CS/HB 1289

1	A bill to be entitled
2	An act relating to Medicaid eligibility; amending s.
3	409.902, F.S.; providing asset transfer limitations for
4	determination of eligibility for certain nursing facility
5	services under the Medicaid program after a specified
6	date; requiring the Department of Children and Family
7	Services to take certain actions if a community spouse
8	refuses to make certain resources available to the
9	institutional spouse; authorizing the Agency for Health
10	Care Administration to recover certain Medicaid expenses;
11	authorizing the Department of Children and Family Services
12	to adopt rules; providing an effective date.
13
14	Be It Enacted by the Legislature of the State of Florida:
15
16	Section 1.  Section 409.902, Florida Statutes, is amended
17	to read:
18	409.902  Designated single state agency; payment
19	requirements; program title; release of medical records;
20	eligibility requirements.-
21	(1)  The Agency for Health Care Administration is
22	designated as the single state agency authorized to make
23	payments for medical assistance and related services under Title
24	XIX of the Social Security Act. These payments shall be made,
25	subject to any limitations or directions provided for in the
26	General Appropriations Act, only for services included in the
27	program, shall be made only on behalf of eligible individuals,
28	and shall be made only to qualified providers in accordance with
29	federal requirements for Title XIX of the Social Security Act
30	and the provisions of state law. This program of medical
31	assistance is designated the "Medicaid program." The Department
32	of Children and Family Services is responsible for Medicaid
33	eligibility determinations, including, but not limited to,
34	policy, rules, and the agreement with the Social Security
35	Administration for Medicaid eligibility determinations for
36	Supplemental Security Income recipients, as well as the actual
37	determination of eligibility. As a condition of Medicaid
38	eligibility, subject to federal approval, the Agency for Health
39	Care Administration and the Department of Children and Family
40	Services shall ensure that each recipient of Medicaid consents
41	to the release of her or his medical records to the Agency for
42	Health Care Administration and the Medicaid Fraud Control Unit
43	of the Department of Legal Affairs.
44	(2)  In determining eligibility for nursing facility
45	services, including institutional hospice services and home and
46	community-based waiver programs under the Medicaid program, the
47	Department of Children and Family Services shall apply the asset
48	transfer limitations specified in subsection (3) for transfers
49	made after July 1, 2011.
50	(3)  Individuals who enter into a personal services
51	contract with a relative shall be considered to have transferred
52	assets without fair compensation to qualify for Medicaid unless
53	all of the following criteria are met:
54	(a)  The contracted services do not duplicate services
55	available through other sources or providers, such as Medicaid,
56	Medicare, private insurance, or another legally obligated third
57	party.
58	(b)  The contracted services directly benefit the
59	individual and are not services normally provided out of
60	consideration for the individual.
61	(c)  The actual cost to deliver services is computed in a
62	manner that clearly reflects the actual number of hours to be
63	expended and the contract clearly identifies each specific
64	service and the average number of hours required to deliver each
65	service each month.
66	(d)  The hourly rate for each contracted service is equal
67	to or less than the amount normally charged by a professional
68	who traditionally provides the same or similar services.
69	(e)  The cost of contracted services is provided on a
70	prospective basis only and does not apply to services provided
71	before July 1, 2011.
72	(f)  The contract for services provides fair compensation
73	to the individual during her or his lifetime as set forth in the
74	life expectancy tables published by the Office of the Actuary of
75	the Social Security Administration.
76	(4)  When determining eligibility for nursing facility
77	services, including institutional hospice services and home and
78	community-based waiver programs under the Medicaid program, if a
79	community spouse refuses to make her or his resources available
80	to her or his institutional spouse, the Department of Children
81	and Family Services shall:
82	(a)  Require proof that estrangement existed during the
83	months before the individual submitted an application for
84	institutional care services. If the individuals have not lived
85	separate and apart without cohabitation and without interruption
86	for at least 36 months, all resources of both individuals shall
87	be considered to determine eligibility.
88	(b)  Consider transfer of assets between spouses in excess
89	of the Community Spouse Resource Allowance within the look-back
90	period to be a transfer of assets for less than fair market
91	value and therefore subject to a penalty period.
92	(c)  Determine that undue hardship does not exist when the
93	individual, or the person acting on her or his behalf, transfers
94	resources to the community spouse and the community spouse
95	refuses to make her or his resources available to the
96	institutional spouse.
97	(d)  Determine the institutional spouse to be ineligible
98	for Medicaid if she or he, or the person acting on her or his
99	behalf, refuses to provide information about the community
100	spouse or cooperate in the pursuit of court-ordered medical
101	support or the recovery of Medicaid expenses paid by the state
102	on her or his behalf.
103	(5)  The Agency for Health Care Administration shall seek
104	recovery of all Medicaid-covered expenses and pursue court-
105	ordered medical support from the community spouse when she or he
106	refuses to make her or his assets available to the institutional
107	spouse.
108	(6)  The Department of Children and Family Services may
109	adopt rules governing the administration of this section
110	pursuant to ss. 120.536(1) and 120.54.
111	Section 2.  This act shall take effect upon becoming a law.

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