Florida Senate - 2016              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 7056
       Proposed Committee Substitute by the Committee on Appropriations
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to long-term care managed care
    3         prioritization; amending s. 409.962, F.S.; defining
    4         terms; amending s. 409.979, F.S.; requiring the
    5         Department of Elderly Affairs to maintain a statewide
    6         wait list for enrollment for home and community-based
    7         services through the Medicaid long-term care managed
    8         care program; requiring the department to prioritize
    9         individuals for potential enrollment using a frailty
   10         based screening tool that provides a priority score;
   11         providing for determinations regarding offers of
   12         enrollment; requiring screening and certain
   13         rescreening by Aging Resource Center personnel of
   14         individuals requesting long-term care services from
   15         the program; requiring the department to adopt by rule
   16         a screening tool; requiring the department to make a
   17         specified methodology available on its website;
   18         requiring the department to notify applicants if they
   19         are placed on the wait list; requiring the department
   20         to conduct prerelease assessments upon notification by
   21         the agency of available capacity; authorizing certain
   22         individuals to enroll in the long-term care managed
   23         care program; authorizing the department to terminate
   24         an individual from the wait list under certain
   25         circumstances; providing for priority enrollment for
   26         home and community-based services; authorizing the
   27         department and the Agency for Health Care
   28         Administration to adopt rules; deleting obsolete
   29         language; providing an effective date.
   31  Be It Enacted by the Legislature of the State of Florida:
   33         Section 1. Present subsections (4) through (13) of section
   34  409.962, Florida Statutes, are redesignated as subsections (5)
   35  through and (14), respectively, present subsection (14) of that
   36  section is redesignated as subsection (18), and new subsection
   37  (4) and subsections (15), (16), and (17) are added to that
   38  section, to read:
   39         409.962 Definitions.—As used in this part, except as
   40  otherwise specifically provided, the term:
   41         (4) “Authorized representative” means an individual who has
   42  the legal authority to make decisions on behalf of a Medicaid
   43  recipient or potential Medicaid recipient in matters related to
   44  the managed care plan or the screening or eligibility process.
   45         (15) “Rescreening” means the use of a screening tool to
   46  conduct annual screenings or screenings due to a significant
   47  change which determine an individual’s placement and
   48  continuation on the wait list.
   49         (16) “Screening” means the use of an information-collection
   50  tool to determine a priority score for placement on the wait
   51  list.
   52         (17) “Significant change” means change in an individual’s
   53  health status after an accident or illness; an actual or
   54  anticipated change in the individual’s living situation; a
   55  change in the caregiver relationship; loss of or damage to the
   56  individual’s home or deterioration of his or her home
   57  environment; or loss of the individual’s spouse or caregiver.
   58         Section 2. Section 409.979, Florida Statutes, is amended to
   59  read:
   60         409.979 Eligibility.—
   62  recipients who meet all of the following criteria are eligible
   63  to receive long-term care services and must receive long-term
   64  care services by participating in the long-term care managed
   65  care program. The recipient must be:
   66         (a) Sixty-five years of age or older, or age 18 or older
   67  and eligible for Medicaid by reason of a disability.
   68         (b) Determined by the Comprehensive Assessment Review and
   69  Evaluation for Long-Term Care Services (CARES) preadmission
   70  screening program to require nursing facility care as defined in
   71  s. 409.985(3).
   72         (2) ENROLLMENT OFFERS.—Medicaid recipients who, on the date
   73  long-term care managed care plans become available in their
   74  region, reside in a nursing home facility or are enrolled in one
   75  of the following long-term care Medicaid waiver programs are
   76  eligible to participate in the long-term care managed care
   77  program for up to 12 months without being reevaluated for their
   78  need for nursing facility care as defined in s. 409.985(3):
   79         (a) The Assisted Living for the Frail Elderly Waiver.
   80         (b) The Aged and Disabled Adult Waiver.
   81         (c) The Consumer-Directed Care Plus Program as described in
   82  s. 409.221.
   83         (d) The Program of All-inclusive Care for the Elderly.
   84         (e) The Channeling Services Waiver for Frail Elders.
   85         (3)Subject to availability of funds, the Department of
   86  Elderly Affairs shall make offers for enrollment to eligible
   87  individuals based on a wait-list prioritization and subject to
   88  availability of funds. Before making enrollment offers, the
   89  agency and the Department of Elderly Affairs department shall
   90  determine that sufficient funds exist to support additional
   91  enrollment into plans.
   92         (3) WAIT LIST, RELEASE, AND OFFER PROCESS.The Department
   93  of Elderly Affairs shall maintain a statewide wait list for
   94  enrollment for home and community-based services through the
   95  long-term care managed care program.
   96         (a) The Department of Elderly Affairs shall prioritize
   97  individuals for potential enrollment for home and community
   98  based services through the long-term care managed care program
   99  using a frailty-based screening tool that results in a priority
  100  score. The priority score is used to set an order for releasing
  101  individuals from the wait list for potential enrollment in the
  102  long-term care managed care program. If capacity is limited for
  103  individuals with identical priority scores, the individual with
  104  the oldest date of placement on the wait list shall receive
  105  priority for release.
  106         1. Pursuant to s. 430.2053, Aging Resource Center personnel
  107  certified by the Department of Elderly Affairs shall perform the
  108  screening for each individual requesting enrollment for home and
  109  community-based services through the long-term care managed care
  110  program. The Department of Elderly Affairs shall request that
  111  the individual or the individual’s authorized representative
  112  provide alternate names and their contact information.
  113         2. The individual requesting the long-term care services,
  114  or the individual’s authorized representative, must participate
  115  in an initial screening or rescreening for placement on the wait
  116  list. The screening or rescreening must be completed in its
  117  entirety before placement on the wait list.
  118         3. Pursuant to s. 430.2053, Aging Resource Center personnel
  119  shall administer rescreening annually or upon notification of a
  120  significant change in an individual’s circumstances.
  121         4. The Department of Elderly Affairs shall adopt by rule a
  122  screening tool that generates the priority score, and shall make
  123  publicly available on its website the specific methodology used
  124  to calculate an individual’s priority score.
  125         (b) Upon completion of the screening or rescreening
  126  process, the Department of Elderly Affairs shall notify the
  127  individual or the individual’s authorized representative that
  128  the individual has been placed on the wait list.
  129         (c) If the Department of Elderly Affairs is unable to
  130  contact the individual or the individual’s authorized
  131  representative to schedule an initial screening or rescreening,
  132  and documents the action steps to do so, it shall send a letter
  133  to the last documented address of the individual or the
  134  individual’s authorized representative. The letter must advise
  135  the individual or his or her authorized representative that he
  136  or she must contact the Department of Elderly Affairs within 30
  137  calendar days after the date of the notice to schedule a
  138  screening or rescreening and must notify the individual that
  139  failure to complete the screening or rescreening will result in
  140  his or her termination from the screening process and the wait
  141  list.
  142         (d) After notification by the agency of available capacity,
  143  the CARES program shall conduct a prerelease assessment. The
  144  Department of Elderly Affairs shall release individuals from the
  145  wait list based on the priority scoring process and prerelease
  146  assessment results. Upon release, individuals who meet all
  147  eligibility criteria may enroll in the long-term care managed
  148  care program.
  149         (e) The Department of Elderly Affairs may terminate an
  150  individual’s inclusion on the wait list if the individual:
  151         1. Does not have a current priority score due to the
  152  individual’s action or inaction;
  153         2. Requests to be removed from the wait list;
  154         3. Does not keep an appointment to complete the rescreening
  155  without scheduling another appointment and has not responded to
  156  three documented attempts to contact by the Department of
  157  Elderly Affairs;
  158         4. Receives an offer to begin the eligibility determination
  159  process for the long-term care managed care program; or
  160         5. Begins receiving services through the long-term care
  161  managed care program.
  163  An individual whose inclusion on the wait list is terminated
  164  must initiate a new request for placement on the wait list, and
  165  any previous priority considerations must be disregarded.
  166         (f) Notwithstanding this subsection, the following
  167  individuals are afforded priority enrollment for home and
  168  community-based services through the long-term care managed care
  169  program and do not have to complete the screening or wait-list
  170  process if all other long-term care managed care program
  171  eligibility requirements are met:
  172         1. Individuals who are 18, 19, or 20 years of age who have
  173  chronic debilitating diseases or conditions of one or more
  174  physiological or organ systems which generally make the
  175  individual dependent upon 24-hour-per-day medical, nursing, or
  176  health supervision or intervention.
  177         2. Nursing facility residents requesting to transition into
  178  the community who have resided in a Florida-licensed skilled
  179  nursing facility for at least 60 consecutive days.
  180         3. Individuals referred by the department’s adult
  181  protective services program as high risk and placed in an
  182  assisted living facility temporarily funded by the department.
  183         (g) The Department of Elderly Affairs and the agency may
  184  adopt rules to implement this subsection.
  185         Section 3. This act shall take effect July 1, 2016.