Florida Senate - 2017 SB 712
By Senator Bean
4-01261-17 2017712__
1 A bill to be entitled
2 An act relating to nursing homes; amending s. 409.908,
3 F.S.; revising provisions related to the setting of
4 Medicaid reimbursement rates for nursing homes;
5 requiring the Agency for Healthcare Administration to
6 recalculate nursing home reimbursement ceilings every
7 3 years and to make some adjustments; amending s.
8 409.9082, F.S.; requiring that an increase in a
9 nursing home facility’s Medicaid rate be allocated
10 proportionately in accordance with a certain quality
11 matrix; providing an effective date.
12
13 Be It Enacted by the Legislature of the State of Florida:
14
15 Section 1. Subsection (2) of section 409.908, Florida
16 Statutes, is amended to read:
17 409.908 Reimbursement of Medicaid providers.—Subject to
18 specific appropriations, the agency shall reimburse Medicaid
19 providers, in accordance with state and federal law, according
20 to methodologies set forth in the rules of the agency and in
21 policy manuals and handbooks incorporated by reference therein.
22 These methodologies may include fee schedules, reimbursement
23 methods based on cost reporting, negotiated fees, competitive
24 bidding pursuant to s. 287.057, and other mechanisms the agency
25 considers efficient and effective for purchasing services or
26 goods on behalf of recipients. If a provider is reimbursed based
27 on cost reporting and submits a cost report late and that cost
28 report would have been used to set a lower reimbursement rate
29 for a rate semester, then the provider’s rate for that semester
30 shall be retroactively calculated using the new cost report, and
31 full payment at the recalculated rate shall be effected
32 retroactively. Medicare-granted extensions for filing cost
33 reports, if applicable, shall also apply to Medicaid cost
34 reports. Payment for Medicaid compensable services made on
35 behalf of Medicaid eligible persons is subject to the
36 availability of moneys and any limitations or directions
37 provided for in the General Appropriations Act or chapter 216.
38 Further, nothing in this section shall be construed to prevent
39 or limit the agency from adjusting fees, reimbursement rates,
40 lengths of stay, number of visits, or number of services, or
41 making any other adjustments necessary to comply with the
42 availability of moneys and any limitations or directions
43 provided for in the General Appropriations Act, provided the
44 adjustment is consistent with legislative intent.
45 (2)(a)1. Reimbursement to nursing homes licensed under part
46 II of chapter 400 and state-owned-and-operated intermediate care
47 facilities for the developmentally disabled licensed under part
48 VIII of chapter 400 must be made prospectively.
49 2. Unless otherwise limited or directed in the General
50 Appropriations Act, reimbursement to hospitals licensed under
51 part I of chapter 395 for the provision of swing-bed nursing
52 home services must be made on the basis of the average statewide
53 nursing home payment, and reimbursement to a hospital licensed
54 under part I of chapter 395 for the provision of skilled nursing
55 services must be made on the basis of the average nursing home
56 payment for those services in the county in which the hospital
57 is located. When a hospital is located in a county that does not
58 have any community nursing homes, reimbursement shall be
59 determined by averaging the nursing home payments in counties
60 that surround the county in which the hospital is located.
61 Reimbursement to hospitals, including Medicaid payment of
62 Medicare copayments, for skilled nursing services shall be
63 limited to 30 days, unless a prior authorization has been
64 obtained from the agency. Medicaid reimbursement may be extended
65 by the agency beyond 30 days, and approval must be based upon
66 verification by the patient’s physician that the patient
67 requires short-term rehabilitative and recuperative services
68 only, in which case an extension of no more than 15 days may be
69 approved. Reimbursement to a hospital licensed under part I of
70 chapter 395 for the temporary provision of skilled nursing
71 services to nursing home residents who have been displaced as
72 the result of a natural disaster or other emergency may not
73 exceed the average county nursing home payment for those
74 services in the county in which the hospital is located and is
75 limited to the period of time which the agency considers
76 necessary for continued placement of the nursing home residents
77 in the hospital.
78 (b) Subject to any limitations or directions in the General
79 Appropriations Act, the agency shall establish and implement a
80 state Title XIX Long-Term Care Reimbursement Plan for nursing
81 home care in order to provide care and services in conformance
82 with the applicable state and federal laws, rules, regulations,
83 and quality and safety standards and to ensure that individuals
84 eligible for medical assistance have reasonable geographic
85 access to such care.
86 1. The agency shall amend the long-term care reimbursement
87 plan and cost reporting system to create direct care and
88 indirect care subcomponents of the patient care component of the
89 per diem rate. These two subcomponents together shall equal the
90 patient care component of the per diem rate. Separate cost-based
91 ceilings shall be calculated for each patient care subcomponent.
92 The direct care subcomponent of the per diem rate shall be
93 limited by the cost-based class ceiling, and the indirect care
94 subcomponent may be limited by the lower of the cost-based class
95 ceiling, the target rate class ceiling, or the individual
96 provider target.
97 2. The direct care subcomponent shall include salaries and
98 benefits of direct care staff providing nursing services
99 including registered nurses, licensed practical nurses, and
100 certified nursing assistants who deliver care directly to
101 residents in the nursing home facility. This excludes nursing
102 administration, staff development, the staffing coordinator, and
103 the administrative portion of the minimum data set and care plan
104 coordinators. The direct care subcomponent also includes
105 medically necessary dental care, vision care, hearing care, and
106 podiatric care.
107 3. All other patient care costs shall be included in the
108 indirect care cost subcomponent of the patient care per diem
109 rate. Costs may not be allocated directly or indirectly to the
110 direct care subcomponent from a home office or management
111 company.
112 4. On July 1 of each year, the agency shall report to the
113 Legislature direct and indirect care costs, including average
114 direct and indirect care costs per resident per facility and
115 direct care and indirect care salaries and benefits per category
116 of staff member per facility.
117 5. In order to offset the cost of general and professional
118 liability insurance, the agency shall amend the plan to allow
119 for interim rate adjustments to reflect increases in the cost of
120 general or professional liability insurance for nursing homes.
121 This provision shall be implemented to the extent existing
122 appropriations are available.
123 6. After July 1, 2017, the agency shall set nursing home
124 rates based only on audited cost reports and may not make
125 retroactive rate adjustments.
126 a. The property component of the reimbursement rates shall
127 be calculated based on the Fair Rental Value System developed by
128 Navigant Consulting, Inc., as part of the study pursuant to
129 Specific Appropriation 186 of the 2016-2017 General
130 Appropriations Act.
131 b. Newly constructed facilities shall be paid the average
132 reimbursement rate of the geographic and size grouping in which
133 they are located.
134 c. Newly licensed providers pursuant to changes of
135 ownership shall be paid the reimbursement rate of the previous
136 licensee.
137 d. The agency shall recalculate nursing home reimbursement
138 ceilings and rates every 3 years and shall adjust the rates in
139 the intervening years with an appropriate inflation adjustment.
140
141 It is the intent of the Legislature that the reimbursement plan
142 achieve the goal of providing access to health care for nursing
143 home residents who require large amounts of care while
144 encouraging diversion services as an alternative to nursing home
145 care for residents who can be served within the community. The
146 agency shall base the establishment of any maximum rate of
147 payment, whether overall or component, on the available moneys
148 as provided for in the General Appropriations Act. The agency
149 may base the maximum rate of payment on the results of
150 scientifically valid analysis and conclusions derived from
151 objective statistical data pertinent to the particular maximum
152 rate of payment.
153 Section 2. Subsection (4) of section 409.9082, Florida
154 Statutes, is amended to read:
155 409.9082 Quality assessment on nursing home facility
156 providers; exemptions; purpose; federal approval required;
157 remedies.—
158 (4) The purpose of the nursing home facility quality
159 assessment is to ensure continued quality of care. Collected
160 assessment funds shall be used to obtain federal financial
161 participation through the Medicaid program to make Medicaid
162 payments for nursing home facility services up to the amount of
163 nursing home facility Medicaid rates as calculated in accordance
164 with the approved state Medicaid plan in effect on December 31,
165 2007. The quality assessment and federal matching funds shall be
166 used exclusively for the following purposes and in the following
167 order of priority:
168 (a) To reimburse the Medicaid share of the quality
169 assessment as a pass-through, Medicaid-allowable cost;
170 (b) To increase to each nursing home facility’s Medicaid
171 rate, as needed, an amount that restores rate reductions
172 effective on or after January 1, 2008, as provided in the
173 General Appropriations Act; and
174 (c) To increase each nursing home facility’s Medicaid rate
175 that accounts for the portion of the total assessment not
176 included in paragraphs (a) and (b) which begins a phase-in to a
177 pricing model for the operating cost component. This increase
178 shall be allocated proportionately to each nursing home facility
179 based on the Quality Matrix without a lower threshold developed
180 by Navigant Consulting, Inc., as part of the study pursuant to
181 Specific Appropriation 186 of the 2016-2017 General
182 Appropriations Act.
183 Section 3. This act shall take effect July 1, 2017.