Florida Senate - 2017                       CS for CS for SB 682
       
       
        
       By the Committees on Appropriations; and Health Policy; and
       Senator Stargel
       
       
       
       
       576-04156-17                                           2017682c2
    1                        A bill to be entitled                      
    2         An act relating to Medicaid managed care; amending s.
    3         400.141, F.S.; requiring that nursing home facilities
    4         be prepared to provide confirmation within a specified
    5         timeframe to the Agency for Health Care Administration
    6         as to whether certain nursing home facility residents
    7         are candidates for certain services; amending s.
    8         409.964, F.S.; providing that covered services for
    9         long-term care under the Medicaid managed care program
   10         are those specified in part IV of ch. 409, F.S.;
   11         deleting an obsolete provision; amending s. 409.965,
   12         F.S.; providing that certain residents of nursing
   13         facilities are exempt from participation in the long
   14         term care managed care program; providing for
   15         application of the exemption; providing that
   16         eligibility for the Medicaid managed medical
   17         assistance program is not affected by such provisions;
   18         providing conditions under which the exemption does
   19         not apply; requiring the agency to confirm whether
   20         certain persons have been identified as candidates for
   21         home and community-based services; requiring a certain
   22         notice to the agency by nursing facility
   23         administrators; amending s. 409.967, F.S.; requiring
   24         the agency to impose fines and authorizing other
   25         sanctions for willful failure to comply with specified
   26         payment provisions; amending s. 409.979, F.S.;
   27         providing that certain exempt Medicaid recipients are
   28         not required to receive long-term care services
   29         through the long-term care managed care program;
   30         amending s. 409.982, F.S.; revising parameters under
   31         which a long-term care managed care plan must contract
   32         with nursing homes and hospices; specifying that the
   33         agency must require certain plans to report
   34         information on the quality or performance criteria
   35         used in making a certain determination; providing
   36         effective dates.
   37          
   38  Be It Enacted by the Legislature of the State of Florida:
   39  
   40         Section 1. Effective October 1, 2018, paragraph (v) is
   41  added to subsection (1) of section 400.141, Florida Statutes, to
   42  read:
   43         400.141 Administration and management of nursing home
   44  facilities.—
   45         (1) Every licensed facility shall comply with all
   46  applicable standards and rules of the agency and shall:
   47         (v) Be prepared to confirm for the agency whether a nursing
   48  home facility resident who is a Medicaid recipient, or whose
   49  Medicaid eligibility is pending, is a candidate for home and
   50  community-based services under s. 409.965(3)(c), no later than
   51  the resident’s 50th consecutive day of residency in the nursing
   52  home facility.
   53         Section 2. Section 409.964, Florida Statutes, is amended to
   54  read:
   55         409.964 Managed care program; state plan; waivers.—The
   56  Medicaid program is established as a statewide, integrated
   57  managed care program for all covered services, including long
   58  term care services as specified under this part. The agency
   59  shall apply for and implement state plan amendments or waivers
   60  of applicable federal laws and regulations necessary to
   61  implement the program. Before seeking a waiver, the agency shall
   62  provide public notice and the opportunity for public comment and
   63  include public feedback in the waiver application. The agency
   64  shall hold one public meeting in each of the regions described
   65  in s. 409.966(2), and the time period for public comment for
   66  each region shall end no sooner than 30 days after the
   67  completion of the public meeting in that region. The agency
   68  shall submit any state plan amendments, new waiver requests, or
   69  requests for extensions or expansions for existing waivers,
   70  needed to implement the managed care program by August 1, 2011.
   71         Section 3. Effective October 1, 2018, section 409.965,
   72  Florida Statutes, is amended to read:
   73         409.965 Mandatory enrollment.—All Medicaid recipients shall
   74  receive covered services through the statewide managed care
   75  program, except as provided by this part pursuant to an approved
   76  federal waiver.
   77         (1) The following Medicaid recipients are exempt from
   78  participation in the statewide managed care program:
   79         (a)(1) Women who are eligible only for family planning
   80  services.
   81         (b)(2) Women who are eligible only for breast and cervical
   82  cancer services.
   83         (c)(3) Persons who are eligible for emergency Medicaid for
   84  aliens.
   85         (2)(a) Persons who are assigned into level of care 1 under
   86  s. 409.983(4) and have resided in a nursing facility for 60 or
   87  more consecutive days are exempt from participation in the long
   88  term care managed care program. For a person who becomes exempt
   89  under this paragraph while enrolled in the long-term care
   90  managed care program, the exemption shall take effect on the
   91  first day of the first month after the person meets the criteria
   92  for the exemption. This paragraph does not affect a person’s
   93  eligibility for the Medicaid managed medical assistance program.
   94         (b) Persons receiving hospice care while residing in a
   95  nursing facility are exempt from participation in the long-term
   96  care managed care program. For a person who becomes exempt under
   97  this paragraph while enrolled in the long-term care managed care
   98  program, the exemption takes effect on the first day of the
   99  first month after the person meets the criteria for the
  100  exemption. This paragraph does not affect a person’s eligibility
  101  for the Medicaid managed medical assistance program.
  102         (3) Notwithstanding subsection (2):
  103         (a) A Medicaid recipient who is otherwise eligible for the
  104  long-term care managed care program, who is 18 years of age or
  105  older, and who is eligible for Medicaid by reason of a
  106  disability is not exempt from the long-term care managed care
  107  program under subsection (2).
  108         (b) A person who is afforded priority enrollment for home
  109  and community-based services under s. 409.979(3)(f) is not
  110  exempt from the long-term care managed care program under
  111  subsection (2).
  112         (c) A nursing facility resident is not exempt from the
  113  long-term care managed care program under paragraph (2)(a) if
  114  the resident has been identified as a candidate for home and
  115  community-based services by the nursing facility administrator
  116  and any long-term care plan case manager assigned to the
  117  resident. Such identification must be made in consultation with
  118  the following persons:
  119         1. The resident or the residents legal representative or
  120  designee;
  121         2. The resident’s personal physician or, if the resident
  122  does not have a personal physician, the facility’s medical
  123  director; and
  124         3. A registered nurse who has participated in developing,
  125  maintaining, or reviewing the individual’s resident care plan as
  126  defined in s. 400.021.
  127         (d) Before determining that a person is exempt from the
  128  long-term care managed care program under paragraph (2)(a), the
  129  agency shall confirm whether the person has been identified as a
  130  candidate for home and community-based services under paragraph
  131  (c). If a nursing facility resident who has been determined
  132  exempt is later identified as a candidate for home and
  133  community-based services, the nursing facility administrator
  134  shall promptly notify the agency.
  135         Section 4. Paragraph (j) of subsection (2) of section
  136  409.967, Florida Statutes, is amended to read:
  137         409.967 Managed care plan accountability.—
  138         (2) The agency shall establish such contract requirements
  139  as are necessary for the operation of the statewide managed care
  140  program. In addition to any other provisions the agency may deem
  141  necessary, the contract must require:
  142         (j) Prompt payment.—Managed care plans shall comply with
  143  ss. 641.315, 641.3155, and 641.513, and the agency shall impose
  144  fines, and may impose other sanctions, on a plan that willfully
  145  fails to comply with those sections or s. 409.982(5).
  146         Section 5. Subsection (1) of section 409.979, Florida
  147  Statutes, is amended to read:
  148         409.979 Eligibility.—
  149         (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid
  150  recipients who meet all of the following criteria are eligible
  151  to receive long-term care services and, unless exempt under s.
  152  409.965, must receive long-term care services by participating
  153  in the long-term care managed care program. The recipient must
  154  be:
  155         (a) Sixty-five years of age or older, or age 18 or older
  156  and eligible for Medicaid by reason of a disability.
  157         (b) Determined by the Comprehensive Assessment Review and
  158  Evaluation for Long-Term Care Services (CARES) preadmission
  159  screening program to require nursing facility care as defined in
  160  s. 409.985(3).
  161         Section 6. Subsections (1) and (2) of section 409.982,
  162  Florida Statutes, are amended to read:
  163         409.982 Long-term care managed care plan accountability.—In
  164  addition to the requirements of s. 409.967, plans and providers
  165  participating in the long-term care managed care program must
  166  comply with the requirements of this section.
  167         (1) PROVIDER NETWORKS.—Managed care plans may limit the
  168  providers in their networks based on credentials, quality
  169  indicators, and price. For the first 12 months of a contract
  170  period following a procurement for the long-term care managed
  171  care program under s. 409.981, if a plan has been period between
  172  October 1, 2013, and September 30, 2014, each selected for a
  173  region that the plan was not serving immediately prior to the
  174  procurement, the plan must offer a network contract to all
  175  nursing homes in that region which meet the recredentialing
  176  requirements and to all hospices in that region which meet the
  177  credentialing requirements specified in the plan’s contract with
  178  the agency the following providers in the region:
  179         (a) Nursing homes.
  180         (b) Hospices.
  181         (c) Aging network service providers that have previously
  182  participated in home and community-based waivers serving elders
  183  or community-service programs administered by the Department of
  184  Elderly Affairs. After a provider specified in this subsection
  185  has actively participated in a managed care plan’s network for
  186  12 months of active participation in a managed care plan’s
  187  network, the plan may exclude the provider any of the providers
  188  named in this subsection from the plan’s network for failure to
  189  meet quality or performance criteria. If a the plan excludes a
  190  provider from its network under this subsection the plan, the
  191  plan must provide written notice to all recipients who have
  192  chosen that provider for care. The notice must be provided at
  193  least 30 days before the effective date of the exclusion. The
  194  agency shall establish contract provisions governing the
  195  transfer of recipients from excluded residential providers. The
  196  agency shall require a plan that excludes a provider from its
  197  network or that fails to renew the plan’s contract with a
  198  provider under this subsection to report to the agency the
  199  quality or performance criteria the plan used in deciding to
  200  exclude the provider and to demonstrate how the provider failed
  201  to meet those criteria.
  202         (2) SELECT PROVIDER PARTICIPATION.—Except as provided in
  203  this subsection, providers may limit the managed care plans they
  204  join. Nursing homes and hospices that are enrolled Medicaid
  205  providers must participate in all eligible plans selected by the
  206  agency in the region in which the provider is located, with the
  207  exception of plans from which the provider has been excluded
  208  under subsection (1).
  209         Section 7. Except as otherwise provided in this act and
  210  except for this section, which shall take effect upon this act
  211  becoming a law, this act shall take effect July 1, 2017.