HB 0887

1	A bill to be entitled
2	An act relating to the aging resource center; amending s.
3	430.205, F.S.; revising the development requirements of
4	the community care service system; requiring the
5	Department of Elderly Affairs to provide for transitioning
6	certain elder services to a certain long-term care
7	delivery system under the direction of an aging resource
8	center; providing that the center shall be the entry point
9	for service for certain persons; providing for staffing of
10	the center; providing duties and responsibilities of the
11	center; establishing administrative oversight with the
12	department; requiring the department to establish quality
13	assurance standards and outcome measures; requiring the
14	department to ensure screening and enrollment of certain
15	persons at such centers; providing a screening and
16	enrollment process; specifying programs and services
17	offered at centers; limiting payments for services for
18	certain persons; revising administration of the model
19	program; requiring the department to publicize certain
20	model system benefits to the statewide elder services
21	network; requiring proposals to be submitted for
22	transition; providing that the department may set a
23	deadline for such proposals; requiring the department to
24	review all proposals and select the areas to designate as
25	model areas; providing criteria; redistributing duties and
26	responsibilities to the aging resource center; deleting
27	certain model area requirements; providing duties and
28	responsibilities of service providers; providing for
29	elective development of capitation rates; removing certain
30	restrictions; removing authority to develop risk-sharing
31	agreements; deleting requirement to seek federal waivers;
32	deleting requirement to develop an eligibility system;
33	deleting requirement to outstation certain nursing home
34	staff; extending the date for submitting an evaluation;
35	revising the contents of said evaluation; providing for
36	possible expansion of the program; providing an effective
37	date.
38
39	Be It Enacted by the Legislature of the State of Florida:
40
41	Section 1.  Subsection (6) of section 430.205, Florida
42	Statutes, is amended to read:
43	430.205  Community care service system.--
44	(6)  Notwithstanding other requirements of this chapter,
45	the department of Elderly Affairs and the Agency for Health Care
46	Administration shall develop a model system to transition all
47	state-funded services for elderly individuals in model one of
48	the department's planning and service areas to a managed,
49	integrated long-term-care delivery system under the direction of
50	a single aging resource center in each area. The Agency for
51	Health Care Administration shall assist the department in
52	developing the model system described in this subsection entity.
53	(a)  The aging resource center shall act as the single
54	point of entry for all persons age 60 and older in each
55	designated area who are seeking the services listed in paragraph
56	(b). The aging resource center shall integrate the staff of the
57	department?s local CARES Medicaid nursing home preadmission
58	screening unit, a sufficient number of staff from the Department
59	of Children and Family Services Economic Self-Sufficiency
60	Services Program Office necessary to determine the financial
61	eligibility for all persons age 60 and older seeking Medicaid
62	services in each designated area, and the staff of the local
63	area agency on aging. The duties and responsibilities of the
64	aging resource center shall be to:
65	1.  Provide an initial screening of each client who
66	requests services through the aging resource center to determine
67	whether the person would be most appropriately served through
68	federally funded programs, state-funded programs, or locally
69	funded or community volunteer programs, or by privately paying
70	for the services.
71	2.  Provide information and referral services for community
72	resources and state-funded long-term-care programs.
73	3.  Develop strong community partnerships necessary to
74	ensure that elders seeking assistance will receive services that
75	meet their needs with the least amount of strain and confusion
76	possible.
77	4.  Develop referral agreements with local community
78	service organizations, such as senior centers, to better assist
79	clients who do not need, or do not wish to enroll in, state-
80	funded long-term-care programs.
81	5.  Determine eligibility for the programs and services
82	listed in paragraph (b).
83	6.  Manage the availability of financial resources for the
84	programs and services listed in paragraph (b).
85	7.  When appropriate, negotiate contracts with providers to
86	provide the services that are administered through the aging
87	resource center.
88	8.  When financial resources become available, refer a
89	client to the most appropriate entity to begin receiving
90	services.
91
92	The department shall retain ultimate administrative oversight
93	over the operations of all aging resource centers it authorizes.
94	The department shall, by rule or through contracts, develop
95	quality assurance standards and outcome measures to ensure that
96	clients receiving services through all model systems are
97	receiving the appropriate care and that contractors and
98	subcontractors are adhering to the terms of their contracts and
99	are acting in the best interests of the clients they are serving
100	The duties of the model system shall include organizing and
101	administering service delivery for the elderly, obtaining
102	contracts for services with providers in the area, monitoring
103	the quality of services provided, determining levels of need and
104	disability for payment purposes, and other activities determined
105	by the department and the agency in order to operate the model
106	system.
107	(b)  The department shall ensure that all persons age 60
108	and older who receive the services listed in this paragraph in
109	each model area are screened and enrolled through the aging
110	resource center. The programs and services to be administered
111	through the aging resource center The agency and the department
112	shall integrate all funding for services to individuals over the
113	age of 65 in the model planning and service areas into a single
114	per-person per-month payment rate, except that funds for
115	Medicaid behavioral health care services are exempt from this
116	section. The funds to be integrated shall include:
117	1.  Community-care-for-the-elderly services. funds;
118	2.  Home-care-for-the-elderly services. funds;
119	3.  Local services programs. program funds;
120	4.  Aged and Disabled Adult Medicaid waiver services.
121	Contracted services funds;
122	5.  Assisted Living for the Elderly Medicaid waiver
123	services. Alzheimer's disease initiative funds;
124	6.  Older Americans Act services. Medicaid home and
125	community-based waiver services funds;
126	7.  Funds for all Medicaid services authorized in ss.
127	409.905 and 409.906, including Medicaid nursing home services;
128	and
129	8.  Funds paid for Medicare premiums, coinsurance and
130	deductibles for persons dually eligible for Medicaid and
131	Medicare as prescribed in s. 409.908(13).
132
133	The department and the agency shall not make payments for the
134	above-listed services for persons residing in a model area
135	services for people age 65 and older except through the model
136	delivery system.
137	(c)  The entity selected to administer the model system
138	shall develop a comprehensive health and long-term-care service
139	delivery system through contracts with providers of medical,
140	social, and long-term-care services sufficient to meet the needs
141	of the population age 65 and older. The entity selected to
142	administer the model system shall not directly provide services
143	other than intake, assessment, and referral services.
144	(c)(d)  The department shall publicize the benefits of the
145	model delivery system to the statewide elder services network.
146	Those local areas that wish to transition to the model delivery
147	system shall submit a proposal to the department requesting
148	approval for such a transition. The department may set the
149	deadline by which a proposal must be submitted for
150	consideration; however, the deadline may not extend beyond
151	January 1, 2005 The department shall determine which of the
152	department's planning and services areas is to be designated as
153	a model area by means of a request for proposals. The department
154	shall review all submitted proposals and shall select the an
155	area or areas to be designated as a model area and the entity to
156	administer the model system based on demonstration of capacity
157	of the local area agency on aging to effectively assist an aging
158	resource center to perform the functions described in paragraph
159	(a), as well as the ability of the service providers within the
160	designated area to perform the functions described in paragraph
161	(d). the entity to:
162	1.  Develop contracts with providers currently under
163	contract with the department, area agencies on aging, or
164	community-care-for-the-elderly lead agencies;
165	2.  Provide a comprehensive system of appropriate medical
166	and long-term-care services that provides high-quality medical
167	and social services to assist older individuals in remaining in
168	the least restrictive setting;
169	3.  Demonstrate a quality assurance and quality improvement
170	system satisfactory to the department and the agency;
171	4.  Develop a system to identify participants who have
172	special health care needs such as polypharmacy, mental health
173	and substance abuse problems, falls, chronic pain, nutritional
174	deficits, and cognitive deficits, in order to respond to and
175	meet these needs;
176	5.  Use a multidisciplinary team approach to participant
177	management which ensures that information is shared among
178	providers responsible for delivering care to a participant;
179	6.  Ensure medical oversight of care plans and service
180	delivery, regular medical evaluation of care plans, and the
181	availability of medical consultation for case managers and
182	service coordinators;
183	7.  Develop, monitor, and enforce quality-of-care
184	requirements;
185	8.  Secure subcontracts with providers of medical, nursing
186	home, and community-based long-term-care services sufficient to
187	assure access to and choice of providers;
188	9.  Ensure a system of case management and service
189	coordination which includes educational and training standards
190	for case managers and service coordinators;
191	10.  Develop a business plan that considers the ability of
192	the applicant to organize and operate a risk-bearing entity;
193	11.  Furnish evidence of adequate liability insurance
194	coverage or an adequate plan of self-insurance to respond to
195	claims for injuries arising out of the furnishing of health
196	care; and
197	12.  Provide, through contract or otherwise, for periodic
198	review of its medical facilities as required by the department
199	and the agency.
200
201	The department shall give preference in selecting an area to be
202	designated as a model area to that in which the administering
203	entity is an existing area agency on aging or community-care-
204	for-the-elderly lead agency demonstrating the ability to perform
205	the functions described in this paragraph.
206	(d)  The duties and responsibilities of the service
207	providers within each model area shall be to:
208	1.  Develop strong community partnerships necessary to
209	ensure that elders seeking assistance will receive services that
210	meet their needs with the least amount of strain and confusion
211	possible.
212	2.  Conduct comprehensive assessments of clients that have
213	been determined eligible and develop a care plan to ensure that
214	the unique needs of each client are met.
215	3.  Coordinate or provide the services listed in paragraph
216	(b).
217	(e)  The department in consultation with the selected
218	entity shall develop a statewide proposal regarding the long-
219	term use and structure of a program that addresses a risk pool
220	to reduce financial risk.
221	(e)(f)  Prior to implementation of the project, the
222	department and the agency are encouraged to shall develop
223	capitation rates for service packages based on the historical
224	cost experience of the state in providing the services listed in
225	paragraph (b) to the population age 60 or older in each model
226	area and to pay the service providers the capitation rate for
227	service packages when appropriate. The department and the agency
228	may develop capitation rates for each program administered by
229	the aging resource center and may develop a capitation rate for
230	case management services that is separate from the capitation
231	rate for the direct service packages. Each capitation rate may
232	vary between counties or model areas acute and long-term-care
233	services to the population over 65 years of age in the area
234	served.
235	1.  Payment rates in the first 2 years of operation shall
236	be set at no more than 100 percent of the costs to the state of
237	providing equivalent services to the population of the model
238	area for the year prior to the year in which the model system is
239	implemented, adjusted forward to account for inflation and
240	population growth. In subsequent years, the rate shall be
241	negotiated Capitation rates for service packages that are not
242	developed prior to implementation of the model delivery system
243	should be negotiated in future years based on the cost
244	experience of the model system in providing the contracted
245	services, but may not exceed 95 percent of the amount that would
246	have been paid by the state for those same services in each
247	model area in the model planning and service area absent the
248	model integrated service delivery system.
249	2.  The agency and the department may develop innovative
250	risk-sharing agreements that limit the level of custodial
251	nursing home risk that the administering entity assumes,
252	consistent with the intent of the Legislature to reduce the use
253	and cost of nursing home care. Under risk-sharing arrangements,
254	the agency and the department may reimburse the administering
255	entity for the cost of providing nursing home care for Medicaid-
256	eligible participants who have been permanently placed and
257	remain in nursing home care for more than 1 year.
258	(g)  The department and the Agency for Health Care
259	Administration shall seek federal waivers necessary to implement
260	the requirements of this section.
261	(h)  The Department of Children and Family Services shall
262	develop a streamlined and simplified eligibility system and
263	shall outstation a sufficient number and quality of eligibility-
264	determination staff with the administering entity to assure
265	determination of Medicaid eligibility for the integrated service
266	delivery system in the model planning and service area within 10
267	days after receipt of a complete application.
268	(i)  The Department of Elderly Affairs shall make
269	arrangements to outstation a sufficient number of nursing home
270	preadmission screening staff with the administering entity to
271	assure timely assessment of level of need for long-term-care
272	services in the model area.
273	(f)(j)  The department of Elderly Affairs shall conduct or
274	contract for an evaluation of the model delivery system pilot
275	project. The department shall submit the evaluation to the
276	Governor, the President of the Senate, and the Speaker of the
277	House of Representatives the Legislature by January 1, 2006
278	2005. The evaluation must address the effectiveness of each
279	aging resource center and the agencies with which it contracts
280	in effects of the pilot project on the effectiveness of the
281	entity providing a comprehensive system of appropriate and high-
282	quality managed, integrated medical and long-term-care services
283	to elders in each model area in the least restrictive setting
284	and in the most cost-effective manner possible. If the
285	evaluation determines that the model delivery system was
286	successful in meeting its stated goals, the evaluation must
287	include, or be accompanied by, a plan to expand the model
288	delivery system to include additional long-term-care services,
289	as well as to expand the model delivery system to other areas of
290	the state that may benefit from such a system. The plan must
291	address the feasibility of integrating the following services
292	into the model system beginning July 1, 2006: make
293	recommendations on a phased-in implementation expansion for the
294	rest of the state.
295	1.  Contracted services.
296	2.  Alzheimer's disease initiative services.
297	3.  Long-term-care community diversion project services.
298	4.  Medicaid nursing home services.
299	5.  Medicaid transportation services.
300	6.  Medicaid hospice care services.
301	7.  Medicaid intermediate care services.
302	8.  Medicaid prescribed drug services.
303	9.  Medicaid assistive care services.
304
305	The plan must also address the appropriateness of integrating
306	the state?s various Medicaid waivers into fewer programs that
307	serve a broader population of elders.
308	Section 2.  This act shall take effect July 1, 2004.

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