HB 0543

CS

CHAMBER ACTION

1	The Health Care Appropriations Committee recommends the
2	following:
3
4	Council/Committee Substitute
5	Remove the entire bill and insert:
6	A bill to be entitled
7	An act relating to Medicaid eligibility; amending s.
8	409.902, F.S.; providing for determination of eligibility
9	for nursing facility services under the Medicaid program;
10	specifying a penalty period; specifying criteria for
11	certain personal services contracts; providing for certain
12	financial instruments signed within a specified period of
13	time to be considered countable assets when determining
14	Medicaid eligibility; specifying criteria for certain
15	annuities; providing direction to hearing officers
16	relating to revisions of community spouse income or
17	resource allowances; authorizing the Department of
18	Children and Family Services to adopt rules; providing a
19	contingent effective date.
20
21	Be It Enacted by the Legislature of the State of Florida:
22
23	Section 1.  Section 409.902, Florida Statutes, is amended
24	to read:
25	409.902  Designated single state agency; payment
26	requirements; program title; release of medical records;
27	eligibility requirements.--
28	(1)  The Agency for Health Care Administration is
29	designated as the single state agency authorized to make
30	payments for medical assistance and related services under Title
31	XIX of the Social Security Act. These payments shall be made,
32	subject to any limitations or directions provided for in the
33	General Appropriations Act, only for services included in the
34	program, shall be made only on behalf of eligible individuals,
35	and shall be made only to qualified providers in accordance with
36	federal requirements for Title XIX of the Social Security Act
37	and the provisions of state law. This program of medical
38	assistance is designated the "Medicaid program." The Department
39	of Children and Family Services is responsible for Medicaid
40	eligibility determinations, including, but not limited to,
41	policy, rules, and the agreement with the Social Security
42	Administration for Medicaid eligibility determinations for
43	Supplemental Security Income recipients, as well as the actual
44	determination of eligibility. As a condition of Medicaid
45	eligibility, subject to federal approval, the Agency for Health
46	Care Administration and the Department of Children and Family
47	Services shall ensure that each recipient of Medicaid consents
48	to the release of her or his medical records to the Agency for
49	Health Care Administration and the Medicaid Fraud Control Unit
50	of the Department of Legal Affairs.
51	(2)(a)  In determining eligibility for nursing facility
52	services, including institutional hospice services and home and
53	community-based waiver programs under the Medicaid program, the
54	Department of Children and Family Services shall apply the
55	following asset transfer limitations effective for transfers
56	made on or after October 1, 2005:
57	1.  The penalty period associated with all transfers of
58	assets for less than fair market value begins on the first day
59	of the month in which an individual applies for medical
60	assistance and is otherwise eligible. For recipients of medical
61	assistance, the penalty period begins on the first day of the
62	month in which the Department of Children and Family Services
63	becomes aware of the transfer or on the first day of the month
64	following a period of ineligibility for an earlier transfer.
65	2.  Individuals who enter into a personal services contract
66	with a relative shall be considered to have transferred assets
67	without fair compensation to qualify for Medicaid unless all of
68	the following criteria are met:
69	a.  The contracted services do not duplicate services
70	available through other sources or providers, such as Medicaid,
71	Medicare, private insurance, or another legally obligated third
72	party.
73	b.  The contracted services directly benefit the individual
74	and are not services normally provided out of love and
75	consideration for the individual.
76	c.  The actual cost to deliver services is computed in a
77	manner that clearly reflects the actual number of hours to be
78	expended and the contract clearly identifies each specific
79	service and the average number of hours of each service to be
80	delivered each month.
81	d.  The hourly rate for each contracted service is equal to
82	or less than the amount normally charged by a professional who
83	traditionally provides the same or similar services.
84	e.  The contracted services are provided on a prospective
85	basis only and not for services provided in the past.
86	f.  The contract provides fair compensation to the
87	individual in his or her lifetime as set forth in life
88	expectancy tables adopted in rule 65A-1.716, Florida
89	Administrative Code.
90	3.  A financial instrument signed within the transfer look-
91	back period for institutional Medicaid coverage or home and
92	community-based waiver programs that allows deferred payments,
93	graduated payments, balloon payments, or debt forgiveness shall
94	be considered a countable asset to the individual in the amount
95	of the outstanding value of the financial instrument when
96	determining Medicaid eligibility.
97	(b)  In determining eligibility for nursing facility
98	services, including institutional hospice services and home and
99	community-based waiver programs under the Medicaid program, the
100	following limitations apply to annuities purchased on or after
101	October 1, 2005, when the applicant or the applicant's spouse
102	owns an annuity, other than a work-related pension annuity, such
103	as a civil service annuity, a railroad retirement annuity, or
104	another similar pension annuity.
105	1.  An annuity is an excluded resource and the monthly
106	payments are counted as unearned income if the annuity:
107	a.  Was purchased from an insurance company or financial
108	institution that is subject to licensing or regulation by the
109	Office of Insurance Regulation or a similar regulatory agency of
110	another state;
111	b.  Is irrevocable;
112	c.  Pays out principal and interest in equal monthly
113	installments wherein the principal investment is paid within the
114	annuitant's life expectancy based on the life expectancy table
115	used by the Social Security Administration or based on a shorter
116	life expectancy, if the annuitant has a condition that would
117	shorten the annuitant's life and that was diagnosed by a
118	physician before funds were placed into the annuity; and
119	d.  With the exception of an annuity for a community spouse
120	who is not requesting Medicaid nursing facility care or home and
121	community-based services waiver care, names the State of Florida
122	or the Agency for Health Care Administration, or its successor
123	agency, as the beneficiary of any funds remaining in the
124	annuity, not to exceed the amount of any Medicaid fund paid on
125	the individual's behalf during his or her lifetime.
126	2.  If all of the conditions in subparagraph 1. are not
127	met, the annuity's fair market value is counted as a resource in
128	the amount of its fair market value with the following
129	exception: When an annuity does not provide for payout of
130	principal and interest in equal installments within the
131	annuitant's lifetime and the issuing company indicates the
132	payout arrangement cannot be changed, the annuity shall be
133	excluded as a resource if the contract is amended to name the
134	State of Florida as the beneficiary of any funds remaining in
135	the annuity, not to exceed the amount of Medicaid funds paid on
136	the individual's behalf during his or her lifetime.
137	(c)  Under the spousal impoverishment policies of s. 1924
138	of the Social Security Act, the following special provision
139	applies: When a hearing officer considers revisions of community
140	spouse income or resource allowances permitted by s. 1924(e)(2)
141	of the Social Security Act, the hearing officer must consider
142	all income first, including the community spouse's own income as
143	well as all potential income that would be available from the
144	institutionalized spouse upon approval of Medicaid institutional
145	care, before raising the community spouse's income or resource
146	allowance.
147	(d)  The Department of Children and Family Services may
148	adopt rules pursuant to ss. 120.536(1) and 120.54 to implement
149	the requirements of this subsection.
150	Section 2.  This act shall take effect July 1, 2005, except
151	that if any provision of subsection (2) of section 409.902,
152	Florida Statutes, as created by this act, is prohibited by
153	federal law, that provision shall take effect when federal law
154	is changed to permit its application or when a waiver is
155	received. If, by October 1, 2005, any provision of subsection
156	(2) of section 409.902, Florida Statutes, as created by this
157	act, has not taken effect because of prohibitions in federal
158	law, the Secretary of Health Care Administration shall apply to
159	the Federal Government by January 1, 2006, for a waiver of the
160	prohibitions in federal law or other federal authority, and the
161	provisions of subsection (2) of section 409.902, Florida
162	Statutes, as created by this act, shall take effect upon receipt
163	of a federal waiver or other federal approval, notification to
164	the Secretary of State, and publication of a notice in the
165	Florida Administrative Weekly to that effect.

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