Florida Senate - 2016 COMMITTEE AMENDMENT Bill No. SB 1144 Ì223842$Î223842 LEGISLATIVE ACTION Senate . House Comm: FAV . 02/17/2016 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— Appropriations Subcommittee on Health and Human Services (Richter) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. Present paragraphs (a) through (t) of subsection 6 (3) of section 408.036, Florida Statutes, are redesignated as 7 paragraphs (c) through (v), respectively, new paragraphs (a) and 8 (b) are added to that subsection, present subsections (4) and 9 (5) of that section are redesignated as subsections (5) and (6), 10 respectively, and a new subsection (4) is added to that section, 11 to read: 12 408.036 Projects subject to review; exemptions.— 13 (3) EXEMPTIONS.—Upon request, the following projects are 14 subject to exemption from the provisions of subsection (1): 15 (a) Except for projects described in paragraphs (b) and 16 (c), any project conditioned upon a significant, active, and 17 continuing commitment to improved access to care for uninsured 18 and low-income residents of the applicable service district. 19 Such commitment is demonstrated by compliance with the following 20 conditions and requirements which the project applicant must 21 accept in a signed agreement with the agency: 22 1. The project licensee must contribute, once the project 23 is operational and at the end of each of the first four calendar 24 quarters of the project’s operations, an amount equal to 1.5 25 percent of the gross revenues earned by the exempt project. 26 Contributions shall be made to the agency and deposited in the 27 Public Medical Assistance Trust Fund. 28 2.a. Beginning in the fifth calendar quarter of the exempt 29 project’s operations, the licensee must provide charity care in 30 an amount equal to twice the applicable district average among 31 licensed providers of similar services. For purposes of this 32 section, the term “charity care” means uncompensated care 33 delivered to uninsured patients having incomes at or below 200 34 percent of the federal poverty level when such services are 35 preauthorized by the licensee and not subject to collection 36 procedures. The valuation of charity care must be based on 37 Medicaid reimbursement rates. 38 b. Alternatively, if the licensee provides less charity 39 care than is required by sub-subparagraph a., the licensee must 40 donate: 41 (I) Pursuant to a written agreement with a charity care 42 provider in the service district, payments for charity care 43 provided to residents of the service district in total amounts 44 equal to or greater than the difference between the value of the 45 charity care provided in sub-subparagraph a. and the applicable 46 district average among licensed providers of similar services; 47 or 48 (II) Payments to Florida Health Choices for health care 49 coverage financial assistance in total amounts equal to or 50 greater than the difference between the value of the charity 51 care provided in sub-subparagraph a. and the applicable district 52 average among licensed providers of similar services. The 53 payments for financial assistance must be made in increments 54 sufficient to purchase silver-level health care coverage for an 55 individual for at least 1 year. The individual receiving this 56 assistance must have been uninsured during the previous 12 57 months. The licensee and Florida Health Choices shall cooperate 58 to identify individuals from the service district who are 59 qualified to receive the available assistance. 60 c. The agreement between the agency and the applicant for 61 an exemption must require the licensee to submit reports and 62 data necessary to monitor compliance with the charity care 63 threshold. 64 (b) Any project to construct or establish a new skilled 65 nursing facility or increase the licensed bed capacity of an 66 existing skilled nursing facility conditioned on a significant, 67 active, and continuing commitment by the facility to improved 68 access to Medicaid long-term care services. Such commitment is 69 demonstrated by an applicant by compliance with a signed 70 agreement between the applicant and the agency which, upon the 71 project becoming operational, requires the project licensee to 72 contribute an amount equal to the state share of one-fourth of 73 the cost of enrolling a person in the long-term care waiver 74 program established pursuant to Part IV of Chapter 409 times 75 twice the number of new beds included in the project. The 76 contribution shall be paid by the project licensee to the agency 77 at the end of each calendar quarter that the project is 78 operational and deposited in the Public Medical Assistance Trust 79 Fund. The agreement between the agency and the applicant must 80 require the licensee to submit reports and data necessary to 81 monitor compliance with the charity care threshold. 82 (4) PENALTIES.—A facility licensed based on the exemption 83 established in subsection (3)(a)-(b) is subject to the following 84 penalties for noncompliance with its specific commitment to 85 improve access to care for uninsured and low-income persons in 86 the service district: 87 (a) For the first quarter in which the value of services, 88 donations, and financial assistance falls below the specified 89 threshold, the fine is equal to twice the amount of the 90 shortfall. The fine is doubled in each subsequent quarter of 91 noncompliance up to a maximum of four quarters. 92 (b) Following a fifth quarter of noncompliance, the exempt 93 license shall be suspended until the licensee implements a 94 corrective action plan that the agency has approved. 95 (c) Failure by the facility to maintain compliance 96 following the implementation of a corrective action plan shall 97 result in revocation of the exempt license. 98 Section 2. This act shall take effect July 1, 2016. 99 100 ================= T I T L E A M E N D M E N T ================ 101 And the title is amended as follows: 102 Delete everything before the enacting clause 103 and insert: 104 A bill to be entitled 105 An act relating to certificates of need for health 106 care-related projects; amending s. 408.036, F.S.; 107 providing an exemption from certificate of need review 108 for certain health care-related projects; specifying 109 conditions and requirements for the exemption; 110 requiring that project applicants enter into an 111 agreement with the Agency for Health Care 112 Administration as a condition of eligibility for the 113 exemption; requiring specified monetary contributions; 114 providing penalties for failure to comply with the 115 terms of the agreement; providing an effective date.