Senate Bill 2242e1
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1 A bill to be entitled
2 An act relating to health care; amending s.
3 409.212, F.S.; providing for periodic increase
4 in the optional state supplementation rate;
5 amending s. 409.901, F.S.; amending definitions
6 of terms used in ss. 409.910-409.920, F.S.;
7 amending s. 409.902, F.S.; providing that the
8 Department of Children and Family Services is
9 responsible for Medicaid eligibility
10 determinations; amending s. 409.903, F.S.;
11 providing responsibility for determinations of
12 eligibility for payments for medical assistance
13 and related services; amending s. 409.905,
14 F.S.; increasing the maximum amount that may be
15 paid under Medicaid for hospital outpatient
16 services; amending s. 409.906, F.S.; allowing
17 the Department of Children and Family Services
18 to transfer funds to the Agency for Health Care
19 Administration to cover state match
20 requirements as specified; amending s. 409.907,
21 F.S.; revising requirements relating to the
22 minimum amount of the surety bond which each
23 provider is required to maintain; specifying
24 grounds on which provider applications may be
25 denied; amending s. 409.908, F.S.; increasing
26 the maximum amount of reimbursement allowable
27 to Medicaid providers for hospital inpatient
28 care; providing legislative findings, intent,
29 and clarification; relating to reimbursement
30 for services to dually eligible Medicare
31 beneficiaries; providing applicability;
1
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1 creating s. 409.9119, F.S.; creating a
2 disproportionate share program for licensed
3 specialty children's hospitals; providing
4 formulas governing payments made to hospitals
5 under the program; providing for withholding
6 payments from a hospital that is not complying
7 with agency rules; amending s. 409.912, F.S.;
8 providing for the transfer of certain
9 unexpended Medicaid funds from the Department
10 of Elderly Affairs to the Agency for Health
11 Care Administration; providing for renewal of
12 contracts for fiscal intermediary services;
13 amending s. 409.919, F.S.; providing for the
14 adoption and the transfer of certain rules
15 relating to the determination of Medicaid
16 eligibility; authorizing developmental research
17 schools to participate in Medicaid certified
18 school match program; providing for the Agency
19 for Health Care Administration to seek a
20 federal waiver allowing the agency to undertake
21 a pilot project that involves contracting with
22 skilled nursing facilities for the provision of
23 rehabilitation services to adult ventilator
24 dependent patients; providing for evaluation of
25 the pilot program; amending s. 430.703, F.S.;
26 defining "other qualified provider"; amending
27 s. 430.707, F.S.; authorizing the Department of
28 Elderly Affairs to contract with other
29 qualified providers to provide long-term care
30 within the pilot project areas; exempting other
31 qualified providers from specified licensing
2
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1 requirements; repealing s. 409.912(4)(b), F.S.,
2 relating to the authorization of the agency to
3 contract with certain prepaid health care
4 services providers; designating Florida
5 Alzheimer's Disease Day; amending s. 394.4615,
6 F.S.; requiring that clinical records be
7 furnished to the unit upon request; amending s.
8 395.3025, F.S.; allowing patient records to be
9 furnished to the unit; amending s. 400.0077,
10 F.S.; providing that certain confidentiality
11 provisions do not limit the subpoena power of
12 the Attorney General; amending s. 400.494,
13 F.S.; providing that certain confidentiality
14 provisions relating to home health agencies do
15 not apply to information requested by the unit;
16 amending s. 409.9071, F.S.; waiving
17 confidentiality and requiring that certain
18 information regarding Medicaid provider
19 agreements with school districts be provided to
20 the unit; amending s. 409.920, F.S.; clarifying
21 the Attorney General's power to subpoena
22 medical records relating to Medicaid
23 recipients; amending s. 409.9205, F.S.;
24 authorizing investigators employed by the unit
25 to serve process; amending s. 430.608, F.S.;
26 providing that certain confidentiality
27 provisions pertaining to the Department of
28 Elderly Affairs do not limit the subpoena
29 authority of the unit; amending s. 455.667,
30 F.S.; providing that certain confidential
31 records held by the Department of Business and
3
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1 Professional Regulation must be provided to the
2 unit; providing an effective date.
3
4 Be It Enacted by the Legislature of the State of Florida:
5
6 Section 1. Present subsection (6) of section 409.212,
7 Florida Statutes, is redesignated as subsection (7), and a new
8 subsection (6) is added to that subsection, to read:
9 409.212 Optional supplementation.--
10 (6) The optional state supplementation rate shall be
11 increased by the cost-of-living adjustment to the federal
12 benefits rate provided that the average state optional
13 supplementation contribution does not increase as a result.
14 Section 2. Subsections (3), (15), and (18) of section
15 409.901, Florida Statutes, are amended to read:
16 409.901 Definitions.--As used in ss. 409.901-409.920,
17 except as otherwise specifically provided, the term:
18 (3) "Applicant" means an individual whose written
19 application for medical assistance provided by Medicaid under
20 ss. 409.903-409.906 has been submitted to the Department of
21 Children and Family Services, or to the Social Security
22 Administration if applying for Supplemental Security Income
23 agency, but has not received final action. This term includes
24 an individual, who need not be alive at the time of
25 application, whose application is submitted through a
26 representative or a person acting for the individual.
27 (15) "Medicaid program" means the program authorized
28 under Title XIX of the federal Social Security Act which
29 provides for payments for medical items or services, or both,
30 on behalf of any person who is determined by the Department of
31 Children and Family Services, or, for Supplemental Security
4
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1 Income, by the Social Security Administration, to be eligible
2 on the date of service for Medicaid assistance.
3 (18) "Medicaid recipient" or "recipient" means an
4 individual whom the Department of Children and Family
5 Services, or, for Supplemental Security Income, the Social
6 Security Administration, determines is eligible, pursuant to
7 federal and state law, to receive medical assistance and
8 related services for which the agency may make payments under
9 the Medicaid program. For the purposes of determining
10 third-party liability, the term includes an individual
11 formerly determined to be eligible for Medicaid, an individual
12 who has received medical assistance under the Medicaid
13 program, or an individual on whose behalf Medicaid has become
14 obligated.
15 Section 3. Section 409.902, Florida Statutes, is
16 amended to read:
17 409.902 Designated single state agency; payment
18 requirements; program title.--The Agency for Health Care
19 Administration is designated as the single state agency
20 authorized to make payments for medical assistance and related
21 services under Title XIX of the Social Security Act. These
22 payments shall be made, subject to any limitations or
23 directions provided for in the General Appropriations Act,
24 only for services included in the program, shall be made only
25 on behalf of eligible individuals, and shall be made only to
26 qualified providers in accordance with federal requirements
27 for Title XIX of the Social Security Act and the provisions of
28 state law. This program of medical assistance is designated
29 the "Medicaid program." The Department of Children and Family
30 Services is responsible for Medicaid eligibility
31 determinations, including policy, rules, and the agreement
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1 with the Social Security Administration for Medicaid
2 eligibility determinations for Supplemental Security Income
3 recipients, as well as the actual determination of
4 eligibility.
5 Section 4. Section 409.903, Florida Statutes, is
6 amended to read:
7 409.903 Mandatory payments for eligible persons.--The
8 agency shall make payments for medical assistance and related
9 services on behalf of the following persons whom the
10 Department of Children and Family Services, or the Social
11 Security Administration by contract with the Department of
12 Children and Family Services, who the agency determines to be
13 eligible, subject to the income, assets, and categorical
14 eligibility tests set forth in federal and state law. Payment
15 on behalf of these Medicaid eligible persons is subject to the
16 availability of moneys and any limitations established by the
17 General Appropriations Act or chapter 216.
18 (1) Low-income families with children are eligible for
19 Medicaid provided they meet the following requirements:
20 (a) The family includes a dependent child who is
21 living with a caretaker relative.
22 (b) The family's income does not exceed the gross
23 income test limit.
24 (c) The family's countable income and resources do not
25 exceed the applicable Aid to Families with Dependent Children
26 (AFDC) income and resource standards under the AFDC state plan
27 in effect in July 1996, except as amended in the Medicaid
28 state plan to conform as closely as possible to the
29 requirements of the WAGES Program as created in s. 414.015, to
30 the extent permitted by federal law.
31
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1 (2) A person who receives payments from, who is
2 determined eligible for, or who was eligible for but lost cash
3 benefits from the federal program known as the Supplemental
4 Security Income program (SSI). This category includes a
5 low-income person age 65 or over and a low-income person under
6 age 65 considered to be permanently and totally disabled.
7 (3) A child under age 21 living in a low-income,
8 two-parent family, and a child under age 7 living with a
9 nonrelative, if the income and assets of the family or child,
10 as applicable, do not exceed the resource limits under the
11 WAGES Program.
12 (4) A child who is eligible under Title IV-E of the
13 Social Security Act for subsidized board payments, foster
14 care, or adoption subsidies, and a child for whom the state
15 has assumed temporary or permanent responsibility and who does
16 not qualify for Title IV-E assistance but is in foster care,
17 shelter or emergency shelter care, or subsidized adoption.
18 (5) A pregnant woman for the duration of her pregnancy
19 and for the post partum period as defined in federal law and
20 rule, or a child under age 1, if either is living in a family
21 that has an income which is at or below 150 percent of the
22 most current federal poverty level, or, effective January 1,
23 1992, that has an income which is at or below 185 percent of
24 the most current federal poverty level. Such a person is not
25 subject to an assets test. Further, a pregnant woman who
26 applies for eligibility for the Medicaid program through a
27 qualified Medicaid provider must be offered the opportunity,
28 subject to federal rules, to be made presumptively eligible
29 for the Medicaid program.
30 (6) A child born after September 30, 1983, living in a
31 family that has an income which is at or below 100 percent of
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1 the current federal poverty level, who has attained the age of
2 6, but has not attained the age of 19. In determining the
3 eligibility of such a child, an assets test is not required.
4 (7) A child living in a family that has an income
5 which is at or below 133 percent of the current federal
6 poverty level, who has attained the age of 1, but has not
7 attained the age of 6. In determining the eligibility of such
8 a child, an assets test is not required.
9 (8) A person who is age 65 or over or is determined by
10 the agency to be disabled, whose income is at or below 100
11 percent of the most current federal poverty level and whose
12 assets do not exceed limitations established by the agency.
13 However, the agency may only pay for premiums, coinsurance,
14 and deductibles, as required by federal law, unless additional
15 coverage is provided for any or all members of this group by
16 s. 409.904(1).
17 Section 5. Subsection (6) of section 409.905, Florida
18 Statutes, is amended to read:
19 409.905 Mandatory Medicaid services.--The agency may
20 make payments for the following services, which are required
21 of the state by Title XIX of the Social Security Act,
22 furnished by Medicaid providers to recipients who are
23 determined to be eligible on the dates on which the services
24 were provided. Any service under this section shall be
25 provided only when medically necessary and in accordance with
26 state and federal law. Nothing in this section shall be
27 construed to prevent or limit the agency from adjusting fees,
28 reimbursement rates, lengths of stay, number of visits, number
29 of services, or any other adjustments necessary to comply with
30 the availability of moneys and any limitations or directions
31 provided for in the General Appropriations Act or chapter 216.
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1 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
2 pay for preventive, diagnostic, therapeutic, or palliative
3 care and other services provided to a recipient in the
4 outpatient portion of a hospital licensed under part I of
5 chapter 395, and provided under the direction of a licensed
6 physician or licensed dentist, except that payment for such
7 care and services is limited to $1,500 $1,000 per state fiscal
8 year per recipient, unless an exception has been made by the
9 agency, and with the exception of a Medicaid recipient under
10 age 21, in which case the only limitation is medical
11 necessity.
12 Section 6. Subsection (5) of section 409.906, Florida
13 Statutes, is amended to read:
14 409.906 Optional Medicaid services.--Subject to
15 specific appropriations, the agency may make payments for
16 services which are optional to the state under Title XIX of
17 the Social Security Act and are furnished by Medicaid
18 providers to recipients who are determined to be eligible on
19 the dates on which the services were provided. Any optional
20 service that is provided shall be provided only when medically
21 necessary and in accordance with state and federal law.
22 Nothing in this section shall be construed to prevent or limit
23 the agency from adjusting fees, reimbursement rates, lengths
24 of stay, number of visits, or number of services, or making
25 any other adjustments necessary to comply with the
26 availability of moneys and any limitations or directions
27 provided for in the General Appropriations Act or chapter 216.
28 If necessary to safeguard the state's systems of providing
29 services to elderly and disabled persons and subject to the
30 notice and review provisions of s. 216.177, the Governor may
31 direct the Agency for Health Care Administration to amend the
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1 Medicaid state plan to delete the optional Medicaid service
2 known as "Intermediate Care Facilities for the Developmentally
3 Disabled." Optional services may include:
4 (5) CASE MANAGEMENT SERVICES.--The agency may pay for
5 primary care case management services rendered to a recipient
6 pursuant to a federally approved waiver, and targeted case
7 management services for specific groups of targeted
8 recipients, for which funding has been provided and which are
9 rendered pursuant to federal guidelines. The agency is
10 authorized to limit reimbursement for targeted case management
11 services in order to comply with any limitations or directions
12 provided for in the General Appropriations Act.
13 Notwithstanding s. 216.292, the Department of Children and
14 Family Services may transfer general funds to the Agency for
15 Health Care Administration to cover state matching
16 requirements exceeding the amount specified in the General
17 Appropriations Act for targeted case management services.
18 Section 7. Subsections (7), (9), and (10) of section
19 409.907, Florida Statutes, are amended to read:
20 409.907 Medicaid provider agreements.--The agency may
21 make payments for medical assistance and related services
22 rendered to Medicaid recipients only to an individual or
23 entity who has a provider agreement in effect with the agency,
24 who is performing services or supplying goods in accordance
25 with federal, state, and local law, and who agrees that no
26 person shall, on the grounds of handicap, race, color, or
27 national origin, or for any other reason, be subjected to
28 discrimination under any program or activity for which the
29 provider receives payment from the agency.
30 (7) The agency may require, as a condition of
31 participating in the Medicaid program and before entering into
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1 the provider agreement, that the provider submit information
2 concerning the professional, business, and personal background
3 of the provider and permit an onsite inspection of the
4 provider's service location by agency staff or other personnel
5 designated by the agency to perform assist in this function.
6 Before entering into the provider agreement, or as a condition
7 of continuing participation in the Medicaid program, the
8 agency and may also require that Medicaid providers reimbursed
9 on a fee-for-services basis or fee schedule basis which is not
10 cost-based, post a surety bond from the provider not to exceed
11 $50,000 or the total amount billed by the provider to the
12 program during the current or most recent calendar year,
13 whichever is greater. For new providers, the amount of the
14 surety bond shall be determined by the agency based on the
15 provider's estimate of its first year's billing. If the
16 provider's billing during the first year exceeds the bond
17 amount, the agency may require the provider to acquire an
18 additional bond equal to the actual billing level of the
19 provider. A provider's bond shall not exceed $50,000 if a
20 physician or group of physicians licensed under chapter 458,
21 chapter 459, or chapter 460 has a 50 percent or greater
22 ownership interest in the provider or if the provider is an
23 assisted living facility licensed under part III of chapter
24 400. The bonds permitted by this section are in addition to
25 the bonds referenced in s. 400.179(4)(d). If the provider is a
26 corporation, partnership, association, or other entity, the
27 agency may require the provider to submit information
28 concerning the background of that entity and of any principal
29 of the entity, including any partner or shareholder having an
30 ownership interest in the entity equal to 5 percent or
31 greater, and any treating provider who participates in or
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1 intends to participate in Medicaid through the entity. The
2 information must include:
3 (a) Proof of holding a valid license or operating
4 certificate, as applicable, if required by the state or local
5 jurisdiction in which the provider is located or if required
6 by the Federal Government.
7 (b) Information concerning any prior violation, fine,
8 suspension, termination, or other administrative action taken
9 under the Medicaid laws, rules, or regulations of this state
10 or of any other state or the Federal Government; any prior
11 violation of the laws, rules, or regulations relating to the
12 Medicare program; any prior violation of the rules or
13 regulations of any other public or private insurer; and any
14 prior violation of the laws, rules, or regulations of any
15 regulatory body of this or any other state.
16 (c) Full and accurate disclosure of any financial or
17 ownership interest that the provider, or any principal,
18 partner, or major shareholder thereof, may hold in any other
19 Medicaid provider or health care related entity or any other
20 entity that is licensed by the state to provide health or
21 residential care and treatment to persons.
22 (d) If a group provider, identification of all members
23 of the group and attestation that all members of the group are
24 enrolled in or have applied to enroll in the Medicaid program.
25 (9) Upon receipt of a completed, signed, and dated
26 application, and completion of any necessary background
27 investigation and criminal history record check, the agency
28 must either:
29 (a) Enroll the applicant as a Medicaid provider; or
30 (b) Deny the application if the agency determines
31 that, based on the grounds listed in subsection (10), it is in
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1 the best interest of the Medicaid program to do so, specifying
2 the reasons for denial. The agency may consider the factors
3 listed in subsection (10), as well as any other factor that
4 could affect the effective and efficient administration of the
5 program, including, but not limited to, the current
6 availability of medical care, services, or supplies to
7 recipients, taking into account geographic location and
8 reasonable travel time.
9 (10) The agency may consider whether deny enrollment
10 in the Medicaid program to a provider if the provider, or any
11 officer, director, agent, managing employee, or affiliated
12 person, or any partner or shareholder having an ownership
13 interest equal to 5 percent or greater in the provider if the
14 provider is a corporation, partnership, or other business
15 entity, has:
16 (a) Made a false representation or omission of any
17 material fact in making the application, including the
18 submission of an application that conceals the controlling or
19 ownership interest of any officer, director, agent, managing
20 employee, affiliated person, or partner or shareholder who may
21 not be eligible to participate;
22 (b) Been or is currently excluded, suspended,
23 terminated from, or has involuntarily withdrawn from
24 participation in, Florida's Medicaid program or any other
25 state's Medicaid program, or from participation in any other
26 governmental or private health care or health insurance
27 program;
28 (c) Been convicted of a criminal offense relating to
29 the delivery of any goods or services under Medicaid or
30 Medicare or any other public or private health care or health
31 insurance program including the performance of management or
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1 administrative services relating to the delivery of goods or
2 services under any such program;
3 (d) Been convicted under federal or state law of a
4 criminal offense related to the neglect or abuse of a patient
5 in connection with the delivery of any health care goods or
6 services;
7 (e) Been convicted under federal or state law of a
8 criminal offense relating to the unlawful manufacture,
9 distribution, prescription, or dispensing of a controlled
10 substance;
11 (f) Been convicted of any criminal offense relating to
12 fraud, theft, embezzlement, breach of fiduciary
13 responsibility, or other financial misconduct;
14 (g) Been convicted under federal or state law of a
15 crime punishable by imprisonment of a year or more which
16 involves moral turpitude;
17 (h) Been convicted in connection with the interference
18 or obstruction of any investigation into any criminal offense
19 listed in this subsection;
20 (i) Been found to have violated federal or state laws,
21 rules, or regulations governing Florida's Medicaid program or
22 any other state's Medicaid program, the Medicare program, or
23 any other publicly funded federal or state health care or
24 health insurance program, and been sanctioned accordingly;
25 (j) Been previously found by a licensing, certifying,
26 or professional standards board or agency to have violated the
27 standards or conditions relating to licensure or certification
28 or the quality of services provided; or
29 (k) Failed to pay any fine or overpayment properly
30 assessed under the Medicaid program in which no appeal is
31 pending or after resolution of the proceeding by stipulation
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1 or agreement, unless the agency has issued a specific letter
2 of forgiveness or has approved a repayment schedule to which
3 the provider agrees to adhere.
4 Section 8. Paragraph (a) of subsection (1) and
5 paragraph (c) of subsection (13) of section 409.908, Florida
6 Statutes, are amended to read:
7 409.908 Reimbursement of Medicaid providers.--Subject
8 to specific appropriations, the agency shall reimburse
9 Medicaid providers, in accordance with state and federal law,
10 according to methodologies set forth in the rules of the
11 agency and in policy manuals and handbooks incorporated by
12 reference therein. These methodologies may include fee
13 schedules, reimbursement methods based on cost reporting,
14 negotiated fees, competitive bidding pursuant to s. 287.057,
15 and other mechanisms the agency considers efficient and
16 effective for purchasing services or goods on behalf of
17 recipients. Payment for Medicaid compensable services made on
18 behalf of Medicaid eligible persons is subject to the
19 availability of moneys and any limitations or directions
20 provided for in the General Appropriations Act or chapter 216.
21 Further, nothing in this section shall be construed to prevent
22 or limit the agency from adjusting fees, reimbursement rates,
23 lengths of stay, number of visits, or number of services, or
24 making any other adjustments necessary to comply with the
25 availability of moneys and any limitations or directions
26 provided for in the General Appropriations Act, provided the
27 adjustment is consistent with legislative intent.
28 (1) Reimbursement to hospitals licensed under part I
29 of chapter 395 must be made prospectively or on the basis of
30 negotiation.
31
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1 (a) Reimbursement for inpatient care is limited as
2 provided for in s. 409.905(5). Reimbursement for hospital
3 outpatient care is limited to $1,500 $1,000 per state fiscal
4 year per recipient, except for:
5 1. Such care provided to a Medicaid recipient under
6 age 21, in which case the only limitation is medical
7 necessity;
8 2. Renal dialysis services; and
9 3. Other exceptions made by the agency.
10 (b) Hospitals that provide services to a
11 disproportionate share of low-income Medicaid recipients, or
12 that participate in the regional perinatal intensive care
13 center program under chapter 383, or that participate in the
14 statutory teaching hospital disproportionate share program, or
15 that participate in the extraordinary disproportionate share
16 program, may receive additional reimbursement. The total
17 amount of payment for disproportionate share hospitals shall
18 be fixed by the General Appropriations Act. The computation of
19 these payments must be made in compliance with all federal
20 regulations and the methodologies described in ss. 409.911,
21 409.9112, and 409.9113.
22 (c) The agency is authorized to limit inflationary
23 increases for outpatient hospital services as directed by the
24 General Appropriations Act.
25 (13) Medicare premiums for persons eligible for both
26 Medicare and Medicaid coverage shall be paid at the rates
27 established by Title XVIII of the Social Security Act. For
28 Medicare services rendered to Medicaid-eligible persons,
29 Medicaid shall pay Medicare deductibles and coinsurance as
30 follows:
31
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1 (c) Medicaid will pay no portion of Medicare
2 deductibles and coinsurance when payment that Medicare has
3 made for the service equals or exceeds what Medicaid would
4 have paid if it had been the sole payor. The combined payment
5 of Medicare and Medicaid shall not exceed the amount Medicaid
6 would have paid had it been the sole payor. The Legislature
7 finds that there has been confusion regarding the
8 reimbursement for services rendered to dually eligible
9 Medicare beneficiaries. Accordingly, the Legislature clarifies
10 that it has always been the intent of the legislature before
11 and after 1991 that, in reimbursing in accordance with fees
12 established by Title XVIII for premiums, deductibles, and
13 coinsurance for Medicare services rendered by physicians to
14 Medicaid eligible persons, that physicians be reimbursed at
15 the lesser of the amount billed by the physician or the
16 Medicaid maximum allowable fee established by the Agency for
17 Health Care Administration, as is permitted by federal law. It
18 has never been the intent of the Legislature with regard to
19 such services rendered by physicians that Medicaid be required
20 to provide any payment for deductibles, coinsurance, or
21 copayments for Medicare cost-sharing, or any expenses incurred
22 relating thereto, in excess of the payment amount provided for
23 under the State Medicaid plan for such service. This payment
24 methodology is applicable even in those situations in which
25 the payment for Medicare cost-sharing for a qualified Medicare
26 beneficiary with respect to an item or service is reduced or
27 eliminated. This expression of the Legislature is in
28 clarification of existing law and shall apply to payment for,
29 and with respect to provider agreements with respect to, items
30 or services furnished on or after the effective date of this
31 act. This paragraph applies to payment by Medicaid for items
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1 and services furnished before the effective date of this act
2 if such payment is the subject of a lawsuit that is based on
3 the provisions of s. 409.908, and that is pending as of, or is
4 initiated after, the effective date of this act.
5 Section 9. Section 409.9119, Florida Statutes, is
6 created to read:
7 409.9119 Disproportionate share program for licensed
8 specialty children's hospitals.--In addition to the payments
9 made under s. 409.911, the Agency for Health Care
10 Administration shall develop and implement a system under
11 which disproportionate share payments are made to those
12 hospitals that are licensed by the state as a licensed
13 specialty children's hospital. This system of payments must
14 conform to federal requirements and must distribute funds in
15 each fiscal year for which an appropriation is made by making
16 quarterly Medicaid payments. Notwithstanding s. 409.915,
17 counties are exempt from contributing toward the cost of this
18 special reimbursement for hospitals that serve a
19 disproportionate share of low-income patients.
20 (1) The agency shall use the following formula to
21 calculate the total amount earned for hospitals that
22 participate in the licensed specialty children's hospital
23 disproportionate share program:
24 TAE = DSR x BMPD x MD
25 Where:
26 TAE = total amount earned by a licensed specialty
27 children's hospital.
28 DSR = disproportionate share rate.
29 BMPD = base Medicaid per diem.
30 MD = Medicaid days.
31
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1 (2) The agency shall calculate the total additional
2 payment for hospitals that participate in the licensed
3 specialty children's hospital disproportionate share program
4 as follows:
5
6 TAP = (TAE x TA)
7
8 STAE
9 Where:
10 TAP = total additional payment for a licensed specialty
11 children's hospital.
12 TAE = total amount earned by a licensed specialty
13 children's hospital.
14 STAE = sum of total amount earned by each hospital that
15 participates in the licensed specialty children's hospital
16 disproportionate share program.
17 TA = total appropriation for the licensed specialty
18 children's hospital disproportionate share program.
19
20 (3) A hospital may not receive any payments under this
21 section until it achieves full compliance with the applicable
22 rules of the agency. A hospital that is not in compliance for
23 two or more consecutive quarters may not receive its share of
24 the funds. Any forfeited funds must be distributed to the
25 remaining participating licensed specialty children's
26 hospitals that are in compliance.
27 Section 10. Subsection (9) of section 409.912, Florida
28 Statutes, is amended to read:
29 409.912 Cost-effective purchasing of health care.--The
30 agency shall purchase goods and services for Medicaid
31 recipients in the most cost-effective manner consistent with
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1 the delivery of quality medical care. The agency shall
2 maximize the use of prepaid per capita and prepaid aggregate
3 fixed-sum basis services when appropriate and other
4 alternative service delivery and reimbursement methodologies,
5 including competitive bidding pursuant to s. 287.057, designed
6 to facilitate the cost-effective purchase of a case-managed
7 continuum of care. The agency shall also require providers to
8 minimize the exposure of recipients to the need for acute
9 inpatient, custodial, and other institutional care and the
10 inappropriate or unnecessary use of high-cost services.
11 (9) The agency, after notifying the Legislature, may
12 apply for waivers of applicable federal laws and regulations
13 as necessary to implement more appropriate systems of health
14 care for Medicaid recipients and reduce the cost of the
15 Medicaid program to the state and federal governments and
16 shall implement such programs, after legislative approval,
17 within a reasonable period of time after federal approval.
18 These programs must be designed primarily to reduce the need
19 for inpatient care, custodial care and other long-term or
20 institutional care, and other high-cost services.
21 (a) Before Prior to seeking legislative approval of
22 such a waiver as authorized by this subsection, the agency
23 must shall provide notice and an opportunity for public
24 comment. Notice must shall be provided to all persons who
25 have made requests of the agency for advance notice and must
26 shall be published in the Florida Administrative Weekly not
27 less than 28 days before prior to the intended action.
28 (b) Notwithstanding s. 216.292, funds that are
29 appropriated to the Department of Elderly Affairs for the
30 Assisted Living for the Elderly Medicaid waiver and are not
31
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1 expended must be transferred to the agency to fund
2 Medicaid-reimbursed nursing home care.
3 Section 11. Notwithstanding the provisions of chapter
4 287, Florida Statutes, the Agency for Health Care
5 Administration may, at its discretion, renew contracts for
6 fiscal intermediary services once or more for such periods as
7 the agency may decide; however, all such renewals may not
8 combine to exceed a total period longer than the term of the
9 original contract.
10 Section 12. Section 409.919, Florida Statutes, is
11 amended to read:
12 409.919 Rules.--The agency shall adopt any rules
13 necessary to comply with or administer ss. 409.901-409.920 and
14 all rules necessary to comply with federal requirements. In
15 addition, the Department of Children and Family Services shall
16 adopt and accept transfer of any rules that are necessary to
17 administer its responsibilities of receiving and processing
18 applications for Medicaid and determining Medicaid eligibility
19 and for assuring compliance with and for administering ss.
20 409.901-409.906, as it relates to these responsibilities.
21 Section 13. Notwithstanding the provisions of sections
22 236.0812, 409.9071, and 409.908(21), Florida Statutes,
23 developmental research schools, as authorized under section
24 228.053, Florida Statutes, shall be authorized to participate
25 in the Medicaid certified school match program subject to the
26 provisions of sections 236.0812, 409.9071, and 409.908(21),
27 Florida Statutes.
28 Section 14. (1) The Agency for Health Care
29 Administration is directed to submit to the Health Care
30 Financing Administration a request for a waiver that will
31 allow the agency to undertake a pilot project that would
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1 implement a coordinated system of care for adult ventilator
2 dependent patients. Under this pilot program, the agency shall
3 identify a network of skilled nursing facilities that have
4 respiratory departments geared towards intensive treatment and
5 rehabilitation of adult ventilator patients and will contract
6 with such a network for respiratory or other services. The
7 pilot project must allow the agency to evaluate a coordinated
8 and focused system of care for adult ventilator dependent
9 patients to determine the overall cost-effectiveness and
10 improved outcomes for participants.
11 (2) The agency must submit the waiver by September 1,
12 2000. The agency must forward a preliminary report of the
13 pilot project's findings to the Governor, the Speaker of the
14 House of Representatives, and the President of the Senate six
15 months after project implementation. The agency must submit a
16 final report of the pilot project's findings to these same
17 recipients no later than February 15, 2002.
18 Section 15. Subsection (7) of section 430.703, Florida
19 Statutes, is renumbered as subsection (8), and a new
20 subsection (7) is added to that section to read:
21 430.703 Definitions.--As used in this act, the term:
22 (7) "Other qualified provider" means an entity
23 licensed under chapter 400 that meets all the financial and
24 quality assurance requirements for a provider service network
25 as specified in s. 409.912 and can demonstrate a long-term
26 care continuum.
27 Section 16. Subsection (1) of section 430.707, Florida
28 Statutes, is amended to read:
29 430.707 Contracts.--
30 (1) The department, in consultation with the agency,
31 shall select and contract with managed care organizations and
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1 with other qualified providers to provide long-term care
2 within community diversion pilot project areas. Other
3 qualified providers are exempt from all licensure and
4 authorization requirements under the Florida Insurance Code
5 with respect to the provision of long term care under a
6 contract with the department.
7 Section 17. Paragraph (b) of subsection (4) of section
8 409.912, Florida Statutes, is repealed.
9 Section 18. February 6th of each year is designated
10 Florida Alzheimer's Disease Day.
11 Section 19. Present subsections (6) through (10) of
12 section 394.4615, Florida Statutes, are redesignated as
13 subsections (7) through (11), respectively, and a new
14 subsection (6) is added to that section to read:
15 394.4615 Clinical records; confidentiality.--
16 (6) Clinical records relating to a Medicaid recipient
17 shall be furnished to the Medicaid Fraud Control Unit in the
18 Department of Legal Affairs, upon request.
19 Section 20. Paragraph (k) is added to subsection (4)
20 of section 395.3025, Florida Statutes, to read:
21 395.3025 Patient and personnel records; copies;
22 examination.--
23 (4) Patient records are confidential and must not be
24 disclosed without the consent of the person to whom they
25 pertain, but appropriate disclosure may be made without such
26 consent to:
27 (k) The Medicaid Fraud Control Unit in the Department
28 of Legal Affairs pursuant to s. 409.920.
29 Section 21. Subsection (6) is added to section
30 400.0077, Florida Statutes, to read:
31 400.0077 Confidentiality.--
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1 (6) This section does not limit the subpoena power of
2 the Attorney General pursuant to s. 409.920(8)(b).
3 Section 22. Section 400.494, Florida Statutes, is
4 amended to read:
5 400.494 Information about patients confidential.--
6 (1) Information about patients received by persons
7 employed by, or providing services to, a home health agency or
8 received by the licensing agency through reports or inspection
9 shall be confidential and exempt from the provisions of s.
10 119.07(1) and shall not be disclosed to any person other than
11 the patient without the written consent of that patient or the
12 patient's guardian.
13 (2) This section does not apply to information
14 lawfully requested by the Medicaid Fraud Control Unit of the
15 Department of Legal Affairs.
16 Section 23. Subsection (7) is added to section
17 409.9071, Florida Statutes, to read:
18 409.9071 Medicaid provider agreements for school
19 districts certifying state match.--
20 (7) The agency's and school districts' confidentiality
21 is waived. They shall provide any information or documents
22 relating to this section to the Medicaid Fraud Control Unit in
23 the Department of Legal Affairs, upon request pursuant to its
24 authority under s. 409.920.
25 Section 24. Paragraph (b) of subsection (8) of section
26 409.920, Florida Statutes, is amended to read:
27 409.920 Medicaid provider fraud.--
28 (8) In carrying out the duties and responsibilities
29 under this subsection, the Attorney General may:
30 (b) Subpoena witnesses or materials, including medical
31 records relating to Medicaid recipients, within or outside the
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1 state and, through any duly designated employee, administer
2 oaths and affirmations and collect evidence for possible use
3 in either civil or criminal judicial proceedings.
4 Section 25. Section 409.9205, Florida Statutes, is
5 amended to read:
6 409.9205 Medicaid Fraud Control Unit; law enforcement
7 officers.--All investigators employed by the Medicaid Fraud
8 Control Unit who have been certified under s. 943.1395 are law
9 enforcement officers of the state. Such investigators have
10 the authority to conduct criminal investigations, bear arms,
11 make arrests, and apply for, serve, and execute search
12 warrants, arrest warrants, and capias, and other process
13 throughout the state pertaining to Medicaid fraud as described
14 in this chapter. The Attorney General shall provide
15 reasonable notice of criminal investigations conducted by the
16 Medicaid Fraud Control Unit to, and coordinate those
17 investigations with, the sheriffs of the respective counties.
18 Investigators employed by the Medicaid Fraud Control Unit are
19 not eligible for membership in the Special Risk Class of the
20 Florida Retirement System under s. 121.0515.
21 Section 26. Section 430.608, Florida Statutes, is
22 amended to read:
23 430.608 Confidentiality of information.--Identifying
24 information about elderly persons who receive services under
25 ss. 430.601-430.606, which is received through files, reports,
26 inspection, or otherwise by the department or by authorized
27 departmental employees, by persons who volunteer services, or
28 by persons who provide services to elderly persons under ss.
29 430.601-430.606 through contracts with the department, is
30 confidential and exempt from the provisions of s. 119.07(1)
31 and s. 24(a), Art. I of the State Constitution. Such
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1 information may not be disclosed publicly in such a manner as
2 to identify an elderly person, unless that person or the
3 person's legal guardian provides written consent.
4 (2) This section does not, however, limit the subpoena
5 authority of the Medicaid Fraud Control Unit of the Department
6 of Legal Affairs pursuant to s. 409.920(8)(b).
7 Section 27. Subsection (8) of subsection 455.667,
8 Florida Statutes, is amended to read:
9 455.667 Ownership and control of patient records;
10 report or copies of records to be furnished.--
11 (8)(a) All patient records obtained by the department
12 and any other documents maintained by the department which
13 identify the patient by name are confidential and exempt from
14 s. 119.07(1) and shall be used solely for the purpose of the
15 department and the appropriate regulatory board in its
16 investigation, prosecution, and appeal of disciplinary
17 proceedings. The records shall not be available to the public
18 as part of the record of investigation for and prosecution in
19 disciplinary proceedings made available to the public by the
20 department or the appropriate board.
21 (b) Notwithstanding paragraph (a), all patient records
22 obtained by the department and any other documents maintained
23 by the department which relate to a current or former Medicaid
24 recipient shall be provided to the Medicaid Fraud Control Unit
25 in the Department of Legal Affairs, upon request.
26 Section 28. This act shall take effect July 1, 2000.
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