Senate Bill sb0400c1
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Florida Senate - 2003 CS for SB 400
By the Committee on Health, Aging, and Long-Term Care; and
Senator Peaden
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1 A bill to be entitled
2 An act relating to health programs; amending s.
3 120.80, F.S.; exempting hearings in the Agency
4 for Health Care Administration from the
5 requirement of being conducted by an
6 administrative law judge; amending s. 400.0255,
7 F.S.; providing for certain hearings to be
8 conducted by the agency's Office of Fair
9 Hearings relating to resident transfer or
10 discharge; amending s. 408.15, F.S.; providing
11 authority of the agency to establish and
12 conduct Medicaid fair hearings; amending s.
13 409.91195, F.S.; revising provisions relating
14 to the establishment of the agency's preferred
15 drug list; providing for appeals of preferred
16 drug list decisions through the Office of Fair
17 Hearings; amending s. 400.0239, F.S.; providing
18 for deposit of certain federal nursing home
19 civil penalties into the Quality of Long-Term
20 Care Facility Improvement Trust Fund; providing
21 for expenditures from the fund; amending s.
22 400.071, F.S.; requiring additional information
23 from applicants for licensure to operate health
24 care facilities; amending s. 400.414, F.S.;
25 revising grounds for denial, revocation, or
26 suspension of a license; amending s. 400.419,
27 F.S.; providing for imposition of
28 administrative fines; providing grounds for
29 such fines; amending s. 400.417, F.S.; revising
30 methods of notifying a facility of the
31 necessity of renewing a license; amending s.
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1 400.557, F.S.; revising methods of notifying
2 adult day care centers of the necessity of
3 renewing a license; amending s. 400.619, F.S.;
4 providing for notification of an adult
5 family-care home of the necessity of renewing a
6 license and providing the method therefor;
7 amending s. 400.980, F.S.; deleting obsolete
8 provisions; amending s. 408.061, F.S.; revising
9 requirements for data submission by nursing
10 homes and continuing care facilities; amending
11 s. 408.062, F.S.; revising duties of the agency
12 with respect to evaluating and monitoring data
13 and reporting its findings; amending s.
14 408.831, F.S.; providing conditions on a change
15 of ownership or a change of licensee,
16 registrant, or certificateholder; amending s.
17 409.811, F.S.; defining the term "managed care
18 plan"; amending s. 409.8132, F.S.; creating a
19 cross-reference to such definition; amending s.
20 409.91188, F.S.; authorizing the agency to
21 contract with private or public entities for
22 health care services; amending s. 409.912,
23 F.S.; revising provisions relating to
24 cost-effective purchasing of health care;
25 deleting provisions relating to preenrollments
26 by managed care plans; deleting obsolete
27 provisions; amending s. 409.901, F.S.;
28 redefining the terms "third party" and
29 "third-party benefit"; amending s. 409.905,
30 F.S.; revising standards for authorization for
31 hospital inpatient services; amending s.
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1 409.913, F.S.; deleting a requirement that a
2 hearing be conducted within a specified time;
3 amending s. 409.919, F.S.; authorizing the
4 agency to adopt rules relating to interagency
5 agreements; amending s. 766.314, F.S.;
6 redefining the term "infant delivered";
7 amending s. 400.462, F.S.; redefining the terms
8 "companion" and "sitter"; amending s. 400.464,
9 F.S.; deleting references to regulated entities
10 other than home health agencies; increasing
11 penalties for specified violations and
12 providing penalties for persons operating home
13 health agencies who fail to cease operation
14 when directed to do so; amending s. 400.471,
15 F.S.; requiring additional information from
16 applicants for home health agency licensure;
17 amending s. 400.487, F.S.; revising
18 requirements relating to treatment orders when
19 claims are submitted to managed care
20 organizations; amending s. 400.491, F.S.;
21 deleting a requirement that home health
22 agencies maintain a service provision plan for
23 clients receiving nonskilled services; amending
24 s. 400.512, F.S., relating to screening of home
25 health agency personnel; deleting references to
26 persons employed as companions and homemakers;
27 amending s. 400.515, F.S.; revising provisions
28 relating to injunctive proceedings by the
29 agency; repealing s. 400.509, F.S., relating to
30 registration of service providers exempt from
31 licensure; providing an effective date.
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1 Be It Enacted by the Legislature of the State of Florida:
2
3 Section 1. Subsection (7) of section 120.80, Florida
4 Statutes, is amended to read:
5 120.80 Exceptions and special requirements;
6 agencies.--
7 (7) DEPARTMENT OF CHILDREN AND FAMILY SERVICES AND
8 AGENCY FOR HEALTH CARE ADMINISTRATION.--Notwithstanding s.
9 120.57(1)(a), hearings conducted within the Department of
10 Children and Family Services and the Agency for Health Care
11 Administration in the execution of those social and economic
12 programs administered by the former Division of Family
13 Services of the former Department of Health and Rehabilitative
14 Services prior to the reorganization effected by chapter
15 75-48, Laws of Florida, need not be conducted by an
16 administrative law judge assigned by the division.
17 Section 2. Subsections (8), (15), and (16) of section
18 400.0255, Florida Statutes, are amended to read:
19 400.0255 Resident transfer or discharge; requirements
20 and procedures; hearings.--
21 (8) The notice required by subsection (7) must be in
22 writing and must contain all information required by state and
23 federal law, rules, or regulations applicable to Medicaid or
24 Medicare cases. The agency shall develop a standard document
25 to be used by all facilities licensed under this part for
26 purposes of notifying residents of a discharge or transfer.
27 Such document must include a means for a resident to request
28 the local long-term care ombudsman council to review the
29 notice and request information about or assistance with
30 initiating a fair hearing with the agency's department's
31 Office of Fair Appeals Hearings. In addition to any other
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1 pertinent information included, the form shall specify the
2 reason allowed under federal or state law that the resident is
3 being discharged or transferred, with an explanation to
4 support this action. Further, the form shall state the
5 effective date of the discharge or transfer and the location
6 to which the resident is being discharged or transferred. The
7 form shall clearly describe the resident's appeal rights and
8 the procedures for filing an appeal, including the right to
9 request the local ombudsman council to review the notice of
10 discharge or transfer. A copy of the notice must be placed in
11 the resident's clinical record, and a copy must be transmitted
12 to the resident's legal guardian or representative and to the
13 local ombudsman council within 5 business days after signature
14 by the resident or resident designee.
15 (15)(a) The agency's department's Office of Fair
16 Appeals Hearings shall conduct hearings under this section.
17 The office shall notify the facility of a resident's request
18 for a hearing.
19 (b) The agency department shall, by rule, establish
20 procedures to be used for fair hearings requested by
21 residents. These procedures shall be equivalent to the
22 procedures used for fair hearings for other Medicaid cases,
23 chapter 65-2 10-2, part VI, Florida Administrative Code. The
24 burden of proof must be clear and convincing evidence. A
25 hearing decision must be rendered within 90 days after receipt
26 of the request for hearing.
27 (c) If the hearing decision is favorable to the
28 resident who has been transferred or discharged, the resident
29 must be readmitted to the facility's first available bed.
30 (d) The decision of the hearing officer shall be
31 final. Any aggrieved party may appeal the decision to the
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1 district court of appeal in the appellate district where the
2 facility is located. Review procedures shall be conducted in
3 accordance with the Florida Rules of Appellate Procedure.
4 (16) The agency department may adopt rules necessary
5 to administer this section.
6 Section 3. Subsection (13) is added to section 408.15,
7 Florida Statutes, to read:
8 408.15 Powers of the agency.--In addition to the
9 powers granted to the agency elsewhere in this chapter, the
10 agency is authorized to:
11 (13) Establish and conduct those Medicaid fair
12 hearings that are unrelated to eligibility determinations, in
13 accordance with 42 C.F.R. s. 431.200 and other applicable
14 federal and state laws.
15 Section 4. Subsections (4) and (11) of section
16 409.91195, Florida Statutes, are amended to read:
17 409.91195 Medicaid Pharmaceutical and Therapeutics
18 Committee.--There is created a Medicaid Pharmaceutical and
19 Therapeutics Committee within the Agency for Health Care
20 Administration for the purpose of developing a preferred drug
21 formulary pursuant to 42 U.S.C. s. 1396r-8.
22 (4) Upon recommendation of the Medicaid Pharmaceutical
23 and Therapeutics Committee, the agency shall adopt a preferred
24 drug list. To the extent feasible, the committee shall review
25 the top 75 percent of all drug classes, based on use, included
26 in the formulary at least every 12 months, and all other
27 therapeutic classes biennially. The committee may recommend
28 additions to and deletions from the formulary, such that the
29 formulary provides for medically appropriate drug therapies
30 for Medicaid patients which achieve cost savings contained in
31 the General Appropriations Act.
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1 (11) Medicaid recipients may appeal agency preferred
2 drug list formulary decisions using the Medicaid fair hearing
3 process administered by the agency's Office of Fair Hearings
4 Department of Children and Family Services.
5 Section 5. Subsections (1) and (2) of section
6 400.0239, Florida Statutes, are amended to read:
7 400.0239 Quality of Long-Term Care Facility
8 Improvement Trust Fund.--
9 (1) There is created within the Agency for Health Care
10 Administration a Quality of Long-Term Care Facility
11 Improvement Trust Fund to support activities and programs
12 directly related to improvement of the care of nursing home
13 and assisted living facility residents. The trust fund shall
14 be funded through proceeds generated pursuant to ss. 400.0238
15 and 400.4298, through funds specifically appropriated by the
16 Legislature, and through gifts, endowments, and other
17 charitable contributions allowed under federal and state law,
18 and federal nursing home civil monetary penalties collected by
19 the Centers for Medicare and Medicaid Services and returned to
20 the state. These funds must be used in accordance with federal
21 requirements.
22 (2) Expenditures from the trust fund shall be
23 allowable for direct support of the following:
24 (a) Development and operation of a mentoring program,
25 in consultation with the Department of Health and the
26 Department of Elderly Affairs, for increasing the competence,
27 professionalism, and career preparation of long-term care
28 facility direct care staff, including nurses, nursing
29 assistants, and social service and dietary personnel.
30 (b) Development and implementation of specialized
31 training programs for long-term care facility personnel who
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1 provide direct care for residents with Alzheimer's disease and
2 other dementias, residents at risk of developing pressure
3 sores, and residents with special nutrition and hydration
4 needs.
5 (c) Areas of deficient practice identified through
6 regulation or state monitoring.
7 (d)(c) Provision of economic and other incentives to
8 enhance the stability and career development of the nursing
9 home direct care workforce, including paid sabbaticals for
10 exemplary direct care career staff to visit facilities
11 throughout the state to train and motivate younger workers to
12 commit to careers in long-term care.
13 (e)(d) Promotion and support for the formation and
14 active involvement of resident and family councils in the
15 improvement of nursing home care.
16 (f) Evaluation of special resident needs in long-term
17 care facilities, including challenges in meeting resident
18 needs; appropriateness of placement and setting; and
19 deficiencies cited related to caring for special needs.
20 (g) Other initiatives authorized by the Centers for
21 Medicare and Medicaid Services for the use of federal civil
22 monetary penalties, including projects recommended through the
23 Medicaid Up or Out program pursuant to s. 400.148.
24 Section 6. Subsection (12) is added to section
25 400.071, Florida Statutes, to read:
26 400.071 Application for license.--
27 (12) The applicant must provide the agency with proof
28 of legal right to occupy the property before a license may be
29 issued. Proof may include, but is not limited to, copies of
30 warranty deeds, lease or rental agreements, contracts for
31 deeds, or quitclaim deeds.
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1 Section 7. Section 400.414, Florida Statutes, is
2 amended to read:
3 400.414 Denial, revocation, or suspension of license;
4 imposition of administrative fine; grounds.--
5 (1) The agency may deny, revoke, or suspend any
6 license issued under this part, or impose an administrative
7 fine in the manner provided in chapter 120, for any of the
8 following actions by an assisted living facility, for the
9 actions of any person subject to level 2 background screening
10 under s. 400.4174, or for the actions of any facility
11 employee:
12 (a) An intentional or negligent act seriously
13 affecting the health, safety, or welfare of a resident of the
14 facility.
15 (b) The determination by the agency that the owner
16 lacks the financial ability to provide continuing adequate
17 care to residents.
18 (c) Misappropriation or conversion of the property of
19 a resident of the facility.
20 (d) Failure to follow the criteria and procedures
21 provided under part I of chapter 394 relating to the
22 transportation, voluntary admission, and involuntary
23 examination of a facility resident.
24 (e) A citation of any of the following deficiencies as
25 defined in s. 400.419:
26 1. One or more cited class I deficiencies;
27 2. Three or more cited class II deficiencies; or
28 3. Five or more cited class III deficiencies that have
29 been cited on a single survey and have not been corrected
30 within the time specified. One or more class I, three or more
31 class II, or five or more repeated or recurring identical or
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1 similar class III violations that are similar or identical to
2 violations which were identified by the agency within the last
3 2 years.
4 (f) A determination that a person subject to level 2
5 background screening under s. 400.4174(1) does not meet the
6 screening standards of s. 435.04 or that the facility is
7 retaining an employee subject to level 1 background screening
8 standards under s. 400.4174(2) who does not meet the screening
9 standards of s. 435.03 and for whom exemptions from
10 disqualification have not been provided by the agency.
11 (g) A determination that an employee, volunteer,
12 administrator, or owner, or person who otherwise has access to
13 the residents of a facility does not meet the criteria
14 specified in s. 435.03(2), and the owner or administrator has
15 not taken action to remove the person. Exemptions from
16 disqualification may be granted as set forth in s. 435.07. No
17 administrative action may be taken against the facility if the
18 person is granted an exemption.
19 (h) Violation of a moratorium.
20 (i) Failure of the license applicant, the licensee
21 during relicensure, or a licensee that holds a provisional
22 license to meet the minimum license requirements of this part,
23 or related rules, at the time of license application or
24 renewal.
25 (j) A fraudulent statement or omission of any material
26 fact on an application for a license or any other document
27 required by the agency, including the submission of a license
28 application that conceals the fact that any board member,
29 officer, or person owning 5 percent or more of the facility
30 may not meet the background screening requirements of s.
31 400.4174, or that the applicant has been excluded, permanently
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1 suspended, or terminated from the Medicaid or Medicare
2 programs.
3 (k) An intentional or negligent life-threatening act
4 in violation of the uniform firesafety standards for assisted
5 living facilities or other firesafety standards that threatens
6 the health, safety, or welfare of a resident of a facility, as
7 communicated to the agency by the local authority having
8 jurisdiction or the State Fire Marshal.
9 (l) Exclusion, permanent suspension, or termination
10 from the Medicare or Medicaid programs.
11 (m) Knowingly operating any unlicensed facility or
12 providing without a license any service that must be licensed
13 under this chapter.
14 (n) Any act constituting a ground upon which
15 application for a license may be denied.
16
17 Administrative proceedings challenging agency action under
18 this subsection shall be reviewed on the basis of the facts
19 and conditions that resulted in the agency action.
20 (2) Upon notification by the local authority having
21 jurisdiction or by the State Fire Marshal, the agency may deny
22 or revoke the license of an assisted living facility that
23 fails to correct cited fire code violations that affect or
24 threaten the health, safety, or welfare of a resident of a
25 facility.
26 (3) The agency may deny a license to any applicant or
27 to any officer or board member of an applicant who is a firm,
28 corporation, partnership, or association or who owns 5 percent
29 or more of the facility, if the applicant, officer, or board
30 member has or had a 25-percent or greater financial or
31 ownership interest in any other facility licensed under this
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1 part, or in any entity licensed by this state or another state
2 to provide health or residential care, which facility or
3 entity during the 5 years prior to the application for a
4 license closed due to financial inability to operate; had a
5 receiver appointed or a license denied, suspended, or revoked;
6 was subject to a moratorium on admissions; had an injunctive
7 proceeding initiated against it; or has an outstanding fine
8 assessed under this chapter.
9 (4) The agency shall deny or revoke the license of an
10 assisted living facility that has two or more class I
11 violations that are similar or identical to violations
12 identified by the agency during a survey, inspection,
13 monitoring visit, or complaint investigation occurring within
14 the previous 2 years.
15 (5) An action taken by the agency to suspend, deny, or
16 revoke a facility's license under this part, in which the
17 agency claims that the facility owner or an employee of the
18 facility has threatened the health, safety, or welfare of a
19 resident of the facility be heard by the Division of
20 Administrative Hearings of the Department of Management
21 Services within 120 days after receipt of the facility's
22 request for a hearing, unless that time limitation is waived
23 by both parties. The administrative law judge must render a
24 decision within 30 days after receipt of a proposed
25 recommended order.
26 (6) The agency shall provide to the Division of Hotels
27 and Restaurants of the Department of Business and Professional
28 Regulation, on a monthly basis, a list of those assisted
29 living facilities that have had their licenses denied,
30 suspended, or revoked or that are involved in an appellate
31
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1 proceeding pursuant to s. 120.60 related to the denial,
2 suspension, or revocation of a license.
3 (7) Agency notification of a license suspension or
4 revocation, or denial of a license renewal, shall be posted
5 and visible to the public at the facility.
6 (8) The agency may issue a temporary license pending
7 final disposition of a proceeding involving the suspension or
8 revocation of an assisted living facility license.
9 Section 8. Section 400.419, Florida Statutes, is
10 amended to read:
11 400.419 Violations; administrative fines; imposition
12 of administrative fines; grounds.--
13 (1) The agency shall impose an administrative fine in
14 the manner provided in chapter 120 for any of the actions or
15 violations as set forth within this section by an assisted
16 living facility, for the actions of any persons subject to
17 level 2 background screening under s. 400.4174, for the
18 actions of any facility employee, or for an intentional or
19 negligent act seriously affecting the health, safety, or
20 welfare of a resident of the facility.
21 (2)(1) Each violation of this part and adopted rules
22 shall be classified according to the nature of the violation
23 and the gravity of its probable effect on facility residents.
24 The agency shall indicate the classification on the written
25 notice of the violation as follows:
26 (a) Class "I" violations are those conditions or
27 occurrences related to the operation and maintenance of a
28 facility or to the personal care of residents which the agency
29 determines present an imminent danger to the residents or
30 guests of the facility or a substantial probability that death
31 or serious physical or emotional harm would result therefrom.
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1 The condition or practice constituting a class I violation
2 shall be abated or eliminated within 24 hours, unless a fixed
3 period, as determined by the agency, is required for
4 correction. The agency shall impose an administrative fine for
5 a cited class I violation is subject to an administrative fine
6 in an amount not less than $5,000 and not exceeding $10,000
7 for each violation. A fine may be levied notwithstanding the
8 correction of the violation.
9 (b) Class "II" violations are those conditions or
10 occurrences related to the operation and maintenance of a
11 facility or to the personal care of residents which the agency
12 determines directly threaten the physical or emotional health,
13 safety, or security of the facility residents, other than
14 class I violations. The agency shall impose an administrative
15 fine for a cited class II violation is subject to an
16 administrative fine in an amount not less than $1,000 and not
17 exceeding $5,000 for each violation. A fine shall be levied
18 notwithstanding the correction of the violation A citation for
19 a class II violation must specify the time within which the
20 violation is required to be corrected.
21 (c) Class "III" violations are those conditions or
22 occurrences related to the operation and maintenance of a
23 facility or to the personal care of residents which the agency
24 determines indirectly or potentially threaten the physical or
25 emotional health, safety, or security of facility residents,
26 other than class I or class II violations. The agency shall
27 impose an administrative fine for a cited class III violation
28 in an amount is subject to an administrative fine of not less
29 than $500 and not exceeding $1,000 for each violation. A
30 citation for a class III violation must specify the time
31 within which the violation is required to be corrected. If a
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1 class III violation is corrected within the time specified, no
2 fine may be imposed, unless it is a repeated offense.
3 (d) Class "IV" violations are those conditions or
4 occurrences related to the operation and maintenance of a
5 building or to required reports, forms, or documents that do
6 not have the potential of negatively affecting residents.
7 These violations are of a type that the agency determines do
8 not threaten the health, safety, or security of residents of
9 the facility. The agency shall impose an administrative fine
10 for a cited class IV violation in an amount A facility that
11 does not correct a class IV violation within the time
12 specified in the agency-approved corrective action plan is
13 subject to an administrative fine of not less than $100 nor
14 more than $200 for each violation. A citation for a class IV
15 violation must specify the time within which the violation is
16 required to be corrected. If a class IV violation is corrected
17 within the time specified, no fine shall be imposed. Any class
18 IV violation that is corrected during the time an agency
19 survey is being conducted will be identified as an agency
20 finding and not as a violation.
21 (3)(2) In determining if a penalty is to be imposed
22 and in fixing the amount of the fine, the agency shall
23 consider the following factors:
24 (a) The gravity of the violation, including the
25 probability that death or serious physical or emotional harm
26 to a resident will result or has resulted, the severity of the
27 action or potential harm, and the extent to which the
28 provisions of the applicable laws or rules were violated.
29 (b) Actions taken by the owner or administrator to
30 correct violations.
31 (c) Any previous violations.
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1 (d) The financial benefit to the facility of
2 committing or continuing the violation.
3 (e) The licensed capacity of the facility.
4 (4)(3) Each day of continuing violation after the date
5 fixed for termination of the violation, as ordered by the
6 agency, constitutes an additional, separate, and distinct
7 violation.
8 (5)(4) Any action taken to correct a violation shall
9 be documented in writing by the owner or administrator of the
10 facility and verified through followup visits by agency
11 personnel. The agency may impose a fine and, in the case of an
12 owner-operated facility, revoke or deny a facility's license
13 when a facility administrator fraudulently misrepresents
14 action taken to correct a violation.
15 (6)(5) For fines that are upheld following
16 administrative or judicial review, the violator shall pay the
17 fine, plus interest at the rate as specified in s. 55.03, for
18 each day beyond the date set by the agency for payment of the
19 fine.
20 (7)(6) Any unlicensed facility that continues to
21 operate after agency notification is subject to a $1,000 fine
22 per day.
23 (8)(7) Any licensed facility whose owner or
24 administrator concurrently operates an unlicensed facility
25 shall be subject to an administrative fine of $5,000 per day.
26 (9)(8) Any facility whose owner fails to apply for a
27 change-of-ownership license in accordance with s. 400.412 and
28 operates the facility under the new ownership is subject to a
29 fine of $5,000.
30 (10)(9) In addition to any administrative fines
31 imposed, the agency may assess a survey fee, equal to the
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1 lesser of one half of the facility's biennial license and bed
2 fee or $500, to cover the cost of conducting initial complaint
3 investigations that result in the finding of a violation that
4 was the subject of the complaint or monitoring visits
5 conducted under s. 400.428(3)(c) to verify the correction of
6 the violations.
7 (11)(10) The agency, as an alternative to or in
8 conjunction with an administrative action against a facility
9 for violations of this part and adopted rules, shall make a
10 reasonable attempt to discuss each violation and recommended
11 corrective action with the owner or administrator of the
12 facility, prior to written notification. The agency, instead
13 of fixing a period within which the facility shall enter into
14 compliance with standards, may request a plan of corrective
15 action from the facility which demonstrates a good faith
16 effort to remedy each violation by a specific date, subject to
17 the approval of the agency.
18 (12)(11) Administrative fines paid by any facility
19 under this section shall be deposited into the Health Care
20 Trust Fund and expended as provided in s. 400.418.
21 (13)(12) The agency shall develop and disseminate an
22 annual list of all facilities sanctioned or fined $5,000 or
23 more for violations of state standards, the number and class
24 of violations involved, the penalties imposed, and the current
25 status of cases. The list shall be disseminated, at no charge,
26 to the Department of Elderly Affairs, the Department of
27 Health, the Department of Children and Family Services, the
28 area agencies on aging, the Florida Statewide Advocacy
29 Council, and the state and local ombudsman councils. The
30 Department of Children and Family Services shall disseminate
31 the list to service providers under contract to the department
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1 who are responsible for referring persons to a facility for
2 residency. The agency may charge a fee commensurate with the
3 cost of printing and postage to other interested parties
4 requesting a copy of this list.
5 Section 9. Subsection (1) of section 400.417, Florida
6 Statutes, is amended to read:
7 400.417 Expiration of license; renewal; conditional
8 license.--
9 (1) Biennial licenses, unless sooner suspended or
10 revoked, shall expire 2 years from the date of issuance.
11 Limited nursing, extended congregate care, and limited mental
12 health licenses shall expire at the same time as the
13 facility's standard license, regardless of when issued. The
14 agency shall notify the facility by certified mail at least
15 120 days prior to expiration that a renewal license is
16 necessary to continue operation. The notification must be
17 provided electronically or by mail delivery. Ninety days prior
18 to the expiration date, an application for renewal shall be
19 submitted to the agency. Fees must be prorated. The failure
20 to file a timely renewal application shall result in a late
21 fee charged to the facility in an amount equal to 50 percent
22 of the current fee.
23 Section 10. Subsection (1) of section 400.557, Florida
24 Statutes, is amended to read:
25 400.557 Expiration of license; renewal; conditional
26 license or permit.--
27 (1) A license issued for the operation of an adult day
28 care center, unless sooner suspended or revoked, expires 2
29 years after the date of issuance. The agency shall notify a
30 licensee by certified mail, return receipt requested, at least
31 120 days before the expiration date that license renewal is
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1 required to continue operation. The notification must be
2 provided electronically or by mail delivery. At least 90 days
3 prior to the expiration date, an application for renewal must
4 be submitted to the agency. A license shall be renewed, upon
5 the filing of an application on forms furnished by the agency,
6 if the applicant has first met the requirements of this part
7 and of the rules adopted under this part. The applicant must
8 file with the application satisfactory proof of financial
9 ability to operate the center in accordance with the
10 requirements of this part and in accordance with the needs of
11 the participants to be served and an affidavit of compliance
12 with the background screening requirements of s. 400.5572.
13 Section 11. Subsection (3) of section 400.619, Florida
14 Statutes, is amended to read:
15 400.619 Licensure application and renewal.--
16 (3) The agency shall notify a licensee at least 120
17 days before the expiration date that license renewal is
18 required to continue operation. The notification must be
19 provided electronically or by mail delivery. Application for a
20 license or annual license renewal must be made on a form
21 provided by the agency, signed under oath, and must be
22 accompanied by a licensing fee of $100 per year.
23 Section 12. Paragraph (h) of subsection (4) of section
24 400.980, Florida Statutes, is repealed.
25 Section 13. Subsections (4) and (6) of section
26 408.061, Florida Statutes, are amended to read:
27 408.061 Data collection; uniform systems of financial
28 reporting; information relating to physician charges;
29 confidential information; immunity.--
30 (4)(a) Within 120 days after the end of its fiscal
31 year, each health care facility, excluding nursing homes and
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1 continuing care facilities as defined in s. 408.07(23) and
2 (36), shall file with the agency, on forms adopted by the
3 agency and based on the uniform system of financial reporting,
4 its actual financial experience for that fiscal year,
5 including expenditures, revenues, and statistical measures.
6 Such data may be based on internal financial reports which are
7 certified to be complete and accurate by the provider.
8 However, hospitals' actual financial experience shall be their
9 audited actual experience. Nursing homes that do not
10 participate in the Medicare or Medicaid programs shall also
11 submit audited actual experience. Every nursing home shall
12 submit to the agency, in a format designated by the agency, a
13 statistical profile of the nursing home residents. The agency,
14 in conjunction with the Department of Elderly Affairs and the
15 Department of Health, shall review these statistical profiles
16 and develop recommendations for the types of residents who
17 might more appropriately be placed in their homes or other
18 noninstitutional settings.
19 (b) Each nursing home shall also submit a schedule of
20 the charges in effect at the beginning of the fiscal year and
21 any changes that were made during the fiscal year. A nursing
22 home which is certified under Title XIX of the Social Security
23 Act and files annual Medicaid cost reports may substitute
24 copies of such reports and any Medicaid audits to the agency
25 in lieu of a report and audit required under this subsection.
26 For such facilities, the agency may require only information
27 in compliance with this chapter that is not contained in the
28 Medicaid cost report. Facilities that are certified under
29 Title XVIII, but not Title XIX, of the Social Security Act
30 must submit a report as developed by the agency. This report
31 shall be substantially the same as the Medicaid cost report
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1 and shall not require any more information than is contained
2 in the Medicare cost report unless that information is
3 required of all nursing homes. The audit under Title XVIII
4 shall satisfy the audit requirement under this subsection.
5 (6) Any nursing home which assesses residents a
6 separate charge for personal laundry services shall submit to
7 the agency data on the monthly charge for such services,
8 excluding drycleaning. For facilities that charge based on
9 the amount of laundry, the most recent schedule of charges and
10 the average monthly charge shall be submitted to the agency.
11 Section 14. Subsection (2) of section 408.062, Florida
12 Statutes, is repealed.
13 Section 15. Present subsection (2) of section 408.831,
14 Florida Statutes, is renumbered as subsection (3), and a new
15 subsection (2) is added to that section, to read:
16 408.831 Denial, suspension, or revocation of a
17 license, registration, certificate, or application.--
18 (2) In reviewing any application requesting a change
19 of ownership or change of the licensee, registrant, or
20 certificateholder, the transferor shall, prior to agency
21 approval of the change, repay or make arrangements to repay
22 any amounts owed to the agency. If the transferor fails to
23 repay or make arrangements to repay the amounts owed to the
24 agency, the issuance of a license, registration, or
25 certificate to the transferee shall be delayed until repayment
26 or until arrangements for repayment are made.
27 Section 16. Present subsections (17) through (27) of
28 section 409.811, Florida Statutes, are renumbered as
29 subsections (18) through (28), respectively, and a new
30 subsection (17) is added to that section, to read:
31
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1 409.811 Definitions relating to Florida Kidcare
2 Act.--As used in ss. 409.810-409.820, the term:
3 (17) "Managed care plan" means a health maintenance
4 organization authorized pursuant to chapter 641 or a prepaid
5 health plan authorized pursuant to s. 409.912.
6 Section 17. Subsection (7) of section 409.8132,
7 Florida Statutes, is amended to read:
8 409.8132 Medikids program component.--
9 (7) ENROLLMENT.--Enrollment in the Medikids program
10 component may only occur during periodic open enrollment
11 periods as specified by the agency. An applicant may apply for
12 enrollment in the Medikids program component and proceed
13 through the eligibility determination process at any time
14 throughout the year. However, enrollment in Medikids shall not
15 begin until the next open enrollment period; and a child may
16 not receive services under the Medikids program until the
17 child is enrolled in a managed care plan, as defined in s.
18 409.811, or in MediPass. In addition, once determined
19 eligible, an applicant may receive choice counseling and
20 select a managed care plan or MediPass. The agency may
21 initiate mandatory assignment for a Medikids applicant who has
22 not chosen a managed care plan or MediPass provider after the
23 applicant's voluntary choice period ends. An applicant may
24 select MediPass under the Medikids program component only in
25 counties that have fewer than two managed care plans available
26 to serve Medicaid recipients and only if the federal Health
27 Care Financing Administration determines that MediPass
28 constitutes "health insurance coverage" as defined in Title
29 XXI of the Social Security Act.
30 Section 18. Section 409.91188, Florida Statutes, is
31 amended to read:
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1 409.91188 Specialty prepaid health plans for Medicaid
2 recipients with HIV or AIDS.--
3 (1) The Agency for Health Care Administration shall
4 issue a request for proposal or intent to implement a is
5 authorized to contract with specialty prepaid health plans
6 authorized pursuant to subsection (2) of this section and to
7 pay them on a prepaid capitated basis to provide Medicaid
8 benefits to Medicaid-eligible recipients who have human
9 immunodeficiency syndrome (HIV) or acquired immunodeficiency
10 syndrome (AIDS). The agency shall apply for or amend existing
11 applications for and is authorized to implement federal
12 waivers or other necessary federal authorization to implement
13 the prepaid health plans authorized by this section. The
14 agency shall procure the specialty prepaid health plans
15 through a competitive procurement. In awarding a contract to a
16 managed care plan, the agency shall take into account price,
17 quality, accessibility, linkages to community-based
18 organizations, and the comprehensiveness of the benefit
19 package offered by the plan. The agency may bid the HIV/AIDS
20 specialty plans on a county, regional, or statewide basis.
21 Qualified plans must be licensed under chapter 641. The agency
22 shall monitor and evaluate the implementation of this waiver
23 program if it is approved by the Federal Government and shall
24 report on its status to the President of the Senate and the
25 Speaker of the House of Representatives by February 1, 2001.
26 To improve coordination of medical care delivery and to
27 increase cost efficiency for the Medicaid program in treating
28 HIV disease, the Agency for Health Care Administration shall
29 seek all necessary federal waivers to allow participation in
30 the Medipass HIV disease management program for Medicare
31 beneficiaries who test positive for HIV infection and who also
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1 qualify for Medicaid benefits such as prescription medications
2 not covered by Medicare.
3 (2) The agency may contract with any public or private
4 entity authorized by this section on a prepaid or fixed-sum
5 basis for the provision of health care services to recipients.
6 An entity may provide prepaid services to recipients, either
7 directly or through arrangements with other entities. Each
8 entity shall:
9 (a) Be organized primarily for the purpose of
10 providing health care or other services of the type regularly
11 offered to Medicaid recipients in compliance with federal
12 laws.
13 (b) Ensure that services meet the standards set by the
14 agency for quality, appropriateness, and timeliness.
15 (c) Make provisions satisfactory to the agency for
16 insolvency protection and ensure that neither enrolled
17 Medicaid recipients nor the agency is liable for the debts of
18 the entity.
19 (d) Provide to the agency a financial plan that
20 ensures fiscal soundness and that may include provisions
21 pursuant to which the entity and the agency share in the risk
22 of providing health care services. The contractual arrangement
23 between an entity and the agency shall provide for risk
24 sharing. The agency may bear the cost of providing certain
25 services when those costs exceed established risk limits or
26 arrangements whereby certain services are specifically
27 excluded under the terms of the contract between an entity and
28 the agency.
29 (e) Provide, through contract or otherwise, for
30 periodic review of its medical facilities and services, as
31 required by the agency.
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1 (f) Furnish evidence satisfactory to the agency of
2 adequate liability insurance coverage or an adequate plan of
3 self-insurance to respond to claims for injuries arising out
4 of the furnishing of health care.
5 (g) Provides organizational, operational, financial,
6 and other information required by the agency.
7 Section 19. Section 409.912, Florida Statutes, is
8 amended to read:
9 409.912 Cost-effective purchasing of health care.--The
10 agency shall purchase goods and services for Medicaid
11 recipients in the most cost-effective manner consistent with
12 the delivery of quality medical care. The agency shall
13 maximize the use of prepaid per capita and prepaid aggregate
14 fixed-sum basis services when appropriate and other
15 alternative service delivery and reimbursement methodologies,
16 including competitive bidding pursuant to s. 287.057, designed
17 to facilitate the cost-effective purchase of a case-managed
18 continuum of care. The agency shall also require providers to
19 minimize the exposure of recipients to the need for acute
20 inpatient, custodial, and other institutional care and the
21 inappropriate or unnecessary use of high-cost services. The
22 agency may establish prior authorization requirements for
23 certain populations of Medicaid beneficiaries, certain drug
24 classes, or particular drugs to prevent fraud, abuse, overuse,
25 and possible dangerous drug interactions. The Pharmaceutical
26 and Therapeutics Committee shall make recommendations to the
27 agency on drugs for which prior authorization is required. The
28 agency shall inform the Pharmaceutical and Therapeutics
29 Committee of its decisions regarding drugs subject to prior
30 authorization.
31
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1 (1) The agency may enter into agreements with
2 appropriate agents of other state agencies or of any agency of
3 the Federal Government and accept such duties in respect to
4 social welfare or public aid as may be necessary to implement
5 the provisions of Title XIX of the Social Security Act and ss.
6 409.901-409.920.
7 (2) The agency may contract with health maintenance
8 organizations certified pursuant to part I of chapter 641 for
9 the provision of services to recipients.
10 (3) The agency may contract with:
11 (a) An entity that provides no prepaid health care
12 services other than Medicaid services under contract with the
13 agency and which is owned and operated by a county, county
14 health department, or county-owned and operated hospital to
15 provide health care services on a prepaid or fixed-sum basis
16 to recipients, which entity may provide such prepaid services
17 either directly or through arrangements with other providers.
18 Such prepaid health care services entities must be licensed
19 under parts I and III by January 1, 1998, and until then are
20 exempt from the provisions of part I of chapter 641. An entity
21 recognized under this paragraph which demonstrates to the
22 satisfaction of the Department of Insurance that it is backed
23 by the full faith and credit of the county in which it is
24 located may be exempted from s. 641.225.
25 (b) An entity that is providing comprehensive
26 behavioral health care services to certain Medicaid recipients
27 through a capitated, prepaid arrangement pursuant to the
28 federal waiver provided for by s. 409.905(5). Such an entity
29 must be licensed under chapter 624, chapter 636, or chapter
30 641 and must possess the clinical systems and operational
31 competence to manage risk and provide comprehensive behavioral
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1 health care to Medicaid recipients. As used in this paragraph,
2 the term "comprehensive behavioral health care services" means
3 covered mental health and substance abuse treatment services
4 that are available to Medicaid recipients. The secretary of
5 the Department of Children and Family Services shall approve
6 provisions of procurements related to children in the
7 department's care or custody prior to enrolling such children
8 in a prepaid behavioral health plan. Any contract awarded
9 under this paragraph must be competitively procured. In
10 developing the behavioral health care prepaid plan procurement
11 document, the agency shall ensure that the procurement
12 document requires the contractor to develop and implement a
13 plan to ensure compliance with s. 394.4574 related to services
14 provided to residents of licensed assisted living facilities
15 that hold a limited mental health license. The agency must
16 ensure that Medicaid recipients have available the choice of
17 at least two managed care plans for their behavioral health
18 care services. To ensure unimpaired access to behavioral
19 health care services by Medicaid recipients, all contracts
20 issued pursuant to this paragraph shall require 80 percent of
21 the capitation paid to the managed care plan, including health
22 maintenance organizations, to be expended for the provision of
23 behavioral health care services. In the event the managed care
24 plan expends less than 80 percent of the capitation paid
25 pursuant to this paragraph for the provision of behavioral
26 health care services, the difference shall be returned to the
27 agency. The agency shall provide the managed care plan with a
28 certification letter indicating the amount of capitation paid
29 during each calendar year for the provision of behavioral
30 health care services pursuant to this section. The agency may
31 reimburse for substance-abuse-treatment services on a
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1 fee-for-service basis until the agency finds that adequate
2 funds are available for capitated, prepaid arrangements.
3 1. By January 1, 2001, the agency shall modify the
4 contracts with the entities providing comprehensive inpatient
5 and outpatient mental health care services to Medicaid
6 recipients in Hillsborough, Highlands, Hardee, Manatee, and
7 Polk Counties, to include substance-abuse-treatment services.
8 2. By December 31, 2001, the agency shall contract
9 with entities providing comprehensive behavioral health care
10 services to Medicaid recipients through capitated, prepaid
11 arrangements in Charlotte, Collier, DeSoto, Escambia, Glades,
12 Hendry, Lee, Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota,
13 and Walton Counties. The agency may contract with entities
14 providing comprehensive behavioral health care services to
15 Medicaid recipients through capitated, prepaid arrangements in
16 Alachua County. The agency may determine if Sarasota County
17 shall be included as a separate catchment area or included in
18 any other agency geographic area.
19 3. Children residing in a Department of Juvenile
20 Justice residential program approved as a Medicaid behavioral
21 health overlay services provider shall not be included in a
22 behavioral health care prepaid health plan pursuant to this
23 paragraph.
24 4. In converting to a prepaid system of delivery, the
25 agency shall in its procurement document require an entity
26 providing comprehensive behavioral health care services to
27 prevent the displacement of indigent care patients by
28 enrollees in the Medicaid prepaid health plan providing
29 behavioral health care services from facilities receiving
30 state funding to provide indigent behavioral health care, to
31 facilities licensed under chapter 395 which do not receive
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1 state funding for indigent behavioral health care, or
2 reimburse the unsubsidized facility for the cost of behavioral
3 health care provided to the displaced indigent care patient.
4 5. Traditional community mental health providers under
5 contract with the Department of Children and Family Services
6 pursuant to part IV of chapter 394 and inpatient mental health
7 providers licensed pursuant to chapter 395 must be offered an
8 opportunity to accept or decline a contract to participate in
9 any provider network for prepaid behavioral health services.
10 (c) A federally qualified health center or an entity
11 owned by one or more federally qualified health centers or an
12 entity owned by other migrant and community health centers
13 receiving non-Medicaid financial support from the Federal
14 Government to provide health care services on a prepaid or
15 fixed-sum basis to recipients. Such prepaid health care
16 services entity must be licensed under parts I and III of
17 chapter 641, but shall be prohibited from serving Medicaid
18 recipients on a prepaid basis, until such licensure has been
19 obtained. However, such an entity is exempt from s. 641.225
20 if the entity meets the requirements specified in subsections
21 (14) and (15).
22 (d) A provider service network No more than four
23 provider service networks for demonstration projects to test
24 Medicaid direct contracting. The demonstration projects may be
25 reimbursed on a fee-for-service or prepaid basis. A provider
26 service network which is reimbursed by the agency on a prepaid
27 basis shall be exempt from parts I and III of chapter 641, but
28 must meet appropriate financial reserve, quality assurance,
29 and patient rights requirements as established by the agency.
30 The agency shall award contracts on a competitive bid basis
31 and shall select bidders based upon price and quality of care.
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1 Medicaid recipients assigned to a demonstration project shall
2 be chosen equally from those who would otherwise have been
3 assigned to prepaid plans and MediPass. The agency is
4 authorized to seek federal Medicaid waivers as necessary to
5 implement the provisions of this section. A demonstration
6 project awarded pursuant to this paragraph shall be for 4
7 years from the date of implementation.
8 (e) An entity that provides comprehensive behavioral
9 health care services to certain Medicaid recipients through an
10 administrative services organization agreement. Such an entity
11 must possess the clinical systems and operational competence
12 to provide comprehensive health care to Medicaid recipients.
13 As used in this paragraph, the term "comprehensive behavioral
14 health care services" means covered mental health and
15 substance abuse treatment services that are available to
16 Medicaid recipients. Any contract awarded under this paragraph
17 must be competitively procured. The agency must ensure that
18 Medicaid recipients have available the choice of at least two
19 managed care plans for their behavioral health care services.
20 (f) An entity that provides in-home physician services
21 to test the cost-effectiveness of enhanced home-based medical
22 care to Medicaid recipients with degenerative neurological
23 diseases and other diseases or disabling conditions associated
24 with high costs to Medicaid. The program shall be designed to
25 serve very disabled persons and to reduce Medicaid reimbursed
26 costs for inpatient, outpatient, and emergency department
27 services. The agency shall contract with vendors on a
28 risk-sharing basis.
29 (g) Children's or adult's provider networks that
30 provide care coordination and care management for
31 Medicaid-eligible pediatric patients, primary care,
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1 authorization of specialty care, and other urgent and
2 emergency care through organized providers designed to service
3 Medicaid eligibles under age 18 and pediatric emergency
4 department departments' diversion programs. The networks shall
5 provide after-hour operations, including evening and weekend
6 hours, to promote, when appropriate, the use of the children's
7 and adult's networks rather than hospital emergency
8 departments.
9 (h) An entity authorized in s. 430.205 to contract
10 with the agency and the Department of Elderly Affairs to
11 provide health care and social services on a prepaid or
12 fixed-sum basis to elderly recipients. Such prepaid health
13 care services entities are exempt from the provisions of part
14 I of chapter 641 for the first 3 years of operation. An entity
15 recognized under this paragraph that demonstrates to the
16 satisfaction of the Department of Insurance that it is backed
17 by the full faith and credit of one or more counties in which
18 it operates may be exempted from s. 641.225.
19 (i) A Children's Medical Services network, as defined
20 in s. 391.021.
21 (4) The agency may contract with any public or private
22 entity otherwise authorized by this section on a prepaid or
23 fixed-sum basis for the provision of health care services to
24 recipients. An entity may provide prepaid services to
25 recipients, either directly or through arrangements with other
26 entities, if each entity involved in providing services:
27 (a) Is organized primarily for the purpose of
28 providing health care or other services of the type regularly
29 offered to Medicaid recipients;
30 (b) Ensures that services meet the standards set by
31 the agency for quality, appropriateness, and timeliness;
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1 (c) Makes provisions satisfactory to the agency for
2 insolvency protection and ensures that neither enrolled
3 Medicaid recipients nor the agency will be liable for the
4 debts of the entity;
5 (d) Submits to the agency, if a private entity, a
6 financial plan that the agency finds to be fiscally sound and
7 that provides for working capital in the form of cash or
8 equivalent liquid assets excluding revenues from Medicaid
9 premium payments equal to at least the first 3 months of
10 operating expenses or $200,000, whichever is greater;
11 (e) Furnishes evidence satisfactory to the agency of
12 adequate liability insurance coverage or an adequate plan of
13 self-insurance to respond to claims for injuries arising out
14 of the furnishing of health care;
15 (f) Provides, through contract or otherwise, for
16 periodic review of its medical facilities and services, as
17 required by the agency; and
18 (g) Provides organizational, operational, financial,
19 and other information required by the agency.
20 (5) The agency may contract on a prepaid or fixed-sum
21 basis with any health insurer that:
22 (a) Pays for health care services provided to enrolled
23 Medicaid recipients in exchange for a premium payment paid by
24 the agency;
25 (b) Assumes the underwriting risk; and
26 (c) Is organized and licensed under applicable
27 provisions of the Florida Insurance Code and is currently in
28 good standing with the Department of Insurance.
29 (6) The agency may contract on a prepaid or fixed-sum
30 basis with an exclusive provider organization to provide
31 health care services to Medicaid recipients provided that the
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1 exclusive provider organization meets applicable managed care
2 plan requirements in this section, ss. 409.9122, 409.9123,
3 409.9128, and 627.6472, and other applicable provisions of
4 law.
5 (7) The Agency for Health Care Administration may
6 provide cost-effective purchasing of chiropractic services on
7 a fee-for-service basis to Medicaid recipients through
8 arrangements with a statewide chiropractic preferred provider
9 organization incorporated in this state as a not-for-profit
10 corporation. The agency shall ensure that the benefit limits
11 and prior authorization requirements in the current Medicaid
12 program shall apply to the services provided by the
13 chiropractic preferred provider organization.
14 (8) The agency shall not contract on a prepaid or
15 fixed-sum basis for Medicaid services with an entity which
16 knows or reasonably should know that any officer, director,
17 agent, managing employee, or owner of stock or beneficial
18 interest in excess of 5 percent common or preferred stock, or
19 the entity itself, has been found guilty of, regardless of
20 adjudication, or entered a plea of nolo contendere, or guilty,
21 to:
22 (a) Fraud;
23 (b) Violation of federal or state antitrust statutes,
24 including those proscribing price fixing between competitors
25 and the allocation of customers among competitors;
26 (c) Commission of a felony involving embezzlement,
27 theft, forgery, income tax evasion, bribery, falsification or
28 destruction of records, making false statements, receiving
29 stolen property, making false claims, or obstruction of
30 justice; or
31
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1 (d) Any crime in any jurisdiction which directly
2 relates to the provision of health services on a prepaid or
3 fixed-sum basis.
4 (9) The agency, after notifying the Legislature, may
5 apply for waivers of applicable federal laws and regulations
6 as necessary to implement more appropriate systems of health
7 care for Medicaid recipients and reduce the cost of the
8 Medicaid program to the state and federal governments and
9 shall implement such programs, after legislative approval,
10 within a reasonable period of time after federal approval.
11 These programs must be designed primarily to reduce the need
12 for inpatient care, custodial care and other long-term or
13 institutional care, and other high-cost services.
14 (a) Prior to seeking legislative approval of such a
15 waiver as authorized by this subsection, the agency shall
16 provide notice and an opportunity for public comment. Notice
17 shall be provided to all persons who have made requests of the
18 agency for advance notice and shall be published in the
19 Florida Administrative Weekly not less than 28 days prior to
20 the intended action.
21 (b) Notwithstanding s. 216.292, funds that are
22 appropriated to the Department of Elderly Affairs for the
23 Assisted Living for the Elderly Medicaid waiver and are not
24 expended shall be transferred to the agency to fund
25 Medicaid-reimbursed nursing home care.
26 (10) The agency shall establish a postpayment
27 utilization control program designed to identify recipients
28 who may inappropriately overuse or underuse Medicaid services
29 and shall provide methods to correct such misuse.
30 (11) The agency shall develop and provide coordinated
31 systems of care for Medicaid recipients and may contract with
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1 public or private entities to develop and administer such
2 systems of care among public and private health care providers
3 in a given geographic area.
4 (12) The agency shall operate or contract for the
5 operation of utilization management and incentive systems
6 designed to encourage cost-effective use services.
7 (13)(a) The agency shall operate the Comprehensive
8 Assessment and Review (CARES) nursing facility preadmission
9 screening program to ensure that Medicaid payment for nursing
10 facility care is made only for individuals whose conditions
11 require such care and to ensure that long-term care services
12 are provided in the setting most appropriate to the needs of
13 the person and in the most economical manner possible. The
14 CARES program shall also ensure that individuals participating
15 in Medicaid home and community-based waiver programs meet
16 criteria for those programs, consistent with approved federal
17 waivers.
18 (b) The agency shall operate the CARES program through
19 an interagency agreement with the Department of Elderly
20 Affairs.
21 (c) Prior to making payment for nursing facility
22 services for a Medicaid recipient, the agency must verify that
23 the nursing facility preadmission screening program has
24 determined that the individual requires nursing facility care
25 and that the individual cannot be safely served in
26 community-based programs. The nursing facility preadmission
27 screening program shall refer a Medicaid recipient to a
28 community-based program if the individual could be safely
29 served at a lower cost and the recipient chooses to
30 participate in such program.
31
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1 (d) By January 1 of each year, the agency shall submit
2 a report to the Legislature and the Office of Long-Term-Care
3 Policy describing the operations of the CARES program. The
4 report must describe:
5 1. Rate of diversion to community alternative
6 programs;
7 2. CARES program staffing needs to achieve additional
8 diversions;
9 3. Reasons the program is unable to place individuals
10 in less restrictive settings when such individuals desired
11 such services and could have been served in such settings;
12 4. Barriers to appropriate placement, including
13 barriers due to policies or operations of other agencies or
14 state-funded programs; and
15 5. Statutory changes necessary to ensure that
16 individuals in need of long-term care services receive care in
17 the least restrictive environment.
18 (14)(a) The agency shall identify health care
19 utilization and price patterns within the Medicaid program
20 which are not cost-effective or medically appropriate and
21 assess the effectiveness of new or alternate methods of
22 providing and monitoring service, and may implement such
23 methods as it considers appropriate. Such methods may include
24 disease management initiatives, an integrated and systematic
25 approach for managing the health care needs of recipients who
26 are at risk of or diagnosed with a specific disease by using
27 best practices, prevention strategies, clinical-practice
28 improvement, clinical interventions and protocols, outcomes
29 research, information technology, and other tools and
30 resources to reduce overall costs and improve measurable
31 outcomes.
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1 (b) The responsibility of the agency under this
2 subsection shall include the development of capabilities to
3 identify actual and optimal practice patterns; patient and
4 provider educational initiatives; methods for determining
5 patient compliance with prescribed treatments; fraud, waste,
6 and abuse prevention and detection programs; and beneficiary
7 case management programs.
8 1. The practice pattern identification program shall
9 evaluate practitioner prescribing patterns based on national
10 and regional practice guidelines, comparing practitioners to
11 their peer groups. The agency and its Drug Utilization Review
12 Board shall consult with a panel of practicing health care
13 professionals consisting of the following: the Speaker of the
14 House of Representatives and the President of the Senate shall
15 each appoint three physicians licensed under chapter 458 or
16 chapter 459; and the Governor shall appoint two pharmacists
17 licensed under chapter 465 and one dentist licensed under
18 chapter 466 who is an oral surgeon. Terms of the panel members
19 shall expire at the discretion of the appointing official. The
20 panel shall begin its work by August 1, 1999, regardless of
21 the number of appointments made by that date. The advisory
22 panel shall be responsible for evaluating treatment guidelines
23 and recommending ways to incorporate their use in the practice
24 pattern identification program. Practitioners who are
25 prescribing inappropriately or inefficiently, as determined by
26 the agency, may have their prescribing of certain drugs
27 subject to prior authorization.
28 2. The agency shall also develop educational
29 interventions designed to promote the proper use of
30 medications by providers and beneficiaries.
31
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1 3. The agency shall implement a pharmacy fraud, waste,
2 and abuse initiative that may include a surety bond or letter
3 of credit requirement for participating pharmacies, enhanced
4 provider auditing practices, the use of additional fraud and
5 abuse software, recipient management programs for
6 beneficiaries inappropriately using their benefits, and other
7 steps that will eliminate provider and recipient fraud, waste,
8 and abuse. The initiative shall address enforcement efforts to
9 reduce the number and use of counterfeit prescriptions.
10 4. By September 30, 2002, the agency shall contract
11 with an entity in the state to implement a wireless handheld
12 clinical pharmacology drug information database for
13 practitioners. The initiative shall be designed to enhance the
14 agency's efforts to reduce fraud, abuse, and errors in the
15 prescription drug benefit program and to otherwise further the
16 intent of this paragraph.
17 5. The agency may apply for any federal waivers needed
18 to implement this paragraph.
19 (15) An entity contracting on a prepaid or fixed-sum
20 basis shall, in addition to meeting any applicable statutory
21 surplus requirements, also maintain at all times in the form
22 of cash, investments that mature in less than 180 days
23 allowable as admitted assets by the Department of Insurance,
24 and restricted funds or deposits controlled by the agency or
25 the Department of Insurance, a surplus amount equal to
26 one-and-one-half times the entity's monthly Medicaid prepaid
27 revenues. As used in this subsection, the term "surplus" means
28 the entity's total assets minus total liabilities. If an
29 entity's surplus falls below an amount equal to
30 one-and-one-half times the entity's monthly Medicaid prepaid
31 revenues, the agency shall prohibit the entity from engaging
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1 in marketing and preenrollment activities, shall cease to
2 process new enrollments, and shall not renew the entity's
3 contract until the required balance is achieved. The
4 requirements of this subsection do not apply:
5 (a) Where a public entity agrees to fund any deficit
6 incurred by the contracting entity; or
7 (b) Where the entity's performance and obligations are
8 guaranteed in writing by a guaranteeing organization which:
9 1. Has been in operation for at least 5 years and has
10 assets in excess of $50 million; or
11 2. Submits a written guarantee acceptable to the
12 agency which is irrevocable during the term of the contracting
13 entity's contract with the agency and, upon termination of the
14 contract, until the agency receives proof of satisfaction of
15 all outstanding obligations incurred under the contract.
16 (16)(a) The agency may require an entity contracting
17 on a prepaid or fixed-sum basis to establish a restricted
18 insolvency protection account with a federally guaranteed
19 financial institution licensed to do business in this state.
20 The entity shall deposit into that account 5 percent of the
21 capitation payments made by the agency each month until a
22 maximum total of 2 percent of the total current contract
23 amount is reached. The restricted insolvency protection
24 account may be drawn upon with the authorized signatures of
25 two persons designated by the entity and two representatives
26 of the agency. If the agency finds that the entity is
27 insolvent, the agency may draw upon the account solely with
28 the two authorized signatures of representatives of the
29 agency, and the funds may be disbursed to meet financial
30 obligations incurred by the entity under the prepaid contract.
31 If the contract is terminated, expired, or not continued, the
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1 account balance must be released by the agency to the entity
2 upon receipt of proof of satisfaction of all outstanding
3 obligations incurred under this contract.
4 (b) The agency may waive the insolvency protection
5 account requirement in writing when evidence is on file with
6 the agency of adequate insolvency insurance and reinsurance
7 that will protect enrollees if the entity becomes unable to
8 meet its obligations.
9 (17) An entity that contracts with the agency on a
10 prepaid or fixed-sum basis for the provision of Medicaid
11 services shall reimburse any hospital or physician that is
12 outside the entity's authorized geographic service area as
13 specified in its contract with the agency, and that provides
14 services authorized by the entity to its members, at a rate
15 negotiated with the hospital or physician for the provision of
16 services or according to the lesser of the following:
17 (a) The usual and customary charges made to the
18 general public by the hospital or physician; or
19 (b) The Florida Medicaid reimbursement rate
20 established for the hospital or physician.
21 (18) When a merger or acquisition of a Medicaid
22 prepaid contractor has been approved by the Department of
23 Insurance pursuant to s. 628.4615, the agency shall approve
24 the assignment or transfer of the appropriate Medicaid prepaid
25 contract upon request of the surviving entity of the merger or
26 acquisition if the contractor and the other entity have been
27 in good standing with the agency for the most recent 12-month
28 period, unless the agency determines that the assignment or
29 transfer would be detrimental to the Medicaid recipients or
30 the Medicaid program. To be in good standing, an entity must
31 not have failed accreditation or committed any material
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1 violation of the requirements of s. 641.52 and must meet the
2 Medicaid contract requirements. For purposes of this section,
3 a merger or acquisition means a change in controlling interest
4 of an entity, including an asset or stock purchase.
5 (19) Any entity contracting with the agency pursuant
6 to this section to provide health care services to Medicaid
7 recipients is prohibited from engaging in any of the following
8 practices or activities:
9 (a) Practices that are discriminatory, including, but
10 not limited to, attempts to discourage participation on the
11 basis of actual or perceived health status.
12 (b) Activities that could mislead or confuse
13 recipients, or misrepresent the organization, its marketing
14 representatives, or the agency. Violations of this paragraph
15 include, but are not limited to:
16 1. False or misleading claims that marketing
17 representatives are employees or representatives of the state
18 or county, or of anyone other than the entity or the
19 organization by whom they are reimbursed.
20 2. False or misleading claims that the entity is
21 recommended or endorsed by any state or county agency, or by
22 any other organization which has not certified its endorsement
23 in writing to the entity.
24 3. False or misleading claims that the state or county
25 recommends that a Medicaid recipient enroll with an entity.
26 4. Claims that a Medicaid recipient will lose benefits
27 under the Medicaid program, or any other health or welfare
28 benefits to which the recipient is legally entitled, if the
29 recipient does not enroll with the entity.
30
31
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1 (c) Granting or offering of any monetary or other
2 valuable consideration for enrollment, except as authorized by
3 subsection (21).
4 (d) Door-to-door solicitation of recipients who have
5 not contacted the entity or who have not invited the entity to
6 make a presentation.
7 (e) Solicitation of Medicaid recipients by marketing
8 representatives stationed in state offices unless approved and
9 supervised by the agency or its agent and approved by the
10 affected state agency when solicitation occurs in an office of
11 the state agency. The agency shall ensure that marketing
12 representatives stationed in state offices shall market their
13 managed care plans to Medicaid recipients only in designated
14 areas and in such a way as to not interfere with the
15 recipients' activities in the state office.
16 (f) Enrollment of Medicaid recipients.
17 (20) The agency may impose a fine for a violation of
18 this section or the contract with the agency by a person or
19 entity that is under contract with the agency. With respect
20 to any nonwillful violation, such fine shall not exceed $2,500
21 per violation. In no event shall such fine exceed an
22 aggregate amount of $10,000 for all nonwillful violations
23 arising out of the same action. With respect to any knowing
24 and willful violation of this section or the contract with the
25 agency, the agency may impose a fine upon the entity in an
26 amount not to exceed $20,000 for each such violation. In no
27 event shall such fine exceed an aggregate amount of $100,000
28 for all knowing and willful violations arising out of the same
29 action.
30 (21) A health maintenance organization or a person or
31 entity exempt from chapter 641 that is under contract with the
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1 agency for the provision of health care services to Medicaid
2 recipients may not use or distribute marketing materials used
3 to solicit Medicaid recipients, unless such materials have
4 been approved by the agency. The provisions of this subsection
5 do not apply to general advertising and marketing materials
6 used by a health maintenance organization to solicit both
7 non-Medicaid subscribers and Medicaid recipients.
8 (22) Upon approval by the agency, health maintenance
9 organizations and persons or entities exempt from chapter 641
10 that are under contract with the agency for the provision of
11 health care services to Medicaid recipients may be permitted
12 within the capitation rate to provide additional health
13 benefits that the agency has found are of high quality, are
14 practicably available, provide reasonable value to the
15 recipient, and are provided at no additional cost to the
16 state.
17 (23) The agency shall utilize the statewide health
18 maintenance organization complaint hotline for the purpose of
19 investigating and resolving Medicaid and prepaid health plan
20 complaints, maintaining a record of complaints and confirmed
21 problems, and receiving disenrollment requests made by
22 recipients.
23 (24) The agency shall require the publication of the
24 health maintenance organization's and the prepaid health
25 plan's consumer services telephone numbers and the "800"
26 telephone number of the statewide health maintenance
27 organization complaint hotline on each Medicaid identification
28 card issued by a health maintenance organization or prepaid
29 health plan contracting with the agency to serve Medicaid
30 recipients and on each subscriber handbook issued to a
31 Medicaid recipient.
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1 (25) The agency shall establish a health care quality
2 improvement system for those entities contracting with the
3 agency pursuant to this section, incorporating all the
4 standards and guidelines developed by the Medicaid Bureau of
5 the Health Care Financing Administration as a part of the
6 quality assurance reform initiative. The system shall
7 include, but need not be limited to, the following:
8 (a) Guidelines for internal quality assurance
9 programs, including standards for:
10 1. Written quality assurance program descriptions.
11 2. Responsibilities of the governing body for
12 monitoring, evaluating, and making improvements to care.
13 3. An active quality assurance committee.
14 4. Quality assurance program supervision.
15 5. Requiring the program to have adequate resources to
16 effectively carry out its specified activities.
17 6. Provider participation in the quality assurance
18 program.
19 7. Delegation of quality assurance program activities.
20 8. Credentialing and recredentialing.
21 9. Enrollee rights and responsibilities.
22 10. Availability and accessibility to services and
23 care.
24 11. Ambulatory care facilities.
25 12. Accessibility and availability of medical records,
26 as well as proper recordkeeping and process for record review.
27 13. Utilization review.
28 14. A continuity of care system.
29 15. Quality assurance program documentation.
30 16. Coordination of quality assurance activity with
31 other management activity.
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1 17. Delivering care to pregnant women and infants; to
2 elderly and disabled recipients, especially those who are at
3 risk of institutional placement; to persons with developmental
4 disabilities; and to adults who have chronic, high-cost
5 medical conditions.
6 (b) Guidelines which require the entities to conduct
7 quality-of-care studies which:
8 1. Target specific conditions and specific health
9 service delivery issues for focused monitoring and evaluation.
10 2. Use clinical care standards or practice guidelines
11 to objectively evaluate the care the entity delivers or fails
12 to deliver for the targeted clinical conditions and health
13 services delivery issues.
14 3. Use quality indicators derived from the clinical
15 care standards or practice guidelines to screen and monitor
16 care and services delivered.
17 (c) Guidelines for external quality review of each
18 contractor which require: focused studies of patterns of care;
19 individual care review in specific situations; and followup
20 activities on previous pattern-of-care study findings and
21 individual-care-review findings. In designing the external
22 quality review function and determining how it is to operate
23 as part of the state's overall quality improvement system, the
24 agency shall construct its external quality review
25 organization and entity contracts to address each of the
26 following:
27 1. Delineating the role of the external quality review
28 organization.
29 2. Length of the external quality review organization
30 contract with the state.
31
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1 3. Participation of the contracting entities in
2 designing external quality review organization review
3 activities.
4 4. Potential variation in the type of clinical
5 conditions and health services delivery issues to be studied
6 at each plan.
7 5. Determining the number of focused pattern-of-care
8 studies to be conducted for each plan.
9 6. Methods for implementing focused studies.
10 7. Individual care review.
11 8. Followup activities.
12 (26) In order to ensure that children receive health
13 care services for which an entity has already been
14 compensated, an entity contracting with the agency pursuant to
15 this section shall achieve an annual Early and Periodic
16 Screening, Diagnosis, and Treatment (EPSDT) Service screening
17 rate of at least 60 percent for those recipients continuously
18 enrolled for at least 8 months. The agency shall develop a
19 method by which the EPSDT screening rate shall be calculated.
20 For any entity which does not achieve the annual 60 percent
21 rate, the entity must submit a corrective action plan for the
22 agency's approval. If the entity does not meet the standard
23 established in the corrective action plan during the specified
24 timeframe, the agency is authorized to impose appropriate
25 contract sanctions. At least annually, the agency shall
26 publicly release the EPSDT Services screening rates of each
27 entity it has contracted with on a prepaid basis to serve
28 Medicaid recipients.
29 (27) The agency shall perform enrollments and
30 disenrollments for Medicaid recipients who are eligible for
31 MediPass or managed care plans. Notwithstanding the
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1 prohibition contained in paragraph (18)(f), managed care plans
2 may perform preenrollments of Medicaid recipients under the
3 supervision of the agency or its agents. For the purposes of
4 this section, "preenrollment" means the provision of marketing
5 and educational materials to a Medicaid recipient and
6 assistance in completing the application forms, but shall not
7 include actual enrollment into a managed care plan. An
8 application for enrollment shall not be deemed complete until
9 the agency or its agent verifies that the recipient made an
10 informed, voluntary choice. The agency, in cooperation with
11 the Department of Children and Family Services, may test new
12 marketing initiatives to inform Medicaid recipients about
13 their managed care options at selected sites. The agency shall
14 report to the Legislature on the effectiveness of such
15 initiatives. The agency may contract with a third party to
16 perform managed care plan and MediPass enrollment and
17 disenrollment services for Medicaid recipients and is
18 authorized to adopt rules to implement such services. The
19 agency may adjust the capitation rate only to cover the costs
20 of a third-party enrollment and disenrollment contract, and
21 for agency supervision and management of the managed care plan
22 enrollment and disenrollment contract.
23 (28) Any lists of providers made available to Medicaid
24 recipients, MediPass enrollees, or managed care plan enrollees
25 shall be arranged alphabetically showing the provider's name
26 and specialty and, separately, by specialty in alphabetical
27 order.
28 (29) The agency shall establish an enhanced managed
29 care quality assurance oversight function, to include at least
30 the following components:
31
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1 (a) At least quarterly analysis and followup,
2 including sanctions as appropriate, of managed care
3 participant utilization of services.
4 (b) At least quarterly analysis and followup,
5 including sanctions as appropriate, of quality findings of the
6 Medicaid peer review organization and other external quality
7 assurance programs.
8 (c) At least quarterly analysis and followup,
9 including sanctions as appropriate, of the fiscal viability of
10 managed care plans.
11 (d) At least quarterly analysis and followup,
12 including sanctions as appropriate, of managed care
13 participant satisfaction and disenrollment surveys.
14 (e) The agency shall conduct regular and ongoing
15 Medicaid recipient satisfaction surveys.
16
17 The analyses and followup activities conducted by the agency
18 under its enhanced managed care quality assurance oversight
19 function shall not duplicate the activities of accreditation
20 reviewers for entities regulated under part III of chapter
21 641, but may include a review of the finding of such
22 reviewers.
23 (30) Each managed care plan that is under contract
24 with the agency to provide health care services to Medicaid
25 recipients shall annually conduct a background check with the
26 Florida Department of Law Enforcement of all persons with
27 ownership interest of 5 percent or more or executive
28 management responsibility for the managed care plan and shall
29 submit to the agency information concerning any such person
30 who has been found guilty of, regardless of adjudication, or
31
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1 has entered a plea of nolo contendere or guilty to, any of the
2 offenses listed in s. 435.03.
3 (31) The agency shall, by rule, develop a process
4 whereby a Medicaid managed care plan enrollee who wishes to
5 enter hospice care may be disenrolled from the managed care
6 plan within 24 hours after contacting the agency regarding
7 such request. The agency rule shall include a methodology for
8 the agency to recoup managed care plan payments on a pro rata
9 basis if payment has been made for the enrollment month when
10 disenrollment occurs.
11 (32) The agency and entities which contract with the
12 agency to provide health care services to Medicaid recipients
13 under this section or s. 409.9122 must comply with the
14 provisions of s. 641.513 in providing emergency services and
15 care to Medicaid recipients and MediPass recipients.
16 (33) All entities providing health care services to
17 Medicaid recipients shall make available, and encourage all
18 pregnant women and mothers with infants to receive, and
19 provide documentation in the medical records to reflect, the
20 following:
21 (a) Healthy Start prenatal or infant screening.
22 (b) Healthy Start care coordination, when screening or
23 other factors indicate need.
24 (c) Healthy Start enhanced services in accordance with
25 the prenatal or infant screening results.
26 (d) Immunizations in accordance with recommendations
27 of the Advisory Committee on Immunization Practices of the
28 United States Public Health Service and the American Academy
29 of Pediatrics, as appropriate.
30 (e) Counseling and services for family planning to all
31 women and their partners.
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1 (f) A scheduled postpartum visit for the purpose of
2 voluntary family planning, to include discussion of all
3 methods of contraception, as appropriate.
4 (g) Referral to the Special Supplemental Nutrition
5 Program for Women, Infants, and Children (WIC).
6 (34) Any entity that provides Medicaid prepaid health
7 plan services shall ensure the appropriate coordination of
8 health care services with an assisted living facility in cases
9 where a Medicaid recipient is both a member of the entity's
10 prepaid health plan and a resident of the assisted living
11 facility. If the entity is at risk for Medicaid targeted case
12 management and behavioral health services, the entity shall
13 inform the assisted living facility of the procedures to
14 follow should an emergent condition arise.
15 (35) The agency may seek and implement federal waivers
16 necessary to provide for cost-effective purchasing of home
17 health services, private duty nursing services,
18 transportation, independent laboratory services, and durable
19 medical equipment and supplies through competitive bidding
20 pursuant to s. 287.057. The agency may request appropriate
21 waivers from the federal Health Care Financing Administration
22 in order to competitively bid such services. The agency may
23 exclude providers not selected through the bidding process
24 from the Medicaid provider network.
25 (36) The Agency for Health Care Administration is
26 directed to issue a request for proposal or intent to
27 negotiate to implement on a demonstration basis an outpatient
28 specialty services pilot project in a rural and urban county
29 in the state. As used in this subsection, the term
30 "outpatient specialty services" means clinical laboratory,
31 diagnostic imaging, and specified home medical services to
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1 include durable medical equipment, prosthetics and orthotics,
2 and infusion therapy.
3 (a) The entity that is awarded the contract to provide
4 Medicaid managed care outpatient specialty services must, at a
5 minimum, meet the following criteria:
6 1. The entity must be licensed by the Department of
7 Insurance under part II of chapter 641.
8 2. The entity must be experienced in providing
9 outpatient specialty services.
10 3. The entity must demonstrate to the satisfaction of
11 the agency that it provides high-quality services to its
12 patients.
13 4. The entity must demonstrate that it has in place a
14 complaints and grievance process to assist Medicaid recipients
15 enrolled in the pilot managed care program to resolve
16 complaints and grievances.
17 (b) The pilot managed care program shall operate for a
18 period of 3 years. The objective of the pilot program shall
19 be to determine the cost-effectiveness and effects on
20 utilization, access, and quality of providing outpatient
21 specialty services to Medicaid recipients on a prepaid,
22 capitated basis.
23 (c) The agency shall conduct a quality assurance
24 review of the prepaid health clinic each year that the
25 demonstration program is in effect. The prepaid health clinic
26 is responsible for all expenses incurred by the agency in
27 conducting a quality assurance review.
28 (d) The entity that is awarded the contract to provide
29 outpatient specialty services to Medicaid recipients shall
30 report data required by the agency in a format specified by
31
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1 the agency, for the purpose of conducting the evaluation
2 required in paragraph (e).
3 (e) The agency shall conduct an evaluation of the
4 pilot managed care program and report its findings to the
5 Governor and the Legislature by no later than January 1, 2001.
6 (36)(37) The agency shall enter into agreements with
7 not-for-profit organizations based in this state for the
8 purpose of providing vision screening.
9 (37)(38)(a) The agency shall implement a Medicaid
10 prescribed-drug spending-control program that includes the
11 following components:
12 1. Medicaid prescribed-drug coverage for brand-name
13 drugs for adult Medicaid recipients is limited to the
14 dispensing of four brand-name drugs per month per recipient.
15 Children are exempt from this restriction. Antiretroviral
16 agents are excluded from this limitation. No requirements for
17 prior authorization or other restrictions on medications used
18 to treat mental illnesses such as schizophrenia, severe
19 depression, or bipolar disorder may be imposed on Medicaid
20 recipients. Medications that will be available without
21 restriction for persons with mental illnesses include atypical
22 antipsychotic medications, conventional antipsychotic
23 medications, selective serotonin reuptake inhibitors, and
24 other medications used for the treatment of serious mental
25 illnesses. The agency shall also limit the amount of a
26 prescribed drug dispensed to no more than a 34-day supply. The
27 agency shall continue to provide unlimited generic drugs,
28 contraceptive drugs and items, and diabetic supplies. Although
29 a drug may be included on the preferred drug formulary, it
30 would not be exempt from the four-brand limit. The agency may
31 authorize exceptions to the brand-name-drug restriction based
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1 upon the treatment needs of the patients, only when such
2 exceptions are based on prior consultation provided by the
3 agency or an agency contractor, but the agency must establish
4 procedures to ensure that:
5 a. There will be a response to a request for prior
6 consultation by telephone or other telecommunication device
7 within 24 hours after receipt of a request for prior
8 consultation;
9 b. A 72-hour supply of the drug prescribed will be
10 provided in an emergency or when the agency does not provide a
11 response within 24 hours as required by sub-subparagraph a.;
12 and
13 c. Except for the exception for nursing home residents
14 and other institutionalized adults and except for drugs on the
15 restricted formulary for which prior authorization may be
16 sought by an institutional or community pharmacy, prior
17 authorization for an exception to the brand-name-drug
18 restriction is sought by the prescriber and not by the
19 pharmacy. When prior authorization is granted for a patient in
20 an institutional setting beyond the brand-name-drug
21 restriction, such approval is authorized for 12 months and
22 monthly prior authorization is not required for that patient.
23 2. Reimbursement to pharmacies for Medicaid prescribed
24 drugs shall be set at the average wholesale price less 13.25
25 percent.
26 3. The agency shall develop and implement a process
27 for managing the drug therapies of Medicaid recipients who are
28 using significant numbers of prescribed drugs each month. The
29 management process may include, but is not limited to,
30 comprehensive, physician-directed medical-record reviews,
31 claims analyses, and case evaluations to determine the medical
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1 necessity and appropriateness of a patient's treatment plan
2 and drug therapies. The agency may contract with a private
3 organization to provide drug-program-management services. The
4 Medicaid drug benefit management program shall include
5 initiatives to manage drug therapies for HIV/AIDS patients,
6 patients using 20 or more unique prescriptions in a 180-day
7 period, and the top 1,000 patients in annual spending.
8 4. The agency may limit the size of its pharmacy
9 network based on need, competitive bidding, price
10 negotiations, credentialing, or similar criteria. The agency
11 shall give special consideration to rural areas in determining
12 the size and location of pharmacies included in the Medicaid
13 pharmacy network. A pharmacy credentialing process may include
14 criteria such as a pharmacy's full-service status, location,
15 size, patient educational programs, patient consultation,
16 disease-management services, and other characteristics. The
17 agency may impose a moratorium on Medicaid pharmacy enrollment
18 when it is determined that it has a sufficient number of
19 Medicaid-participating providers.
20 5. The agency shall develop and implement a program
21 that requires Medicaid practitioners who prescribe drugs to
22 use a counterfeit-proof prescription pad for Medicaid
23 prescriptions. The agency shall require the use of
24 standardized counterfeit-proof prescription pads by
25 Medicaid-participating prescribers or prescribers who write
26 prescriptions for Medicaid recipients. The agency may
27 implement the program in targeted geographic areas or
28 statewide.
29 6. The agency may enter into arrangements that require
30 manufacturers of generic drugs prescribed to Medicaid
31 recipients to provide rebates of at least 15.1 percent of the
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1 average manufacturer price for the manufacturer's generic
2 products. These arrangements shall require that if a
3 generic-drug manufacturer pays federal rebates for
4 Medicaid-reimbursed drugs at a level below 15.1 percent, the
5 manufacturer must provide a supplemental rebate to the state
6 in an amount necessary to achieve a 15.1-percent rebate level.
7 7. The agency may establish a preferred drug formulary
8 in accordance with 42 U.S.C. s. 1396r-8, and, pursuant to the
9 establishment of such formulary, it is authorized to negotiate
10 supplemental rebates from manufacturers that are in addition
11 to those required by Title XIX of the Social Security Act and
12 at no less than 10 percent of the average manufacturer price
13 as defined in 42 U.S.C. s. 1936 on the last day of a quarter
14 unless the federal or supplemental rebate, or both, equals or
15 exceeds 25 percent. There is no upper limit on the
16 supplemental rebates the agency may negotiate. The agency may
17 determine that specific products, brand-name or generic, are
18 competitive at lower rebate percentages. Agreement to pay the
19 minimum supplemental rebate percentage will guarantee a
20 manufacturer that the Medicaid Pharmaceutical and Therapeutics
21 Committee will consider a product for inclusion on the
22 preferred drug formulary. However, a pharmaceutical
23 manufacturer is not guaranteed placement on the formulary by
24 simply paying the minimum supplemental rebate. Agency
25 decisions will be made on the clinical efficacy of a drug and
26 recommendations of the Medicaid Pharmaceutical and
27 Therapeutics Committee, as well as the price of competing
28 products minus federal and state rebates. The agency is
29 authorized to contract with an outside agency or contractor to
30 conduct negotiations for supplemental rebates. For the
31 purposes of this section, the term "supplemental rebates" may
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1 include, at the agency's discretion, cash rebates and other
2 program benefits that offset a Medicaid expenditure. Such
3 other program benefits may include, but are not limited to,
4 disease management programs, drug product donation programs,
5 drug utilization control programs, prescriber and beneficiary
6 counseling and education, fraud and abuse initiatives, and
7 other services or administrative investments with guaranteed
8 savings to the Medicaid program in the same year the rebate
9 reduction is included in the General Appropriations Act. The
10 agency is authorized to seek any federal waivers to implement
11 this initiative.
12 8. The agency shall establish an advisory committee
13 for the purposes of studying the feasibility of using a
14 restricted drug formulary for nursing home residents and other
15 institutionalized adults. The committee shall be comprised of
16 seven members appointed by the Secretary of Health Care
17 Administration. The committee members shall include two
18 physicians licensed under chapter 458 or chapter 459; three
19 pharmacists licensed under chapter 465 and appointed from a
20 list of recommendations provided by the Florida Long-Term Care
21 Pharmacy Alliance; and two pharmacists licensed under chapter
22 465.
23 9. The Agency for Health Care Administration shall
24 expand home delivery of pharmacy products. To assist Medicaid
25 patients in securing their prescriptions and reduce program
26 costs, the agency shall expand its current mail-order-pharmacy
27 diabetes-supply program to include all generic and brand-name
28 drugs used by Medicaid patients with diabetes. Medicaid
29 recipients in the current program may obtain nondiabetes drugs
30 on a voluntary basis. This initiative is limited to the
31 geographic area covered by the current contract. The agency
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1 may seek and implement any federal waivers necessary to
2 implement this subparagraph.
3 (b) The agency shall implement this subsection to the
4 extent that funds are appropriated to administer the Medicaid
5 prescribed-drug spending-control program. The agency may
6 contract all or any part of this program to private
7 organizations.
8 (c) The agency shall submit quarterly reports to the
9 Governor, the President of the Senate, and the Speaker of the
10 House of Representatives which must include, but need not be
11 limited to, the progress made in implementing this subsection
12 and its effect on Medicaid prescribed-drug expenditures.
13 (38)(39) Notwithstanding the provisions of chapter
14 287, the agency may, at its discretion, renew a contract or
15 contracts for fiscal intermediary services one or more times
16 for such periods as the agency may decide; however, all such
17 renewals may not combine to exceed a total period longer than
18 the term of the original contract.
19 (39)(40) The agency shall provide for the development
20 of a demonstration project by establishment in Miami-Dade
21 County of a long-term-care facility licensed pursuant to
22 chapter 395 to improve access to health care for a
23 predominantly minority, medically underserved, and medically
24 complex population and to evaluate alternatives to nursing
25 home care and general acute care for such population. Such
26 project is to be located in a health care condominium and
27 colocated with licensed facilities providing a continuum of
28 care. The establishment of this project is not subject to the
29 provisions of s. 408.036 or s. 408.039. The agency shall
30 report its findings to the Governor, the President of the
31
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1 Senate, and the Speaker of the House of Representatives by
2 January 1, 2003.
3 Section 20. Subsections (25) and (26) of section
4 409.901, Florida Statutes, are amended to read:
5 409.901 Definitions; ss. 409.901-409.920.--As used in
6 ss. 409.901-409.920, except as otherwise specifically
7 provided, the term:
8 (25) "Third party" means an individual, entity, or
9 program, excluding Medicaid, that is, may be, could be, should
10 be, or has been liable for all or part of the cost of medical
11 services related to any medical assistance covered by
12 Medicaid. The term includes third party administrators and
13 pharmacy benefit managers.
14 (26) "Third-party benefit" means any benefit that is
15 or may be available at any time through contract, court award,
16 judgment, settlement, agreement, or any arrangement between a
17 third party and any person or entity, including, without
18 limitation, a Medicaid recipient, a provider, another third
19 party, an insurer, or the agency, for any Medicaid-covered
20 injury, illness, goods, or services, including costs of
21 medical services related thereto, for personal injury or for
22 death of the recipient, but specifically excluding policies of
23 life insurance on the recipient, unless available under terms
24 of the policy to pay medical expenses prior to death. The
25 term includes, without limitation, collateral, as defined in
26 this section, health insurance, any benefit under a health
27 maintenance organization, Neurological Injury Compensation
28 Association funds, preferred provider arrangement, a prepaid
29 health clinic, liability insurance, uninsured motorist
30 insurance or personal injury protection coverage, medical
31
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1 benefits under workers' compensation, and any obligation under
2 law or equity to provide medical support.
3 Section 21. Paragraph (a) of subsection (5) of section
4 409.905, Florida Statutes, is amended to read:
5 409.905 Mandatory Medicaid services.--The agency may
6 make payments for the following services, which are required
7 of the state by Title XIX of the Social Security Act,
8 furnished by Medicaid providers to recipients who are
9 determined to be eligible on the dates on which the services
10 were provided. Any service under this section shall be
11 provided only when medically necessary and in accordance with
12 state and federal law. Mandatory services rendered by
13 providers in mobile units to Medicaid recipients may be
14 restricted by the agency. Nothing in this section shall be
15 construed to prevent or limit the agency from adjusting fees,
16 reimbursement rates, lengths of stay, number of visits, number
17 of services, or any other adjustments necessary to comply with
18 the availability of moneys and any limitations or directions
19 provided for in the General Appropriations Act or chapter 216.
20 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay
21 for all covered services provided for the medical care and
22 treatment of a recipient who is admitted as an inpatient by a
23 licensed physician or dentist to a hospital licensed under
24 part I of chapter 395. However, the agency shall limit the
25 payment for inpatient hospital services for a Medicaid
26 recipient 21 years of age or older to 45 days or the number of
27 days necessary to comply with the General Appropriations Act.
28 (a) The agency is authorized to implement
29 reimbursement and utilization management reforms in order to
30 comply with any limitations or directions in the General
31 Appropriations Act, which may include, but are not limited to:
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1 prior authorization for inpatient psychiatric days; prior
2 authorization for nonemergency hospital inpatient admissions
3 for individuals 21 years of age and older; authorization of
4 emergency and urgent-care admissions within 24 hours after
5 admission; enhanced utilization and concurrent review programs
6 for highly utilized services; reduction or elimination of
7 covered days of service; adjusting reimbursement ceilings for
8 variable costs; adjusting reimbursement ceilings for fixed and
9 property costs; and implementing target rates of increase. The
10 agency may limit prior authorization for hospital inpatient
11 services to selected diagnosis-related groups, based on an
12 analysis of the cost and potential for unnecessary
13 hospitalizations represented by certain diagnoses. Admissions
14 for normal delivery and newborns are exempt from requirements
15 for prior authorization. In implementing the provisions of
16 this section related to prior authorization, the agency shall
17 ensure that the process for authorization is accessible 24
18 hours per day, 7 days per week and authorization is
19 automatically granted when not denied within 24 4 hours after
20 the request. Authorization procedures must include steps for
21 review of denials. Upon implementing the prior authorization
22 program for hospital inpatient services, the agency shall
23 discontinue its hospital retrospective review program.
24 Section 22. Subsection (30) of section 409.913,
25 Florida Statutes, is amended to read:
26 409.913 Oversight of the integrity of the Medicaid
27 program.--The agency shall operate a program to oversee the
28 activities of Florida Medicaid recipients, and providers and
29 their representatives, to ensure that fraudulent and abusive
30 behavior and neglect of recipients occur to the minimum extent
31 possible, and to recover overpayments and impose sanctions as
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1 appropriate. Beginning January 1, 2003, and each year
2 thereafter, the agency and the Medicaid Fraud Control Unit of
3 the Department of Legal Affairs shall submit a joint report to
4 the Legislature documenting the effectiveness of the state's
5 efforts to control Medicaid fraud and abuse and to recover
6 Medicaid overpayments during the previous fiscal year. The
7 report must describe the number of cases opened and
8 investigated each year; the sources of the cases opened; the
9 disposition of the cases closed each year; the amount of
10 overpayments alleged in preliminary and final audit letters;
11 the number and amount of fines or penalties imposed; any
12 reductions in overpayment amounts negotiated in settlement
13 agreements or by other means; the amount of final agency
14 determinations of overpayments; the amount deducted from
15 federal claiming as a result of overpayments; the amount of
16 overpayments recovered each year; the amount of cost of
17 investigation recovered each year; the average length of time
18 to collect from the time the case was opened until the
19 overpayment is paid in full; the amount determined as
20 uncollectible and the portion of the uncollectible amount
21 subsequently reclaimed from the Federal Government; the number
22 of providers, by type, that are terminated from participation
23 in the Medicaid program as a result of fraud and abuse; and
24 all costs associated with discovering and prosecuting cases of
25 Medicaid overpayments and making recoveries in such cases. The
26 report must also document actions taken to prevent
27 overpayments and the number of providers prevented from
28 enrolling in or reenrolling in the Medicaid program as a
29 result of documented Medicaid fraud and abuse and must
30 recommend changes necessary to prevent or recover
31 overpayments. For the 2001-2002 fiscal year, the agency shall
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1 prepare a report that contains as much of this information as
2 is available to it.
3 (30) If a provider requests an administrative hearing
4 pursuant to chapter 120, such hearing must be conducted within
5 90 days following assignment of an administrative law judge,
6 absent exceptionally good cause shown as determined by the
7 administrative law judge or hearing officer. Upon issuance of
8 a final order, the outstanding balance of the amount
9 determined to constitute a Medicaid the overpayment shall
10 become due. If a provider fails to make payments in full,
11 fails to enter into a satisfactory repayment plan, or fails to
12 comply with the terms of a repayment plan or settlement
13 agreement, the agency may withhold medical assistance
14 reimbursement payments until the amount due is paid in full.
15 Section 23. Section 409.919, Florida Statutes, is
16 amended to read:
17 409.919 Rules.--The agency shall adopt any rules
18 necessary to comply with or administer ss. 409.901-409.920;
19 those rules necessary to effect and implement interagency
20 agreements between the agency and other departments; and all
21 rules necessary to comply with federal requirements. In
22 addition, the Department of Children and Family Services shall
23 adopt and accept transfer of any rules necessary to carry out
24 its responsibilities for receiving and processing Medicaid
25 applications and determining Medicaid eligibility, and for
26 assuring compliance with and administering ss.
27 409.901-409.906, as they relate to these responsibilities, and
28 any other provisions related to responsibility for the
29 determination of Medicaid eligibility.
30 Section 24. Paragraph (a) of subsection (4) of section
31 766.314, Florida Statutes, is amended to read:
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1 766.314 Assessments; plan of operation.--
2 (4) The following persons and entities shall pay into
3 the association an initial assessment in accordance with the
4 plan of operation:
5 (a) On or before October 1, 1988, each hospital
6 licensed under chapter 395 shall pay an initial assessment of
7 $50 per infant delivered in the hospital during the prior
8 calendar year, as reported to the Agency for Health Care
9 Administration; provided, however, that a hospital owned or
10 operated by the state or a county, special taxing district, or
11 other political subdivision of the state shall not be required
12 to pay the initial assessment or any assessment required by
13 subsection (5). The term "infant delivered" includes live
14 births and not stillbirths, but the term does not include
15 infants delivered by employees or agents of the Board of
16 Regents, or those born in a teaching hospital as defined in s.
17 408.07, or those born in a teaching hospital as defined in s.
18 395.806 which had been deemed by the association as being
19 exempt from assessments since fiscal year 1997 to fiscal year
20 2001. The initial assessment and any assessment imposed
21 pursuant to subsection (5) may not include any infant born to
22 a charity patient (as defined by rule of the Agency for Health
23 Care Administration) or born to a patient for whom the
24 hospital receives Medicaid reimbursement, if the sum of the
25 annual charges for charity patients plus the annual Medicaid
26 contractuals of the hospital exceeds 10 percent of the total
27 annual gross operating revenues of the hospital. The hospital
28 is responsible for documenting, to the satisfaction of the
29 association, the exclusion of any birth from the computation
30 of the assessment. Upon demonstration of financial need by a
31
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1 hospital, the association may provide for installment payments
2 of assessments.
3 Section 25. Subsection (5) of section 400.462, Florida
4 Statutes, is amended to read:
5 400.462 Definitions.--As used in this part, the term:
6 (5) "Companion" or "sitter" means a person who
7 provides companionship to an elderly, handicapped, or
8 convalescent individual; cares for an elderly, handicapped, or
9 convalescent individual and accompanies such individual on
10 trips and outings; and may prepare and serve meals to such
11 individual. A companion may not provide hands-on personal care
12 to a client.
13 Section 26. Subsections (4) and (5) of section
14 400.464, Florida Statutes, are amended to read:
15 400.464 Home health agencies to be licensed;
16 expiration of license; exemptions; unlawful acts; penalties.--
17 (4)(a) An organization may not provide, offer, or
18 advertise home health services to the public unless the
19 organization has a valid license or is specifically exempted
20 under this part. An organization that offers or advertises to
21 the public any service for which licensure or registration is
22 required under this part must include in the advertisement the
23 license number or regulation number issued to the organization
24 by the agency. The agency shall assess a fine of not less
25 than $100 to any licensee or registrant who fails to include
26 the license or registration number when submitting the
27 advertisement for publication, broadcast, or printing. The
28 holder of a license issued under this part may not advertise
29 or indicate to the public that it holds a home health agency
30 or nurse registry license other than the one it has been
31 issued.
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1 (b) A person who violates paragraph (a) is subject to
2 an injunctive proceeding under s. 400.515. A violation of
3 paragraph (a) is a deceptive and unfair trade practice and
4 constitutes a violation of the Florida Deceptive and Unfair
5 Trade Practices Act under part II of chapter 501.
6 (c) A person who violates the provisions of paragraph
7 (a) commits a felony misdemeanor of the third second degree,
8 punishable as provided in s. 775.082, or s. 775.083, or s.
9 775.084. Any person who commits a second or subsequent
10 violation commits a felony misdemeanor of the second first
11 degree, punishable as provided in s. 775.082, or s. 775.083,
12 or s. 775.084. Each day of continuing violation constitutes a
13 separate offense.
14 (d) Any person who owns, operates, or maintains an
15 unlicensed home health agency or unlicensed nurse registry and
16 who, within 10 working days after receiving notification from
17 the agency, fails to cease operation and apply for a license
18 under this part commits a felony of the third degree,
19 punishable as provided in s. 775.082, s. 775.083, or s.
20 775.084. Each day of continued operation is a separate
21 offense.
22 (e) Any home health agency, as defined in this part,
23 or nurse registry that fails to cease operation after agency
24 notification may be fined $500 for each day of noncompliance.
25 (5) The following are exempt from the licensure
26 requirements of this part:
27 (a) A home health agency operated by the Federal
28 Government.
29 (b) Home health services provided by a state agency,
30 either directly or through a contractor with:
31 1. The Department of Elderly Affairs.
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1 2. The Department of Health, a community health
2 center, or a rural health network that furnishes home visits
3 for the purpose of providing environmental assessments, case
4 management, health education, personal care services, family
5 planning, or followup treatment, or for the purpose of
6 monitoring and tracking disease.
7 3. Services provided to persons who have developmental
8 disabilities, as defined in s. 393.063(12).
9 4. Companion and sitter organizations that were
10 registered under s. 400.509(1) on January 1, 1999, and were
11 authorized to provide personal services under s. 393.063(33)
12 under a developmental services provider certificate on January
13 1, 1999, may continue to provide such services to past,
14 present, and future clients of the organization who need such
15 services, notwithstanding the provisions of this act.
16 5. The Department of Children and Family Services.
17 (c) A health care professional, whether or not
18 incorporated, who is licensed under chapter 457; chapter 458;
19 chapter 459; part I of chapter 464; chapter 467; part I, part
20 III, part V, or part X of chapter 468; chapter 480; chapter
21 486; chapter 490; or chapter 491; and who is acting alone
22 within the scope of his or her professional license to provide
23 care to patients in their homes.
24 (d) A home health aide or certified nursing assistant
25 who is acting in his or her individual capacity, within the
26 definitions and standards of his or her occupation, and who
27 provides hands-on care to patients in their homes.
28 (e) An individual who acts alone, in his or her
29 individual capacity, and who is not employed by or affiliated
30 with a licensed home health agency or registered with a
31 licensed nurse registry. This exemption does not entitle an
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1 individual to perform home health services without the
2 required professional license.
3 (f) The delivery of instructional services in home
4 dialysis and home dialysis supplies and equipment.
5 (g) The delivery of nursing home services for which
6 the nursing home is licensed under part II of this chapter, to
7 serve its residents in its facility.
8 (h) The delivery of assisted living facility services
9 for which the assisted living facility is licensed under part
10 III of this chapter, to serve its residents in its facility.
11 (i) The delivery of hospice services for which the
12 hospice is licensed under part VI of this chapter, to serve
13 hospice patients admitted to its service.
14 (j) A hospital that provides services for which it is
15 licensed under chapter 395.
16 (k) The delivery of community residential services for
17 which the community residential home is licensed under chapter
18 419, to serve the residents in its facility.
19 (l) A not-for-profit, community-based agency that
20 provides early intervention services to infants and toddlers.
21 (m) Certified rehabilitation agencies and
22 comprehensive outpatient rehabilitation facilities that are
23 certified under Title 18 of the Social Security Act.
24 (n) The delivery of adult family care home services
25 for which the adult family care home is licensed under part
26 VII of this chapter, to serve the residents in its facility.
27 Section 27. Subsection (2) of section 400.471, Florida
28 Statutes, is amended to read:
29 400.471 Application for license; fee; provisional
30 license; temporary permit.--
31
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1 (2) The applicant must file with the application
2 satisfactory proof that the home health agency is in
3 compliance with this part and applicable rules, including:
4 (a) A listing of services to be provided, either
5 directly by the applicant or through contractual arrangements
6 with existing providers;
7 (b) The number and discipline of professional staff to
8 be employed; and
9 (c) Proof of financial ability to operate; and.
10 (d) Completion of volume data questions on the renewal
11 application.
12 Section 28. Subsection (2) of section 400.487, Florida
13 Statutes, is amended to read:
14 400.487 Home health service agreements; physician's
15 treatment orders; patient assessment; establishment and review
16 of plan of care; provision of services; orders not to
17 resuscitate.--
18 (2) When required by the provisions of chapter 464;
19 part I, part III, or part V of chapter 468; or chapter 486,
20 the attending physician for a patient who is to receive
21 skilled care must establish treatment orders. The treatment
22 orders must be signed by the physician. If the claim is
23 submitted to a managed care organization, the treatment orders
24 shall be signed in the time allowed under the provider
25 agreement. The treatment orders shall within 30 days after the
26 start of care and must be reviewed, as frequently as the
27 patient's illness requires, by the physician in consultation
28 with the home health agency personnel that provide services to
29 the patient.
30 Section 29. Section 400.491, Florida Statutes, is
31 amended to read:
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1 400.491 Clinical records.--
2 (1) The home health agency must maintain for each
3 patient who receives skilled care a clinical record that
4 includes pertinent past and current medical, nursing, social
5 and other therapeutic information, the treatment orders, and
6 other such information as is necessary for the safe and
7 adequate care of the patient. When home health services are
8 terminated, the record must show the date and reason for
9 termination. Such records are considered patient records
10 under s. 456.057, and must be maintained by the home health
11 agency for 5 years following termination of services. If a
12 patient transfers to another home health agency, a copy of his
13 or her record must be provided to the other home health agency
14 upon request.
15 (2) The home health agency must maintain for each
16 client who receives nonskilled care a service provision plan.
17 Such records must be maintained by the home health agency for
18 1 year following termination of services.
19 Section 30. Section 400.512, Florida Statutes, is
20 amended to read:
21 400.512 Screening of home health agency personnel and;
22 nurse registry personnel; and companions and homemakers.--The
23 agency shall require employment or contractor screening as
24 provided in chapter 435, using the level 1 standards for
25 screening set forth in that chapter, for home health agency
26 personnel and; persons referred for employment by nurse
27 registries; and persons employed by companion or homemaker
28 services registered under s. 400.509.
29 (1)(a) The Agency for Health Care Administration may,
30 upon request, grant exemptions from disqualification from
31 employment or contracting under this section as provided in s.
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1 435.07, except for health care practitioners licensed by the
2 Department of Health or a regulatory board within that
3 department.
4 (b) The appropriate regulatory board within the
5 Department of Health, or that department itself when there is
6 no board, may, upon request of the licensed health care
7 practitioner, grant exemptions from disqualification from
8 employment or contracting under this section as provided in s.
9 435.07.
10 (2) The administrator of each home health agency and,
11 the managing employee of each nurse registry, and the managing
12 employee of each companion or homemaker service registered
13 under s. 400.509 must sign an affidavit annually, under
14 penalty of perjury, stating that all personnel hired or,
15 contracted with, or registered on or after October 1, 1994,
16 who enter the home of a patient or client in their service
17 capacity have been screened and that its remaining personnel
18 have worked for the home health agency or registrant
19 continuously since before October 1, 1994.
20 (3) As a prerequisite to operating as a home health
21 agency or, nurse registry, or companion or homemaker service
22 under s. 400.509, the administrator or managing employee,
23 respectively, must submit to the agency his or her name and
24 any other information necessary to conduct a complete
25 screening according to this section. The agency shall submit
26 the information to the Department of Law Enforcement for state
27 processing. The agency shall review the record of the
28 administrator or manager with respect to the offenses
29 specified in this section and shall notify the owner of its
30 findings. If disposition information is missing on a criminal
31 record, the administrator or manager, upon request of the
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1 agency, must obtain and supply within 30 days the missing
2 disposition information to the agency. Failure to supply
3 missing information within 30 days or to show reasonable
4 efforts to obtain such information will result in automatic
5 disqualification.
6 (4) Proof of compliance with the screening
7 requirements of chapter 435 shall be accepted in lieu of the
8 requirements of this section if the person has been
9 continuously employed or registered without a breach in
10 service that exceeds 180 days, the proof of compliance is not
11 more than 2 years old, and the person has been screened by the
12 Department of Law Enforcement. A home health agency or, nurse
13 registry, or companion or homemaker service registered under
14 s. 400.509 shall directly provide proof of compliance to
15 another home health agency or, nurse registry, or companion or
16 homemaker service registered under s. 400.509. The recipient
17 home health agency or, nurse registry, or companion or
18 homemaker service registered under s. 400.509 may not accept
19 any proof of compliance directly from the person who requires
20 screening. Proof of compliance with the screening requirements
21 of this section shall be provided upon request to the person
22 screened by the home health agencies or; nurse registries; or
23 companion or homemaker services registered under s. 400.509.
24 (5) There is no monetary liability on the part of, and
25 no cause of action for damages arises against, a licensed home
26 health agency or, licensed nurse registry, or companion or
27 homemaker service registered under s. 400.509, that, upon
28 notice that the employee or contractor has been found guilty
29 of, regardless of adjudication, or entered a plea of nolo
30 contendere or guilty to, any offense prohibited under s.
31 435.03 or under any similar statute of another jurisdiction,
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1 terminates the employee or contractor, whether or not the
2 employee or contractor has filed for an exemption with the
3 agency in accordance with chapter 435 and whether or not the
4 time for filing has expired.
5 (6) The costs of processing the statewide
6 correspondence criminal records checks must be borne by the
7 home health agency or; the nurse registry; or the companion or
8 homemaker service registered under s. 400.509, or by the
9 person being screened, at the discretion of the home health
10 agency or, nurse registry, or s. 400.509 registrant.
11 (7)(a) It is a misdemeanor of the first degree,
12 punishable under s. 775.082 or s. 775.083, for any person
13 willfully, knowingly, or intentionally to:
14 1. Fail, by false statement, misrepresentation,
15 impersonation, or other fraudulent means, to disclose in any
16 application for voluntary or paid employment a material fact
17 used in making a determination as to such person's
18 qualifications to be an employee under this section;
19 2. Operate or attempt to operate an entity licensed or
20 registered under this part with persons who do not meet the
21 minimum standards for good moral character as contained in
22 this section; or
23 3. Use information from the criminal records obtained
24 under this section for any purpose other than screening that
25 person for employment as specified in this section or release
26 such information to any other person for any purpose other
27 than screening for employment under this section.
28 (b) It is a felony of the third degree, punishable
29 under s. 775.082, s. 775.083, or s. 775.084, for any person
30 willfully, knowingly, or intentionally to use information from
31 the juvenile records of a person obtained under this section
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1 for any purpose other than screening for employment under this
2 section.
3 Section 31. Section 400.515, Florida Statutes, is
4 amended to read:
5 400.515 Injunction proceedings.--Notwithstanding the
6 existence or pursuit of any other remedy, the agency may
7 maintain an action in the name of the state for injunction or
8 other process to enforce the provisions of this part and rules
9 adopted to implement this part. The Agency for Health Care
10 Administration may institute injunction proceedings in a court
11 of competent jurisdiction when violation of this part or of
12 applicable rules constitutes an emergency affecting the
13 immediate health and safety of a patient or client.
14 Section 32. Section 400.509, Florida Statutes, is
15 repealed.
16 Section 33. This act shall take effect July 1, 2003.
17
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22
23
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25
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27
28
29
30
31
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 400
3
4 Authorizes the Agency to establish and conduct fair hearings
requested by Medicaid recipients unrelated to eligibility
5 determinations and fair hearings relating to nursing home
resident transfers and discharges.
6
Changes the requirement from a 100 percent class review by the
7 Pharmaceutical and Therapeutics Committee to an annual review
of the top 75 percent of therapeutic classes and a biennial
8 review of all other classes. Provides that appeals of
preferred drug list (PDL) decisions can be heard through the
9 Office of Fair Hearings.
10 Modifies the Quality of Long-Term Care Facility Improvement
Trust Fund, allowing the federal civil monetary penalty
11 revenues to be deposited in the fund and to expand the
programs that can be supported through the fund to include
12 nursing home consumer satisfaction, evaluation of special
resident needs, initiatives authorized by the Centers for
13 Medicare and Medicaid Services (CMS), and projects recommended
through the Medicaid Up or Out demonstration program.
14
Requires nursing homes to provide proof of legal right to
15 occupy the property as part of an application for licensure or
change of ownership and eliminates the nursing home financial
16 reporting requirement.
17 Revises the grounds for denial, revocation, or suspension of a
license of an assisted living facility and provides for the
18 imposition of administrative fines and grounds for the fines
for assisted living facilities. Authorizes the Agency to
19 require that fines be paid prior to approval of a change of
ownership to a new licensee. Eliminates the requirement that
20 the Agency send renewal notices by certified mail to assisted
living facilities, adult day care centers, and adult family
21 care homes.
22 Authorizes the Agency to enroll MediKids beneficiaries in
managed care plans as defined in s. 409.811, F.S.
23
Repeals the requirement for specialty prepaid health plans to
24 be licensed under chapter 641 and provides that the Agency
shall issue a request for proposal or intent to implement a
25 contract with a prepaid health plan to pay them on a prepaid
basis to provide benefits to Medicaid-eligible recipients who
26 have HIV or AIDS.
27 Eliminates the requirement that the Agency must issue an
intent to negotiate to implement an outpatient specialty
28 services pilot project.
29 Revises the definition of "third-party" for purposes of the
Medicaid program to include third-party administrators and
30 pharmacy benefit managers and revises the definition of
"third-party benefit" to include the Neurological Injury
31 Compensation Association. Removes a requirement that
administrative hearings be reinstated within 90 days following
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Florida Senate - 2003 CS for SB 400
317-2322A-03
1 assignment of an administrative law judge in Medicaid cases
involving recovery of overpayments.
2
Provides that children born in a family practice teaching
3 hospital shall not be considered for the purposes of making
assessments for the Florida Birth-Related Neurological Injury
4 Compensation Plan.
5 Revises the definition of companion or sitter to a person who
provides companionship to an elderly, handicapped or
6 convalescent individual. Increases the penalty for violating
home health agency licensure requirements to a third degree
7 felony for the first violation and a second degree felony for
the second or subsequent violation. Provides that an
8 individual who owns, operates, or maintains an unlicensed home
health agency or nurse registry who fails to cease operation
9 and apply for a license within 10 working days of being
notified by the Agency, commits a third degree felony, and
10 that each day of continued operation is a separate offense.
Provides that a home health agency or nurse registry may be
11 fined $500 per day for each day of noncompliance. Provides
that the completion of volume data questions on the home
12 health agency application is required information for an
application for license, provisional license, or temporary
13 permit.
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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