HB 0371

1	A bill to be entitled
2	An act relating to long-term care coverage; amending s.
3	409.902, F.S.; directing the Agency for Health Care
4	Administration to establish the Long-term Care Partnership
5	Program; providing purpose and duties; amending s.
6	409.905, F.S.; providing conditions for eligibility;
7	directing the agency to submit a plan and proposed
8	legislation to the Legislature; providing a contingent
9	effective date.
10
11	Be It Enacted by the Legislature of the State of Florida:
12
13	Section 1.  Section 409.902, Florida Statutes, is amended
14	to read:
15	409.902  Designated single state agency; payment
16	requirements; program title; release of medical records; Florida
17	Long-term Care Partnership Program.--
18	(1)  The Agency for Health Care Administration is
19	designated as the single state agency authorized to make
20	payments for medical assistance and related services under Title
21	XIX of the Social Security Act. These payments shall be made,
22	subject to any limitations or directions provided for in the
23	General Appropriations Act, only for services included in the
24	program, shall be made only on behalf of eligible individuals,
25	and shall be made only to qualified providers in accordance with
26	federal requirements for Title XIX of the Social Security Act
27	and the provisions of state law. This program of medical
28	assistance is designated the "Medicaid program." The Department
29	of Children and Family Services is responsible for Medicaid
30	eligibility determinations, including, but not limited to,
31	policy, rules, and the agreement with the Social Security
32	Administration for Medicaid eligibility determinations for
33	Supplemental Security Income recipients, as well as the actual
34	determination of eligibility. As a condition of Medicaid
35	eligibility, subject to federal approval, the Agency for Health
36	Care Administration and the Department of Children and Family
37	Services shall ensure that each recipient of Medicaid consents
38	to the release of her or his medical records to the Agency for
39	Health Care Administration and the Medicaid Fraud Control Unit
40	of the Department of Legal Affairs.
41	(2)  The Agency for Health Care Administration is directed
42	to establish the Florida Long-term Care Partnership Program,
43	which shall:
44	(a)  Provide incentives for an individual to obtain
45	insurance to cover the costs of long-term care.
46	(b)  Review and approve, in consultation with the Office of
47	Insurance Regulation, long-term care insurance policies for
48	designation as approved long-term care partnership program
49	policies.
50	(c)  Provide a mechanism to qualify for coverage of the
51	costs of long-term care needs under Medicaid without first being
52	required to substantially exhaust his or her resources,
53	including a reduction of the individual's asset valuation by $1
54	for each $1 of benefits paid out under the individual's approved
55	long-term care partnership program policy as a determination of
56	Medicaid eligibility.
57	(d)  Provide counseling services to assist an individual in
58	planning for long-term care needs.
59	(e)  Alleviate the financial burden on the state's medical
60	assistance program by encouraging the pursuit of private
61	initiatives.
62	Section 2.  Subsection (8) of section 409.905, Florida
63	Statutes, is amended to read:
64	409.905  Mandatory Medicaid services.--The agency may make
65	payments for the following services, which are required of the
66	state by Title XIX of the Social Security Act, furnished by
67	Medicaid providers to recipients who are determined to be
68	eligible on the dates on which the services were provided. Any
69	service under this section shall be provided only when medically
70	necessary and in accordance with state and federal law.
71	Mandatory services rendered by providers in mobile units to
72	Medicaid recipients may be restricted by the agency. Nothing in
73	this section shall be construed to prevent or limit the agency
74	from adjusting fees, reimbursement rates, lengths of stay,
75	number of visits, number of services, or any other adjustments
76	necessary to comply with the availability of moneys and any
77	limitations or directions provided for in the General
78	Appropriations Act or chapter 216.
79	(8)  NURSING FACILITY SERVICES.--The agency shall pay for
80	24-hour-a-day nursing and rehabilitative services for a
81	recipient in a nursing facility licensed under part II of
82	chapter 400 or in a rural hospital, as defined in s. 395.602, or
83	in a Medicare certified skilled nursing facility operated by a
84	hospital, as defined by s. 395.002(11), that is licensed under
85	part I of chapter 395, and in accordance with provisions set
86	forth in s. 409.908(2)(a), which services are ordered by and
87	provided under the direction of a licensed physician. However,
88	if a nursing facility has been destroyed or otherwise made
89	uninhabitable by natural disaster or other emergency and another
90	nursing facility is not available, the agency must pay for
91	similar services temporarily in a hospital licensed under part I
92	of chapter 395 provided federal funding is approved and
93	available. The agency shall pay only for bed-hold days if the
94	facility has an occupancy rate of 95 percent or greater. When
95	determining eligibility for nursing and rehabilitative services,
96	if the individual is a beneficiary of an approved long-term care
97	partnership program policy and has exhausted the benefits of the
98	policy, the total countable assets of the individual shall be
99	reduced by $1 for each $1 of benefits paid out under the
100	individual's approved long-term care partnership program policy.
101	The agency is authorized to seek any federal waivers to
102	implement this policy.
103	Section 3.  The Agency for Health Care Administration shall
104	develop a plan for implementation of the Florida Long-term Care
105	Partnership Program. The agency shall present the plan in the
106	form of recommended legislation to the President of the Senate
107	and the Speaker of House of Representatives prior to the
108	commencement of the next legislative session.
109	Section 4.  This act shall take effect upon becoming a law,
110	except that the amendments to sections 409.902 and 409.905,
111	Florida Statutes, provided in this act shall take effect
112	contingent upon amendment to section 1917(b)(1)(c) of the Social
113	Security Act by the United States Congress to delete the "May
114	14, 1993," deadline for approval by states of long-term care
115	partnership plans.

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