HB 0887

CS

CHAMBER ACTION

1	The Committee on Future of Florida's Families recommends the
2	following:
3
4	Committee Substitute
5	Remove the entire bill and insert:
6	A bill to be entitled
7	An act relating to services for the elderly; amending s.
8	20.41, F.S.; requiring personnel evaluation of executive
9	directors of area agency on aging boards; amending s.
10	409.912, F.S.; allowing contracting for certain CARES
11	program functions; requiring assessment and review of
12	certain nursing home placements; requiring a database to
13	track individuals assessed under the CARES program and
14	diverted from nursing home care; requiring an annual study
15	on individuals diverted from nursing home placement;
16	requiring a report on modifying level of care criteria;
17	amending s. 430.205, F.S.; requiring development of a
18	managed care delivery system for Medicaid services;
19	providing for submission to the Governor and Legislature
20	of a plan to include Medicare in an integrated long-term-
21	care system; providing for integration of Medicare and
22	Medicaid services; creating s. 430.2051, F.S.; requiring
23	integration of certain home and community-based Medicaid
24	waiver programs; requiring a certain funding level after
25	integration; requiring the agency to seek waivers or
26	amendments to waivers as necessary; providing that the
27	agency may reimburse providers; requiring rulemaking;
28	requiring the department and agency to study and develop a
29	plan to integrate certain databases; requiring that such
30	plan be submitted to the Governor and Legislature;
31	requiring evaluations of the plan and certain services;
32	amending s. 430.041, F.S.; revising duties to the Office
33	of Long-Term-Care Policy; removing the advisory council of
34	the Office of Long-Term-Care Policy; providing for an
35	interagency coordinating team; revising requirements for
36	reports; amending s. 430.203, F.S.; revising requirements
37	for the community care service system; revising
38	requirements for competitive bidding exemptions; requiring
39	all services to be delivered directly by or through lead
40	agencies; amending s. 430.7031, F.S.; revising
41	requirements for preadmission screening under the nursing
42	home transition program; creating s. 430.2053, F.S.;
43	requiring pilot projects for aging resource centers;
44	requiring an implementation plan; requiring that area
45	agencies on aging submit proposals for transition to aging
46	resource centers; requiring a review of the department's
47	process for determining readiness; specifying purposes and
48	duties of an aging resource center; requiring integration
49	of certain functions of other state agencies; specifying
50	criteria for selection of entities to become aging
51	resource centers; specifying the duties and
52	responsibilities of community care for the elderly
53	providers in an area served by an aging resource center;
54	specifying programs administered by an aging resource
55	center; requiring rules; allowing capitated payments;
56	requiring reports; amending s. 430.709, F.S.; revising
57	requirements for evaluation of community diversion pilot
58	projects; requiring the agency to select a contractor to
59	make such evaluations; requiring a report; amending
60	430.705, F.S.; providing additional requirements for long-
61	term-care community diversion pilot projects; providing
62	legislative findings; requiring a demonstration project;
63	requiring rules; requiring integration of certain managed
64	care programs; providing an effective date.
65
66	Be It Enacted by the Legislature of the State of Florida:
67
68	Section 1.  Subsection (8) of section 20.41, Florida
69	Statutes, is amended to read:
70	20.41  Department of Elderly Affairs.--There is created a
71	Department of Elderly Affairs.
72	(8)  The area agency on aging board shall, in consultation
73	with the secretary, appoint a chief executive officer, hereafter
74	referred to as the "executive director," to whom shall be
75	delegated responsibility for agency management and for
76	implementation of board policy, and who shall be accountable for
77	the agency's performance. In addition to the personnel
78	requirements of the area agency on aging board, the performance
79	of the executive director shall be evaluated annually by the
80	secretary, and the board shall consider the evaluation and
81	recommendation when it considers reappointments.
82	Section 2.  Paragraph (h) of subsection (4) and subsection
83	(15) of section 409.912, Florida Statutes, are amended to read:
84	409.912  Cost-effective purchasing of health care.--The
85	agency shall purchase goods and services for Medicaid recipients
86	in the most cost-effective manner consistent with the delivery
87	of quality medical care. The agency shall maximize the use of
88	prepaid per capita and prepaid aggregate fixed-sum basis
89	services when appropriate and other alternative service delivery
90	and reimbursement methodologies, including competitive bidding
91	pursuant to s. 287.057, designed to facilitate the cost-
92	effective purchase of a case-managed continuum of care. The
93	agency shall also require providers to minimize the exposure of
94	recipients to the need for acute inpatient, custodial, and other
95	institutional care and the inappropriate or unnecessary use of
96	high-cost services. The agency may establish prior authorization
97	requirements for certain populations of Medicaid beneficiaries,
98	certain drug classes, or particular drugs to prevent fraud,
99	abuse, overuse, and possible dangerous drug interactions. The
100	Pharmaceutical and Therapeutics Committee shall make
101	recommendations to the agency on drugs for which prior
102	authorization is required. The agency shall inform the
103	Pharmaceutical and Therapeutics Committee of its decisions
104	regarding drugs subject to prior authorization.
105	(4)  The agency may contract with:
106	(h)  An entity authorized in s. 430.705(10) 430.205 to
107	contract with the agency and the Department of Elderly Affairs
108	to provide health care and social services on a prepaid or
109	fixed-sum basis to elderly recipients. Such prepaid health care
110	services entities are exempt from the provisions of part I of
111	chapter 641 for the first 3 years of operation. An entity
112	recognized under this paragraph that demonstrates to the
113	satisfaction of the Office of Insurance Regulation that it is
114	backed by the full faith and credit of one or more counties in
115	which it operates may be exempted from s. 641.225.
116	(15)(a)  The agency shall operate the Comprehensive
117	Assessment and Review and Evaluation for Long-Term Care Services
118	(CARES) nursing facility preadmission screening program to
119	ensure that Medicaid payment for nursing facility care is made
120	only for individuals whose conditions require such care and to
121	ensure that long-term care services are provided in the setting
122	most appropriate to the needs of the person and in the most
123	economical manner possible. The CARES program shall also ensure
124	that individuals participating in Medicaid home and community-
125	based waiver programs meet criteria for those programs,
126	consistent with approved federal waivers.
127	(b)  The agency shall operate the CARES program through an
128	interagency agreement with the Department of Elderly Affairs.
129	The agency, with agreement from the Department of Elderly
130	Affairs, may contract for any function or activity of the CARES
131	program, including any function or activity required by 42
132	C.F.R. part 483.20, relating to preadmission screening and
133	resident review, if the agency and the department can
134	demonstrate that contracting for such a function will result in
135	a savings to the state and increased efficiency and
136	accountability.
137	(c)  Prior to making payment for nursing facility services
138	for a Medicaid recipient, the agency must verify that the
139	nursing facility preadmission screening program has determined
140	that the individual requires nursing facility care and that the
141	individual cannot be safely served in community-based programs.
142	The nursing facility preadmission screening program shall refer
143	a Medicaid recipient to a community-based program if the
144	individual could be safely served at a lower cost and the
145	recipient chooses to participate in such program.
146	(d)  For the purpose of initiating immediate prescreening
147	and diversion assistance for individuals residing in nursing
148	homes and in order to make families aware of alternative long-
149	term-care resources so that they may choose a more cost-
150	effective setting for long-term placement, within existing
151	appropriated staffing, CARES staff shall conduct an assessment
152	and review of a sample of individuals whose nursing home stay is
153	expected to exceed 20 days, regardless of the initial funding
154	source for the nursing home placement. CARES staff shall provide
155	counseling and referral services to these individuals regarding
156	choosing a facility. This paragraph does not apply to continuing
157	care facilities licensed under chapter 651 or to retirement
158	communities that provide a combination of nursing home,
159	independent living, and other long-term-care services.
160	(e)(d)  By January 15 1 of each year, the agency shall
161	submit a report to the President of the Senate and the Speaker
162	of the House of Representatives Legislature and the Office of
163	Long-Term-Care Policy describing the operations of the CARES
164	program. The report must describe:
165	1.  Rate of diversion to community alternative programs;
166	2.  CARES program staffing needs to achieve additional
167	diversions;
168	3.  Reasons the program is unable to place individuals in
169	less restrictive settings when such individuals desired such
170	services and could have been served in such settings;
171	4.  Barriers to appropriate placement, including barriers
172	due to policies or operations of other agencies or state-funded
173	programs; and
174	5.  Statutory changes necessary to ensure that individuals
175	in need of long-term care services receive care in the least
176	restrictive environment.
177	(f)  The Department of Elderly Affairs shall develop a
178	database to track individuals over time who are assessed under
179	the CARES program and who are diverted from nursing home
180	placement. By January 15 of each year, the department shall
181	submit to the President of the Senate and the Speaker of the
182	House of Representatives and the Office of Long-Term-Care
183	Policy, a longitudinal study of the individuals who are diverted
184	from nursing home placement. The study must include:
185	1.  The demographic characteristics of the individuals
186	assessed and diverted from nursing home placement, including,
187	but not limited to, age, race, gender, frailty, caregiver
188	status, living arrangements, and geographic location.
189	2.  A summary of community services provided to individuals
190	for 1 year after assessment and diversion.
191	3.  A summary of inpatient hospital admissions for
192	individuals who have been diverted.
193	4.  A summary of the length of time between diversion and
194	subsequent entry into a nursing home or death.
195	(g)  By July 1, 2005, the department and the Agency for
196	Health Care Administration shall report to the President of the
197	Senate and the Speaker of the House of Representatives regarding
198	the impact to the state of modifying level of care criteria to
199	eliminate the Intermediate II level of care.
200	Section 3.  Subsection (6) of section 430.205, Florida
201	Statutes, is amended to read:
202	430.205  Community care service system.--
203	(6)  Notwithstanding other requirements of this chapter,
204	the department of Elderly Affairs and the Agency for Health Care
205	Administration shall develop a model system to transition all
206	Medicaid state-funded services for elderly individuals in one or
207	more of the department's planning and service areas to a
208	managed, integrated long-term-care delivery system under the
209	direction of a single entity.
210	(a)  The duties of a managed care organization contracted
211	to operate the managed the model system shall include organizing
212	and administering service delivery for the elderly, obtaining
213	contracts for services with providers in the area, monitoring
214	the quality of services provided, determining levels of need and
215	disability for payment purposes, and other activities determined
216	by the department and the agency in order to operate the managed
217	model system.
218	(b)  The agency and the department shall integrate all
219	funding for Medicaid services to individuals over the age of 65
220	in the managed system model planning and service areas into a
221	single per-person per-month payment rate, except that funds for
222	Medicaid behavioral health care services are exempt from this
223	section. The funds to be integrated shall include:
224	1.  Community-care-for-the-elderly funds;
225	2.  Home-care-for-the-elderly funds;
226	3.  Local services program funds;
227	4.  Contracted services funds;
228	5.  Alzheimer's disease initiative funds;
229	1.6.  Medicaid home and community-based waiver services
230	funds;
231	2.7.  Funds for all Medicaid services authorized in ss.
232	409.905 and 409.906, including Medicaid nursing home services;
233	and
234	3.8.  Funds paid for Medicare premiums, coinsurance and
235	deductibles for persons dually eligible for Medicaid and
236	Medicare as prescribed in s. 409.908(13).
237
238	The department and the agency shall not make Medicaid payments
239	for services for people age 65 and older in the areas in which
240	the managed system operates except through the managed model
241	delivery system.
242	(c)  The entity selected to administer the managed model
243	system shall develop a comprehensive health and long-term-care
244	service delivery system through contracts with providers of
245	medical, social, and long-term-care services sufficient to meet
246	the needs of the population age 65 and older. The entity
247	selected to administer the model system shall not directly
248	provide services other than intake, assessment, and referral
249	services.
250	(d)  The department and the agency shall contract through
251	competitive procurement with two managed care organizations to
252	administer the project determine which of the department's
253	planning and services areas is to be designated as a model area
254	by means of a request for proposals. The department shall select
255	an area to be designated as a model area and the entity to
256	administer the model system based on demonstration of capacity
257	of each provider the entity to:
258	1.  Develop contracts with providers currently under
259	contract with the department, area agencies on aging, or
260	community-care-for-the-elderly lead agencies;
261	2.  Provide a comprehensive system of appropriate medical
262	and long-term-care services that provides high-quality medical
263	and social services to assist older individuals in remaining in
264	the least restrictive setting;
265	3.  Demonstrate a quality assurance and quality improvement
266	system satisfactory to the department and the agency;
267	4.  Develop a system to identify participants who have
268	special health care needs such as polypharmacy, mental health
269	and substance abuse problems, falls, chronic pain, nutritional
270	deficits, and cognitive deficits, in order to respond to and
271	meet these needs;
272	5.  Use a multidisciplinary team approach to participant
273	management which ensures that information is shared among
274	providers responsible for delivering care to a participant;
275	6.  Ensure medical oversight of care plans and service
276	delivery, regular medical evaluation of care plans, and the
277	availability of medical consultation for case managers and
278	service coordinators;
279	7.  Develop, monitor, and enforce quality-of-care
280	requirements;
281	8.  Secure subcontracts with providers of medical, nursing
282	home, and community-based long-term-care services sufficient to
283	ensure assure access to and choice of providers by project
284	participants;
285	9.  Ensure a system of case management and service
286	coordination which includes educational and training standards
287	for case managers and service coordinators;
288	10.  Develop a business plan that considers the ability of
289	the applicant to organize and operate a risk-bearing entity;
290	11.  Furnish evidence of adequate liability insurance
291	coverage or an adequate plan of self-insurance to respond to
292	claims for injuries arising out of the furnishing of health
293	care; and
294	12.  Provide, through contract or otherwise, for periodic
295	review of its medical facilities as required by the department
296	and the agency.
297
298	The department shall give preference in selecting an area to be
299	designated as a model area to that in which the administering
300	entity is an existing area agency on aging or community-care-
301	for-the-elderly lead agency demonstrating the ability to perform
302	the functions described in this paragraph.
303	(e)  The department in consultation with the selected
304	entity shall develop a statewide proposal regarding the long-
305	term use and structure of a program that addresses a risk pool
306	to reduce financial risk.
307	(e)(f)  The department and the agency shall develop
308	capitation rates based on the historical cost experience of the
309	state in providing acute and long-term-care services to the
310	population over 65 years of age in the area served. The agency,
311	in consultation with the department, shall contract for an
312	independent entity to study the historical cost experience of
313	the state in providing services listed in paragraph (b) to the
314	population age 65 and older residing within the model area and
315	to develop and certify a per-person, per-month capitation rate
316	for the managed system. The agency, in consultation with the
317	department, shall reevaluate and recertify the capitation rate
318	annually, adjusting based on the cost of providing the services
319	listed in paragraph (b).
320	1.  Payment rates in the first 2 years of operation shall
321	be set at no more than 100 percent of the costs to the state of
322	providing equivalent services to the population of the model
323	area for the year prior to the year in which the model system is
324	implemented, adjusted forward to account for inflation and
325	population growth. In subsequent years, the rate shall be
326	negotiated based on the cost experience of the model system in
327	providing contracted services, but may not exceed 95 percent of
328	the amount that would have been paid by the state in the model
329	planning and service area absent the model integrated service
330	delivery system.
331	2.  The agency and the department may develop innovative
332	risk-sharing agreements that limit the level of custodial
333	nursing home risk that the administering entity assumes,
334	consistent with the intent of the Legislature to reduce the use
335	and cost of nursing home care. Under risk-sharing arrangements,
336	the agency and the department may reimburse the administering
337	entity for the cost of providing nursing home care for Medicaid-
338	eligible participants who have been permanently placed and
339	remain in nursing home care for more than 1 year.
340	(f)(g)  The department and the Agency for Health Care
341	Administration shall seek federal waivers, or amendments to
342	existing waivers, necessary to implement the requirements of
343	this section.
344	(g)(h)  The agency and the department shall give preference
345	in contracting for the managed system to those entities whose
346	proposals create innovative, functional partnerships with
347	existing community-care-for-the-elderly lead agencies. The
348	Department of Children and Family Services shall develop a
349	streamlined and simplified eligibility system and shall
350	outstation a sufficient number and quality of eligibility-
351	determination staff with the administering entity to assure
352	determination of Medicaid eligibility for the integrated service
353	delivery system in the model planning and service area within 10
354	days after receipt of a complete application.
355	(h)(i)  The agency, in consultation with the department,
356	shall begin discussions with the federal Centers for Medicare
357	and Medicaid Services regarding the inclusion of Medicare in an
358	integrated long-term-care system. By December 31, 2006, the
359	agency shall provide to the Governor, the President of the
360	Senate, and the Speaker of the House of Representatives a plan
361	for including Medicare in an integrated long-term-care system.
362	The Department of Elderly Affairs shall make arrangements to
363	outstation a sufficient number of nursing home preadmission
364	screening staff with the administering entity to assure timely
365	assessment of level of need for long-term-care services in the
366	model area.
367	(i)(j)  The department, in consultation with the agency,
368	shall consider whether providers operating in the managed system
369	should be placed at risk for the state-funded community care for
370	the elderly, home care for the elderly, and Alzheimer's disease
371	initiative The Department of Elderly Affairs shall conduct or
372	contract for an evaluation of the pilot project. The department
373	shall submit the evaluation to the Governor and the Legislature
374	by January 1, 2005. The evaluation must address the effects of
375	the pilot project on the effectiveness of the entity providing a
376	comprehensive system of appropriate and high-quality medical and
377	long-term-care services to elders in the least restrictive
378	setting and make recommendations on a phased-in implementation
379	expansion for the rest of the state.
380	(j)  The agency shall ensure that, to the extent possible,
381	Medicare and Medicaid services are integrated. Where possible,
382	individuals served in the managed system who are eligible for
383	Medicare shall be enrolled in a Medicare managed health care
384	plan operated by the same entity which is placed at risk for
385	long-term care services.
386	Section 4.  Section 430.2051, Florida Statutes, is created
387	to read:
388	430.2051  Home and community-based waiver services.--
389	(1)  The agency, in consultation with the department, shall
390	integrate the assisted living for the elderly Medicaid waiver
391	program into the aged and disabled adult Medicaid waiver
392	program, and each program's funds into one fee-for-service
393	Medicaid waiver program serving the aged and disabled.
394	(a)  After the programs are integrated, funding to provide
395	care in assisted-living facilities under the new waiver may not
396	be less than the amount appropriated in the 2003-2004 fiscal
397	year for the assisted living for the elderly Medicaid waiver.
398	(b)  The agency shall seek federal waivers, or amendments
399	to existing waivers, necessary to integrate these waiver
400	programs.
401	(c)  The agency and the department may reimburse providers
402	for case management services on a capitated basis and shall
403	develop uniform standards for case management in this fee-for-
404	service Medicaid waiver program.
405	(d)  The agency and the department shall adopt any rules
406	necessary to comply with or administer these requirements,
407	effect and implement interagency agreements between the
408	department and the agency, and comply with federal requirements.
409	(2)  The department, in consultation with the agency, shall
410	study the integration of the database systems for the
411	Comprehensive Assessment Review and Evaluation of Long-Term Care
412	Services (CARES) program and the Client Information and Referral
413	Tracking System (CIRTS) and develop a plan for database
414	integration. The department shall submit the plan to the
415	Governor, the President of the Senate, and the Speaker of the
416	House of Representatives by December 31, 2004.
417	(3)  The department, in consultation with the agency, shall
418	develop a plan to evaluate the newly integrated program over
419	time, from the beginning of the implementation process forward.
420	The department shall contract with a research entity through
421	competitive procurement to help develop the evaluation plan and
422	conduct the evaluation. The evaluation shall be ongoing and
423	shall determine whether the newly integrated program is
424	achieving its goals and evaluate the effects the changes have
425	had on consumers. The evaluation plan must include baseline
426	measures for evaluating cost-effectiveness, the quality of care,
427	and consumer satisfaction of the program. The department shall
428	submit the plan to the Governor, the President of the Senate,
429	and the Speaker of the House of Representatives by December 31,
430	2004.
431	(4)  The department, in consultation with the agency and
432	the Department of Children and Family Services, shall develop a
433	plan to improve the interaction among the department's newly
434	integrated assessment database, the Florida Medicaid Management
435	Information System, and the FLORIDA system in order to
436	facilitate enrollment of individuals in capitated and fee-for-
437	service programs, as well as to monitor eligibility
438	requirements.
439	(5)  Consistent with federal requirements, the agency, in
440	consultation with the department, shall evaluate the Alzheimer's
441	disease waiver program and the adult day health care waiver
442	program to assess whether providing limited intensive services
443	through these waiver programs produces better outcomes for
444	individuals than providing those services through the fee-for-
445	service or capitated programs that provide a larger array of
446	services.
447	Section 5.  Section 430.041, Florida Statutes, is amended
448	to read:
449	430.041  Office of Long-Term-Care Policy.--
450	(1)  There is established in the Department of Elderly
451	Affairs the Office of Long-Term-Care Policy to evaluate the
452	state's long-term-care service delivery system and make
453	recommendations to increase the efficiency and effectiveness of
454	government-funded long-term-care programs for availability and
455	the use of noninstitutional settings to provide care to the
456	elderly and to ensure coordination among the agencies
457	responsible for setting policies for funding and for
458	administering the long-term-care programs for the elderly
459	continuum.
460	(2)  The purpose of the Office of Long-Term-Care Policy is
461	to:
462	(a)  Ensure close communication and coordination among
463	state agencies involved in developing and administering a more
464	efficient and coordinated long-term-care service delivery system
465	in this state;
466	(b)  Identify duplication and unnecessary service provision
467	in the long-term-care system and make recommendations to
468	decrease inappropriate service provision;
469	(b)(c)  Review current programs providing long-term-care
470	services to determine whether the programs are cost effective,
471	of high quality, and operating efficiently and make
472	recommendations to increase consistency and effectiveness in the
473	state's long-term-care programs;
474	(c)(d)  Develop strategies for promoting and implementing
475	cost-effective home and community-based services as an
476	alternative to institutional care which coordinate and integrate
477	the continuum of care needs of the elderly; and
478	(d)  Recommend roles for state agencies that are
479	responsible for administering long-term-care programs for the
480	elderly and an organization framework for the planning,
481	coordination, implementation, and evaluation of long-term-care
482	programs for the elderly.
483	(e)  Assist the Office of Long-Term-Care Policy Advisory
484	Council as necessary to help implement this section.
485	(3)  The Director of the Office of Long-Term-Care Policy
486	shall be appointed by, and serve at the pleasure of, the
487	Governor. The director shall report to, and be under the general
488	supervision of, the Secretary of Elderly Affairs and shall not
489	be subject to supervision by any other employee of the
490	department.
491	(4)  The Office of Long-Term-Care Policy shall have an
492	advisory council. The purposes of the advisory council are to
493	provide assistance and direction to the office and to ensure
494	that the appropriate state agencies are properly implementing
495	recommendations from the office.
496	(a)  The advisory council shall consist of:
497	1.  A member of the Senate, appointed by the President of
498	the Senate;
499	2.  A member of the House of Representatives, appointed by
500	the Speaker of the House of Representatives;
501	3.  The Secretary of Health Care Administration;
502	4.  The Secretary of Elderly Affairs;
503	5.  The Secretary of Children and Family Services;
504	6.  The Secretary of Health;
505	7.  The Executive Director of the Department of Veterans'
506	Affairs;
507	8.  Three people with broad knowledge and experience in the
508	delivery of long-term-care services, appointed by the Governor
509	from groups representing elderly persons; and
510	9.  Two representatives of people using long-term-care
511	services, appointed by the Governor from groups representing
512	elderly persons.
513	(b)  The council shall elect a chair from among its
514	membership to serve for a 1-year term. A chair may not serve
515	more than two consecutive terms.
516	(c)  Members shall serve without compensation, but are
517	entitled to receive reimbursement for travel and per diem as
518	provided in s. 112.061.
519	(d)  The advisory council shall meet at the call of its
520	chair or at the request of a majority of its members. During its
521	first year of existence, the advisory council shall meet at
522	least monthly.
523	(e)  Members of the advisory council appointed by the
524	Governor shall serve at the pleasure of the Governor and shall
525	be appointed to 4-year staggered terms in accordance with s.
526	20.052.
527	(4)(5)(a)  The Department of Elderly Affairs shall provide
528	administrative support and services to the Office of Long-Term-
529	Care Policy.
530	(b)  The office shall call upon appropriate agencies of
531	state government, including the centers on aging in the State
532	University System, for assistance needed in discharging its
533	duties.
534	(c)  Each state agency represented on the Office of Long-
535	Term-Care Policy Advisory Council shall make at least one
536	employee available to work with the Office of Long-Term-Care
537	Policy. All state agencies and universities shall assist the
538	office in carrying out its responsibilities prescribed by this
539	section.
540	(d)  The Secretary of Health Care Administration, the
541	Secretary of Elderly Affairs, the Secretary of Children and
542	Family Services, the Secretary of Health, and the executive
543	director of the Department of Veterans' Affairs shall each
544	appoint at least one high-level employee with the authority to
545	recommend and implement agency policy and with experience in the
546	area of long-term-care service delivery and financing to work
547	with the Office of Long-Term-Care Policy, as part of an
548	interagency coordinating team. The interagency coordinating team
549	shall meet monthly with the director of the Office of Long-Term-
550	Care Policy to implement the purposes of the office.
551	(e)(d)  Each state agency shall pay from its own funds any
552	expenses related to its support of the Office of Long-Term-Care
553	Policy and its participation on the advisory council. The
554	Department of Elderly Affairs shall be responsible for expenses
555	related to participation on the advisory council by members
556	appointed by the Governor.
557	(5)(6)(a)  By December 31 of each year 1, 2002, the office
558	shall submit to the Governor, the President of the Senate, and
559	the Speaker of the House of Representatives a advisory council a
560	preliminary report of its activities and the progress made in
561	findings and recommendations on improving the long-term-care
562	continuum in this state and make recommendations accordingly.
563	The report shall contain the activities completed by the office
564	during the calendar year, recommendations and implementation
565	proposals for policy changes, and as well as legislative and
566	funding recommendations that will make the system more effective
567	and efficient. The report shall contain a specific
568	implementation strategies, with timelines, plan for
569	accomplishing the recommendations and proposals set out in the
570	report. Thereafter, the office shall revise and update the
571	report annually and resubmit it to the advisory council for
572	review and comments by November 1 of each year.
573	(b)  The advisory council shall review and recommend any
574	suggested changes to the preliminary report, and each subsequent
575	annual update of the report, within 30 days after the receipt of
576	the preliminary report. Suggested revisions, additions, or
577	deletions shall be made to the Director of the Office of Long-
578	Term-Care Policy.
579	(c)  The office shall submit its final report, and each
580	subsequent annual update of the report, to the Governor and the
581	Legislature within 30 days after the receipt of any revisions,
582	additions, or deletions suggested by the advisory council, or
583	after the time such comments are due to the office.
584	Section 6.  Subsection (3) and paragraphs (b) and (c) of
585	subsection (9) of section 430.203, Florida Statutes, are amended
586	to read:
587	430.203  Community care for the elderly; definitions.--As
588	used in ss. 430.201-430.207, the term:
589	(3)  "Community care service system" means a service
590	network comprising a variety of home-delivered services, day
591	care services, and other basic services, hereinafter referred to
592	as "core services," for functionally impaired elderly persons
593	which are provided by or through several agencies under the
594	direction of a single lead agency. Its purpose is to provide a
595	continuum of care encompassing a full range of preventive,
596	maintenance, and restorative services for functionally impaired
597	elderly persons.
598	(9)  "Lead agency" means an agency designated at least once
599	every 3 years by an area agency on aging as the result of a
600	request for proposal process to be in place no later than the
601	state fiscal year 1996-1997.
602	(b)  The area agency on aging, in consultation with the
603	department, shall may exempt from the competitive bid process
604	any contract with a provider who meets or exceeds established
605	minimum standards, as determined by the department.
606	(c)  In each community care service system the lead agency
607	must be given the authority and responsibility to coordinate
608	some or all of the services, either directly or through
609	subcontracts, for functionally impaired elderly persons. These
610	services must include case management, and may include homemaker
611	and chore services, respite care, adult day care, personal care
612	services, home-delivered meals, counseling, information and
613	referral, and emergency home repair services. The lead agency
614	must compile community care statistics and monitor, when
615	applicable, subcontracts with agencies providing core services.
616	Section 7.  Subsection (2) of section 430.7031, Florida
617	Statutes, is amended to read:
618	430.7031  Nursing home transition program.--The department
619	and the Agency for Health Care Administration:
620	(2)  Shall collaboratively work to identify long-stay
621	nursing home residents who are able to move to community
622	placements, and to provide case management and supportive
623	services to such individuals while they are in nursing homes to
624	assist such individuals in moving to less expensive and less
625	restrictive settings. CARES program staff shall annually review
626	at least 20 percent of the case files for nursing home residents
627	who are Medicaid recipients to determine which nursing home
628	residents are able to move to community placements.
629	Section 8.  Section 430.2053, Florida Statutes, is created
630	to read:
631	430.2053  Aging resource centers.--
632	(1)  The department, in consultation with the Agency for
633	Health Care Administration and the Department of Children and
634	Family Services, shall develop pilot projects for aging resource
635	centers. By October 31, 2004, the department, in consultation
636	with the agency and the Department of Children and Family
637	Services, shall develop an implementation plan for aging
638	resource centers and submit the plan to the Governor, the
639	President of the Senate, and the Speaker of the House of
640	Representatives. The plan must include qualifications for
641	designation as a center, the functions to be performed by each
642	center, and a process for determining that a current area agency
643	on aging is ready to assume the functions of a resource center
644	on aging.
645	(2)  Each area agency on aging shall develop, in
646	consultation with the existing community care for the elderly
647	lead agencies within their planning and service areas, a
648	proposal that describes the process the area agency on aging
649	intends to undertake to transition to an aging resource center
650	prior to July 1, 2005, and that describes the area agency's
651	compliance with the requirements of this section. The proposals
652	must be submitted to the department prior to December 31, 2004.
653	The department shall evaluate all proposals for readiness and,
654	prior to March 1, 2005, shall select three area agencies on
655	aging which meet the requirements of this section to begin the
656	transition to aging resource centers. Those area agencies on
657	aging which are not selected to begin the transition to aging
658	resource centers shall, in consultation with the department and
659	the existing community care for the elderly lead agencies within
660	their planning and service areas, amend their proposals as
661	necessary and resubmit them to the department prior to July 1,
662	2005. The department may transition additional area agencies to
663	aging resource centers as it determines that area agencies are
664	in compliance with the requirements of this section.
665	(3)  The Auditor General and the Office of Program Policy
666	Analysis and Government Accountability (OPPAGA) shall jointly
667	review and assess the department's process for determining an
668	area agency's readiness to transition to an aging resource
669	center.
670	(a)  The review must, at a minimum, address the
671	appropriateness of the department's criteria for selection of an
672	area agency to transition to an aging resource center, the
673	instruments applied, the degree to which the department
674	accurately determined each area agency's compliance with the
675	readiness criteria, the quality of the technical assistance
676	provided by the department to an area agency in correcting any
677	weaknesses identified in the readiness assessment, and the
678	degree to which each area agency overcame any identified
679	weaknesses.
680	(b)  Reports of these reviews must be submitted to the
681	appropriate substantive and appropriations committees in the
682	Senate and the House of Representatives on March 1 and September
683	1 of each year until full transition to aging resource centers
684	has been accomplished statewide, except that the first report
685	must be submitted by February 1, 2005, and must address all
686	readiness activities undertaken through December 31, 2004. The
687	perspectives of all participants in this review process must be
688	included in each report.
689	(4)  The purposes of an aging resource center shall be:
690	(a)  To provide Florida's elders and their families with a
691	locally focused, coordinated approach to integrating information
692	and referral for all available services for elders with the
693	eligibility determination entities for state and federally
694	funded long-term-care services.
695	(b)  To provide for easier access to long-term-care
696	services by Florida's elders and their families by creating
697	multiple access points to the long-term-care network that flow
698	through one established entity with wide community recognition.
699	(5)  The duties of an aging resource center are to:
700	(a)  Develop referral agreements with local community
701	service organizations, such as senior centers, existing elder
702	service providers, volunteer associations, and other similar
703	organizations, to better assist clients who do not need or do
704	not wish to enroll in programs funded by the department or the
705	agency. The referral agreements must also include a protocol,
706	developed and approved by the department, which provides
707	specific actions that an aging resource center and local
708	community service organizations must take when an elder or an
709	elder's representative seeking information on long-term-care
710	services contacts a local community service organization prior
711	to contacting the aging resource center. The protocol shall be
712	designed to ensure that elders and their families are able to
713	access information and services in the most efficient and least
714	cumbersome manner possible.
715	(b)  Provide an initial screening of all clients who
716	request services funded wholly or in part by the Department of
717	Elderly Affairs to determine whether the person would be most
718	appropriately served through any combination of federally funded
719	programs, state-funded programs, locally funded or community
720	volunteer programs, or private funding for services.
721	(c)  Determine eligibility for the programs and services
722	listed in subsection (11) for persons residing within the
723	geographic area served by the aging resource center and
724	determine a priority ranking for services which is based upon
725	the potential recipient's frailty level and likelihood of
726	institutional placement without such services.
727	(d)  Manage the availability of financial resources for the
728	programs and services listed in subsection (11) for persons
729	residing within the geographic area served by the aging resource
730	center.
731	(e)  When financial resources become available, refer a
732	client to the most appropriate entity to begin receiving
733	services. The aging resource center shall make referrals to lead
734	agencies for service provision that ensure that individuals who
735	are vulnerable adults in need of services pursuant to s.
736	415.104(3)(b), or who are victims of abuse, neglect, or
737	exploitation in need of immediate services to prevent further
738	harm and are referred by the adult protective services program,
739	are given primary consideration for receiving community-care-
740	for-the-elderly services in compliance with the requirements of
741	s. 430.205(5)(a) and that other referrals for services are in
742	compliance with s. 430.205(5)(b).
743	(f)  Convene a work group to advise in the planning,
744	implementation, and evaluation of the aging resource center. The
745	work group shall be comprised of representatives of local
746	service providers, Alzheimer's Association chapters, housing
747	authorities social service organizations, advocacy groups,
748	representatives of clients receiving services through the aging
749	resource center, and any other persons or groups as determined
750	by the department. The aging resource center, in consultation
751	with the work group, must develop annual program improvement
752	plans that shall be submitted to the department for
753	consideration. The department shall review each annual
754	improvement plan and make recommendations on how to implement
755	the components of the plan.
756	(g)  Enhance the existing area agency on aging in each
757	planning and service area by integrating, either physically or
758	virtually, the staff and services of the area agency on aging
759	with the staff of the department's local CARES Medicaid nursing
760	home preadmission screening unit and a sufficient number of
761	staff from the Department of Children and Family Services'
762	Economic Self Sufficiency Unit necessary to determine the
763	financial eligibility for all persons age 60 and older residing
764	within the area served by the aging resource center that are
765	seeking Medicaid services, Supplemental Security Income, and
766	food stamps.
767	(6)  The department shall select the entities to become
768	aging resource centers based on each entity's readiness and
769	ability to perform the duties listed in subsection (5) and the
770	entity's:
771	(a)  Expertise in the needs of each target population the
772	center proposes to serve and a thorough knowledge of the
773	providers that serve these populations.
774	(b)  Strong connections to service providers, volunteer
775	agencies, and community institutions.
776	(c)  Expertise in information and referral activities.
777	(d)  Knowledge of long-term-care resources, including
778	resources designed to provide services in the least restrictive
779	setting.
780	(e)  Financial solvency and stability.
781	(f)  Ability to collect, monitor, and analyze data in a
782	timely and accurate manner, along with systems that meet the
783	department's standards.
784	(g)  Commitment to adequate staffing by qualified personnel
785	to effectively perform all functions.
786	(h)  Ability to meet all performance standards established
787	by the department.
788	(7)  The aging resource center shall have a governing body
789	which shall be the same entity described in s. 20.41(7), and an
790	executive director who may be the same person as described in s.
791	20.41(8). The governing body shall annually evaluate the
792	performance of the executive director.
793	(8)  The aging resource center may not be a provider of
794	direct services other than information and referral services.
795	(9)  The aging resource center must agree to allow the
796	department to review any financial information the department
797	determines is necessary for monitoring or reporting purposes,
798	including financial relationships.
799	(10)  The duties and responsibilities of the community care
800	for the elderly lead agencies within each area served by an
801	aging resource center shall be to:
802	(a)  Develop strong community partnerships to maximize the
803	use of community resources for the purpose of assisting elders
804	to remain in their community settings for as long as it is
805	safely possible.
806	(b)  Conduct comprehensive assessments of clients that have
807	been determined eligible and develop a care plan consistent with
808	established protocols that ensures that the unique needs of each
809	client are met.
810	(11)  The services to be administered through the aging
811	resource center shall include those funded by the following
812	programs:
813	(a)  Community care for the elderly.
814	(b)  Home care for the elderly.
815	(c)  Contracted services.
816	(d)  Alzheimer's disease initiative.
817	(e)  Aged and disabled adult Medicaid waiver.
818	(f)  Assisted living for the frail elderly Medicaid waiver.
819	(g)  Long-term-care community diversion project.
820	(h)  Older Americans Act.
821	(12)  The department shall, prior to designation of an
822	aging resource center, develop by rule operational and quality
823	assurance standards and outcome measures to ensure that clients
824	receiving services through all long-term-care programs
825	administered through an aging resource center are receiving the
826	appropriate care they require and that contractors and
827	subcontractors are adhering to the terms of their contracts and
828	are acting in the best interests of the clients they are
829	serving, consistent with the intent of the Legislature to reduce
830	the use of and cost of nursing home care. The department shall
831	by rule provide operating procedures for aging resource centers,
832	which shall include:
833	(a)  Minimum standards for financial operation, including
834	audit procedures.
835	(b)  Procedures for monitoring and sanctioning of service
836	providers.
837	(c)  Minimum standards for technology utilized by the aging
838	resource center.
839	(d)  Minimum staff requirements which shall ensure that the
840	aging resource center employs sufficient quality and quantity of
841	staff to adequately meet the needs of the elders residing within
842	the area served by the aging resource center.
843	(e)  Minimum accessibility standards, including hours of
844	operation.
845	(f)  Minimum requirements regarding meetings of the
846	governing body of the aging resource center, training standards
847	for governing body members, and the minimum level of involvement
848	of such members in activities such as monitoring, evaluations,
849	and other necessary functions of the aging resource center as
850	determined by the department.
851	(g)  Minimum requirements that a candidate must meet in
852	order to be eligible for appointment as executive director of an
853	aging resource center.
854	(h)  Minimum requirements regarding any executive staff
855	positions that the aging resource center must employ and minimum
856	requirements that a candidate must meet in order to be eligible
857	for appointment to such positions.
858	(13)  In an area in which the department has designated an
859	area agency on aging as an aging resource center, the department
860	and the agency shall not make payments for the services listed
861	in subsection (11) for such persons who were not screened and
862	enrolled through the aging resource center.
863	(14)  Each aging resource center shall enter into a
864	memorandum of understanding with the department for
865	collaboration with the CARES unit staff. The memorandum of
866	understanding shall outline the staff person responsible for
867	each function and shall provide the staffing levels necessary to
868	carry out the functions of the aging resource center.
869	(15)  Each aging resource center shall enter into a
870	memorandum of understanding with the Department of Children and
871	Family Services for collaboration with the Economic Self-
872	Sufficiency Unit staff. The memorandum of understanding shall
873	outline which staff persons are responsible for which functions
874	and shall provide the staffing levels necessary to carry out the
875	functions of the aging resource center.
876	(16)  If any of the state programs described in this
877	paragraph are outsourced by the state, either in part or in
878	whole, the contract executing the outsourcing shall mandate that
879	the contractor or its subcontractors shall, either physically or
880	virtually, execute the provisions of the memorandum of
881	understanding instead of the state entity whose function the
882	contractor or subcontractor now performs.
883	(17)  In order to be eligible to begin transitioning to an
884	aging resource center, an area agency on aging board must ensure
885	that the area agency on aging which it oversees meets all of the
886	minimum requirements set by law and in agency rule.
887	(18)  The department shall monitor the three initial
888	projects for aging resource centers and report on the progress
889	of those projects to the Governor, the President of the Senate,
890	and the Speaker of the House of Representatives by June 30,
891	2005. The report must include an evaluation of the
892	implementation process.
893	(19)(a)  Once an aging resource center is operational, the
894	department, in consultation with the agency, may develop
895	capitation rates for any of the programs administered through
896	the aging resource center. Capitation rates for programs shall
897	be based on the historical cost experience of the state in
898	providing those same services to the population age 60 or older
899	residing within each area served by an aging resource center.
900	Each capitated rate may vary by geographic area as determined by
901	the department.
902	(b)  The department and the agency may determine for each
903	area served by an aging resource center whether it is
904	appropriate, consistent with federal and state laws and
905	regulations, to develop and pay separate capitated rates for
906	each program administered through the aging resource center or
907	to develop and pay capitated rates for service packages which
908	include more than one program or service administered through
909	the aging resource center.
910	(c)  Once capitation rates have been developed and
911	certified as actuarially sound, the department and the agency
912	may pay service providers the capitated rates for services when
913	appropriate.
914	(d)  The department, in consultation with the agency, shall
915	annually reevaluate and recertify the capitation rates,
916	adjusting forward to account for inflation, programmatic
917	changes, and provider costs.
918	(20)  The department, in consultation with the agency,
919	shall submit to the Governor, the President of the Senate, and
920	the Speaker of the House of Representatives, by December 1,
921	2006, a report addressing the feasibility of administering the
922	following services through aging resource centers beginning July
923	1, 2007:
924	(a)  Medicaid nursing home services.
925	(b)  Medicaid transportation services.
926	(c)  Medicaid hospice care services.
927	(d)  Medicaid intermediate care services.
928	(e)  Medicaid prescribed drug services.
929	(f)  Medicaid assistive care services.
930	(g)  Any other long-term-care program or Medicaid service.
931	Section 9.  Subsection (2) of section 430.709, Florida
932	Statutes, is amended to read:
933	430.709  Reports and evaluations.--
934	(2)  The agency, in consultation with the department, shall
935	contract for an independent, comprehensive evaluation of the
936	community diversion pilot projects which includes a comparison
937	to the assisted living for the elderly Medicaid waiver program
938	and the aged and disabled adult Medicaid waiver program. Such
939	evaluation must include a careful review and assessment of the
940	actual cost for the provision of services to participants. The
941	agency shall select a contractor with experience and expertise
942	in evaluating capitation rates for managed care organizations
943	that serve persons who are disabled or frail and elderly in
944	order to evaluate the community diversion pilot projects
945	operated under s. 430.705. The contractor shall analyze and
946	report on the individual services and the array of services most
947	associated with effective diversion of frail and elderly
948	enrollees from placement in a nursing home, consumer and family
949	satisfaction with the projects, the quality of care for
950	participants, the length of time diverted from nursing home
951	placement, the number of hospital admissions, the cost-
952	effectiveness of the projects, and the demonstrated savings to
953	the agency, as compared to similar fee-for-service programs. By
954	June 30, 2005, the agency shall submit to the Governor, the
955	President of the Senate, and the Speaker of the House of
956	Representatives a report of the findings from the evaluation.
957	The report must contain recommendations and proposals for
958	changes to the community diversion pilot projects.
959	Section 10.  Section 430.705, Florida Statutes, is amended
960	to read:
961	430.705  Implementation of the long-term care community
962	diversion pilot projects.--
963	(1)  In designing and implementing the community diversion
964	pilot projects, the department shall work in consultation with
965	the agency.
966	(2)  The department shall select projects whose design and
967	providers demonstrate capacity to maximize the placement of
968	participants in the least restrictive appropriate care setting.
969	The department shall select providers that have a plan
970	administrator who is dedicated to the diversion pilot project
971	and project staff who perform the necessary project
972	administrative functions, including data collection, reporting,
973	and analysis. The department shall select providers that
974	demonstrate the ability to:
975	(a)  Meet surplus requirements that are comparable to those
976	specified in s. 641.225.
977	(b)  Comply with the standards for financial solvency
978	comparable to those provided in s. 641.285.
979	(c)  Provide for the prompt payment of claims in a manner
980	comparable to the requirements of s. 641.3155.
981	(d)  Provide technology with the capability for data
982	collection which meets the security requirements of the federal
983	Health Insurance Portability and Accountability Act of 1996, 42
984	C.F.R. ss. 160 and 164.
985	(e)  Contract with multiple providers that provide the same
986	type of service.
987	(3)  Pursuant to 42 C.F.R. s. 438.6(c), the agency, in
988	consultation with the department, shall annually reevaluate and
989	recertify the capitation rates for the diversion pilot projects.
990	The agency, in consultation with the department, shall secure
991	the claims data for Medicare beneficiaries which shall be used
992	in developing rates for the diversion pilot projects.
993	(4)  In order to achieve rapid enrollment into the program
994	and efficient diversion of applicants from nursing home care,
995	the department and the agency shall allow enrollment of Medicaid
996	beneficiaries on the date that eligibility for the community
997	diversion pilot project is approved. The provider shall receive
998	a prorated capitated rate for those enrollees who are enrolled
999	after the first of each month.
1000	(5)(3)  The department shall provide to prospective
1001	participants a choice of participating in a community diversion
1002	pilot project or any other appropriate placement available. To
1003	the extent possible, individuals shall be allowed to choose
1004	their care providers, including long-term care service providers
1005	affiliated with an individual's religious faith or denomination.
1006	(6)(4)  The department shall enroll participants. Providers
1007	shall not directly enroll participants in community diversion
1008	pilot projects.
1009	(7)(5)  In selecting the pilot project area, the department
1010	shall consider the following factors in the area:
1011	(a)  The nursing home occupancy level.
1012	(b)  The number of certificates of need awarded for nursing
1013	home beds for which renovation, expansion, or construction has
1014	not begun.
1015	(c)  The annual number of additional nursing home beds.
1016	(d)  The annual number of nursing home admissions.
1017	(e)  The adequacy of community-based long-term care service
1018	providers.
1019	(8)(6)  The department may require participants to
1020	contribute to their cost of care in an amount not to exceed the
1021	cost-sharing required of Medicaid-eligible nursing home
1022	residents.
1023	(9)(7)  Community diversion pilot projects must:
1024	(a)  Provide services for participants that are of
1025	sufficient quality, quantity, type, and duration to prevent or
1026	delay nursing facility placement.
1027	(b)  Integrate acute and long-term care services, and the
1028	funding sources for such services, as feasible.
1029	(c)  Encourage individuals, families, and communities to
1030	plan for their long-term care needs.
1031	(d)  Provide skilled and intermediate nursing facility care
1032	for participants who cannot be adequately cared for in
1033	noninstitutional settings.
1034	(10)  The Legislature finds that preservation of the
1035	historic aging network of service providers is essential to the
1036	well-being of Florida's elderly population. The Legislature
1037	finds that the Florida aging network constitutes a system of
1038	essential community providers which should be nurtured and
1039	assisted to develop systems of operations which allow the
1040	gradual assumption of responsibility and financial risk for
1041	managing the entire continuum of long-term-care services and
1042	which allow these providers to develop managed systems of
1043	service delivery. The department and the agency shall therefore:
1044	(a)  Develop a demonstration system in which existing
1045	community care for the elderly lead agencies are assisted in
1046	transitioning their business model and service delivery system
1047	over a period of time to enable assumption of full risk as a
1048	diversion pilot project contractor providing long-term-care
1049	services in their areas of operation.
1050	(b)  In the demonstration system, a community care for the
1051	elderly lead agency shall be initially reimbursed on a prepaid
1052	or fixed-sum basis for services provided under the Aged and
1053	Disabled Adult Medicaid waiver program, state-funded programs
1054	serving the aged, including community care for the elderly, home
1055	care for the elderly, local services program, and the
1056	Alzheimer's disease initiative. By the end of the third year of
1057	operation, the demonstration shall include services under the
1058	long-term-care community diversion pilot project.
1059	(c)  During the first year of operation, the department and
1060	the agency may place the provider at risk to provide the nursing
1061	home services for the enrolled individuals who are participating
1062	in the demonstration project. During the 3-year development
1063	period, the agency and the department may limit the level of
1064	custodial nursing home risk that the administering entity
1065	assumes, consistent with the intent of the Legislature to reduce
1066	the use and cost of nursing home care. Under risk-sharing
1067	arrangements, during the first 3 years of operation, the agency
1068	and the department may reimburse the administering entity for
1069	the cost of providing nursing home care for Medicaid-eligible
1070	participants who have been permanently placed and remain in
1071	nursing home care for more than 1 year, or may disenroll such
1072	participants from the demonstration project.
1073	(d)  The agency and the department shall develop
1074	reimbursement rates based on the historical cost experience of
1075	the state in providing long-term care and nursing home services
1076	under Medicaid waiver programs and providing state-funded long-
1077	term care services to the population older than 60 years of age
1078	in the area served by the pilot project.
1079	(e)  The agency, in consultation with the department, shall
1080	ensure that the entity or entities receiving prepaid or fixed-
1081	sum reimbursement are assisted in developing internal management
1082	and financial control systems necessary to manage the risk
1083	associated with providing services under a prepaid or fixed-sum
1084	rate system.
1085	(f)  If the agency and the department share risk of
1086	custodial nursing home placement, payment rates during the first
1087	3 years of operation shall be set at not more than 100 percent
1088	of the costs to the agency and the department of providing
1089	equivalent services to the population within the area of the
1090	pilot project for the year prior to the year in which the pilot
1091	project is implemented, adjusted forward to account for
1092	inflation and policy changes of the Medicaid program. In
1093	subsequent years, the rate shall be negotiated, based on the
1094	cost experience of the entity in providing contracted services,
1095	but may not exceed 95 percent of the amount that would have been
1096	paid in the area of the pilot project absent the prepaid or
1097	fixed sum reimbursement methodology.
1098	(g)  Community care for the elderly lead agencies which
1099	have operated for a period of at least 20 years, which operate a
1100	Medicare-certified home health agency, and which have developed
1101	a system of service provision by health care volunteers shall be
1102	given priority in the selection of pilot projects if they meet
1103	the minimum requirements specified in the competitive
1104	procurement.
1105	(h)  In order to facilitate the development of the
1106	demonstration project, the agency, subject to appropriations
1107	included in the General Appropriation Act, shall advance
1108	$500,000 for the purpose of funding development costs for the
1109	demonstration project provider. The terms of repayment may not
1110	extend beyond 6 years from the date of funding.
1111	(i)  The agency and the department shall adopt any rules
1112	necessary to comply with or administer these requirements,
1113	effect and implement interagency agreements between the agency
1114	and the department, and comply with federal requirements.
1115	(j)  The department and the agency shall seek federal
1116	waivers necessary to implement the requirements of this section,
1117	including waivers available from the federal Assistant Secretary
1118	on Aging necessary to include Older Americans Act services in
1119	the demonstration project.
1120	(11)  During the 2004-2005 state fiscal year, the agency,
1121	in consultation with the department, shall integrate the frail
1122	elder option into the nursing home diversion pilot project
1123	consisting of capitated long-term-care programs and each
1124	program's funds into one capitated program serving the aged.
1125	(a)  The agency shall seek federal waivers necessary to
1126	integrate these programs.
1127	(b)  The agency and the department shall develop uniform
1128	standards for case management in this newly integrated capitated
1129	system.
1130	(12)  The agency and the department shall adopt any rules
1131	necessary to comply with or administer these requirements,
1132	effect and implement interagency agreements between the
1133	department and the agency, and comply with federal requirements.
1134	Section 11.  This act shall take effect upon becoming a
1135	law.

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