and prepaid health
1299 clinics as defined in chapter 641, and, on behalf of their
1300 clients, third-party administrators, and pharmacy benefits
1301 managers, and any other third parties, as defined in s.
1302 409.901(27), which are legally responsible for payment of a
1303 claim for a health care item or service as a condition of doing
1304 business in the state or providing coverage to residents of this
1305 state, shall provide such records and information as are
1306 necessary to accomplish the purpose of this section, unless such
1307 requirement results in an unreasonable burden.
1308 (b) An entity must respond to a request for payment with
1309 payment on the claim, a written request for additional
1310 information with which to process the claim, or a written reason
1311 for denial of the claim within 90 working days after receipt of
1312 written proof of loss or claim for payment for a health care
1313 item or service provided to a Medicaid recipient who is covered
1314 by the entity. Failure to pay or deny a claim within 140 days
1315 after receipt of the claim creates an uncontestable obligation
1316 to pay the claim.
1317 (a) The director of the agency and the Director of the
1318 Office of Insurance Regulation of the Financial Services
1319 Commission shall enter into a cooperative agreement for
1320 requesting and obtaining information necessary to effect the
1321 purpose and objective of this section.
1322 1. The agency shall request only that information necessary
1323 to determine whether health insurance as defined pursuant to s.
1324 624.603, or those health services provided pursuant to chapter
1325 641, could be, should be, or have been claimed and paid with
1326 respect to items of medical care and services furnished to any
1327 person eligible for services under this section.
1328 2. All information obtained pursuant to subparagraph 1. is
1329 confidential and exempt from s. 119.07(1). The agency shall
1330 provide the information obtained pursuant to subparagraph 1. to
1331 the Department of Revenue for purposes of administering the
1332 state Title IV-D program. The agency and the Department of
1333 Revenue shall enter into a cooperative agreement for purposes of
1334 implementing this requirement.
1335 3. The cooperative agreement or rules adopted under this
1336 subsection may include financial arrangements to reimburse the
1337 reporting entities for reasonable costs or a portion thereof
1338 incurred in furnishing the requested information. Neither the
1339 cooperative agreement nor the rules shall require the automation
1340 of manual processes to provide the requested information.
1341 (b) The agency and the Financial Services Commission
1342 jointly shall adopt rules for the development and administration
1343 of the cooperative agreement. The rules shall include the
1344 following:
1345 1. A method for identifying those entities subject to
1346 furnishing information under the cooperative agreement.
1347 2. A method for furnishing requested information.
1348 3. Procedures for requesting exemption from the cooperative
1349 agreement based on an unreasonable burden to the reporting
1350 entity.
1351 Section 20. Notwithstanding section 27 of chapter 2016-65,
1352 Laws of Florida, and subject to federal approval of the
1353 application to be a site for the Program of All-inclusive Care
1354 for the Elderly (PACE), the Agency for Health Care
1355 Administration shall contract with a not-for-profit
1356 organization, formed by a partnership with a not-for-profit
1357 hospital, a not-for-profit agency serving elders, and a not-for
1358 profit hospice in Leon County. The not-for-profit PACE shall
1359 serve eligible PACE enrollees in Gadsden, Jefferson, Leon, and
1360 Wakulla Counties. The Agency for Health Care Administration, in
1361 consultation with the Department of Elderly Affairs and subject
1362 to an appropriation, shall approve up to 300 initial enrollees
1363 for the additional PACE site.
1364 Section 21. Section 17 of chapter 2011-61, Laws of Florida,
1365 is amended to read:
1366 Section 17. Notwithstanding s. 430.707, Florida Statutes,
1367 and subject to federal approval of the application to be a site
1368 for the Program of All-inclusive Care for the Elderly, the
1369 Agency for Health Care Administration shall contract with one
1370 private health care organization, the sole member of which is a
1371 private, not-for-profit corporation that owns and manages health
1372 care organizations which provide comprehensive long-term care
1373 services, including nursing home, assisted living, independent
1374 housing, home care, adult day care, and care management, with a
1375 board-certified, trained geriatrician as the medical director.
1376 This organization shall provide these services to frail and
1377 elderly persons who reside in Indian River, Martin, Okeechobee,
1378 Palm Beach, and St. Lucie Counties County. The organization is
1379 exempt from the requirements of chapter 641, Florida Statutes.
1380 The agency, in consultation with the Department of Elderly
1381 Affairs and subject to an appropriation, shall approve up to 150
1382 initial enrollees who reside in Palm Beach County and up to 150
1383 initial enrollees who reside in Martin County in the Program of
1384 All-inclusive Care for the Elderly established by this
1385 organization to serve elderly persons who reside in Palm Beach
1386 County.
1387 Section 22. Section 29 of chapter 2016-65, Laws of Florida,
1388 is amended to read:
1389 Section 29. Subject to federal approval of the application
1390 to be a site for the Program of All-inclusive Care for the
1391 Elderly (PACE), the Agency for Health Care Administration shall
1392 contract with one private, not-for-profit hospice organization
1393 located in Lake County which operates health care organizations
1394 licensed in Hospice Areas 7B and 3E and which provides
1395 comprehensive services, including hospice and palliative care,
1396 to frail elders who reside in these service areas. The
1397 organization is exempt from the requirements of chapter 641,
1398 Florida Statutes. The agency, in consultation with the
1399 Department of Elderly Affairs and subject to the appropriation
1400 of funds by the Legislature, shall approve up to 150 initial
1401 enrollees in the Program of All-inclusive Care for the Elderly
1402 established by the organization to serve frail elders who reside
1403 in Hospice Service Areas 7B and 3E. The agency, in consultation
1404 with the department and subject to an appropriation, shall
1405 approve up to 150 enrollees in the Program of All-inclusive Care
1406 for the Elderly established by this organization to serve frail
1407 elders who reside in Hospice Service Area 7C.
1408 Section 23. Subsection (3) of section 391.055, Florida
1409 Statutes, is amended to read:
1410 391.055 Service delivery systems.—
1411 (3) The Children’s Medical Services network may contract
1412 with school districts participating in the certified school
1413 match program pursuant to ss. 409.908(21) 409.908(22) and
1414 1011.70 for the provision of school-based services, as provided
1415 for in s. 409.9071, for Medicaid-eligible children who are
1416 enrolled in the Children’s Medical Services network.
1417 Section 24. Subsection (7) of section 393.0661, Florida
1418 Statutes, is amended to read:
1419 393.0661 Home and community-based services delivery system;
1420 comprehensive redesign.—The Legislature finds that the home and
1421 community-based services delivery system for persons with
1422 developmental disabilities and the availability of appropriated
1423 funds are two of the critical elements in making services
1424 available. Therefore, it is the intent of the Legislature that
1425 the Agency for Persons with Disabilities shall develop and
1426 implement a comprehensive redesign of the system.
1427 (7) The agency shall collect premiums or cost sharing
1428 pursuant to s. 409.906(13)(c) 409.906(13)(d).
1429 Section 25. Paragraph (a) of subsection (4) of section
1430 409.968, Florida Statutes, is amended to read:
1431 409.968 Managed care plan payments.—
1432 (4)(a) Subject to a specific appropriation and federal
1433 approval under s. 409.906(13)(d) 409.906(13)(e), the agency
1434 shall establish a payment methodology to fund managed care plans
1435 for flexible services for persons with severe mental illness and
1436 substance use disorders, including, but not limited to,
1437 temporary housing assistance. A managed care plan eligible for
1438 these payments must do all of the following:
1439 1. Participate as a specialty plan for severe mental
1440 illness or substance use disorders or participate in counties
1441 designated by the General Appropriations Act;
1442 2. Include providers of behavioral health services pursuant
1443 to chapters 394 and 397 in the managed care plan’s provider
1444 network; and
1445 3. Document a capability to provide housing assistance
1446 through agreements with housing providers, relationships with
1447 local housing coalitions, and other appropriate arrangements.
1448 Section 26. Subsection (3) of section 427.0135, Florida
1449 Statutes, is amended to read:
1450 427.0135 Purchasing agencies; duties and responsibilities.
1451 Each purchasing agency, in carrying out the policies and
1452 procedures of the commission, shall:
1453 (3) Not procure transportation disadvantaged services
1454 without initially negotiating with the commission, as provided
1455 in s. 287.057(3)(e)12., or unless otherwise authorized by
1456 statute. If the purchasing agency, after consultation with the
1457 commission, determines that it cannot reach mutually acceptable
1458 contract terms with the commission, the purchasing agency may
1459 contract for the same transportation services provided in a more
1460 cost-effective manner and of comparable or higher quality and
1461 standards. The Medicaid agency shall implement this subsection
1462 in a manner consistent with s. 409.908(18) 409.908(19) and as
1463 otherwise limited or directed by the General Appropriations Act.
1464 Section 27. Subsections (1) and (5) of section 1011.70,
1465 Florida Statutes, are amended to read:
1466 1011.70 Medicaid certified school funding maximization.—
1467 (1) Each school district, subject to the provisions of ss.
1468 409.9071 and 409.908(21) 409.908(22) and this section, is
1469 authorized to certify funds provided for a category of required
1470 Medicaid services termed “school-based services,” which are
1471 reimbursable under the federal Medicaid program. Such services
1472 shall include, but not be limited to, physical, occupational,
1473 and speech therapy services, behavioral health services, mental
1474 health services, transportation services, Early Periodic
1475 Screening, Diagnosis, and Treatment (EPSDT) administrative
1476 outreach for the purpose of determining eligibility for
1477 exceptional student education, and any other such services, for
1478 the purpose of receiving federal Medicaid financial
1479 participation. Certified school funding shall not be available
1480 for the following services:
1481 (a) Family planning.
1482 (b) Immunizations.
1483 (c) Prenatal care.
1484 (5) Lab schools, as authorized under s. 1002.32, shall be
1485 authorized to participate in the Medicaid certified school match
1486 program on the same basis as school districts subject to the
1487 provisions of subsections (1)-(4) and ss. 409.9071 and
1488 409.908(21) 409.908(22).
1489 Section 28. For the 2017-2018 fiscal year, $578,918,460 in
1490 nonrecurring funds from the Grants and Donations Trust Fund and
1491 $924,467,313 in nonrecurring funds from the Medical Care Trust
1492 Fund are appropriated to the Agency for Health Care
1493 Administration for the purpose of implementing a Low-Income Pool
1494 Program. These funds shall be held in reserve. Subject to the
1495 federal approval of the final terms and conditions of the Low
1496 Income Pool, the Agency for Health Care Administration shall
1497 submit a budget amendment requesting release of the funds held
1498 in reserve pursuant to chapter 216, Florida Statutes. If the
1499 chair and vice chair of the Legislative Budget Commission or the
1500 President of the Senate and the Speaker of the House of
1501 Representatives object in writing to a proposed amendment within
1502 14 days after notification, the Governor shall void the action.
1503 In addition to the proposed amendment, the agency must submit:
1504 the Reimbursement and Funding Methodology Document, as specified
1505 in the terms and conditions, which documents permissible Low
1506 Income Pool expenditures; a proposed distribution model by
1507 entity; and a proposed listing of entities contributing
1508 Intergovernmental Transfers to support the state match required.
1509 Low-Income Pool payments to providers under this section are
1510 contingent upon the nonfederal share being provided through
1511 intergovernmental transfers in the Grants and Donations Trust
1512 Fund. In the event the funds are not available in the Grants and
1513 Donations Trust Fund, the State of Florida is not obligated to
1514 make payments under this section. This section expires July 1,
1515 2018.
1516 Section 29. For the 2017-2018 fiscal year, $94,414,800 in
1517 nonrecurring funds from the Grants and Donations Trust Fund and
1518 $151,585,200 in nonrecurring funds from the Medical Care Trust
1519 Funds are appropriated to the Agency for Health Care
1520 Administration to continue medical school faculty physician
1521 supplemental payments. These funds shall be held in reserve.
1522 These funds shall be used to continue supplemental payments for
1523 services provided by doctors of medicine and osteopathy, as well
1524 as other licensed health care practitioners acting under the
1525 supervision of those doctors, who are employed by or under
1526 contract with a medical school in Florida. These funds may also
1527 be used for pass-through, sub-capitation, differential fee, or
1528 directed lump sum payments for doctors of medicine and
1529 osteopathy, as well as other licensed health care practitioners
1530 acting under the supervision of those doctors, who are employed
1531 by or under contract with a medical school in Florida. Subject
1532 to federal approval to continue the supplemental and/or pass
1533 through, sub-capitation, differential fee, or directed lump sum
1534 payments, the Agency for Health Care Administration may submit a
1535 budget amendment requesting release of the funds held in reserve
1536 pursuant to the provisions of chapter 216, Florida Statutes. If
1537 the chair and vice chair of the Legislative Budget Commission or
1538 the President of the Senate and the Speaker of the House of
1539 Representatives object in writing to a proposed amendment within
1540 14 days following notification, the Governor shall void the
1541 action. The amendment shall include the federal approvals, a
1542 proposed distribution model by entity, and a proposed listing of
1543 entities contributing Intergovernmental Transfers to support the
1544 state match required. Payments to providers under this section
1545 are contingent upon the nonfederal share being provided through
1546 intergovernmental transfers in the Grants and Donations Trust
1547 Fund. In the event the funds are not available in the Grants and
1548 Donations Trust Fund, the State of Florida is not obligated to
1549 make payments under this section. This section expires July 1,
1550 2018.
1551 Section 30. Except as otherwise expressly provided in this
1552 act, this act shall take effect July 1, 2017.
1553
1554 ================= T I T L E A M E N D M E N T ================
1555 And the title is amended as follows:
1556 Delete everything before the enacting clause
1557 and insert:
1558 A bill to be entitled
1559 An act relating to health care; amending s. 210.20,
1560 F.S.; providing that a specified percentage of the
1561 cigarette tax, up to a specified amount, be paid
1562 annually to the Florida Consortium of National Cancer
1563 Institute Centers Program, rather than the Sanford
1564 Burnham Medical Research Institute; requiring that the
1565 funds be used to advance cures for cancers afflicting
1566 pediatric populations through basic or applied
1567 research; amending s. 381.922, F.S.; revising the
1568 goals of the William G. “Bill” Bankhead, Jr., and
1569 David Coley Cancer Research Program to include
1570 identifying ways to increase pediatric enrollment in
1571 cancer clinical trials; establishing the Live Like
1572 Bella Initiative to advance progress toward curing
1573 pediatric cancer, subject to an appropriation;
1574 amending s. 394.9082, F.S.; revising the reporting
1575 requirements of the acute care services utilization
1576 database; requiring the Department of Children and
1577 Families to post certain data on its website; amending
1578 s. 395.602, F.S.; revising the definition of the term
1579 “rural hospital” to include a hospital classified as a
1580 sole community hospital, regardless of the number of
1581 licensed beds; amending s. 400.179, F.S.; providing
1582 that certain fees deposited into the Medicaid nursing
1583 home overpayment account in the Grants and Donations
1584 Trust Fund may be used by the agency for enhanced
1585 payments to nursing facilities as specified in the
1586 General Appropriations Act or other law; amending s.
1587 409.904, F.S.; authorizing the agency to make payments
1588 for medical assistance and related services on behalf
1589 of a person diagnosed with acquired immune deficiency
1590 syndrome who meets certain criteria, subject to the
1591 availability of moneys and specified limitations;
1592 amending s. 409.906, F.S.; deleting a provision
1593 relating to consolidation of waiver services to
1594 conform to changes made by the act; amending s.
1595 409.908, F.S.; revising requirements related to the
1596 long-term care reimbursement plan and cost reporting
1597 system; requiring the calculation of separate prices
1598 for each patient care subcomponent based on specified
1599 cost reports; providing that certain ceilings and
1600 targets apply only to providers being reimbursed on a
1601 cost-based system; requiring implementation of a
1602 prospective payment methodology for rate setting
1603 purposes; providing parameters; expanding the direct
1604 care subcomponent to include allowable therapy and
1605 dietary costs; specifying that allowable ancillary
1606 costs are included in the indirect care cost
1607 subcomponent; requiring that nursing home prospective
1608 payment rates be rebased at a specified interval;
1609 authorizing the payment of a direct care supplemental
1610 payment to certain providers; specifying the amount
1611 providers will be reimbursed for a specified period of
1612 time, which may be a cost-based rate or a prospective
1613 payment rate; providing for expiration of this
1614 reimbursement mechanism on a specified date; requiring
1615 the agency to reimburse providers on a cost-based rate
1616 or a rebased prospective payment rate, beginning on a
1617 specified date; requiring that Medicaid pay
1618 deductibles and coinsurance for certain X-ray services
1619 provided in an assisted living facility or in the
1620 patient’s home; deleting a provision relating to
1621 reimbursement rate parameters for certain Medicaid
1622 providers; authorizing the agency to receive funds
1623 from certain governmental entities for specified
1624 purposes; providing requirements for letters of
1625 agreement executed by a local governmental entity;
1626 amending s. 409.9082, F.S.; revising the uses of
1627 quality assessment and federal matching funds to
1628 include the partial funding of the quality incentive
1629 payment program for nursing facilities that exceed
1630 quality benchmarks; amending s. 409.909, F.S.;
1631 providing that the agency shall make payments and
1632 distribute funds to qualifying institutions in
1633 addition to hospitals under the Statewide Medicaid
1634 Residency Program; amending s. 409.911, F.S.; updating
1635 obsolete language; amending s. 409.9119, F.S.;
1636 revising criteria for the participation of hospitals
1637 in the disproportionate share program for specialty
1638 hospitals for children; amending s. 409.913, F.S.;
1639 removing a requirement that the agency provide each
1640 Medicaid recipient with an explanation of benefits;
1641 authorizing the agency to provide an explanation of
1642 benefits to a sample of Medicaid recipients or their
1643 representatives; amending s. 409.975, F.S.;
1644 authorizing, rather than requiring, a managed care
1645 plan to offer a network contract to certain medical
1646 equipment and supplies providers in the region;
1647 amending s. 409.979, F.S.; expanding eligibility for
1648 long-term care services to include hospital level of
1649 care for certain individuals diagnosed with cystic
1650 fibrosis; revising eligibility for certain Medicaid
1651 recipients in the long-term care managed care program;
1652 amending s. 409.983, F.S.; eliminating the requirement
1653 that the agency consider facility costs adjusted for
1654 inflation and other factors in the establishment of
1655 certain payment rates for nursing facilities; amending
1656 s. 409.901, F.S.; revising the definition of the term
1657 “third party”; amending s. 409.910, F.S.; revising
1658 provisions relating to responsibility for Medicaid
1659 payments in settlement proceedings; extending period
1660 of time for filing a claim of lien filed for purposes
1661 of third-party liability; extending the period of time
1662 within which the agency is authorized to pursue
1663 certain causes of action; revising procedures for a
1664 recipient to contest the amount payable to the agency
1665 when federal law limits reimbursement under certain
1666 circumstances; requiring certain entities responsible
1667 for payment of claims to provide certain records and
1668 information and respond to requests for payment of
1669 claims within a specified timeframe as a condition of
1670 doing business in the state; providing circumstances
1671 under which such parties are obligated to pay claims;
1672 deleting provisions relating to cooperative agreements
1673 between the agency, the Office of Insurance
1674 Regulation, and the Department of Revenue; requiring
1675 the agency to contract with a specified not-for-profit
1676 organization, a not-for-profit agency serving elders,
1677 and a not-for-profit hospice in Leon County to be a
1678 site for the Program for All-inclusive Care for the
1679 Elderly (PACE), subject to federal approval of the
1680 application site; authorizing PACE to serve eligible
1681 enrollees in Gadsden, Jefferson, Leon, and Wakulla
1682 Counties; requiring the agency, in consultation with
1683 the department, to approve a certain number of initial
1684 enrollees in PACE at the new site, subject to an
1685 appropriation; amending s. 17 of chapter 2011-61, Laws
1686 of Florida; requiring the agency, in consultation with
1687 the department, to approve a certain number of initial
1688 enrollees in PACE to serve frail elders who reside in
1689 certain counties; amending s. 29 of chapter 2016-65,
1690 Laws of Florida; requiring the agency, in consultation
1691 with the department, to approve a certain number of
1692 enrollees in the PACE established to serve frail
1693 elders who reside in Hospice Service Area 7C;
1694 requiring the agency, in consultation with the
1695 department, to approve a certain number of initial
1696 enrollees in PACE at the new site, subject to certain
1697 conditions; amending ss. 391.055, 393.0661, 409.968,
1698 427.0135, and 1011.70, F.S.; conforming cross
1699 references; providing appropriations; providing
1700 effective dates.