HB 1525

1	A bill to be entitled
2	An act relating to elderly affairs; amending s. 430.205,
3	F.S.; deleting provisions relating to implementation plans
4	to integrate certain functions of the Agency for Health
5	Care Administration; providing for development of uniform
6	case management standards within the Aged and Disabled
7	Adult Medicaid waiver program; authorizing, rather than
8	requiring, coordination of acute and chronic medical
9	service between the agency and the Department of Elderly
10	Affairs to be included in the capitated rate for case
11	management services; requiring the agency to consult with
12	the department before adopting rules relating to
13	reimbursement of providers and case management standards;
14	revising provisions relating to certain reimbursement
15	rates; deleting obsolete provisions; providing that
16	evaluation of a specified pilot project relating to elder
17	care is subject to an appropriation; amending s. 430.7031,
18	F.S.; deleting provision that requires the department and
19	agency to review the case files of a specified percentage
20	of Medicaid nursing home residents annually for the
21	purpose of determining whether the residents are able to
22	move to community placements; providing an effective date.
23
24	Be It Enacted by the Legislature of the State of Florida:
25
26	Section 1.  Paragraphs (b) and (c) of subsection (6) of
27	section 430.205, Florida Statutes, are amended to read:
28	430.205  Community care service system.--
29	(6)  Notwithstanding other requirements of this chapter,
30	the Department of Elderly Affairs and the Agency for Health Care
31	Administration shall develop an integrated long-term-care
32	delivery system.
33	(b)  During the 2004-2005 state fiscal year:
34	1.  The agency, in consultation with the department, shall
35	develop an implementation plan to integrate the Frail Elder
36	Option into the Nursing Home Diversion pilot project and each
37	program's funds into one capitated program serving the aged.
38	Beginning July 1, 2004, the agency may not enroll additional
39	individuals in the Frail Elder Option.
40	2.  The agency, in consultation with the department, shall
41	integrate the Aged and Disabled Adult Medicaid waiver program
42	and the Assisted Living for the Elderly Medicaid waiver program
43	and each program's funds into one fee-for-service Medicaid
44	waiver program serving the aged and disabled. Once the programs
45	are integrated, funding to provide care in assisted-living
46	facilities under the new waiver may not be less than the amount
47	appropriated in the 2003-2004 fiscal year for the Assisted
48	Living for the Elderly Medicaid waiver.
49	a.  The agency shall seek federal waivers necessary to
50	integrate these waiver programs.
51	b.  The agency and the department shall reimburse providers
52	for case management services on a capitated basis and develop
53	uniform standards for case management within the Aged and
54	Disabled Adult in this fee-for-service Medicaid waiver program.
55	The coordination of acute and chronic medical services for
56	individuals may shall be included in the capitated rate for case
57	management services.
58	c.  The agency, in consultation with and the department,
59	shall adopt any rules necessary to comply with or administer
60	these requirements, effect and implement interagency agreements
61	between the department and the agency, and comply with federal
62	requirements.
63	2.3.  The Legislature finds that preservation of the
64	historic aging network of lead agencies is essential to the
65	well-being of Florida's elderly population. The Legislature
66	finds that the Florida aging network constitutes a system of
67	essential community providers which should be nurtured and
68	assisted to develop systems of operations which allow the
69	gradual assumption of responsibility and financial risk for
70	managing a client through the entire continuum of long-term care
71	services within the area the lead agency is currently serving,
72	and which allow lead agency providers to develop managed systems
73	of service delivery. The department, in consultation with the
74	agency, shall therefore:
75	a.  Develop a demonstration project in which existing
76	community care for the elderly lead agencies are assisted in
77	transferring their business model and the service delivery
78	system within their current community care service area to
79	enable assumption, over a period of time, of full risk as a
80	community diversion pilot project contractor providing long-term
81	care services in the areas of operation. The department, in
82	consultation with the agency and the Department of Children and
83	Family Services, shall develop an implementation plan for no
84	more than three lead agencies by October 31, 2004.
85	b.  In the demonstration area, a community care for the
86	elderly lead agency shall be initially reimbursed on a prepaid
87	or fixed-sum basis for all home and community-based services
88	provided under the long-term care community diversion pilot
89	project newly integrated fee-for-service Medicaid waiver. By the
90	end of the third year of operation, the lead agency shall be
91	reimbursed on a prepaid or fixed-sum basis for demonstration
92	project shall include all services under the long-term care
93	community diversion pilot project.
94	c.  During the first year of operation, the department, in
95	consultation with the agency, may place providers at risk to
96	provide nursing home services for the enrolled individuals who
97	are participating in the demonstration project. During the 3-
98	year development period, the agency and the department may limit
99	the level of custodial nursing home risk that the administering
100	entities assume. Under risk-sharing arrangements, during the
101	first 3 years of operation, the department, in consultation with
102	the agency, may reimburse the administering entity for the cost
103	of providing nursing home care for Medicaid-eligible
104	participants who have been permanently placed and remain in a
105	nursing home for more than 1 year, or may disenroll such
106	participants from the demonstration project.
107	d.  The agency, in consultation with the department, shall
108	develop reimbursement rates based on the federally approved,
109	actuarially certified rate methodology for the long-term care
110	community diversion pilot project historical cost experience of
111	the state in providing long-term care and nursing home services
112	under Medicaid waiver programs to the population 65 years of age
113	and older in the area served by the pilot project.
114	e.  The department, in consultation with the agency, shall
115	ensure that the entity or entities receiving prepaid or fixed-
116	sum reimbursement are assisted in developing internal management
117	and financial control systems necessary to manage the risk
118	associated with providing services under a prepaid or fixed-sum
119	rate system.
120	f.  If the department and the agency share risk of
121	custodial nursing home placement, payment rates during the first
122	3 years of operation shall be set at not more than 100 percent
123	of the costs to the agency and the department of providing
124	equivalent services to the population within the area of the
125	pilot project for the year prior to the year in which the pilot
126	project is implemented, adjusted forward to account for
127	inflation and policy changes in the Medicaid program. In
128	subsequent years, the rate shall be negotiated, based on the
129	cost experience of the entity in providing contracted services,
130	but may not exceed 95 percent of the amount that would have been
131	paid in the pilot project area absent the prepaid or fixed sum
132	reimbursement methodology.
133	g.  Community care for the elderly lead agencies that have
134	operated for a period of at least 20 years, which provide
135	Medicare-certified services to elders, and which have developed
136	a system of service provision by health care volunteers shall be
137	given priority in the selection of the pilot project if they
138	meet the minimum requirements specified in the competitive
139	procurement.
140	h.  The agency and the department shall adopt rules
141	necessary to comply with or administer these requirements,
142	effect and implement interagency agreements between the agency
143	and the department, and comply with federal requirements.
144	i.  The department and the agency shall seek federal
145	waivers necessary to implement the requirements of this section.
146	j.  The Department of Elderly Affairs shall conduct or
147	contract for an evaluation of the demonstration project. The
148	department shall submit the evaluation to the Governor and the
149	Legislature by January 1, 2007. The evaluation must address the
150	effectiveness of the pilot project in providing a comprehensive
151	system of appropriate and high-quality, long-term care services
152	to elders in the least restrictive setting and make
153	recommendations on expanding the project to other parts of the
154	state. This subparagraph is subject to an appropriation by the
155	Legislature.
156	4.  The department, in consultation with the agency, shall
157	study the integration of the database systems for the
158	Comprehensive Assessment and Review of Long-Term Care (CARES)
159	program and the Client Information and Referral Tracking System
160	(CIRTS) and develop a plan for database integration. The
161	department shall submit the plan to the Governor, the President
162	of the Senate, and the Speaker of the House of Representatives
163	by December 31, 2004.
164	3.5.  The agency, in consultation with the department,
165	shall work with the fiscal agent for the Medicaid program to
166	develop a service utilization reporting system that operates
167	through the fiscal agent for the capitated plans.
168	(c)  During the 2005-2006 state fiscal year:
169	1.  The agency, in consultation with the department, shall
170	monitor the newly integrated programs and report on the progress
171	of those programs to the Governor, the President of the Senate,
172	and the Speaker of the House of Representatives by June 30,
173	2006. The report must include an initial evaluation of the
174	programs in their early stages following the evaluation plan
175	developed by the department, in consultation with the agency and
176	the selected contractor.
177	2.  The department shall monitor the pilot projects for
178	resource centers on aging and report on the progress of those
179	projects to the Governor, the President of the Senate, and the
180	Speaker of the House of Representatives by June 30, 2006. The
181	report must include an evaluation of the implementation process
182	in its early stages.
183	3.  The department, in consultation with the agency, shall
184	integrate the database systems for the Comprehensive Assessment
185	and Review for of Long-Term Care Services (CARES) program and
186	the Client Information and Referral Tracking System (CIRTS) into
187	a single operating assessment information system by June 30,
188	2006.
189	4.  The agency, in consultation with the department, shall
190	integrate the Frail Elder Option into the Nursing Home Diversion
191	pilot project and each program's funds into one capitated
192	program serving the aged.
193	a.  The department, in consultation with the agency, shall
194	develop uniform standards for case management in this newly
195	integrated capitated system.
196	b.  The agency shall seek federal waivers necessary to
197	integrate these programs.
198	c.  The department, in consultation with the agency, shall
199	adopt any rules necessary to comply with or administer these
200	requirements, effect and implement interagency agreements
201	between the department and the agency, and comply with federal
202	requirements.
203	Section 2.  Subsection (2) of section 430.7031, Florida
204	Statutes, is amended to read:
205	430.7031  Nursing home transition program.--The department
206	and the Agency for Health Care Administration:
207	(2)  Shall collaboratively work to identify nursing home
208	residents who are able to move to community placements, and to
209	provide case management and supportive services to such
210	individuals while they are in nursing homes to assist such
211	individuals to move in moving to less expensive and less
212	restrictive settings. CARES program staff shall annually review
213	at least 20 percent of the case files for nursing home residents
214	who are Medicaid recipients to determine which nursing home
215	residents are able to move to community placements.
216	Section 3.  This act shall take effect upon becoming a law.

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