Florida Senate - 2018                   (PROPOSED BILL) SPB 2506
       
       
        
       FOR CONSIDERATION By the Committee on Appropriations
       
       
       
       
       
       576-01868E-18                                         20182506pb
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 409.908,
    3         F.S.; revising parameters relating to the prospective
    4         payment methodology for the reimbursement of Medicaid
    5         providers to be implemented for rate setting purposes;
    6         requiring the Agency for Health Care Administration to
    7         establish prospective payment reimbursement rates for
    8         nursing home services as provided in this act and in
    9         the General Appropriations Act; conforming provisions
   10         to changes made by the act; amending s. 409.9082,
   11         F.S.; authorizing the agency to seek certain remedies
   12         from any nursing home facility provider that fails to
   13         report its total number of resident days monthly,
   14         including the imposition of a specified fine; amending
   15         s. 409.9083, F.S.; authorizing the agency to seek
   16         certain remedies from any intermediate care facility
   17         for the developmentally disabled provider that fails
   18         to report its total number of resident days monthly,
   19         including the imposition of a specified fine;
   20         requiring the agency to seek authorization from the
   21         federal Centers for Medicare and Medicaid Services to
   22         modify the period of retroactive Medicaid eligibility
   23         in a manner that ensures that the modification becomes
   24         effective by a certain date; requiring the agency to
   25         contract with a nonprofit organization in Miami-Dade
   26         County, which must meet certain requirements, to be a
   27         site for the Program for All-inclusive Care for the
   28         Elderly (PACE), subject to federal approval of the
   29         application site; requiring the nonprofit organization
   30         to provide PACE services to frail elders in Miami-Dade
   31         County; requiring the agency, in consultation with the
   32         Department of Elderly Affairs, to approve up to a
   33         certain number of initial enrollees in PACE at the new
   34         site, subject to an appropriation; providing effective
   35         dates.
   36          
   37  Be It Enacted by the Legislature of the State of Florida:
   38  
   39         Section 1. Effective October 1, 2018, subsection (2) of
   40  section 409.908, Florida Statutes, as amended by section 8 of
   41  chapter 2017-129, Laws of Florida, is amended to read:
   42         Section 8. Effective October 1, 2018, subsection (2) of
   43  section 409.908, Florida Statutes, is amended to read:
   44         409.908 Reimbursement of Medicaid providers.—Subject to
   45  specific appropriations, the agency shall reimburse Medicaid
   46  providers, in accordance with state and federal law, according
   47  to methodologies set forth in the rules of the agency and in
   48  policy manuals and handbooks incorporated by reference therein.
   49  These methodologies may include fee schedules, reimbursement
   50  methods based on cost reporting, negotiated fees, competitive
   51  bidding pursuant to s. 287.057, and other mechanisms the agency
   52  considers efficient and effective for purchasing services or
   53  goods on behalf of recipients. If a provider is reimbursed based
   54  on cost reporting and submits a cost report late and that cost
   55  report would have been used to set a lower reimbursement rate
   56  for a rate semester, then the provider’s rate for that semester
   57  shall be retroactively calculated using the new cost report, and
   58  full payment at the recalculated rate shall be effected
   59  retroactively. Medicare-granted extensions for filing cost
   60  reports, if applicable, shall also apply to Medicaid cost
   61  reports. Payment for Medicaid compensable services made on
   62  behalf of Medicaid eligible persons is subject to the
   63  availability of moneys and any limitations or directions
   64  provided for in the General Appropriations Act or chapter 216.
   65  Further, nothing in this section shall be construed to prevent
   66  or limit the agency from adjusting fees, reimbursement rates,
   67  lengths of stay, number of visits, or number of services, or
   68  making any other adjustments necessary to comply with the
   69  availability of moneys and any limitations or directions
   70  provided for in the General Appropriations Act, provided the
   71  adjustment is consistent with legislative intent.
   72         (2)(a)1. Reimbursement to nursing homes licensed under part
   73  II of chapter 400 and state-owned-and-operated intermediate care
   74  facilities for the developmentally disabled licensed under part
   75  VIII of chapter 400 must be made prospectively.
   76         2. Unless otherwise limited or directed in the General
   77  Appropriations Act, reimbursement to hospitals licensed under
   78  part I of chapter 395 for the provision of swing-bed nursing
   79  home services must be made on the basis of the average statewide
   80  nursing home payment, and reimbursement to a hospital licensed
   81  under part I of chapter 395 for the provision of skilled nursing
   82  services must be made on the basis of the average nursing home
   83  payment for those services in the county in which the hospital
   84  is located. When a hospital is located in a county that does not
   85  have any community nursing homes, reimbursement shall be
   86  determined by averaging the nursing home payments in counties
   87  that surround the county in which the hospital is located.
   88  Reimbursement to hospitals, including Medicaid payment of
   89  Medicare copayments, for skilled nursing services shall be
   90  limited to 30 days, unless a prior authorization has been
   91  obtained from the agency. Medicaid reimbursement may be extended
   92  by the agency beyond 30 days, and approval must be based upon
   93  verification by the patient’s physician that the patient
   94  requires short-term rehabilitative and recuperative services
   95  only, in which case an extension of no more than 15 days may be
   96  approved. Reimbursement to a hospital licensed under part I of
   97  chapter 395 for the temporary provision of skilled nursing
   98  services to nursing home residents who have been displaced as
   99  the result of a natural disaster or other emergency may not
  100  exceed the average county nursing home payment for those
  101  services in the county in which the hospital is located and is
  102  limited to the period of time which the agency considers
  103  necessary for continued placement of the nursing home residents
  104  in the hospital.
  105         (b) Subject to any limitations or directions in the General
  106  Appropriations Act, the agency shall establish and implement a
  107  state Title XIX Long-Term Care Reimbursement Plan for nursing
  108  home care in order to provide care and services in conformance
  109  with the applicable state and federal laws, rules, regulations,
  110  and quality and safety standards and to ensure that individuals
  111  eligible for medical assistance have reasonable geographic
  112  access to such care.
  113         1. The agency shall amend the long-term care reimbursement
  114  plan and cost reporting system to create direct care and
  115  indirect care subcomponents of the patient care component of the
  116  per diem rate. These two subcomponents together shall equal the
  117  patient care component of the per diem rate. Separate prices
  118  shall be calculated for each patient care subcomponent,
  119  initially based on the September 2016 rate setting cost reports
  120  and subsequently based on the most recently audited cost report
  121  used during a rebasing year. The direct care subcomponent of the
  122  per diem rate for any providers still being reimbursed on a cost
  123  basis shall be limited by the cost-based class ceiling, and the
  124  indirect care subcomponent may be limited by the lower of the
  125  cost-based class ceiling, the target rate class ceiling, or the
  126  individual provider target. The ceilings and targets apply only
  127  to providers being reimbursed on a cost-based system. Effective
  128  October 1, 2018, a prospective payment methodology shall be
  129  implemented for rate setting purposes with the following
  130  parameters:
  131         a. Peer Groups, including:
  132         (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
  133  Counties; and
  134         (II) South-SMMC Regions 10-11, plus Palm Beach and
  135  Okeechobee Counties.
  136         b. Percentage of Median Costs based on the cost reports
  137  used for September 2016 rate setting:
  138         (I) Direct Care Costs....................105 100 percent.
  139         (II) Indirect Care Costs......................92 percent.
  140         (III) Operating Costs.........................86 percent.
  141         c. Floors:
  142         (I) Direct Care Component.....................95 percent.
  143         (II) Indirect Care Component................92.5 percent.
  144         (III) Operating Component...........................None.
  145         d. Pass-through PaymentsReal Estate and Personal Property
  146  Taxes and Property Insurance.
  147         e. Quality Incentive Program Payment Pool7.5 6 percent of
  148  September 2016 non-property related payments of included
  149  facilities.
  150         f. Quality Score Threshold to Quality for Quality Incentive
  151  Payment..................20th percentile of included facilities.
  152         g. Fair Rental Value System Payment Parameters:
  153         (I) Building Value per Square Foot based on 2018 RS Means.
  154         (II) Land Valuation...10 percent of Gross Building value.
  155         (III) Facility Square Footage......Actual Square Footage.
  156         (IV) Moveable Equipment Allowance.........$8,000 per bed.
  157         (V) Obsolescence Factor......................1.5 percent.
  158         (VI) Fair Rental Rate of Return................8 percent.
  159         (VII) Minimum Occupancy.......................90 percent.
  160         (VIII) Maximum Facility Age.....................40 years.
  161         (IX) Minimum Square Footage per Bed..................350.
  162         (X) Maximum Square Footage for Bed...................500.
  163         (XI) Minimum Cost of a renovation/replacements$500 per bed.
  164         h. Ventilator Supplemental payment of $200 per Medicaid day
  165  of 40,000 ventilator Medicaid days per fiscal year.
  166         2. The direct care subcomponent shall include salaries and
  167  benefits of direct care staff providing nursing services
  168  including registered nurses, licensed practical nurses, and
  169  certified nursing assistants who deliver care directly to
  170  residents in the nursing home facility, allowable therapy costs,
  171  and dietary costs. This excludes nursing administration, staff
  172  development, the staffing coordinator, and the administrative
  173  portion of the minimum data set and care plan coordinators. The
  174  direct care subcomponent also includes medically necessary
  175  dental care, vision care, hearing care, and podiatric care.
  176         3. All other patient care costs shall be included in the
  177  indirect care cost subcomponent of the patient care per diem
  178  rate, including complex medical equipment, medical supplies, and
  179  other allowable ancillary costs. Costs may not be allocated
  180  directly or indirectly to the direct care subcomponent from a
  181  home office or management company.
  182         4. On July 1 of each year, the agency shall report to the
  183  Legislature direct and indirect care costs, including average
  184  direct and indirect care costs per resident per facility and
  185  direct care and indirect care salaries and benefits per category
  186  of staff member per facility.
  187         5. Every fourth year, the agency shall rebase nursing home
  188  prospective payment rates to reflect changes in cost based on
  189  the most recently audited cost report for each participating
  190  provider.
  191         6. A direct care supplemental payment may be made to
  192  providers whose direct care hours per patient day are above the
  193  80th percentile and who provide Medicaid services to a larger
  194  percentage of Medicaid patients than the state average.
  195         7. For the period beginning on October 1, 2018, and ending
  196  on September 30, 2021, the agency shall reimburse providers the
  197  greater of their September 2016 cost-based rate or their
  198  prospective payment rate. Effective October 1, 2021, the agency
  199  shall reimburse providers the greater of 95 percent of their
  200  cost-based rate or their rebased prospective payment rate, using
  201  the most recently audited cost report for each facility. This
  202  subparagraph shall expire September 30, 2023.
  203         8. Pediatric, Florida Department of Veterans Affairs, and
  204  government-owned facilities are exempt from the pricing model
  205  established in this subsection and shall remain on a cost-based
  206  prospective payment system. Effective October 1, 2018, the
  207  agency shall set rates for all facilities remaining on a cost
  208  based prospective payment system using each facility’s most
  209  recently audited cost report, eliminating retroactive
  210  settlements.
  211  
  212  It is the intent of the Legislature that the reimbursement plan
  213  achieve the goal of providing access to health care for nursing
  214  home residents who require large amounts of care while
  215  encouraging diversion services as an alternative to nursing home
  216  care for residents who can be served within the community. The
  217  agency shall base the establishment of any maximum rate of
  218  payment, whether overall or component, on the available moneys
  219  as provided for in the General Appropriations Act. The agency
  220  may base the maximum rate of payment on the results of
  221  scientifically valid analysis and conclusions derived from
  222  objective statistical data pertinent to the particular maximum
  223  rate of payment.
  224         Section 2. Effective October 1, 2018, subsection (23) of
  225  section 409.908, Florida Statutes, is amended to read:
  226         409.908 Reimbursement of Medicaid providers.—Subject to
  227  specific appropriations, the agency shall reimburse Medicaid
  228  providers, in accordance with state and federal law, according
  229  to methodologies set forth in the rules of the agency and in
  230  policy manuals and handbooks incorporated by reference therein.
  231  These methodologies may include fee schedules, reimbursement
  232  methods based on cost reporting, negotiated fees, competitive
  233  bidding pursuant to s. 287.057, and other mechanisms the agency
  234  considers efficient and effective for purchasing services or
  235  goods on behalf of recipients. If a provider is reimbursed based
  236  on cost reporting and submits a cost report late and that cost
  237  report would have been used to set a lower reimbursement rate
  238  for a rate semester, then the provider’s rate for that semester
  239  shall be retroactively calculated using the new cost report, and
  240  full payment at the recalculated rate shall be effected
  241  retroactively. Medicare-granted extensions for filing cost
  242  reports, if applicable, shall also apply to Medicaid cost
  243  reports. Payment for Medicaid compensable services made on
  244  behalf of Medicaid eligible persons is subject to the
  245  availability of moneys and any limitations or directions
  246  provided for in the General Appropriations Act or chapter 216.
  247  Further, nothing in this section shall be construed to prevent
  248  or limit the agency from adjusting fees, reimbursement rates,
  249  lengths of stay, number of visits, or number of services, or
  250  making any other adjustments necessary to comply with the
  251  availability of moneys and any limitations or directions
  252  provided for in the General Appropriations Act, provided the
  253  adjustment is consistent with legislative intent.
  254         (23)(a) The agency shall establish rates at a level that
  255  ensures no increase in statewide expenditures resulting from a
  256  change in unit costs for county health departments effective
  257  July 1, 2011. Reimbursement rates shall be as provided in the
  258  General Appropriations Act.
  259         (b)1. Base rate reimbursement for inpatient services under
  260  a diagnosis-related group payment methodology shall be provided
  261  in the General Appropriations Act.
  262         2.(c) Base rate reimbursement for outpatient services under
  263  an enhanced ambulatory payment group methodology shall be
  264  provided in the General Appropriations Act.
  265         3. Prospective payment system reimbursement for nursing
  266  home services shall be as provided in subsection (2) and in the
  267  General Appropriations Act
  268         (d) This subsection applies to the following provider
  269  types:
  270         1. Nursing homes.
  271         2. County health departments.
  272         (e)The agency shall apply the effect of this subsection to
  273  the reimbursement rates for nursing home diversion programs.
  274         Section 3. Subsection (7) of section 409.9082, Florida
  275  Statutes, is amended to read:
  276         409.9082 Quality assessment on nursing home facility
  277  providers; exemptions; purpose; federal approval required;
  278  remedies.—
  279         (7) The agency may seek any of the following remedies for
  280  failure of any nursing home facility provider to report its
  281  total number of resident days monthly or to pay its assessment
  282  timely:
  283         (a) Withholding any medical assistance reimbursement
  284  payments until such time as the assessment amount is recovered;
  285         (b) Suspension or revocation of the nursing home facility
  286  license; and
  287         (c) Imposition of a fine of up to $1,000 per day for each
  288  offense delinquent payment, not to exceed the amount of the
  289  assessment.
  290         Section 4. Subsection (6) of section 409.9083, Florida
  291  Statutes, is amended to read:
  292         409.9083 Quality assessment on privately operated
  293  intermediate care facilities for the developmentally disabled;
  294  exemptions; purpose; federal approval required; remedies.—
  295         (6) The agency may seek any of the following remedies for
  296  failure of any ICF/DD provider to report its total number of
  297  resident days monthly or to timely pay its assessment:
  298         (a) Withholding any medical assistance reimbursement
  299  payments until the assessment amount is recovered.
  300         (b) Suspending or revoking the facility’s license.
  301         (c) Imposing a fine of up to $1,000 per day for each
  302  offense delinquent payment, not to exceed the amount of the
  303  assessment.
  304         Section 5. The Agency for Health Care Administration shall
  305  seek authorization from the federal Centers for Medicare and
  306  Medicaid Services to modify the period of retroactive Medicaid
  307  eligibility from 90 days to 30 days in a manner that ensures
  308  that the modification becomes effective on July 1, 2018.
  309         Section 6. Effective July 1, 2018, and subject to federal
  310  approval of the application to be a site for the Program of All
  311  inclusive Care for the Elderly (PACE), the Agency for Health
  312  Care Administration shall contract with an additional nonprofit
  313  organization to serve individuals and families in Miami-Dade
  314  County. The nonprofit organization must have a history of
  315  serving primarily the Hispanic population by providing primary
  316  care services, nutrition, meals, and adult day care to the
  317  senior population. The nonprofit organization shall leverage
  318  existing community-based care providers and health care
  319  organizations to provide PACE services to frail elders who
  320  reside in Miami-Dade County. The organization is exempt from the
  321  requirements of chapter 641, Florida Statutes. The agency, in
  322  consultation with the Department of Elderly Affairs and subject
  323  to an appropriation, shall approve up to 250 initial enrollees
  324  in the PACE site established by this organization to serve frail
  325  elders who reside in Miami-Dade County.
  326         Section 7. Except as expressly provided in this act, this
  327  act shall take effect upon becoming a law.