Amendment
Bill No. 1893
Amendment No. 430313
CHAMBER ACTION
Senate House
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1Representative(s) Homan offered the following:
2
3     Amendment (with directory and title amendments)
4     Remove lines 176-701 and insert:
5to methodologies set forth in the rules of the agency and in
6policy manuals and handbooks incorporated by reference therein.
7These methodologies may include fee schedules, reimbursement
8methods based on cost reporting, negotiated fees, competitive
9bidding pursuant to s. 287.057, and other mechanisms the agency
10considers efficient and effective for purchasing services or
11goods on behalf of recipients. If a provider is reimbursed based
12on cost reporting and submits a cost report late and that cost
13report would have been used to set a lower reimbursement rate
14for a rate semester, then the provider's rate for that semester
15shall be retroactively calculated using the new cost report, and
16full payment at the recalculated rate shall be effected
17retroactively. Medicare-granted extensions for filing cost
18reports, if applicable, shall also apply to Medicaid cost
19reports. Payment for Medicaid compensable services made on
20behalf of Medicaid eligible persons is subject to the
21availability of moneys and any limitations or directions
22provided for in the General Appropriations Act or chapter 216.
23Further, nothing in this section shall be construed to prevent
24or limit the agency from adjusting fees, reimbursement rates,
25lengths of stay, number of visits, or number of services, or
26making any other adjustments necessary to comply with the
27availability of moneys and any limitations or directions
28provided for in the General Appropriations Act, provided the
29adjustment is consistent with legislative intent.
30     (2)
31     (b)  Subject to any limitations or directions provided for
32in the General Appropriations Act, the agency shall establish
33and implement a Florida Title XIX Long-Term Care Reimbursement
34Plan (Medicaid) for nursing home care in order to provide care
35and services in conformance with the applicable state and
36federal laws, rules, regulations, and quality and safety
37standards and to ensure that individuals eligible for medical
38assistance have reasonable geographic access to such care.
39     1.  Changes of ownership or of licensed operator do not
40qualify for increases in reimbursement rates associated with the
41change of ownership or of licensed operator. The agency shall
42amend the Title XIX Long Term Care Reimbursement Plan to provide
43that the initial nursing home reimbursement rates, for the
44operating, patient care, and MAR components, associated with
45related and unrelated party changes of ownership or licensed
46operator filed on or after September 1, 2001, are equivalent to
47the previous owner's reimbursement rate.
48     2.  The agency shall amend the long-term care reimbursement
49plan and cost reporting system to create direct care and
50indirect care subcomponents of the patient care component of the
51per diem rate. These two subcomponents together shall equal the
52patient care component of the per diem rate. Separate cost-based
53ceilings shall be calculated for each patient care subcomponent.
54The direct care and indirect care subcomponents subcomponent of
55the per diem rate shall be limited by the cost-based class
56ceiling, and the indirect care subcomponent shall be limited by
57the lower of a the cost-based class ceiling, a by the target
58rate class ceiling, or an by the individual provider target for
59each subcomponent. The agency shall adjust the patient care
60component effective January 1, 2002. The cost to adjust the
61direct care subcomponent shall be the net of the total funds
62previously allocated for the case mix add-on. The agency shall
63make the required changes to the nursing home cost reporting
64forms to implement this requirement effective January 1, 2002.
65     3.  The direct care subcomponent shall include salaries and
66benefits of direct care staff providing nursing services
67including registered nurses, licensed practical nurses, and
68certified nursing assistants who deliver care directly to
69residents in the nursing home facility. This excludes nursing
70administration, MDS, and care plan coordinators, staff
71development, and staffing coordinator.
72     4.  All other patient care costs shall be included in the
73indirect care cost subcomponent of the patient care per diem
74rate. There shall be no costs directly or indirectly allocated
75to the direct care subcomponent from a home office or management
76company.
77     5.  On July 1 of each year, the agency shall report to the
78Legislature direct and indirect care costs, including average
79direct and indirect care costs per resident per facility and
80direct care and indirect care salaries and benefits per category
81of staff member per facility.
82     6.  In order to offset the cost of general and professional
83liability insurance, the agency shall amend the plan to allow
84for interim rate adjustments to reflect increases in the cost of
85general or professional liability insurance for nursing homes.
86This provision shall be implemented to the extent existing
87appropriations are available.
88
89It is the intent of the Legislature that the reimbursement plan
90achieve the goal of providing access to health care for nursing
91home residents who require large amounts of care while
92encouraging diversion services as an alternative to nursing home
93care for residents who can be served within the community. The
94agency shall base the establishment of any maximum rate of
95payment, whether overall or component, on the available moneys
96as provided for in the General Appropriations Act. The agency
97may base the maximum rate of payment on the results of
98scientifically valid analysis and conclusions derived from
99objective statistical data pertinent to the particular maximum
100rate of payment.
101     (14)  A provider of prescribed drugs shall be reimbursed
102the least of the amount billed by the provider, the provider's
103usual and customary charge, or the Medicaid maximum allowable
104fee established by the agency, plus a dispensing fee.
105     (a)  For pharmacies with less than $75,000 in average
106aggregate monthly payments, the Medicaid maximum allowable fee
107for ingredient cost will be based on the lower of: average
108wholesale price (AWP) minus 15.4 percent, wholesaler acquisition
109cost (WAC) plus 5.75 percent, the federal upper limit (FUL), the
110state maximum allowable cost (SMAC), or the usual and customary
111(UAC) charge billed by the provider.
112     (b)  For pharmacies with $75,000 or more in average
113aggregate monthly payments, the Medicaid maximum allowable fee
114for ingredient cost will be based on the lower of: average
115wholesale price (AWP) minus 17 percent, wholesaler acquisition
116cost (WAC) plus 3.5 percent, the federal upper limit (FUL), the
117state maximum allowable cost (SMAC), or the usual and customary
118(UAC) charge billed by the provider.
119     (c)  Medicaid providers are required to dispense generic
120drugs if available at lower cost and the agency has not
121determined that the branded product is more cost-effective,
122unless the prescriber has requested and received approval to
123require the branded product. The agency is directed to implement
124a variable dispensing fee for payments for prescribed medicines
125while ensuring continued access for Medicaid recipients. The
126variable dispensing fee may be based upon, but not limited to,
127either or both the volume of prescriptions dispensed by a
128specific pharmacy provider, the volume of prescriptions
129dispensed to an individual recipient, and dispensing of
130preferred-drug-list products. The agency may increase the
131pharmacy dispensing fee authorized by statute and in the annual
132General Appropriations Act by $0.50 for the dispensing of a
133Medicaid preferred-drug-list product and reduce the pharmacy
134dispensing fee by $0.50 for the dispensing of a Medicaid product
135that is not included on the preferred drug list. The agency may
136establish a supplemental pharmaceutical dispensing fee to be
137paid to providers returning unused unit-dose packaged
138medications to stock and crediting the Medicaid program for the
139ingredient cost of those medications if the ingredient costs to
140be credited exceed the value of the supplemental dispensing fee.
141The agency is authorized to limit reimbursement for prescribed
142medicine in order to comply with any limitations or directions
143provided for in the General Appropriations Act, which may
144include implementing a prospective or concurrent utilization
145review program.
146
147=========== D I R E C T O R Y  A M E N D M E N T ==========
148     Remove line 171 and insert:
149     Section 6.  Paragraph (b) of subsection (2) and subsection
150(14) of section 409.908, Florida Statutes, are amended
151
152================ T I T L E  A M E N D M E N T =============
153     Remove lines 14 and 15 and insert:
154F.S.; revising provisions


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