CODING: Words stricken are deletions; words underlined are additions.



                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
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  4  ______________________________________________________________

  5                                           ORIGINAL STAMP BELOW

  6

  7

  8

  9

10  ______________________________________________________________

11  Representative(s) Green offered the following:

12

13         Amendment (with title amendment) 

14  Remove everything after the enacting clause

15

16  and insert:

17         Section 1.  Section 409.221, Florida Statutes, is

18  created to read:

19         409.221  Consumer-directed care program.--

20         (1)  SHORT TITLE.--This section may be cited as the

21  "Florida Consumer-Directed Care Act."

22         (2)  LEGISLATIVE FINDINGS.--The Legislature finds that

23  alternatives to institutional care, such as in-home and

24  community-based care, should be encouraged. The Legislature

25  finds that giving recipients of in-home and community-based

26  services the opportunity to select the services they need and

27  the providers they want, including family and friends,

28  enhances their sense of dignity and autonomy. The Legislature

29  also finds that providing consumers choice and control, as

30  tested in current research and demonstration projects, has

31  been beneficial and should be developed further and

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  implemented statewide.

  2         (3)  LEGISLATIVE INTENT.--It is the intent of the

  3  Legislature to nurture the autonomy of those citizens of the

  4  state, of all ages, who have disabilities by providing the

  5  long-term care services they need in the least restrictive,

  6  appropriate setting. It is the intent of the Legislature to

  7  give such individuals more choices in and greater control over

  8  the purchased long-term care services they receive.

  9         (4)  CONSUMER-DIRECTED CARE.--

10         (a)  Program established.--The Agency for Health Care

11  Administration shall establish the consumer-directed care

12  program which shall be based on the principles of consumer

13  choice and control. The agency shall implement the program

14  upon federal approval. The agency shall establish interagency

15  cooperative agreements with and shall work with the

16  Departments of Elderly Affairs, Health, and Children and

17  Family Services to implement and administer the program. The

18  program shall allow enrolled persons to choose the providers

19  of services and to direct the delivery of services, to best

20  meet their long-term care needs. The program must operate

21  within the funds appropriated by the Legislature.

22         (b)  Eligibility and enrollment.--Persons who are

23  enrolled in one of the Medicaid home and community-based

24  waiver programs and are able to direct their own care, or to

25  designate an eligible representative, may choose to

26  participate in the consumer-directed care program.

27         (c)  Definitions.--For purposes of this section, the

28  term:

29         1.  "Budget allowance" means the amount of money made

30  available each month to a consumer to purchase needed

31  long-term care services, based on the results of a functional

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  needs assessment.

  2         2.  "Consultant" means an individual who provides

  3  technical assistance to consumers in meeting their

  4  responsibilities under this section.

  5         3.  "Consumer" means a person who has chosen to

  6  participate in the program, has met the enrollment

  7  requirements, and has received an approved budget allowance.

  8         4.  "Fiscal intermediary" means an entity approved by

  9  the agency that helps the consumer manage the consumer's

10  budget allowance, retains the funds, processes employment

11  information, if any, and tax information, reviews records to

12  ensure correctness, writes paychecks to providers, and

13  delivers paychecks to the consumer for distribution to

14  providers and caregivers.

15         5.  "Provider" means:

16         a.  A person licensed or otherwise permitted to render

17  services eligible for reimbursement under this program for

18  whom the consumer is not the employer of record; or

19         b.  A consumer-employed caregiver for whom the consumer

20  is the employer of record.

21         6.  "Representative" means an uncompensated individual

22  designated by the consumer to assist in managing the

23  consumer's budget allowance and needed services.

24         (d)  Budget allowances.--Consumers enrolled in the

25  program shall be given a monthly budget allowance based on the

26  results of their assessed functional needs and the financial

27  resources of the program. Consumers shall receive the budget

28  allowance directly from an agency-approved fiscal

29  intermediary. Each department shall develop purchasing

30  guidelines, approved by the agency, to assist consumers in

31  using the budget allowance to purchase needed, cost-effective

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  services.

  2         (e)  Services.--Consumers shall use the budget

  3  allowance only to pay for home and community-based services

  4  that meet the consumer's long-term care needs and are a

  5  cost-efficient use of funds. Such services may include, but

  6  are not limited to, the following:

  7         1.  Personal care.

  8         2.  Homemaking and chores, including housework, meals,

  9  shopping, and transportation.

10         3.  Home modifications and assistive devices which may

11  increase the consumer's independence or make it possible to

12  avoid institutional placement.

13         4.  Assistance in taking self-administered medication.

14         5.  Day care and respite care services, including those

15  provided by nursing home facilities pursuant to s. 400.141(6)

16  or by adult day care facilities licensed pursuant to s.

17  400.554.

18         6.  Personal care and support services provided in an

19  assisted living facility.

20         (f)  Consumer roles and responsibilities.--Consumers

21  shall be allowed to choose the providers of services, as well

22  as when and how the services are provided. Providers may

23  include a consumer's neighbor, friend, spouse, or relative.

24         1.  In cases where a consumer is the employer of

25  record, the consumer's roles and responsibilities include, but

26  are not limited to, the following:

27         a.  Developing a job description.

28         b.  Selecting caregivers and submitting information for

29  the background screening as required in s. 435.05.

30         c.  Communicating needs, preferences, and expectations

31  about services being purchased.

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1         d.  Providing the fiscal intermediary with all

  2  information necessary for provider payments and tax

  3  requirements.

  4         e.  Ending the employment of an unsatisfactory

  5  caregiver.

  6         2.  In cases where a consumer is not the employer of

  7  record, the consumer's roles and responsibilities include, but

  8  are not limited to, the following:

  9         a.  Communicating needs, preferences, and expectations

10  about services being purchased.

11         b.  Ending the services of an unsatisfactory provider.

12         c.  Providing the fiscal agent with all information

13  necessary for provider payments and tax requirements.

14         (g)  Agency and departments roles and

15  responsibilities.--The agency's and the departments' roles and

16  responsibilities include, but are not limited to, the

17  following:

18         1.  Assessing each consumer's functional needs, helping

19  with the service plan, and providing ongoing assistance with

20  the service plan.

21         2.  Offering the services of consultants who shall

22  provide training, technical assistance, and support to the

23  consumer.

24         3.  Completing the background screening for providers.

25         4.  Approving fiscal intermediaries.

26         5.  Establishing the minimum qualifications for all

27  caregivers and providers and being the final arbiter of the

28  fitness of any individual to be a caregiver or provider.

29         (h)  Fiscal intermediary roles and

30  responsibilities.--The fiscal intermediary's roles and

31  responsibilities include, but are not limited to, the

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  following:

  2         1.  Providing recordkeeping services.

  3         2.  Retaining the consumer-directed care funds,

  4  processing employment and tax information, if any, reviewing

  5  records to ensure correctness, writing paychecks to providers,

  6  and delivering paychecks to the consumer for distribution.

  7         (i)  Background screening requirements.--All persons

  8  who render care under this section shall comply with the

  9  requirements of s. 435.05. Persons shall be excluded from

10  employment pursuant to s. 435.06.

11         1.  Persons excluded from employment may request an

12  exemption from disqualification, as provided in s. 435.07.

13  Persons not subject to certification or professional licensure

14  may request an exemption from the agency. In considering a

15  request for an exemption, the agency shall comply with the

16  provisions of s. 435.07.

17         2.  The agency shall, as allowable, reimburse

18  consumer-employed caregivers for the cost of conducting

19  background screening as required by this section.

20

21  For purposes of this section, a person who has undergone

22  screening, who is qualified for employment under this section

23  and applicable rule, and who has not been unemployed for more

24  than 180 days following such screening is not required to be

25  rescreened. Such person must attest under penalty of perjury

26  to not having been convicted of a disqualifying offense since

27  completing such screening.

28         (j)  Rules; federal waivers.--In order to implement

29  this section:

30         1.  The agency and the Departments of Elderly Affairs,

31  Health, and Children and Family Services are authorized to

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  adopt and enforce rules.

  2         2.  The agency shall take all necessary action to

  3  ensure state compliance with federal regulations. The agency

  4  shall apply for any necessary federal waivers or waiver

  5  amendments needed to implement the program.

  6         (k)  Reviews and reports.--The agency and the

  7  Departments of Elderly Affairs, Health, and Children and

  8  Family Services shall each, on an ongoing basis, review and

  9  assess the implementation of the consumer-directed care

10  program. By January 15 of each year, the agency shall submit a

11  written report to the Legislature that includes each

12  department's review of the program and contains

13  recommendations for improvements to the program.

14         Section 2.  (1)  Prior to December 1, 2002, the Agency

15  for Health Care Administration, in consultation with the

16  Department of Elderly Affairs, shall submit to the Governor,

17  the President of the Senate, and the Speaker of the House of

18  Representatives a plan to reduce the number of nursing home

19  bed days purchased by the state Medicaid program and to

20  replace such nursing home care with care provided in less

21  costly alternative settings.

22         (2)  The plan must include specific goals for reducing

23  Medicaid-funded bed days and recommend specific statutory and

24  operational changes necessary to achieve such reduction.

25         (3)  The plan must include an evaluation of the

26  cost-effectiveness and the relative strengths and weaknesses

27  of programs that serve as alternatives to nursing homes.

28         Section 3.  Section 408.034, Florida Statutes, is

29  amended to read:

30         408.034  Duties and responsibilities of agency;

31  rules.--

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1         (1)  The agency is designated as the single state

  2  agency to issue, revoke, or deny certificates of need and to

  3  issue, revoke, or deny exemptions from certificate-of-need

  4  review in accordance with the district plans and present and

  5  future federal and state statutes.  The agency is designated

  6  as the state health planning agency for purposes of federal

  7  law.

  8         (2)  In the exercise of its authority to issue licenses

  9  to health care facilities and health service providers, as

10  provided under chapters 393, 395, and parts II and VI of

11  chapter 400, the agency may not issue a license to any health

12  care facility, health service provider, hospice, or part of a

13  health care facility which fails to receive a certificate of

14  need or an exemption for the licensed facility or service.

15         (3)  The agency shall establish, by rule, uniform need

16  methodologies for health services and health facilities. In

17  developing uniform need methodologies, the agency shall, at a

18  minimum, consider the demographic characteristics of the

19  population, the health status of the population, service use

20  patterns, standards and trends, geographic accessibility, and

21  market economics.

22         (4)  Prior to determining that there is a need for

23  additional community nursing facility beds in any area of the

24  state, the agency shall determine that the need cannot be met

25  through the provision, enhancement, or expansion of home and

26  community-based services. In determining such need, the agency

27  shall examine nursing home placement patterns and demographic

28  patterns of persons entering nursing homes and the

29  availability of and effectiveness of existing home-based and

30  community-based service delivery systems at meeting the

31  long-term care needs of the population. The agency shall

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  recommend to the Office of Long-Term Care Policy changes that

  2  could be made to existing home-based and community-based

  3  delivery systems to lessen the need for additional nursing

  4  facility beds.

  5         (5)(4)  The agency shall establish by rule a

  6  nursing-home-bed-need methodology that reduces the community

  7  nursing home bed need for the areas of the state where the

  8  agency establishes pilot community diversion programs through

  9  the Title XIX aging waiver program.

10         (6)(5)  The agency may adopt rules necessary to

11  implement ss. 408.031-408.045.

12         Section 4.  Paragraph (f) of subsection (3) of section

13  409.912, Florida Statutes, is amended, and present subsections

14  (13) through (39) of said section are renumbered as

15  subsections (14) through (40), respectively, and a new

16  subsection (13) is added to that section, to read:

17         409.912  Cost-effective purchasing of health care.--The

18  agency shall purchase goods and services for Medicaid

19  recipients in the most cost-effective manner consistent with

20  the delivery of quality medical care.  The agency shall

21  maximize the use of prepaid per capita and prepaid aggregate

22  fixed-sum basis services when appropriate and other

23  alternative service delivery and reimbursement methodologies,

24  including competitive bidding pursuant to s. 287.057, designed

25  to facilitate the cost-effective purchase of a case-managed

26  continuum of care. The agency shall also require providers to

27  minimize the exposure of recipients to the need for acute

28  inpatient, custodial, and other institutional care and the

29  inappropriate or unnecessary use of high-cost services. The

30  agency may establish prior authorization requirements for

31  certain populations of Medicaid beneficiaries, certain drug

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  classes, or particular drugs to prevent fraud, abuse, overuse,

  2  and possible dangerous drug interactions. The Pharmaceutical

  3  and Therapeutics Committee shall make recommendations to the

  4  agency on drugs for which prior authorization is required. The

  5  agency shall inform the Pharmaceutical and Therapeutics

  6  Committee of its decisions regarding drugs subject to prior

  7  authorization.

  8         (3)  The agency may contract with:

  9         (f)  An entity that provides in-home physician services

10  to test the cost-effectiveness of enhanced home-based medical

11  care to Medicaid recipients with degenerative neurological

12  diseases and other diseases or disabling conditions associated

13  with high costs to Medicaid. The program shall be designed to

14  serve very disabled persons and to reduce Medicaid reimbursed

15  costs for inpatient, outpatient, and emergency department

16  services. The agency shall contract with vendors on a

17  risk-sharing basis. in Pasco County or Pinellas County that

18  provides in-home physician services to Medicaid recipients

19  with degenerative neurological diseases in order to test the

20  cost-effectiveness of enhanced home-based medical care. The

21  entity providing the services shall be reimbursed on a

22  fee-for-service basis at a rate not less than comparable

23  Medicare reimbursement rates. The agency may apply for waivers

24  of federal regulations necessary to implement such program.

25  This paragraph shall be repealed on July 1, 2002.

26         (13)(a)  The agency shall operate the Comprehensive

27  Assessment and Review (CARES) nursing facility preadmission

28  screening program to ensure that Medicaid payment for nursing

29  facility care is made only for individuals whose conditions

30  require such care and to ensure that long-term care services

31  are provided in the setting most appropriate to the needs of

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  the person and in the most economical manner possible. The

  2  CARES program shall also ensure that individuals participating

  3  in Medicaid home and community-based waiver programs meet

  4  criteria for those programs, consistent with approved federal

  5  waivers.

  6         (b)  The agency shall operate the CARES program through

  7  an interagency agreement with the Department of Elderly

  8  Affairs.

  9         (c)  Prior to making payment for nursing facility

10  services for a Medicaid recipient, the agency must verify that

11  the nursing facility preadmission screening program has

12  determined that the individual requires nursing facility care

13  and that the individual cannot be safely served in

14  community-based programs. The nursing facility preadmission

15  screening program shall refer a Medicaid recipient to a

16  community-based program if the individual could be safely

17  served at a lower cost and the recipient chooses to

18  participate in such program.

19         (d)  By January 1 of each year, the agency shall submit

20  a report to the Legislature and the Office of Long-Term Care

21  Policy describing the operations of the CARES program. The

22  report must describe:

23         1.  Rate of diversion to community alternative

24  programs;

25         2.  CARES program staffing needs to achieve additional

26  diversions;

27         3.  Reasons the program is unable to place individuals

28  in less restrictive settings when such individuals desired

29  such services and could have been served in such settings;

30         4.  Barriers to appropriate placement, including

31  barriers due to policies or operations of other agencies or

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  state-funded programs; and

  2         5.  Statutory changes necessary to ensure that

  3  individuals in need of long-term care services receive care in

  4  the least restrictive environment.

  5         Section 5.  Section 430.041, Florida Statutes, is

  6  created to read:

  7         430.041  Office of Long-Term Care Policy.--

  8         (1)  There is established in the Department of Elderly

  9  Affairs the Office of Long-Term Care Policy to evaluate the

10  state's long-term care service delivery system and make

11  recommendations to increase the availability and the use of

12  noninstitutional settings to provide care to the elderly and

13  ensure coordination among the agencies responsible for the

14  long-term care continuum.

15         (2)  The purpose of the Office of Long-Term Care Policy

16  is to:

17         (a)  Ensure close communication and coordination among

18  state agencies involved in developing and administering a more

19  efficient and coordinated long-term care service delivery

20  system in this state.

21         (b)  Identify duplication and unnecessary service

22  provision in the long-term care system and make

23  recommendations to decrease inappropriate service provision.

24         (c)  Review current programs providing long-term care

25  services to determine whether the programs are cost effective,

26  of high quality, and operating efficiently and make

27  recommendations to increase consistency and effectiveness in

28  the state's long-term care programs.

29         (d)  Develop strategies for promoting and implementing

30  cost-effective home and community-based services as an

31  alternative to institutional care which coordinate and

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  integrate the continuum of care needs of the elderly.

  2         (e)  Assist the Office of Long-Term Care Policy

  3  Advisory Council as necessary to help implement this section.

  4         (3)  The Director of the Office of Long-Term Care

  5  Policy shall be appointed by, and serve at the pleasure of,

  6  the Governor. The director shall report to, and be under the

  7  general supervision of, the Secretary of Elderly Affairs and

  8  shall not be subject to supervision by any other employee of

  9  the department.

10         (4)  The Office of Long-Term Care Policy shall have an

11  advisory council, whose chair shall be the Director of the

12  Office of Long-Term Care Policy. The purposes of the advisory

13  council are to provide assistance and direction to the office

14  and to ensure that the appropriate state agencies are properly

15  implementing recommendations from the office.

16         (a)  The advisory council shall consist of:

17         1.  A member of the Senate, appointed by the President

18  of the Senate.

19         2.  A member of the House of Representatives, appointed

20  by the Speaker of the House of Representatives.

21         3.  The Director of the Office of Long-Term Care

22  Policy.

23         4.  The Secretary of Health Care Administration.

24         5.  The Secretary of Elderly Affairs.

25         6.  The Secretary of Children and Family Services.

26         7.  The Secretary of Health.

27         8.  The Executive Director of the Department of

28  Veterans' Affairs.

29         9.  A representative of the Florida Association of Area

30  Agencies on Aging, appointed by the Governor.

31         10.  A representative of the Florida Association of

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1  Aging Service Providers, appointed by the Governor.

  2         11.  Three persons possessing broad knowledge and

  3  experience in the delivery of long-term care services,

  4  appointed by the Governor.

  5         12.  Two representatives of persons using long-term

  6  care services, appointed by the Governor from groups

  7  representing elderly persons.

  8         (b)  Members shall serve without compensation but are

  9  entitled to receive reimbursement for travel and per diem as

10  provided in s. 112.061.

11         (c)  The advisory council shall meet at the call of its

12  chair or at the request of a majority of its members. During

13  its first year of existence, the advisory council shall meet

14  at least monthly.

15         (d)  Members of the advisory council appointed by the

16  Governor shall serve at the pleasure of the Governor and shall

17  be appointed to 4-year staggered terms in accordance with s.

18  20.052.

19         (5)(a)  The Department of Elderly Affairs shall provide

20  administrative support and services to the Office of Long-Term

21  Care Policy.

22         (b)  The office shall call upon appropriate agencies of

23  state government, including the centers on aging in the State

24  University System, for assistance needed in discharging its

25  duties.

26         (c)  Each state agency represented on the Office of

27  Long-Term Care Policy Advisory Council shall make at least one

28  employee available to work with the Office of Long-Term Care

29  Policy. All state agencies and universities shall assist the

30  office in carrying out its responsibilities prescribed by this

31  section.

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1         (d)  Each state agency shall pay from its own funds any

  2  expenses related to its support of the Office of Long-Term

  3  Care Policy and its participation on the advisory council. The

  4  Department of Elderly Affairs shall be responsible for

  5  expenses related to participation on the advisory council by

  6  members appointed by the Governor.

  7         (6)(a)  By December 1, 2002, the office shall submit to

  8  the advisory council a preliminary report of its findings and

  9  recommendations on improving the long-term care continuum in

10  this state. The report must contain recommendations and

11  implementation proposals for policy changes, as well as

12  legislative and funding recommendations that will make the

13  system more effective and efficient. The report shall contain

14  a specific plan for accomplishing the recommendations and

15  proposals. Thereafter, the office shall revise and update the

16  report annually and resubmit it to the advisory council for

17  review and comments by November 1 of each year.

18         (b)  The advisory council shall review and recommend

19  any suggested changes to the preliminary report, and each

20  subsequent annual update of the report, within 30 days after

21  the receipt of the preliminary report. Suggested revisions,

22  additions, or deletions shall be made to the Director of the

23  Office of Long-Term Care Policy.

24         (c)  The office shall submit its final report, and each

25  subsequent annual update of the report, to the Governor and

26  the Legislature within 30 days after the receipt of any

27  revisions, additions, or deletions suggested by the advisory

28  council, or after the time such comments are due to the

29  office.

30         Section 6.  Section 430.7031, Florida Statutes, is

31  created to read:

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1         430.7031  Nursing home transition program.--The

  2  department and the Agency for Health Care Administration:

  3         (1)  Shall implement a system of care designed to

  4  assist individuals residing in nursing homes to regain

  5  independence and to move to less costly settings.

  6         (2)  Shall collaboratively work to identify long-stay

  7  nursing home residents who are able to move to community

  8  placements, and to provide case management and supportive

  9  services to such individuals while they are in nursing homes

10  to assist such individuals in moving to less expensive and

11  less restrictive settings.

12         (3)  Shall modify existing service delivery systems or

13  develop new service delivery systems to economically and

14  efficiently meet such individuals' care needs.

15         (4)  Shall offer such individuals priority placement

16  and services in all home-based and community-based care

17  programs and shall ensure that funds are available to provide

18  services to individuals to whom services are offered.

19         (5)  May seek federal waivers necessary to administer

20  this section.

21         Section 7.  Subsection (4) of section 409.908, Florida

22  Statutes, is amended to read:

23         409.908  Reimbursement of Medicaid providers.--Subject

24  to specific appropriations, the agency shall reimburse

25  Medicaid providers, in accordance with state and federal law,

26  according to methodologies set forth in the rules of the

27  agency and in policy manuals and handbooks incorporated by

28  reference therein.  These methodologies may include fee

29  schedules, reimbursement methods based on cost reporting,

30  negotiated fees, competitive bidding pursuant to s. 287.057,

31  and other mechanisms the agency considers efficient and

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  1  effective for purchasing services or goods on behalf of

  2  recipients.  Payment for Medicaid compensable services made on

  3  behalf of Medicaid eligible persons is subject to the

  4  availability of moneys and any limitations or directions

  5  provided for in the General Appropriations Act or chapter 216.

  6  Further, nothing in this section shall be construed to prevent

  7  or limit the agency from adjusting fees, reimbursement rates,

  8  lengths of stay, number of visits, or number of services, or

  9  making any other adjustments necessary to comply with the

10  availability of moneys and any limitations or directions

11  provided for in the General Appropriations Act, provided the

12  adjustment is consistent with legislative intent.

13         (4)  Subject to any limitations or directions provided

14  for in the General Appropriations Act, alternative health

15  plans, health maintenance organizations, and prepaid health

16  plans shall be reimbursed a fixed, prepaid amount negotiated,

17  or competitively bid pursuant to s. 287.057, by the agency and

18  prospectively paid to the provider monthly for each Medicaid

19  recipient enrolled.  The amount may not exceed the average

20  amount the agency determines it would have paid, based on

21  claims experience, for recipients in the same or similar

22  category of eligibility.  The agency shall calculate

23  capitation rates on a regional basis and, beginning September

24  1, 1995, shall include age-band differentials in such

25  calculations. Effective July 1, 2001, the cost of exempting

26  statutory teaching hospitals, specialty hospitals, and

27  community hospital education program hospitals from

28  reimbursement ceilings and the cost of special Medicaid

29  payments shall not be included in premiums paid to health

30  maintenance organizations or prepaid health care plans. Each

31  rate semester, the agency shall calculate and publish a

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  1  Medicaid hospital rate schedule that does not reflect either

  2  special Medicaid payments or the elimination of rate

  3  reimbursement ceilings, to be used by hospitals and Medicaid

  4  health maintenance organizations, in order to determine the

  5  Medicaid rate referred to in ss. 409.912(17) 409.912(16),

  6  409.9128(5), and 641.513(6).

  7         Section 8.  Section 430.708, Florida Statutes, is

  8  amended to read:

  9         430.708  Certificate of need.--To ensure that Medicaid

10  community diversion pilot projects result in a reduction in

11  the projected average monthly nursing home caseload, the

12  agency shall, in accordance with the provisions of s.

13  408.034(5) s. 408.034(4):

14         (1)  Reduce the projected nursing home bed need in each

15  certificate-of-need batching cycle in the community diversion

16  pilot project areas.

17         (2)  Reduce the conditions imposed on existing nursing

18  homes or those to be constructed, in accordance with the

19  number of projected community diversion slots.

20         (3)  Adopt rules to reduce the number of beds in

21  Medicaid-participating nursing homes eligible for Medicaid,

22  through a Medicaid-selective contracting process or some other

23  appropriate method.

24         (4)  Determine the feasibility of increasing the

25  nursing home occupancy threshold used in determining nursing

26  home bed needs under the certificate-of-need process.

27         Section 9.  Subsection (4) of section 641.386, Florida

28  Statutes, is amended to read:

29         641.386  Agent licensing and appointment required;

30  exceptions.--

31         (4)  All agents and health maintenance organizations

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  1  shall comply with and be subject to the applicable provisions

  2  of ss. 641.309 and 409.912(19) 409.912(18), and all companies

  3  and entities appointing agents shall comply with s. 626.451,

  4  when marketing for any health maintenance organization

  5  licensed pursuant to this part, including those organizations

  6  under contract with the Agency for Health Care Administration

  7  to provide health care services to Medicaid recipients or any

  8  private entity providing health care services to Medicaid

  9  recipients pursuant to a prepaid health plan contract with the

10  Agency for Health Care Administration.

11         Section 10.  Subsection (4) of section 20.41, Florida

12  Statutes, is amended to read:

13         20.41  Department of Elderly Affairs.--There is created

14  a Department of Elderly Affairs.

15         (4)  The department shall administer administratively

16  house the State Long-Term Care Ombudsman Council, created by

17  s. 400.0067, and the local long-term care ombudsman councils,

18  created by s. 400.0069 and shall, as required by s. 712 of the

19  federal Older Americans Act of 1965, ensure that both the

20  state and local long-term care ombudsman councils operate in

21  compliance with the Older Americans Act.  The councils in

22  performance of their duties shall not be subject to control,

23  supervision, or direction by the department.

24         Section 11.  Subsection (1) and paragraph (b) of

25  subsection (2) of section 400.0063, Florida Statutes, are

26  amended to read:

27         400.0063  Establishment of Office of State Long-Term

28  Care Ombudsman; designation of ombudsman and legal advocate.--

29         (1)  There is created an Office of State Long-Term Care

30  Ombudsman, which shall be located for administrative purposes

31  in the Department of Elderly Affairs.

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  1         (2)

  2         (b)  The State Long-Term Care Ombudsman shall be

  3  appointed by and shall serve at the pleasure of the Secretary

  4  of Elderly Affairs State Long-Term Care Ombudsman Council.  No

  5  person who has a conflict of interest, or has an immediate

  6  family member who has a conflict of interest, may be involved

  7  in the designation of the ombudsman.

  8         Section 12.  Paragraphs (c) and (f) of subsection (2)

  9  and subsection (3) of section 400.0065, Florida Statutes, are

10  amended to read:

11         400.0065  State Long-Term Care Ombudsman; duties and

12  responsibilities; conflict of interest.--

13         (2)  The State Long-Term Care Ombudsman shall have the

14  duty and authority to:

15         (c)  Within the limits of federal and state funding

16  authorized and appropriated, employ such personnel, including

17  staff for local ombudsman councils, as are necessary to

18  perform adequately the functions of the office and provide or

19  contract for legal services to assist the state and local

20  ombudsman councils in the performance of their duties.  Staff

21  positions for each local ombudsman council may be established

22  as career service positions, and shall be filled by the

23  ombudsman after approval by the secretary consultation with

24  the respective local ombudsman council.

25         (f)  Annually prepare a budget request that shall be

26  submitted to the Governor by the department for transmittal to

27  the Legislature.

28         (3)  The State Long-Term Care Ombudsman shall not:

29         (a)  Have a direct involvement in the licensing or

30  certification of, or an ownership or investment interest in, a

31  long-term care facility or a provider of a long-term care

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  1  service.

  2         (b)  Be employed by, or participate in the management

  3  of, a long-term care facility.

  4         (c)  Receive, or have a right to receive, directly or

  5  indirectly, remuneration, in cash or in kind, under a

  6  compensation agreement with the owner or operator of a

  7  long-term care facility.

  8

  9  The Department of Elderly Affairs, in consultation with the

10  ombudsman, shall adopt rules to establish procedures to

11  identify and eliminate conflicts of interest as described in

12  this subsection.

13         Section 13.  Paragraphs (c), (d), (f), and (g) of

14  subsection (2) and paragraph (b) of subsection (3) of section

15  400.0067, Florida Statutes, are amended to read:

16         400.0067  Establishment of State Long-Term Care

17  Ombudsman Council; duties; membership.--

18         (2)  The State Long-Term Care Ombudsman Council shall:

19         (c)  Assist the ombudsman to discover, investigate, and

20  determine the existence of abuse or neglect in any long-term

21  care facility. and to develop procedures, in consultation with

22  The Department of Elderly Affairs shall develop procedures,

23  relating to such investigations. Investigations may consist,

24  in part, of one or more onsite administrative inspections.

25         (d)  Assist the ombudsman in eliciting, receiving,

26  responding to, and resolving complaints made by or on behalf

27  of long-term care facility residents and in developing

28  procedures, in consultation with the Department of Elderly

29  Affairs, relating to the receipt and resolution of such

30  complaints. The secretary shall approve all such procedures.

31         (f)  Be authorized to call upon appropriate agencies of

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  1  state government for such professional assistance as may be

  2  needed in the discharge of its duties, including assistance

  3  from the adult protective services program of the Department

  4  of Children and Family Services.

  5         (f)(g)  Prepare an annual report describing the

  6  activities carried out by the ombudsman and the State

  7  Long-Term Care Ombudsman Council in the year for which the

  8  report is prepared.  The State Long-Term Care Ombudsman

  9  Council shall submit the report to the Secretary of Elderly

10  Affairs. The secretary shall in turn submit the report to the

11  Commissioner of the United States Administration on Aging, the

12  Governor, the President of the Senate, the Speaker of the

13  House of Representatives, the minority leaders of the House

14  and Senate, the chairpersons of appropriate House and Senate

15  committees, the Secretary of Secretaries of Elderly Affairs

16  and Children and Family Services, and the Secretary of Health

17  Care Administration.  The report shall be submitted by the

18  Secretary of Elderly Affairs at least 30 days before the

19  convening of the regular session of the Legislature and shall,

20  at a minimum:

21         1.  Contain and analyze data collected concerning

22  complaints about and conditions in long-term care facilities.

23         2.  Evaluate the problems experienced by residents of

24  long-term care facilities.

25         3.  Contain recommendations for improving the quality

26  of life of the residents and for protecting the health,

27  safety, welfare, and rights of the residents.

28         4.  Analyze the success of the ombudsman program during

29  the preceding year and identify the barriers that prevent the

30  optimal operation of the program.  The report of the program's

31  successes shall also address the relationship between the

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  1  state long-term care ombudsman program, the Department of

  2  Elderly Affairs, the Agency for Health Care Administration,

  3  and the Department of Children and Family Services, and an

  4  assessment of how successfully the state long-term care

  5  ombudsman program has carried out its responsibilities under

  6  the Older Americans Act.

  7         5.  Provide policy and regulatory and legislative

  8  recommendations to solve identified problems; resolve

  9  residents' complaints; improve the quality of care and life of

10  the residents; protect the health, safety, welfare, and rights

11  of the residents; and remove the barriers to the optimal

12  operation of the state long-term care ombudsman program.

13         6.  Contain recommendations from the local ombudsman

14  councils regarding program functions and activities.

15         7.  Include a report on the activities of the legal

16  advocate and other legal advocates acting on behalf of the

17  local and state councils.

18         (3)

19         (b)1.  The ombudsman, in consultation with the

20  secretary and the state ombudsman council, shall submit to the

21  Governor a list of at least eight names of persons who are not

22  serving on a local council.

23         2.  The Governor shall appoint three members chosen

24  from the list, at least one of whom must be over 60 years of

25  age.

26         3.  If the Governor's appointments are not made within

27  60 days after the ombudsman submits the list, the ombudsman,

28  in consultation with the secretary State Long-Term Care

29  Ombudsman Council, shall appoint three members, one of whom

30  must be over 60 years of age.

31         Section 14.  Subsection (4) of section 400.0069,

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  1  Florida Statutes, is amended to read:

  2         400.0069  Local long-term care ombudsman councils;

  3  duties; membership.--

  4         (4)  Each local ombudsman council shall be composed of

  5  no less than 15 members and no more than 40 30 members from

  6  the local planning and service area, to include the following:

  7  one medical or osteopathic physician whose practice includes

  8  or has included a substantial number of geriatric patients and

  9  who may have limited practice in a long-term care facility;

10  one registered nurse who has geriatric experience, if

11  possible; one licensed pharmacist; one registered dietitian;

12  at least six nursing home residents or representative consumer

13  advocates for nursing home residents; at least three residents

14  of assisted living facilities or adult family-care homes or

15  three representative consumer advocates for long-term care

16  facility residents; one attorney; and one professional social

17  worker.  In no case shall the medical director of a long-term

18  care facility or an employee of the Agency for Health Care

19  Administration, the Department of Children and Family

20  Services, or the Department of Elderly Affairs serve as a

21  member or as an ex officio member of a council.  Each member

22  of the council shall certify that neither the council member

23  nor any member of the council member's immediate family has

24  any conflict of interest pursuant to subsection (10).  Local

25  ombudsman councils are encouraged to recruit council members

26  who are 60 years of age or older.

27         Section 15.  Subsection (1) of section 400.0071,

28  Florida Statutes, is amended to read:

29         400.0071  Complaint procedures.--

30         (1)  The state ombudsman council shall recommend to the

31  ombudsman and the secretary establish state and local

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  1  procedures for receiving complaints against a nursing home or

  2  long-term care facility or its employee. The procedures shall

  3  be implemented after the approval of the ombudsman and the

  4  secretary.

  5         Section 16.  Subsections (1) and (2) of section

  6  400.0087, Florida Statutes, are amended to read:

  7         400.0087  Agency oversight.--

  8         (1)  The Department of Elderly Affairs shall monitor

  9  the local ombudsman councils responsible for carrying out the

10  duties delegated by s. 400.0069 and federal law.  The

11  department, in consultation with the ombudsman and the State

12  Long-Term Care Ombudsman Council, shall adopt rules to

13  establish the policies and procedures for the monitoring of

14  local ombudsman councils.

15         (2)  The department is responsible for ensuring that

16  the Office of State Long-Term Care Ombudsman prepares its

17  annual report; provides information to public and private

18  agencies, legislators, and others; provides appropriate

19  training to representatives of the office or of the state or

20  local long-term care ombudsman councils; and coordinates

21  ombudsman services with the Advocacy Center for Persons with

22  Disabilities and with providers of legal services to residents

23  of long-term care facilities in compliance with state and

24  federal laws.

25         Section 17.  Section 400.0089, Florida Statutes, is

26  amended to read:

27         400.0089  Agency reports.--The State Long-Term Care

28  Ombudsman Council, shall, in cooperation with the Department

29  of Elderly Affairs shall, maintain a statewide uniform

30  reporting system to collect and analyze data relating to

31  complaints and conditions in long-term care facilities and to

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  1  residents, for the purpose of identifying and resolving

  2  significant problems. The department and the State Long-Term

  3  Care Ombudsman Council shall submit such data as part of its

  4  annual report required pursuant to s. 400.0067(2)(g) to the

  5  Agency for Health Care Administration, the Department of

  6  Children and Family Services, the Florida Statewide Advocacy

  7  Council, the Advocacy Center for Persons with Disabilities,

  8  the Commissioner for the United States Administration on

  9  Aging, the National Ombudsman Resource Center, and any other

10  state or federal entities that the ombudsman determines

11  appropriate. The State Long-Term Care Ombudsman Council shall

12  publish quarterly and make readily available information

13  pertaining to the number and types of complaints received by

14  the long-term care ombudsman program.

15         Section 18.  Section 400.0091, Florida Statutes, is

16  amended to read:

17         400.0091  Training.--The ombudsman shall provide

18  appropriate training to all employees of the Office of State

19  Long-Term Care Ombudsman and to the state and local long-term

20  care ombudsman councils, including all unpaid volunteers. All

21  volunteers and appropriate employees of the Office of the

22  State Long-Term Care Ombudsman must be given a minimum of 20

23  hours of training upon employment or enrollment as a volunteer

24  and 10 hours of continuing education annually thereafter.

25  Training must cover, at a minimum, guardianships and powers of

26  attorney, medication administration, care and medication of

27  residents with dementia and Alzheimer's disease, accounting

28  for residents' funds, discharge rights and responsibilities,

29  and cultural sensitivity. No employee, officer, or

30  representative of the office or of the state or local

31  long-term care ombudsman councils, other than the ombudsman,

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  1  may carry out any authorized ombudsman duty or responsibility

  2  unless the person has received the training required by this

  3  section and has been approved by the ombudsman as qualified to

  4  carry out ombudsman activities on behalf of the office or the

  5  state or local long-term care ombudsman councils.

  6         Section 19.  Paragraph (d) of subsection (5) of section

  7  400.179, Florida Statutes, is amended to read:

  8         400.179  Sale or transfer of ownership of a nursing

  9  facility; liability for Medicaid underpayments and

10  overpayments.--

11         (5)  Because any transfer of a nursing facility may

12  expose the fact that Medicaid may have underpaid or overpaid

13  the transferor, and because in most instances, any such

14  underpayment or overpayment can only be determined following a

15  formal field audit, the liabilities for any such underpayments

16  or overpayments shall be as follows:

17         (d)  Where the transfer involves a facility that has

18  been leased by the transferor:

19         1.  The transferee shall, as a condition to being

20  issued a license by the agency, acquire, maintain, and provide

21  proof to the agency of a bond with a term of 30 months,

22  renewable annually, in an amount not less than the total of 3

23  months Medicaid payments to the facility computed on the basis

24  of the preceding 12-month average Medicaid payments to the

25  facility.

26         2.  The leasehold operator may meet the bond

27  requirement through other arrangements acceptable to the

28  department.

29         3.  All existing nursing facility licensees, operating

30  the facility as a leasehold, shall acquire, maintain, and

31  provide proof to the agency of the 30-month bond required in

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  1  subparagraph 1., above, on and after July 1, 1993, for each

  2  license renewal.

  3         4.  It shall be the responsibility of all nursing

  4  facility operators, operating the facility as a leasehold, to

  5  renew the 30-month bond and to provide proof of such renewal

  6  to the agency annually at the time of application for license

  7  renewal.

  8         5.  Any failure of the nursing facility operator to

  9  acquire, maintain, renew annually, or provide proof to the

10  agency shall be grounds for the agency to deny, cancel,

11  revoke, or suspend the facility license to operate such

12  facility and to take any further action, including, but not

13  limited to, enjoining the facility, asserting a moratorium, or

14  applying for a receiver, deemed necessary to ensure compliance

15  with this section and to safeguard and protect the health,

16  safety, and welfare of the facility's residents. A lease

17  agreement required as a condition of bond financing or

18  refinancing under s. 154.213 by a health facilities authority

19  or required under s. 159.30 by a county or municipality is not

20  a leasehold for purposes of this paragraph and is not subject

21  to the bond requirement of this paragraph.

22         Section 20.  Subsection (1) of section 477.025, Florida

23  Statutes, is amended, and subsection (11) is added to said

24  section, to read:

25         477.025  Cosmetology salons; specialty salons;

26  requisites; licensure; inspection; mobile cosmetology

27  salons.--

28         (1)  No cosmetology salon or specialty salon shall be

29  permitted to operate without a license issued by the

30  department except as provided in subsection (11).

31         (11)  Facilities licensed under part II or part III of

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  1  chapter 400 shall be exempt from the provisions of this

  2  section and a cosmetologist licensed pursuant to s. 477.019

  3  may provide salon services exclusively for facility residents.

  4         Section 21.  Section 627.9408, Florida Statutes, is

  5  amended to read:

  6         627.9408  Rules.--

  7         (1)  The department has authority to adopt rules

  8  pursuant to ss. 120.536(1) and 120.54 to implement the

  9  provisions of this part.

10         (2)  The department may adopt by rule the provisions of

11  the Long-Term Care Insurance Model Regulation adopted by the

12  National Association of Insurance Commissioners in the second

13  quarter of the year 2000 which are not in conflict with the

14  Florida Insurance Code.

15         Section 22.  Subsections (2) and (3) of section

16  400.0066, Florida Statutes, are repealed.

17         Section 23.  Section 65 of chapter 2001-45, Laws of

18  Florida, is repealed.

19         Section 24.  This act shall take effect July 1, 2002.

20

21

22  ================ T I T L E   A M E N D M E N T ===============

23  And the title is amended as follows:

24  remove:  the entire title

25

26  and insert:

27                      A bill to be entitled

28         An act relating to long-term care; creating s.

29         409.221, F.S.; creating the "Florida

30         Consumer-Directed Care Act"; providing

31         legislative findings; providing legislative

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  1         intent; establishing the consumer-directed care

  2         program; providing for consumer selection of

  3         certain long-term care services and providers;

  4         providing for interagency agreements among the

  5         Agency for Health Care Administration and the

  6         Department of Elderly Affairs, the Department

  7         of Health, and the Department of Children and

  8         Family Services; providing for program

  9         eligibility and enrollment; providing

10         definitions; providing for consumer budget

11         allowances and purchasing guidelines;

12         specifying authorized services; providing roles

13         and responsibilities of consumers, the agency

14         and departments, and fiduciary intermediaries;

15         providing background screening requirements for

16         persons who render care under the program;

17         providing rulemaking authority of the agency

18         and departments; requiring the agency to apply

19         for federal waivers as necessary; requiring

20         ongoing program reviews and annual reports;

21         requiring the Agency for Health Care

22         Administration and the Department of Elderly

23         Affairs to submit a plan to the Governor and

24         Legislature for reducing nursing home bed days

25         funded under the Medicaid program; amending s.

26         408.034, F.S.; providing additional

27         requirements for the Agency for Health Care

28         Administration in determining the need for

29         additional nursing facility beds; amending s.

30         409.912, F.S.; authorizing the Agency for

31         Health Care Administration to contract with

                                  30

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1         vendors on a risk-sharing basis for in-home

  2         physician services; requiring the Agency for

  3         Health Care Administration to establish a

  4         nursing facility preadmission screening program

  5         through an interagency agreement with the

  6         Department of Elderly Affairs; requiring an

  7         annual report to the Legislature and the Office

  8         of Long-Term Care Policy; creating s. 430.041,

  9         F.S.; establishing the Office of Long-Term Care

10         Policy within the Department of Elderly

11         Affairs; requiring the office to make

12         recommendations for coordinating the services

13         provided by state agencies; providing for the

14         appointment of a director and an advisory

15         council to the Office of Long-Term Care Policy;

16         specifying membership and duties of the

17         director and advisory council; providing for

18         reimbursement of per diem and travel expenses

19         for members of the advisory council; requiring

20         that the office submit an annual report to the

21         Governor and Legislature; requiring assistance

22         to the office by state agencies and

23         universities; creating s. 430.7031, F.S.;

24         requiring the Department of Elderly Affairs and

25         the Agency for Health Care Administration to

26         implement a nursing home transition program;

27         providing requirements for the program;

28         amending ss. 409.908, 430.708, and 641.386,

29         F.S., relating to reimbursement of Medicaid

30         providers, certificates of need, and agent

31         licensing and appointment; conforming cross

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1         references to changes made by the act; amending

  2         s. 20.41, F.S.; providing for administration of

  3         the State Long-Term Care Ombudsman Council by

  4         the Department of Elderly Affairs; amending s.

  5         400.0063, F.S.; locating the Office of the

  6         State Long-Term Care Ombudsman in the

  7         department; providing for appointment of the

  8         ombudsman by the Secretary of Elderly Affairs;

  9         amending s. 400.0065, F.S.; requiring the

10         secretary's approval of staff for the local

11         ombudsman councils; deleting requirement that

12         the ombudsman prepare an annual legislative

13         budget request; revising rulemaking authority;

14         amending s. 400.0067, F.S.; revising duties of

15         the State Long-Term Care Ombudsman Council;

16         providing duties of the department and

17         secretary; amending s. 400.0069, F.S.;

18         increasing the maximum membership of the local

19         long-term care ombudsman councils; amending s.

20         400.0071, F.S.; revising procedures relating to

21         complaints; amending s. 400.0087, F.S.;

22         revising provisions relating to agency

23         oversight; amending s. 400.0089, F.S.; revising

24         reporting responsibilities; requiring the State

25         Long-Term Care Ombudsman Council to publish

26         complaint information quarterly; amending s.

27         400.0091, F.S.; specifying training

28         requirements for employees of the Office of the

29         State Long-Term Care Ombudsman and its

30         volunteers; amending s. 400.179, F.S.;

31         providing an exemption from certain

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                                                   HOUSE AMENDMENT

    705-165AXI-08          Bill No. CS for CS for SB 596, 1st Eng.

    Amendment No. ___ (for drafter's use only)





  1         requirements that the transferor of a nursing

  2         facility maintain a bond; amending s. 477.025,

  3         F.S.; exempting certain facilities from a

  4         provision of law requiring licensing as a

  5         cosmetology salon; amending s. 627.9408, F.S.;

  6         authorizing the department to adopt by rule

  7         certain provisions of the Long-Term Care

  8         Insurance Model Regulation, as adopted by the

  9         National Association of Insurance

10         Commissioners; repealing s. 400.0066(2) and

11         (3), F.S., relating to the Office of State

12         Long-Term Care Ombudsman; deleting a

13         prohibition on interference with the official

14         duty of any ombudsman staff or volunteers;

15         deleting reference to administrative support by

16         the Department of Elderly Affairs; repealing s.

17         65, ch. 2001-45, Laws of Florida, relating to

18         office space for the Office of State Long-Term

19         Care Ombudsman; providing an effective date.

20

21

22

23

24

25

26

27

28

29

30

31

                                  33

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