Florida Senate - 2020 SB 1544
By Senator Albritton
26-01529A-20 20201544__
1 A bill to be entitled
2 An act relating to elderly care; creating s. 409.9022,
3 F.S.; providing applicability; prohibiting the
4 Department of Children and Families, in determining
5 Medicaid eligibility, from considering the cash
6 surrender value of certain life insurance policies as
7 assets if certain conditions are met; specifying
8 requirements for a collateral assignment by a Medicaid
9 applicant; requiring Medicaid recipients, or their
10 guardians or legal representatives, to continue to pay
11 premiums on such policies; requiring the deduction of
12 the cost of premiums from a recipient’s income for
13 certain purposes; requiring the Agency for Health Care
14 Administration to file a claim for the death benefit
15 upon the recipient’s death; specifying requirements
16 for the payment of a certain funeral expense benefit
17 by the state and the distribution of remaining
18 balances by the issuer of the policy; providing that
19 certain transfers constitute improper asset transfers
20 unless certain conditions are met; requiring the
21 Department of Children and Families and the agency, in
22 collaboration with the Office of Insurance Regulation,
23 to adopt rules; authorizing the agency to seek a
24 federal waiver; amending s. 409.979, F.S.; revising
25 the individuals who must be rescreened annually by
26 aging resource centers under the Medicaid long-term
27 care managed care program; revising the individuals
28 who must be placed on the wait list for potential
29 enrollment for certain services; requiring that
30 certain other individuals be placed on a registry of
31 interest maintained by the Department of Elderly
32 Affairs; requiring personnel of the aging resource
33 center to provide certain information to individuals
34 on the registry of interest; providing construction;
35 requiring the Department of Elderly Affairs to notify
36 individuals or their authorized representatives of
37 placement on the registry of interest; amending s.
38 430.04, F.S.; requiring the Department of Elderly
39 Affairs to develop, and adopt by rule, a tool for
40 comprehensive assessment of long-term-care supports
41 and services needed by family and friend caregivers
42 for elderly and disabled adults; providing the purpose
43 of the tool; amending s. 430.205, F.S.; authorizing a
44 community-care-for-the-elderly services provider to
45 dispute certain referrals and request certain
46 negotiations by the adult protective services program;
47 providing construction; providing an effective date.
48
49 Be It Enacted by the Legislature of the State of Florida:
50
51 Section 1. Section 409.9022, Florida Statutes, is created
52 to read:
53 409.9022 Exemption for certain life insurance policies as
54 assets; requirements.—
55 (1) This section applies to an applicant:
56 (a) Who is in need of the services of a licensed nursing
57 facility;
58 (b) Who meets the nursing facility level of care;
59 (c) Whose income does not exceed 300 percent of the
60 Supplemental Security Income standard;
61 (d) Who owns one or more whole or universal life insurance
62 policies; and
63 (e) Who would meet the assets standards for Medicaid
64 eligibility except for the cash surrender value of the whole or
65 universal life insurance policy or policies he or she owns.
66 (2) Notwithstanding any law to the contrary, in determining
67 an applicant’s eligibility for Medicaid, the department may not
68 consider the cash surrender value of a whole or universal life
69 insurance policy owned by the applicant as an asset if the
70 applicant collaterally assigns the face value of the life
71 insurance policy to the state for an amount that is not greater
72 than the amount of Medicaid benefits to be provided to the
73 applicant.
74 (3) The collateral assignment:
75 (a) Must be a written agreement submitted to and recorded
76 by the issuing company of the life insurance.
77 (b) Must provide for the issuer to notify the department
78 before a potential lapse in the policy.
79 (c) Must be completed and accepted by the department as
80 part of the application process before Medicaid benefits may be
81 authorized or provided.
82 (d) Is void if the application for Medicaid benefits is not
83 approved.
84 (4) The Medicaid recipient, or his or her guardian or legal
85 representative, shall continue to pay premiums on a life
86 insurance policy that is subject to the collateral assignment.
87 The cost of premiums must be deducted from the recipient’s
88 income for purposes of calculating his or her assets.
89 (5) Upon the recipient’s death:
90 (a) The agency shall file a claim for the death benefit
91 under the policy, up to the costs expended to provide Medicaid
92 services to the recipient, to be remitted to the state.
93 (b) The state shall pay to the recipient’s estate a funeral
94 expense benefit of $7,500 or 5 percent of the policy’s face
95 value, whichever is less.
96 (c) Any remaining balance of the death benefit must be paid
97 by the issuer of each policy to other beneficiaries under the
98 policy.
99 (6) A transfer of ownership of a whole or universal life
100 insurance policy within the 60-month period preceding the
101 Medicaid application by the applicant to a person or entity
102 related to the applicant for less than the net present value of
103 the death benefit, as determined by a standard actuarial
104 discount factor, constitutes an improper asset transfer by the
105 applicant unless the transferee collaterally assigns the face
106 value of the policy pursuant to this section.
107 (7) The department and the agency shall, in collaboration
108 with the Office of Insurance Regulation, adopt rules to
109 administer this section.
110 (8) The agency may seek any federal waiver to implement
111 this section.
112 Section 2. Subsection (3) of section 409.979, Florida
113 Statutes, is amended to read:
114 409.979 Eligibility.—
115 (3) REGISTRY OF INTEREST, WAIT LIST, RELEASE, AND OFFER
116 PROCESS.—The Department of Elderly Affairs shall maintain a
117 statewide wait list for enrollment for home and community-based
118 services through the long-term care managed care program.
119 (a) The Department of Elderly Affairs shall prioritize
120 individuals for potential enrollment for home and community
121 based services through the long-term care managed care program
122 using a frailty-based screening tool that results in a priority
123 score. The priority score is used to set an order for releasing
124 individuals from the wait list for potential enrollment in the
125 long-term care managed care program. If capacity is limited for
126 individuals with identical priority scores, the individual with
127 the oldest date of placement on the wait list shall receive
128 priority for release.
129 1. Pursuant to s. 430.2053, aging resource center personnel
130 certified by the Department of Elderly Affairs shall perform the
131 screening for each individual requesting enrollment for home and
132 community-based services through the long-term care managed care
133 program. The Department of Elderly Affairs shall request that
134 the individual or the individual’s authorized representative
135 provide alternate contact names and contact information.
136 2. The individual requesting the long-term care services,
137 or the individual’s authorized representative, must participate
138 in an initial screening or rescreening for placement on the wait
139 list. The screening or rescreening must be completed in its
140 entirety before placement on the wait list.
141 3. Pursuant to s. 430.2053, aging resource center personnel
142 shall administer rescreening annually for individuals with a
143 priority score of 3, 4, or 5; or upon notification of a
144 significant change in an individual’s circumstances.
145 4. The Department of Elderly Affairs shall adopt by rule a
146 screening tool that generates the priority score, and shall make
147 publicly available on its website the specific methodology used
148 to calculate an individual’s priority score.
149 (b) Upon completion of the screening or rescreening
150 process, the Department of Elderly Affairs shall place all
151 individuals with a priority score of 3, 4, or 5 on the wait
152 list. Individuals with a priority score of 1 or 2 must be placed
153 on a registry of interest established and maintained by the
154 Department of Elderly Affairs. Aging resource center personnel
155 shall inform individuals who are placed on the registry of
156 interest of other community resources that may be available to
157 assist them and shall inform them that they may contact the
158 agency resource center for a new assessment if they experience a
159 significant change in circumstances. Placement on the registry
160 of interest does not prohibit an individual from receiving
161 services, if available. The Department of Elderly Affairs shall
162 notify the individual or the individual’s authorized
163 representative that the individual has been placed on the wait
164 list or on the registry of interest.
165 (c) If the Department of Elderly Affairs is unable to
166 contact the individual or the individual’s authorized
167 representative to schedule an initial screening or rescreening,
168 and documents the actions taken to make such contact, it shall
169 send a letter to the last documented address of the individual
170 or the individual’s authorized representative. The letter must
171 advise the individual or his or her authorized representative
172 that he or she must contact the Department of Elderly Affairs
173 within 30 calendar days after the date of the notice to schedule
174 a screening or rescreening and must notify the individual that
175 failure to complete the screening or rescreening will result in
176 his or her termination from the screening process and the wait
177 list.
178 (d) After notification by the agency of available capacity,
179 the CARES program shall conduct a prerelease assessment. The
180 Department of Elderly Affairs shall release individuals from the
181 wait list based on the priority scoring process and prerelease
182 assessment results. Upon release, individuals who meet all
183 eligibility criteria may enroll in the long-term care managed
184 care program.
185 (e) The Department of Elderly Affairs may terminate an
186 individual’s inclusion on the wait list if the individual:
187 1. Does not have a current priority score due to the
188 individual’s action or inaction;
189 2. Requests to be removed from the wait list;
190 3. Does not keep an appointment to complete the rescreening
191 without scheduling another appointment and has not responded to
192 three documented attempts by the Department of Elderly Affairs
193 to contact the individual;
194 4. Receives an offer to begin the eligibility determination
195 process for the long-term care managed care program; or
196 5. Begins receiving services through the long-term care
197 managed care program.
198
199 An individual whose inclusion on the wait list is terminated
200 must initiate a new request for placement on the wait list, and
201 any previous priority considerations must be disregarded.
202 (f) Notwithstanding this subsection, the following
203 individuals are afforded priority enrollment for home and
204 community-based services through the long-term care managed care
205 program and do not have to complete the screening or wait-list
206 process if all other long-term care managed care program
207 eligibility requirements are met:
208 1. An individual who is 18, 19, or 20 years of age who has
209 a chronic debilitating disease or condition of one or more
210 physiological or organ systems which generally make the
211 individual dependent upon 24-hour-per-day medical, nursing, or
212 health supervision or intervention.
213 2. A nursing facility resident who requests to transition
214 into the community and who has resided in a Florida-licensed
215 skilled nursing facility for at least 60 consecutive days.
216 3. An individual who is referred by the Department of
217 Children and Families pursuant to the Adult Protective Services
218 Act, ss. 415.101-415.113, as high risk and who is placed in an
219 assisted living facility temporarily funded by the Department of
220 Children and Families.
221 (g) The Department of Elderly Affairs and the agency may
222 adopt rules to implement this subsection.
223 Section 3. Subsection (15) is added to section 430.04,
224 Florida Statutes, to read:
225 430.04 Duties and responsibilities of the Department of
226 Elderly Affairs.—The Department of Elderly Affairs shall:
227 (15) Develop, and adopt by rule, a tool for comprehensive
228 assessment of long-term-care supports and services needed by
229 family and friend caregivers for elderly and disabled adults.
230 The tool is to be used by persons administering state funds for
231 such supports and services in determining eligibility and which
232 supports and services are appropriate for service recipients and
233 their caregivers.
234 Section 4. Paragraph (a) of subsection (5) of section
235 430.205, Florida Statutes, is amended to read:
236 430.205 Community care service system.—
237 (5) Any person who has been classified as a functionally
238 impaired elderly person is eligible to receive community-care
239 for-the-elderly core services.
240 (a) Those elderly persons who are determined by protective
241 investigations to be vulnerable adults in need of services,
242 pursuant to s. 415.104(3)(b), or to be victims of abuse,
243 neglect, or exploitation who are in need of immediate services
244 to prevent further harm and are referred by the adult protective
245 services program, shall be given primary consideration for
246 receiving community-care-for-the-elderly services. As used in
247 this paragraph, “primary consideration” means that an assessment
248 and services must commence within 72 hours after referral to the
249 department or as established in accordance with department
250 contracts by local protocols developed between department
251 service providers and the adult protective services program.
252 However, a community-care-for-the-elderly services provider may
253 dispute the referral by requesting that the adult protective
254 services program negotiate the referral placement of, and the
255 services to be provided to, a vulnerable adult or victim of
256 abuse, neglect, or exploitation. If an agreement cannot be
257 reached with the adult protective services program for
258 modification of the referral decision, the adult protective
259 services program’s determination shall control.
260 Section 5. This act shall take effect July 1, 2020.