HB 0887

CS

CHAMBER ACTION

1	The Committee on Appropriations recommends the following:
2
3	Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to services for the elderly; amending s.
7	400.441, F.S.; requiring facilities to conduct resident
8	elopement drills; amending s. 409.912, F.S.; allowing
9	contracting for certain CARES program functions; requiring
10	assessment and review of certain nursing home placements;
11	requiring a database to track individuals assessed under
12	the CARES program and diverted from nursing home care;
13	requiring an annual study on individuals diverted from
14	nursing home placement; requiring a report on modifying
15	level of care criteria; amending s. 430.205, F.S.;
16	requiring development of a managed care delivery system
17	for Medicaid services; providing for submission to the
18	Governor and Legislature of a plan to include Medicare in
19	an integrated long-term-care system; providing for
20	integration of Medicare and Medicaid services; creating s.
21	430.2071, F.S.; requiring integration of certain home and
22	community-based Medicaid waiver programs; requiring a
23	specific funding level after integration; requiring the
24	agency to seek waivers or amendments to waivers as
25	necessary; providing that the agency may reimburse
26	providers; requiring rules; requiring the department and
27	agency to study and develop a plan to integrate certain
28	databases; requiring that such plan be submitted to the
29	Governor and Legislature; requiring evaluations of the
30	plan and certain services; amending s. 430.041, F.S.;
31	revising duties to the Office of Long-Term-Care Policy;
32	removing the advisory council of the Office of Long-Term-
33	Care Policy; providing for an interagency coordinating
34	team; revising requirements for reports; amending s.
35	430.203, F.S.; revising requirements for the community
36	care service system; revising requirements for competitive
37	bidding exemptions; requiring all services to be delivered
38	directly by or through lead agencies; amending s.
39	430.7031, F.S.; requiring CARES program staff to review a
40	percentage of case files; creating s. 430.2053, F.S.;
41	requiring pilot projects for aging resource centers;
42	requiring an implementation plan; requiring that area
43	agencies on aging submit proposals for transition to aging
44	resource centers; requiring a review of the department's
45	process for determining readiness; specifying purposes and
46	duties of an aging resource center; requiring integration
47	of certain functions of other state agencies; specifying
48	criteria for selection of entities to become aging
49	resource centers; specifying the duties and
50	responsibilities of community-care-for-the-elderly
51	providers in an area served by an aging resource center;
52	specifying programs administered by an aging resource
53	center; requiring rules; allowing capitated payments;
54	requiring reports; amending s. 430.703, F.S.; revising
55	requirements for other qualified providers; amending s.
56	430.705, F.S.; providing additional requirements for long-
57	term-care community diversion pilot projects; providing
58	legislative findings; requiring a demonstration project;
59	requiring rules; requiring integration of certain managed
60	care programs; amending s. 430.502, F.S.; designating a
61	Memory Disorder Clinic; amending s. 1004.445, F.S.;
62	providing for appointments to the board of the Alzheimer's
63	Center; requiring a report; making contingent on an
64	appropriation; providing an effective date.
65
66	Be It Enacted by the Legislature of the State of Florida:
67
68	Section 1.  Paragraph (l) is added to subsection (1) of
69	section 400.441, Florida Statutes, to read:
70	400.441  Rules establishing standards.--
71	(1)  It is the intent of the Legislature that rules
72	published and enforced pursuant to this section shall include
73	criteria by which a reasonable and consistent quality of
74	resident care and quality of life may be ensured and the results
75	of such resident care may be demonstrated. Such rules shall also
76	ensure a safe and sanitary environment that is residential and
77	noninstitutional in design or nature. It is further intended
78	that reasonable efforts be made to accommodate the needs and
79	preferences of residents to enhance the quality of life in a
80	facility. In order to provide safe and sanitary facilities and
81	the highest quality of resident care accommodating the needs and
82	preferences of residents, the department, in consultation with
83	the agency, the Department of Children and Family Services, and
84	the Department of Health, shall adopt rules, policies, and
85	procedures to administer this part, which must include
86	reasonable and fair minimum standards in relation to:
87	(l)  The establishment of specific policies and procedures
88	on resident elopement. Facilities shall conduct a minimum of two
89	resident elopement drills per year. All administrators and
90	direct care staff shall participate in the drills. Facilities
91	shall document the drills.
92	Section 2.  Paragraph (h) of subsection (4) and subsection
93	(15) of section 409.912, Florida Statutes, are amended to read:
94	409.912  Cost-effective purchasing of health care.--The
95	agency shall purchase goods and services for Medicaid recipients
96	in the most cost-effective manner consistent with the delivery
97	of quality medical care. The agency shall maximize the use of
98	prepaid per capita and prepaid aggregate fixed-sum basis
99	services when appropriate and other alternative service delivery
100	and reimbursement methodologies, including competitive bidding
101	pursuant to s. 287.057, designed to facilitate the cost-
102	effective purchase of a case-managed continuum of care. The
103	agency shall also require providers to minimize the exposure of
104	recipients to the need for acute inpatient, custodial, and other
105	institutional care and the inappropriate or unnecessary use of
106	high-cost services. The agency may establish prior authorization
107	requirements for certain populations of Medicaid beneficiaries,
108	certain drug classes, or particular drugs to prevent fraud,
109	abuse, overuse, and possible dangerous drug interactions. The
110	Pharmaceutical and Therapeutics Committee shall make
111	recommendations to the agency on drugs for which prior
112	authorization is required. The agency shall inform the
113	Pharmaceutical and Therapeutics Committee of its decisions
114	regarding drugs subject to prior authorization.
115	(4)  The agency may contract with:
116	(h)  An entity authorized in s. 430.705(10) 430.205 to
117	contract with the agency and the Department of Elderly Affairs
118	to provide health care and social services on a prepaid or
119	fixed-sum basis to elderly recipients. Such prepaid health care
120	services entities are exempt from the provisions of part I of
121	chapter 641 for the first 3 years of operation. An entity
122	recognized under this paragraph that demonstrates to the
123	satisfaction of the Office of Insurance Regulation that it is
124	backed by the full faith and credit of one or more counties in
125	which it operates may be exempted from s. 641.225.
126	(15)(a)  The agency shall operate the Comprehensive
127	Assessment and Review and Evaluation for Long-Term Care Services
128	(CARES) nursing facility preadmission screening program to
129	ensure that Medicaid payment for nursing facility care is made
130	only for individuals whose conditions require such care and to
131	ensure that long-term care services are provided in the setting
132	most appropriate to the needs of the person and in the most
133	economical manner possible. The CARES program shall also ensure
134	that individuals participating in Medicaid home and community-
135	based waiver programs meet criteria for those programs,
136	consistent with approved federal waivers.
137	(b)  The agency shall operate the CARES program through an
138	interagency agreement with the Department of Elderly Affairs.
139	The agency, with agreement from the Department of Elderly
140	Affairs, may contract for any function or activity of the CARES
141	program, including any function or activity required by 42
142	C.F.R. part 483.20, relating to preadmission screening and
143	resident review, if the agency and the department can
144	demonstrate that contracting for such a function will result in
145	a savings to the state and increased efficiency and
146	accountability.
147	(c)  Prior to making payment for nursing facility services
148	for a Medicaid recipient, the agency must verify that the
149	nursing facility preadmission screening program has determined
150	that the individual requires nursing facility care and that the
151	individual cannot be safely served in community-based programs.
152	The nursing facility preadmission screening program shall refer
153	a Medicaid recipient to a community-based program if the
154	individual could be safely served at a lower cost and the
155	recipient chooses to participate in such program.
156	(d)  For the purpose of initiating immediate prescreening
157	and diversion assistance for individuals residing in nursing
158	homes and in order to make families aware of alternative long-
159	term-care resources so that they may choose a more cost-
160	effective setting for long-term placement, within existing
161	appropriated staffing, CARES staff shall conduct an assessment
162	and review of a sample of individuals whose nursing home stay is
163	expected to exceed 20 days, regardless of the initial funding
164	source for the nursing home placement. CARES staff shall provide
165	counseling and referral services to these individuals regarding
166	choosing a facility. This paragraph does not apply to continuing
167	care facilities licensed under chapter 651 or to retirement
168	communities that provide a combination of nursing home,
169	independent living, and other long-term-care services.
170	(e)(d)  By January 15 1 of each year, the agency shall
171	submit a report to the President of the Senate, the Speaker of
172	the House of Representatives, Legislature and the Office of
173	Long-Term-Care Policy describing the operations of the CARES
174	program. The report must describe:
175	1.  Rate of diversion to community alternative programs;
176	2.  CARES program staffing needs to achieve additional
177	diversions;
178	3.  Reasons the program is unable to place individuals in
179	less restrictive settings when such individuals desired such
180	services and could have been served in such settings;
181	4.  Barriers to appropriate placement, including barriers
182	due to policies or operations of other agencies or state-funded
183	programs; and
184	5.  Statutory changes necessary to ensure that individuals
185	in need of long-term care services receive care in the least
186	restrictive environment.
187	(f)  Subject to available appropriations, the Department of
188	Elderly Affairs shall develop a database to track individuals
189	over time who are assessed under the CARES program and who are
190	diverted from nursing home placement. By January 15 of each
191	year, the department shall submit to the President of the
192	Senate, the Speaker of the House of Representatives, and the
193	Office of Long-Term-Care Policy a longitudinal study of the
194	individuals who are diverted from nursing home placement. The
195	study must include:
196	1.  The demographic characteristics of the individuals
197	assessed and diverted from nursing home placement, including,
198	but not limited to, age, race, gender, frailty, caregiver
199	status, living arrangements, and geographic location.
200	2.  A summary of community services provided to individuals
201	for 1 year after assessment and diversion.
202	3.  A summary of inpatient hospital admissions for
203	individuals who have been diverted.
204	4.  A summary of the length of time between diversion and
205	subsequent entry into a nursing home or death.
206	(g)  By July 1, 2005, the department and the Agency for
207	Health Care Administration shall report to the President of the
208	Senate and the Speaker of the House of Representatives regarding
209	the impact to the state of modifying level of care criteria to
210	eliminate the Intermediate II level of care.
211	Section 3.  Subsection (6) of section 430.205, Florida
212	Statutes, is amended to read:
213	430.205  Community care service system.--
214	(6)  Notwithstanding other requirements of this chapter,
215	the department of Elderly Affairs and the Agency for Health Care
216	Administration shall develop a model system to transition all
217	Medicaid state-funded services for elderly individuals in
218	portions of one or more of the department's planning and service
219	areas, including both rural and urban areas, to a managed,
220	integrated long-term-care delivery system under the direction of
221	a single entity.
222	(a)  The duties of each managed care organization, or other
223	qualified provider as defined in s. 430.703, contracted to
224	operate the managed the model system shall include organizing
225	and administering service delivery for the elderly, obtaining
226	contracts for services with providers in the area, monitoring
227	the quality of services provided, determining levels of need and
228	disability for payment purposes, and other activities determined
229	by the department and the agency in order to operate the managed
230	model system.
231	(b)  The agency and the department shall integrate all
232	funding for Medicaid services to individuals over the age of 60
233	65 in the managed system model planning and service areas into a
234	single per-person per-month payment rate, except that funds for
235	Medicaid behavioral health care services are exempt from this
236	section. The funds to be integrated shall include:
237	1.  Community-care-for-the-elderly funds;
238	2.  Home-care-for-the-elderly funds;
239	3.  Local services program funds;
240	4.  Contracted services funds;
241	5.  Alzheimer's disease initiative funds;
242	1.6.  Medicaid home and community-based waiver services
243	funds;
244	2.7.  Funds for all Medicaid services authorized in ss.
245	409.905 and 409.906, including Medicaid nursing home services;
246	and
247	3.8.  Funds paid for Medicare premiums, coinsurance and
248	deductibles for persons dually eligible for Medicaid and
249	Medicare as prescribed in s. 409.908(13).
250
251	The department and the agency shall not make Medicaid payments
252	for services for people age 60 or older in the areas in which
253	the managed system operates 65 and older except through the
254	managed model delivery system.
255	(c)  The entities entity selected to administer the managed
256	model system shall develop a comprehensive health and long-term-
257	care service delivery system through contracts with providers of
258	medical, social, and long-term-care services sufficient to meet
259	the needs of the population age 60 or older 65 and older. The
260	entity selected to administer the model system shall not
261	directly provide services other than intake, assessment, and
262	referral services.
263	(d)  The department and the agency shall contract through
264	competitive procurement with no less than two and no more than
265	three managed care organizations, or other qualified providers
266	as defined in s. 430.703, to administer the project determine
267	which of the department's planning and services areas is to be
268	designated as a model area by means of a request for proposals.
269	The department shall select an area to be designated as a model
270	area and the entity to administer the model system based on
271	demonstration of capacity of each provider the entity to:
272	1.  Develop contracts with providers currently under
273	contract with the department, area agencies on aging, or
274	community-care-for-the-elderly lead agencies.;
275	2.  Provide a comprehensive system of appropriate medical
276	and long-term-care services that provides high-quality medical
277	and social services to assist older individuals in remaining in
278	the least restrictive setting.;
279	3.  Demonstrate a quality assurance and quality improvement
280	system satisfactory to the department and the agency.;
281	4.  Develop a system to identify participants who have
282	special health care needs such as polypharmacy, mental health
283	and substance abuse problems, falls, chronic pain, nutritional
284	deficits, and cognitive deficits, in order to respond to and
285	meet these needs.;
286	5.  Use a multidisciplinary team approach to participant
287	management which ensures that information is shared among
288	providers responsible for delivering care to a participant.;
289	6.  Ensure medical oversight of care plans and service
290	delivery, regular medical evaluation of care plans, and the
291	availability of medical consultation for case managers and
292	service coordinators.;
293	7.  Develop, monitor, and enforce quality-of-care
294	requirements.;
295	(e)8.  The selected entities shall secure subcontracts with
296	providers of medical, nursing home, and community-based long-
297	term-care services sufficient to ensure assure access to and
298	choice of providers by project participants. In the absence of a
299	separate contractual relationship between a nursing home
300	provider and a managed care organization, the nursing home shall
301	cooperate with the managed care organization's efforts to
302	determine if a project participant would be more appropriately
303	served in a community setting, and payments shall be made in
304	accordance with Medicaid nursing home rates as calculated in the
305	state plan.;
306	(f)  To ensure that the contracted providers meet a high
307	quality of care standard, the entity selected to administer the
308	managed care system shall:
309	1.  Develop and use a service provider qualification system
310	which describes the quality-of-care standards that a nursing
311	home must meet in order to obtain a contract with the managing
312	entity.
313	2.  Contract with all qualified nursing homes located in
314	the area that is served by the project, including those
315	designated as Gold Seal.
316	3.  Ensure that as an area is transitioned to managed care,
317	individuals who are residents of nursing homes in the project
318	area prior to plan implementation and who do not choose to move
319	to another setting are allowed to remain in the facility in
320	which they are receiving care.
321	(g)9.  The selected entities shall:
322	1.  Ensure a system of case management and service
323	coordination which includes educational and training standards
324	for case managers and service coordinators.;
325	2.10.  Develop a business plan that considers the ability
326	of the applicant to organize and operate a risk-bearing entity.;
327	3.11.  Furnish evidence of adequate liability insurance
328	coverage or an adequate plan of self-insurance that is
329	determined adequate by the Department of Financial Services to
330	respond to claims for injuries arising out of the furnishing of
331	health care.; and
332	4.12.  Provide, through contract or otherwise, for periodic
333	review of its medical facilities as required by the department
334	and the agency.
335	5.  Furnish in a timely manner, in a form determined by the
336	department, requested financial data that has been determined by
337	the department and the agency to be necessary to develop and
338	annually recertify appropriate capitation rates for the project.
339	6.  Provide enrollees the ability, to the extent possible,
340	to choose care providers, including nursing home and assisted
341	living service providers affiliated with an individual's
342	religious faith or denomination and nursing home and ALF
343	providers that are part of a retirement community in which an
344	enrollee resides as provided for in s. 641.31(25).
345
346	The department shall give preference in selecting an area to be
347	designated as a model area to that in which the administering
348	entity is an existing area agency on aging or community-care-
349	for-the-elderly lead agency demonstrating the ability to perform
350	the functions described in this paragraph.
351	(e)  The department in consultation with the selected
352	entity shall develop a statewide proposal regarding the long-
353	term use and structure of a program that addresses a risk pool
354	to reduce financial risk.
355	(h)(f)  The department and the agency shall develop
356	capitation rates based on the historical cost experience of the
357	state in providing acute and long-term-care services to the
358	population over 60 65 years of age in the area served. The
359	agency, in consultation with the department, shall contract for
360	an independent entity to study the historical cost experience,
361	adjusted to reflect changes in regulatory requirements, of the
362	state in providing services listed in paragraph (b) to the
363	population age 60 and older residing within the model area and
364	to develop and certify a per-person, per-month capitation rate
365	for the managed system. The agency, in consultation with the
366	department, shall reevaluate and recertify the capitation rate
367	annually. The agency and the department shall give preference in
368	contracting for the managed system to those entities whose
369	proposals create innovative, functional partnerships with
370	existing community-care-for-the-elderly lead agencies.
371	1.  Payment rates in the first 2 years of operation shall
372	be set at no more than 100 percent of the costs to the state of
373	providing equivalent services to the population of the model
374	area for the year prior to the year in which the model system is
375	implemented, adjusted forward to account for inflation and
376	population growth. In subsequent years, the rate shall be
377	negotiated based on the cost experience of the model system in
378	providing contracted services, but may not exceed 95 percent of
379	the amount that would have been paid by the state in the model
380	planning and service area absent the model integrated service
381	delivery system.
382	2.  The agency and the department may develop innovative
383	risk-sharing agreements that limit the level of custodial
384	nursing home risk that the administering entity assumes,
385	consistent with the intent of the Legislature to reduce the use
386	and cost of nursing home care. Under risk-sharing arrangements,
387	the agency and the department may reimburse the administering
388	entity for the cost of providing nursing home care for Medicaid-
389	eligible participants who have been permanently placed and
390	remain in nursing home care for more than 1 year.
391	(i)(g)  The department and the Agency for Health Care
392	Administration shall seek federal waivers, or amendments to
393	existing waivers, necessary to implement the requirements of
394	this section.
395	(h)  The Department of Children and Family Services shall
396	develop a streamlined and simplified eligibility system and
397	shall outstation a sufficient number and quality of eligibility-
398	determination staff with the administering entity to assure
399	determination of Medicaid eligibility for the integrated service
400	delivery system in the model planning and service area within 10
401	days after receipt of a complete application.
402	(j)(i)  The agency, in consultation with the department,
403	shall begin discussions with the federal Centers for Medicare
404	and Medicaid Services regarding the inclusion of Medicare in an
405	integrated long-term-care system. By December 31, 2006, the
406	agency shall provide to the Governor, the President of the
407	Senate, and the Speaker of the House of Representatives a plan
408	for including Medicare in an integrated long-term-care system
409	The Department of Elderly Affairs shall make arrangements to
410	outstation a sufficient number of nursing home preadmission
411	screening staff with the administering entity to assure timely
412	assessment of level of need for long-term-care services in the
413	model area.
414	(k)(j)  The Department of Elderly Affairs shall conduct or
415	contract for an evaluation of the managed system pilot project.
416	The department shall submit the evaluation to the Governor and
417	the Legislature by January 1, 2006 2005. The evaluation must
418	address the effects of the managed system in pilot project on
419	the effectiveness of the entity providing a comprehensive system
420	of appropriate and high-quality medical and long-term-care
421	services to elders in the least restrictive setting, provide a
422	comparison of average monthly rate incurred by diverted
423	individuals to those of nursing home residents in a similar
424	geographic area, and make recommendations on a phased-in
425	implementation expansion for the rest of the state. In addition,
426	the department, in consultation with the agency, shall consider
427	whether providers operating in the managed system should be
428	placed at risk for the state-funded community care for the
429	elderly, home care for the elderly, and Alzheimer's disease
430	initiative programs.
431	(l)  The agency shall ensure that, to the extent possible,
432	Medicare and Medicaid services are integrated. Where possible,
433	individuals served in the managed system who are eligible for
434	Medicare shall be enrolled in a Medicare managed health care
435	plan operated by the same entity which is placed at risk for
436	long-term care services.
437	Section 4.  Section 430.2071, Florida Statutes, is created
438	to read:
439	430.2071  Home and community-based waiver services.--
440	(1)  The agency, in consultation with the department, shall
441	integrate the assisted living for the elderly Medicaid waiver
442	program into the aged and disabled adult Medicaid waiver program
443	and each program's funds into one fee-for-service Medicaid
444	waiver program serving the aged and disabled.
445	(a)  After the programs are integrated, funding to provide
446	care in assisted-living facilities under the new waiver may not
447	be less than the amount appropriated in the 2003-2004 fiscal
448	year for the assisted living for the elderly Medicaid waiver.
449	(b)  The agency shall seek federal waivers, or amendments
450	to existing waivers, necessary to integrate these waiver
451	programs.
452	(c)  The agency and the department may reimburse providers
453	for case management services on a capitated basis and shall
454	develop uniform standards for case management in this fee-for-
455	service Medicaid waiver program.
456	(d)  The agency and the department shall adopt any rules
457	necessary to comply with or administer these requirements,
458	effect and implement interagency agreements between the
459	department and the agency, and comply with federal requirements.
460	(2)  The department, in consultation with the agency, shall
461	study the integration of the database systems for the
462	Comprehensive Assessment Review and Evaluation for Long-Term
463	Care Services (CARES) program and the Client Information and
464	Referral Tracking System (CIRTS) and develop a plan for database
465	integration.
466	(3)  The department, in consultation with the agency,
467	subject to an appropriation, shall develop a plan to evaluate
468	the newly integrated program over time, from the beginning of
469	the implementation process forward. The department shall
470	contract with a research entity through competitive procurement
471	to help develop the evaluation plan and conduct the evaluation.
472	The evaluation shall be ongoing and shall determine whether the
473	newly integrated program is achieving its goals and evaluate the
474	effects the changes have had on consumers. The evaluation plan
475	must include baseline measures for evaluating cost-
476	effectiveness, the quality of care, and consumer satisfaction of
477	the program. The department shall submit the plan to the
478	Governor, the President of the Senate, and the Speaker of the
479	House of Representatives by December 31, 2004.
480	(4)  The department, in consultation with the agency and
481	the Department of Children and Family Services, shall develop a
482	plan to improve the interaction among the department's newly
483	integrated assessment database, the Florida Medicaid Management
484	Information System, and the FLORIDA system in order to
485	facilitate enrollment of individuals in capitated and fee-for-
486	service programs, as well as to monitor eligibility
487	requirements.
488	(5)  Consistent with federal requirements, the agency, in
489	consultation with the department, shall evaluate the Alzheimer's
490	disease waiver program and the adult day health care waiver
491	program to assess whether providing limited intensive services
492	through these waiver programs produces better outcomes for
493	individuals than providing those services through the fee-for-
494	service or capitated programs that provide a larger array of
495	services.
496	Section 5.  Section 430.041, Florida Statutes, is amended
497	to read:
498	430.041  Office of Long-Term-Care Policy.--
499	(1)  There is established in the Department of Elderly
500	Affairs the Office of Long-Term-Care Policy to evaluate the
501	state's long-term-care service delivery system and make
502	recommendations to increase the efficiency and effectiveness of
503	government-funded long-term-care programs for availability and
504	the use of noninstitutional settings to provide care to the
505	elderly and to ensure coordination among the agencies
506	responsible for setting policies for funding and for
507	administering the long-term-care programs for the elderly
508	continuum.
509	(2)  The purpose of the Office of Long-Term-Care Policy is
510	to:
511	(a)  Ensure close communication and coordination among
512	state agencies involved in developing and administering a more
513	efficient and coordinated long-term-care service delivery system
514	in this state;
515	(b)  Identify duplication and unnecessary service provision
516	in the long-term-care system and make recommendations to
517	decrease inappropriate service provision;
518	(b)(c)  Review current programs providing long-term-care
519	services to determine whether the programs are cost effective,
520	of high quality, and operating efficiently and make
521	recommendations to increase consistency and effectiveness in the
522	state's long-term-care programs;
523	(c)(d)  Develop strategies for promoting and implementing
524	cost-effective home and community-based services as an
525	alternative to institutional care which coordinate and integrate
526	the continuum of care needs of the elderly; and
527	(d)  Recommend roles for state agencies that are
528	responsible for administering long-term-care programs for the
529	elderly and an organization framework for the planning,
530	coordination, implementation, and evaluation of long-term-care
531	programs for the elderly.
532	(e)  Assist the Office of Long-Term-Care Policy Advisory
533	Council as necessary to help implement this section.
534	(3)  The Director of the Office of Long-Term-Care Policy
535	shall be appointed by, and serve at the pleasure of, the
536	Governor. The director shall report to, and be under the general
537	supervision of, the Secretary of Elderly Affairs and shall not
538	be subject to supervision by any other employee of the
539	department.
540	(4)  The Office of Long-Term-Care Policy shall have an
541	advisory council. The purposes of the advisory council are to
542	provide assistance and direction to the office and to ensure
543	that the appropriate state agencies are properly implementing
544	recommendations from the office.
545	(a)  The advisory council shall consist of:
546	1.  A member of the Senate, appointed by the President of
547	the Senate;
548	2.  A member of the House of Representatives, appointed by
549	the Speaker of the House of Representatives;
550	3.  The Secretary of Health Care Administration;
551	4.  The Secretary of Elderly Affairs;
552	5.  The Secretary of Children and Family Services;
553	6.  The Secretary of Health;
554	7.  The Executive Director of the Department of Veterans'
555	Affairs;
556	8.  Three people with broad knowledge and experience in the
557	delivery of long-term-care services, appointed by the Governor
558	from groups representing elderly persons; and
559	9.  Two representatives of people using long-term-care
560	services, appointed by the Governor from groups representing
561	elderly persons.
562	(b)  The council shall elect a chair from among its
563	membership to serve for a 1-year term. A chair may not serve
564	more than two consecutive terms.
565	(c)  Members shall serve without compensation, but are
566	entitled to receive reimbursement for travel and per diem as
567	provided in s. 112.061.
568	(d)  The advisory council shall meet at the call of its
569	chair or at the request of a majority of its members. During its
570	first year of existence, the advisory council shall meet at
571	least monthly.
572	(e)  Members of the advisory council appointed by the
573	Governor shall serve at the pleasure of the Governor and shall
574	be appointed to 4-year staggered terms in accordance with s.
575	20.052.
576	(4)(5)(a)  The Department of Elderly Affairs shall provide
577	administrative support and services to the Office of Long-Term-
578	Care Policy.
579	(b)  The office shall call upon appropriate agencies of
580	state government, including the centers on aging in the State
581	University System, for assistance needed in discharging its
582	duties.
583	(c)  Each state agency represented on the Office of Long-
584	Term-Care Policy Advisory Council shall make at least one
585	employee available to work with the Office of Long-Term-Care
586	Policy. All state agencies and universities shall assist the
587	office in carrying out its responsibilities prescribed by this
588	section.
589	(d)  The Secretary of Health Care Administration, the
590	Secretary of Elderly Affairs, the Secretary of Children and
591	Family Services, the Secretary of Health, and the executive
592	director of the Department of Veterans' Affairs shall each
593	appoint at least one high-level employee with the authority to
594	recommend and implement agency policy and with experience in the
595	area of long-term-care service delivery and financing to work
596	with the Office of Long-Term-Care Policy as part of an
597	interagency coordinating team. The interagency coordinating team
598	shall meet monthly with the director of the Office of Long-Term-
599	Care Policy to implement the purposes of the office.
600	(e)(d)  Each state agency shall pay from its own funds any
601	expenses related to its support of the Office of Long-Term-Care
602	Policy and its participation on the advisory council. The
603	Department of Elderly Affairs shall be responsible for expenses
604	related to participation on the advisory council by members
605	appointed by the Governor.
606	(5)(6)(a)  By December 31 of each year 1, 2002, the office
607	shall submit to the Governor, the President of the Senate, and
608	the Speaker of the House of Representatives a advisory council a
609	preliminary report of its activities and the progress made in
610	findings and recommendations on improving the long-term-care
611	continuum in this state and make recommendations accordingly.
612	The report shall contain the activities completed by the office
613	during the calendar year, recommendations and implementation
614	proposals for policy changes, and as well as legislative and
615	funding recommendations that will make the system more effective
616	and efficient. The report shall contain a specific
617	implementation strategies, with timelines, plan for
618	accomplishing the recommendations and proposals set out in the
619	report. Thereafter, the office shall revise and update the
620	report annually and resubmit it to the advisory council for
621	review and comments by November 1 of each year.
622	(b)  The advisory council shall review and recommend any
623	suggested changes to the preliminary report, and each subsequent
624	annual update of the report, within 30 days after the receipt of
625	the preliminary report. Suggested revisions, additions, or
626	deletions shall be made to the Director of the Office of Long-
627	Term-Care Policy.
628	(c)  The office shall submit its final report, and each
629	subsequent annual update of the report, to the Governor and the
630	Legislature within 30 days after the receipt of any revisions,
631	additions, or deletions suggested by the advisory council, or
632	after the time such comments are due to the office.
633	Section 6.  Subsection (3) and paragraph (c) of subsection
634	(9) of section 430.203, Florida Statutes, are amended to read:
635	430.203  Community care for the elderly; definitions.--As
636	used in ss. 430.201-430.207, the term:
637	(3)  "Community care service system" means a service
638	network comprising a variety of home-delivered services, day
639	care services, and other basic services, hereinafter referred to
640	as "core services," for functionally impaired elderly persons
641	which are provided by or through several agencies under the
642	direction of a single lead agency. Its purpose is to provide a
643	continuum of care encompassing a full range of preventive,
644	maintenance, and restorative services for functionally impaired
645	elderly persons.
646	(9)  "Lead agency" means an agency designated at least once
647	every 3 years by an area agency on aging as the result of a
648	request for proposal process to be in place no later than the
649	state fiscal year 1996-1997.
650	(c)  In each community care service system the lead agency
651	must be given the authority and responsibility to coordinate
652	some or all of the services, either directly or through
653	subcontracts, for functionally impaired elderly persons. These
654	services must include case management. Other services, such as
655	and may include homemaker and chore services, respite care,
656	adult day care, personal care services, home-delivered meals,
657	counseling, information and referral, and emergency home repair
658	services, may be included subject to competitive bidding. The
659	lead agency must compile community care statistics and monitor,
660	when applicable, subcontracts with agencies providing core
661	services.
662	Section 7.  Subsection (2) of section 430.7031, Florida
663	Statutes, is amended to read:
664	430.7031  Nursing home transition program.--The department
665	and the Agency for Health Care Administration:
666	(2)  Shall collaboratively work to identify Medicaid long-
667	stay nursing home residents who are able to move to community
668	placements, and to provide case management and supportive
669	services to such individuals while they are in nursing homes to
670	assist such individuals in moving to less expensive and less
671	restrictive settings. CARES program staff shall annually review
672	at least 20 percent of the case files for nursing home residents
673	who are Medicaid recipients to determine which nursing home
674	residents are able to move to community placements.
675	Section 8.  Section 430.2053, Florida Statutes, is created
676	to read:
677	430.2053  Aging resource centers.--
678	(1)  The department, in consultation with the Agency for
679	Health Care Administration and the Department of Children and
680	Family Services, shall develop pilot projects for aging resource
681	centers. By October 31, 2004, the department, in consultation
682	with the agency and the Department of Children and Family
683	Services, shall develop an implementation plan for aging
684	resource centers and submit the plan to the Governor, the
685	President of the Senate, and the Speaker of the House of
686	Representatives. The plan must include qualifications for
687	designation as a center, the functions to be performed by each
688	center, and a process for determining that a current area agency
689	on aging is ready to assume the functions of an aging resource
690	center.
691	(2)  Each area agency on aging shall develop, in
692	consultation with the existing community care for the elderly
693	lead agencies within their planning and service areas, a
694	proposal that describes the process the area agency on aging
695	intends to undertake to transition to an aging resource center
696	prior to July 1, 2005, and that describes the area agency's
697	compliance with the requirements of this section. The proposals
698	must be submitted to the department prior to December 31, 2004.
699	The department shall evaluate all proposals for readiness and,
700	prior to March 1, 2005, shall select three area agencies on
701	aging which meet the requirements of this section to begin the
702	transition to aging resource centers. Those area agencies on
703	aging which are not selected to begin the transition to aging
704	resource centers shall, in consultation with the department and
705	the existing community care for the elderly lead agencies within
706	their planning and service areas, amend their proposals as
707	necessary and resubmit them to the department prior to July 1,
708	2005. The department may transition additional area agencies to
709	aging resource centers as it determines that area agencies are
710	in compliance with the requirements of this section.
711	(3)  The Auditor General and the Office of Program Policy
712	Analysis and Government Accountability (OPPAGA) shall jointly
713	review and assess the department's process for determining an
714	area agency's readiness to transition to an aging resource
715	center.
716	(a)  The review must, at a minimum, address the
717	appropriateness of the department's criteria for selection of an
718	area agency to transition to an aging resource center, the
719	instruments applied, the degree to which the department
720	accurately determined each area agency's compliance with the
721	readiness criteria, the quality of the technical assistance
722	provided by the department to an area agency in correcting any
723	weaknesses identified in the readiness assessment, and the
724	degree to which each area agency overcame any identified
725	weaknesses.
726	(b)  Reports of these reviews must be submitted to the
727	appropriate substantive and appropriations committees in the
728	Senate and the House of Representatives on March 1 and September
729	1 of each year until full transition to aging resource centers
730	has been accomplished statewide, except that the first report
731	must be submitted by February 1, 2005, and must address all
732	readiness activities undertaken through December 31, 2004. The
733	perspectives of all participants in this review process must be
734	included in each report.
735	(4)  The purposes of an aging resource center shall be:
736	(a)  To provide Florida's elders and their families with a
737	locally focused, coordinated approach to integrating information
738	and referral for all available services for elders with the
739	eligibility determination entities for state and federally
740	funded long-term-care services.
741	(b)  To provide for easier access to long-term-care
742	services by Florida's elders and their families by creating
743	multiple access points to the long-term-care network that flow
744	through one established entity with wide community recognition.
745	(5)  The duties of an aging resource center are to:
746	(a)  Develop referral agreements with local community
747	service organizations, such as senior centers, existing elder
748	service providers, volunteer associations, and other similar
749	organizations, to better assist clients who do not need or do
750	not wish to enroll in programs funded by the department or the
751	agency. The referral agreements must also include a protocol,
752	developed and approved by the department, which provides
753	specific actions that an aging resource center and local
754	community service organizations must take when an elder or an
755	elder's representative seeking information on long-term-care
756	services contacts a local community service organization prior
757	to contacting the aging resource center. The protocol shall be
758	designed to ensure that elders and their families are able to
759	access information and services in the most efficient and least
760	cumbersome manner possible.
761	(b)  Provide an initial screening of all clients who
762	request long-term care services to determine whether the person
763	would be most appropriately served through any combination of
764	federally funded programs, state-funded programs, locally funded
765	or community volunteer programs, or private funding for
766	services.
767	(c)  Determine eligibility for the programs and services
768	listed in subsection (11) for persons residing within the
769	geographic area served by the aging resource center and
770	determine a priority ranking for services which is based upon
771	the potential recipient's frailty level and likelihood of
772	institutional placement without such services.
773	(d)  Manage the availability of financial resources for the
774	programs and services listed in subsection (11) for persons
775	residing within the geographic area served by the aging resource
776	center.
777	(e)  When financial resources become available, refer a
778	client to the most appropriate entity to begin receiving
779	services. The aging resource center shall make referrals to lead
780	agencies for service provision that ensure that individuals who
781	are vulnerable adults in need of services pursuant to s.
782	415.104(3)(b), or who are victims of abuse, neglect, or
783	exploitation in need of immediate services to prevent further
784	harm and are referred by the adult protective services program,
785	are given primary consideration for receiving community-care-
786	for-the-elderly services in compliance with the requirements of
787	s. 430.205(5)(a) and that other referrals for services are in
788	compliance with s. 430.205(5)(b).
789	(f)  Convene a work group to advise in the planning,
790	implementation, and evaluation of the aging resource center. The
791	work group shall be comprised of representatives of local
792	service providers, Alzheimer's Association chapters, housing
793	authorities, social service organizations, advocacy groups,
794	representatives of clients receiving services through the aging
795	resource center, and any other persons or groups as determined
796	by the department. The aging resource center, in consultation
797	with the work group, must develop annual program improvement
798	plans that shall be submitted to the department for
799	consideration. The department shall review each annual
800	improvement plan and make recommendations on how to implement
801	the components of the plan.
802	(g)  Enhance the existing area agency on aging in each
803	planning and service area by integrating, either physically or
804	virtually, the staff and services of the area agency on aging
805	with the staff of the department's local CARES Medicaid nursing
806	home preadmission screening unit and a sufficient number of
807	staff from the Department of Children and Family Services'
808	Economic Self Sufficiency Unit necessary to determine the
809	financial eligibility for all persons age 60 and older residing
810	within the area served by the aging resource center that are
811	seeking Medicaid services, Supplemental Security Income, and
812	food stamps.
813	(6)  The department shall select the entities to become
814	aging resource centers based on each entity's readiness and
815	ability to perform the duties listed in subsection (5) and the
816	entity's:
817	(a)  Expertise in the needs of each target population the
818	center proposes to serve and a thorough knowledge of the
819	providers that serve these populations.
820	(b)  Strong connections to service providers, volunteer
821	agencies, and community institutions.
822	(c)  Expertise in information and referral activities.
823	(d)  Knowledge of long-term-care resources, including
824	resources designed to provide services in the least restrictive
825	setting.
826	(e)  Financial solvency and stability.
827	(f)  Ability to collect, monitor, and analyze data in a
828	timely and accurate manner, along with systems that meet the
829	department's standards.
830	(g)  Commitment to adequate staffing by qualified personnel
831	to effectively perform all functions.
832	(h)  Ability to meet all performance standards established
833	by the department.
834	(7)  The aging resource center shall have a governing body
835	which shall be the same entity described in s. 20.41(7), and an
836	executive director who may be the same person as described in s.
837	20.41(8). The governing body shall annually evaluate the
838	performance of the executive director.
839	(8)  The aging resource center may not be a provider of
840	direct services other than information and referral services and
841	screening.
842	(9)  The aging resource center must agree to allow the
843	department to review any financial information the department
844	determines is necessary for monitoring or reporting purposes,
845	including financial relationships.
846	(10)  The duties and responsibilities of the community care
847	for the elderly lead agencies within each area served by an
848	aging resource center shall be to:
849	(a)  Develop strong community partnerships to maximize the
850	use of community resources for the purpose of assisting elders
851	to remain in their community settings for as long as it is
852	safely possible.
853	(b)  Conduct comprehensive assessments of clients that have
854	been determined eligible and develop a care plan consistent with
855	established protocols that ensures that the unique needs of each
856	client are met.
857	(11)  The services to be administered through the aging
858	resource center shall include those funded by the following
859	programs:
860	(a)  Community care for the elderly.
861	(b)  Home care for the elderly.
862	(c)  Contracted services.
863	(d)  Alzheimer's disease initiative.
864	(e)  Aged and disabled adult Medicaid waiver.
865	(f)  Assisted living for the frail elderly Medicaid waiver.
866	(g)  Older Americans Act.
867	(12)  The department shall, prior to designation of an
868	aging resource center, develop by rule operational and quality
869	assurance standards and outcome measures to ensure that clients
870	receiving services through all long-term-care programs
871	administered through an aging resource center are receiving the
872	appropriate care they require and that contractors and
873	subcontractors are adhering to the terms of their contracts and
874	are acting in the best interests of the clients they are
875	serving, consistent with the intent of the Legislature to reduce
876	the use of and cost of nursing home care. The department shall
877	by rule provide operating procedures for aging resource centers,
878	which shall include:
879	(a)  Minimum standards for financial operation, including
880	audit procedures.
881	(b)  Procedures for monitoring and sanctioning of service
882	providers.
883	(c)  Minimum standards for technology utilized by the aging
884	resource center.
885	(d)  Minimum staff requirements which shall ensure that the
886	aging resource center employs sufficient quality and quantity of
887	staff to adequately meet the needs of the elders residing within
888	the area served by the aging resource center.
889	(e)  Minimum accessibility standards, including hours of
890	operation.
891	(f)  Minimum oversight standards for the governing body of
892	the aging resource center to ensure its continuous involvement
893	in, and accountability for, all matters related to the
894	development, implementation, staffing, administration, and
895	operations of the aging resource center.
896	(g)  Minimum education and experience requirements for
897	executive directors and other executive staff positions of aging
898	resource centers.
899	(h)  Minimum requirements regarding any executive staff
900	positions that the aging resource center must employ and minimum
901	requirements that a candidate must meet in order to be eligible
902	for appointment to such positions.
903	(13)  In an area in which the department has designated an
904	area agency on aging as an aging resource center, the department
905	and the agency shall not make payments for the services listed
906	in subsection (11) and the Long-Term Care Community Diversion
907	Project for such persons who were not screened and enrolled
908	through the aging resource center.
909	(14)  Each aging resource center shall enter into a
910	memorandum of understanding with the department for
911	collaboration with the CARES unit staff. The memorandum of
912	understanding shall outline the staff person responsible for
913	each function and shall provide the staffing levels necessary to
914	carry out the functions of the aging resource center.
915	(15)  Each aging resource center shall enter into a
916	memorandum of understanding with the Department of Children and
917	Family Services for collaboration with the Economic Self-
918	Sufficiency Unit staff. The memorandum of understanding shall
919	outline which staff persons are responsible for which functions
920	and shall provide the staffing levels necessary to carry out the
921	functions of the aging resource center.
922	(16)  If any of the state activities described in this
923	section are outsourced, either in part or in whole, the contract
924	executing the outsourcing shall mandate that the contractor or
925	its subcontractors shall, either physically or virtually,
926	execute the provisions of the memorandum of understanding
927	instead of the state entity whose function the contractor or
928	subcontractor now performs.
929	(17)  In order to be eligible to begin transitioning to an
930	aging resource center, an area agency on aging board must ensure
931	that the area agency on aging which it oversees meets all of the
932	minimum requirements set by law and in rule.
933	(18)  The department shall monitor the three initial
934	projects for aging resource centers and report on the progress
935	of those projects to the Governor, the President of the Senate,
936	and the Speaker of the House of Representatives by June 30,
937	2005. The report must include an evaluation of the
938	implementation process.
939	(19)(a)  Once an aging resource center is operational, the
940	department, in consultation with the agency, may develop
941	capitation rates for any of the programs administered through
942	the aging resource center. Capitation rates for programs shall
943	be based on the historical cost experience of the state in
944	providing those same services to the population age 60 or older
945	residing within each area served by an aging resource center.
946	Each capitated rate may vary by geographic area as determined by
947	the department.
948	(b)  The department and the agency may determine for each
949	area served by an aging resource center whether it is
950	appropriate, consistent with federal and state laws and
951	regulations, to develop and pay separate capitated rates for
952	each program administered through the aging resource center or
953	to develop and pay capitated rates for service packages which
954	include more than one program or service administered through
955	the aging resource center.
956	(c)  Once capitation rates have been developed and
957	certified as actuarially sound, the department and the agency
958	may pay service providers the capitated rates for services when
959	appropriate.
960	(d)  The department, in consultation with the agency, shall
961	annually reevaluate and recertify the capitation rates,
962	adjusting forward to account for inflation, programmatic
963	changes.
964	(20)  The department, in consultation with the agency,
965	shall submit to the Governor, the President of the Senate, and
966	the Speaker of the House of Representatives, by December 1,
967	2006, a report addressing the feasibility of administering the
968	following services through aging resource centers beginning July
969	1, 2007:
970	(a)  Medicaid nursing home services.
971	(b)  Medicaid transportation services.
972	(c)  Medicaid hospice care services.
973	(d)  Medicaid intermediate care services.
974	(e)  Medicaid prescribed drug services.
975	(f)  Medicaid assistive care services.
976	(g)  Any other long-term-care program or Medicaid service.
977	(21)  This section shall not be construed to allow an aging
978	resource center to restrict, manage or impede the local fund-
979	raising activities of service providers.
980	Section 9.  Subsection (7) of section 430.703, Florida
981	Statutes, is amended to read:
982	430.703  Definitions.--As used in this act, the term:
983	(7)  "Other qualified provider" means an entity licensed
984	under chapter 400 that demonstrates a long-term care continuum,
985	meets the requirements of s. 430.705(2), and meets posts a
986	$500,000 performance bond, and meets all the financial and
987	quality assurance requirements for a provider service network as
988	specified in s. 409.912 and all requirements pursuant to an
989	interagency agreement between the agency and the department.
990	Section 10.  Section 430.705, Florida Statutes, is amended
991	to read:
992	430.705  Implementation of the long-term care community
993	diversion pilot projects.--
994	(1)  In designing and implementing the community diversion
995	pilot projects, the department shall work in consultation with
996	the agency.
997	(2)  The department shall select projects whose design and
998	providers demonstrate capacity to maximize the placement of
999	participants in the least restrictive appropriate care setting.
1000	The department shall select providers that have a plan
1001	administrator who is dedicated to the diversion pilot project
1002	and project staff who perform the necessary project
1003	administrative functions, including data collection, reporting,
1004	and analysis. The department shall select providers that:
1005	(a)  Are determined by the Department of Financial Services
1006	to:
1007	1.  Meet surplus requirements specified in s. 641.225.
1008	2.  Demonstrate the ability to comply with the standards
1009	for financial solvency specified in s. 641.285.
1010	3.  Demonstrate the ability to provide for the prompt
1011	payment of claims as specified in s. 641.3155.
1012	4.  Demonstrate the ability to provide technology with the
1013	capability for data collection which meets the security
1014	requirements of the federal Health Insurance Portability and
1015	Accountability Act of 1996, 42 C.F.R. ss. 160 and 164.
1016	(b)  Demonstrate the ability to contract with multiple
1017	providers that provide the same type of service.
1018	(3)  Pursuant to 42 C.F.R. s. 438.6(c), the agency, in
1019	consultation with the department, shall annually reevaluate and
1020	recertify the capitation rates for the diversion pilot projects.
1021	The agency, in consultation with the department, shall secure
1022	the utilization and cost data for Medicaid and Medicare
1023	beneficiaries served by the program which shall be used in
1024	developing rates for the diversion pilot projects.
1025	(4)  In order to achieve rapid enrollment into the program
1026	and efficient diversion of applicants from nursing home care,
1027	the department and the agency shall allow enrollment of Medicaid
1028	beneficiaries on the date that eligibility for the community
1029	diversion pilot project is approved. The provider shall receive
1030	a prorated capitated rate for those enrollees who are enrolled
1031	after the first of each month.
1032	(5)(3)  The department shall provide to prospective
1033	participants a choice of participating in a community diversion
1034	pilot project or any other appropriate placement available. To
1035	the extent possible, individuals shall be allowed to choose
1036	their care providers, including long-term care service providers
1037	affiliated with an individual's religious faith or denomination.
1038	(6)(4)  The department shall enroll participants. Providers
1039	shall not directly enroll participants in community diversion
1040	pilot projects.
1041	(7)(5)  In selecting the pilot project area, the department
1042	shall consider the following factors in the area:
1043	(a)  The nursing home occupancy level.
1044	(b)  The number of certificates of need awarded for nursing
1045	home beds for which renovation, expansion, or construction has
1046	not begun.
1047	(c)  The annual number of additional nursing home beds.
1048	(d)  The annual number of nursing home admissions.
1049	(e)  The adequacy of community-based long-term care service
1050	providers.
1051	(8)(6)  The department may require participants to
1052	contribute to their cost of care in an amount not to exceed the
1053	cost-sharing required of Medicaid-eligible nursing home
1054	residents.
1055	(9)(7)  Community diversion pilot projects must:
1056	(a)  Provide services for participants that are of
1057	sufficient quality, quantity, type, and duration to prevent or
1058	delay nursing facility placement.
1059	(b)  Integrate acute and long-term care services, and the
1060	funding sources for such services, as feasible.
1061	(c)  Encourage individuals, families, and communities to
1062	plan for their long-term care needs.
1063	(d)  Provide skilled and intermediate nursing facility care
1064	for participants who cannot be adequately cared for in
1065	noninstitutional settings.
1066	(10)  The Legislature finds that preservation of the
1067	historic aging network of lead agencies is essential to the
1068	well-being of Florida's elderly population. The Legislature
1069	finds that the Florida aging network constitutes a system of
1070	essential community providers which should be nurtured and
1071	assisted to develop systems of operations which allow the
1072	gradual assumption of responsibility and financial risk for
1073	managing a client through the entire continuum of long-term-care
1074	services within the area the lead agency is currently serving
1075	and which allow lead agency providers to develop managed systems
1076	of service delivery. The department and the agency shall
1077	therefore:
1078	(a)  Develop a demonstration system in which existing
1079	community care for the elderly lead agencies are assisted in
1080	transitioning their business model and the service delivery
1081	system within their current community care service area to
1082	enable assumption, over a period of time, of full risk as a
1083	diversion pilot project contractor providing long-term-care
1084	services in their areas of operation. The department, in
1085	consultation with the Agency for Health Care Administration and
1086	the Department of Children and Family Services, shall develop an
1087	implementation plan for three lead agencies by October 31, 2004.
1088	The department may postpone the bidding specified in s.
1089	430.203(9)(c) until such time as the project areas have been
1090	designated.
1091	(b)  In each demonstration system, a community care for the
1092	elderly lead agency shall be initially reimbursed on a prepaid
1093	or fixed-sum basis for services provided under the Aged and
1094	Disabled Adult Medicaid Waiver Program and the Assisted Living
1095	for the Elderly Medicaid Waiver Program. By the end of the third
1096	year of operation, the demonstration shall include services
1097	under the long-term-care community diversion pilot project.
1098	(c)  During the first year of operation, the department and
1099	the agency may place providers at risk to provide the nursing
1100	home services for the enrolled individuals who are participating
1101	in the demonstration project. During the 3-year development
1102	period, the agency and the department may limit the level of
1103	custodial nursing home risk that the administering entities
1104	assume, consistent with the intent of the Legislature to reduce
1105	the use and cost of nursing home care. Under risk-sharing
1106	arrangements, during the first 3 years of operation, the agency
1107	and the department may reimburse the administering entities for
1108	the cost of providing nursing home care for Medicaid-eligible
1109	participants who have been permanently placed and remain in
1110	nursing home care for more than 1 year, or may disenroll such
1111	participants from the demonstration projects.
1112	(d)  The agency and the department shall develop
1113	reimbursement rates based on the historical cost experience of
1114	the state in providing long-term care and nursing home services
1115	under Medicaid waiver programs and providing state-funded long-
1116	term care services to the population 60 years of age and older
1117	in the area served by the pilot project.
1118	(e)  The agency, in consultation with the department, shall
1119	ensure that the entity or entities receiving prepaid or fixed-
1120	sum reimbursement are assisted in developing internal management
1121	and financial control systems necessary to manage the risk
1122	associated with providing services under a prepaid or fixed-sum
1123	rate system.
1124	(f)  If the agency and the department share risk of
1125	custodial nursing home placement, payment rates during the first
1126	3 years of operation shall be set at not more than 100 percent
1127	of the costs to the agency and the department of providing
1128	equivalent services to the population within the area of the
1129	pilot project for the year prior to the year in which the pilot
1130	project is implemented, adjusted forward to account for
1131	inflation and policy changes of the Medicaid program. In
1132	subsequent years, the rate shall be negotiated, based on the
1133	cost experience of the entity in providing contracted services,
1134	but may not exceed 95 percent of the amount that would have been
1135	paid in the area of the pilot project absent the prepaid or
1136	fixed sum reimbursement methodology.
1137	(g)  Community care for the elderly lead agencies which
1138	have operated for a period of at least 20 years, which operate a
1139	Medicare-certified home health agency, and which have developed
1140	a system of service provision by health care volunteers shall be
1141	given priority in the selection of pilot projects if they meet
1142	the minimum requirements specified in the competitive
1143	procurement.
1144	(h)  In order to facilitate the development of the
1145	demonstration project, the agency, subject to appropriations
1146	included in the General Appropriation Act, shall advance
1147	$500,000, if requested by the lead agency, for the purpose of
1148	funding development costs for each demonstration project
1149	provider. The terms of repayment may not extend beyond 6 years
1150	from the date of funding.
1151	(i)  The agency and the department shall adopt any rules
1152	necessary to comply with or administer these requirements,
1153	effect and implement interagency agreements between the agency
1154	and the department, and comply with federal requirements.
1155	(j)  The department and the agency shall seek federal
1156	waivers necessary to implement the requirements of this section,
1157	including waivers available from the federal Assistant Secretary
1158	on Aging necessary to include Older Americans Act services in
1159	the demonstration project.
1160	(k)  The Department of Elderly Affairs shall conduct or
1161	contract for an evaluation of the demonstration project. The
1162	department shall submit the evaluation to the Governor, the
1163	President of the Senate, and the Speaker of the House of
1164	Representatives by January 1, 2006. The evaluation must address
1165	the effects of the demonstration pilot project on the
1166	effectiveness of the project in providing a comprehensive system
1167	of appropriate and high-quality long-term-care services to
1168	elders in the least restrictive setting and make recommendations
1169	on implementation expansion for other parts of the state.
1170	(11)  The agency, in consultation with the department,
1171	shall evaluate the feasibility of integrating the frail elder
1172	option into the nursing home diversion pilot project and the
1173	feasibility of integrating each program's funds into one
1174	capitated program serving the aged.
1175	(12)  The agency shall seek federal waivers necessary to
1176	place a cap on the number of Nursing Home Diversion providers in
1177	each geographic area. The agency may seek federal approval in
1178	advance of approval of its formal waiver application to limit
1179	the diversion provider network by freezing enrollment of
1180	providers at current levels when an area already has three or
1181	more providers or, in an expansion area, when enrollment reaches
1182	a level of three providers. This subsection does not prevent the
1183	department from approving a provider to expand service to
1184	additional counties within a planning and service area for which
1185	the provider is already approved to serve.
1186	(13)  The agency and the department shall adopt any rules
1187	necessary to comply with or administer these requirements,
1188	effect and implement interagency agreements between the
1189	department and the agency, and comply with federal requirements.
1190	Section 11.  Paragraphs (j) and (k) of subsection (1) of
1191	section 430.502, Florida Statutes, are amended, and paragraph
1192	(l) is added to said subsection, to read:
1193	430.502  Alzheimer's disease; memory disorder clinics and
1194	day care and respite care programs.--
1195	(1)  There is established:
1196	(j)  A memory disorder clinic at Lee Memorial Hospital
1197	created by chapter 63-1552, Laws of Florida, as amended; and
1198	(k)  A memory disorder clinic at Sarasota Memorial Hospital
1199	in Sarasota County; and,
1200	(l)  A memory disorder clinic at Morton Plant Hospital,
1201	Clearwater, in Pinellas County,
1202
1203	for the purpose of conducting research and training in a
1204	diagnostic and therapeutic setting for persons suffering from
1205	Alzheimer's disease and related memory disorders. However,
1206	memory disorder clinics funded as of June 30, 1995, shall not
1207	receive decreased funding due solely to subsequent additions of
1208	memory disorder clinics in this subsection.
1209	Section 12.  Paragraph (b) of subsection (2) of section
1210	1000.445, Florida Statutes, as amended by chapter 2004-2, Laws
1211	of Florida, is amended to read:
1212	1004.445  Johnnie B. Byrd, Sr., Alzheimer's Center and
1213	Research Institute.--
1214	(2)
1215	(b)1.  The affairs of the not-for-profit corporation shall
1216	be managed by a board of directors who shall serve without
1217	compensation. The board of directors shall consist of the
1218	President of the University of South Florida and the chair of
1219	the State Board of Education, or their designees, 5
1220	representatives of the state universities, and no fewer than 9
1221	nor more than 14 representatives of the public who are neither
1222	medical doctors nor state employees. Each director who is a
1223	representative of a state university or of the public shall be
1224	appointed to serve a term of 3 years. The chair of the board of
1225	directors shall be selected by a majority vote of the directors.
1226	Each director shall have only one vote.
1227	2.  The initial board of directors shall consist of the
1228	President of the University of South Florida and the chair of
1229	the State Board of Education, or their designees; the five
1230	university representatives, of whom one shall be appointed by
1231	the Governor, two by the President of the Senate, and two by the
1232	Speaker of the House of Representatives; and nine public
1233	representatives, of whom three shall be appointed by the
1234	Governor, three by the President of the Senate, and three by the
1235	Speaker of the House of Representatives.
1236	3.  Upon the expiration of the terms of the initial
1237	appointed directors, all directors subject to 3-year terms of
1238	office under this paragraph shall be appointed by a majority
1239	vote of the directors. and
1240	4.  The board may be expanded to include additional public
1241	representative directors up to the maximum number allowed.
1242	Additional members shall be added by a majority vote of the
1243	directors.
1244	5.  Any vacancy in office shall be filled for the remainder
1245	of the term by majority vote of the directors. Any director may
1246	be reappointed.
1247	Section 13.  By January 1 of each year, the Department of
1248	Elderly Affairs shall submit to the Governor, the President of
1249	the Senate, and the Speaker of the House of Representatives, a
1250	summary of the results of the departmental monitoring of the
1251	activities of area agencies on aging. The report shall include
1252	information about area agency compliance with state and federal
1253	rules pertaining to all programs administered by the area
1254	agency, information about each area agency's financial
1255	management of state and federally-funded programs, information
1256	about each agency's compliance with the terms of its contracts
1257	with the department, and a summary of corrective action required
1258	by the department.
1259	Section 14.  This act is subject to a specific
1260	appropriation in the General Appropriations Act for fiscal year
1261	2004-2005.
1262	Section 15.  This act shall take effect upon becoming a
1263	law.

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