Florida Senate - 2020              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 916
       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 the Program of All-Inclusive Care
    3         for the Elderly; creating s. 430.84, F.S.; defining
    4         terms; authorizing the Agency for Health Care
    5         Administration, in consultation with the Department of
    6         Elderly Affairs, to approve certain applicants to
    7         provide benefits pursuant to the Program of All
    8         Inclusive Care for the Elderly (PACE); specifying
    9         requirements and procedures for the submission,
   10         publication, review, and initial approval of
   11         applications; requiring prospective PACE organizations
   12         that are granted initial approval to apply within a
   13         certain timeframe for federal approval; providing
   14         accountability requirements; exempting PACE
   15         organizations from certain requirements; authorizing
   16         the transfer of PACE approvals and the assignment of
   17         PACE contracts if certain conditions are met;
   18         specifying a requirement for future appropriations to
   19         approved transferees; providing construction;
   20         providing an effective date.
   22  Be It Enacted by the Legislature of the State of Florida:
   24         Section 1. Section 430.84, Florida Statutes, is created to
   25  read:
   26         430.84Program of All-Inclusive Care for the Elderly.—
   27         (1)DEFINITIONS.—As used in this section, the term:
   28         (a)“Agency” means the Agency for Health Care
   29  Administration.
   30         (b)“Applicant” means an entity that has filed an
   31  application with the agency for consideration as a Program of
   32  All-Inclusive Care for the Elderly (PACE) organization.
   33         (c)“CMS” means the Centers for Medicare and Medicaid
   34  Services within the United States Department of Health and Human
   35  Services.
   36         (d)“Department” means the Department of Elderly Affairs.
   37         (e)“PACE organization” means an entity under contract with
   38  the agency to deliver PACE services.
   39         (f)“Participant” means an individual receiving services
   40  from a PACE organization and who has been determined by the
   41  department to need the level of care required under the state
   42  Medicaid plan for coverage of nursing facility services.
   43         (2)PROGRAM CREATION.—The agency, in consultation with the
   44  department, may approve entities that have submitted
   45  applications required by the CMS to the agency for review and
   46  consideration which contain the data and information required in
   47  subsection (3) to provide benefits pursuant to the PACE program
   48  as established in 42 U.S.C. s. 1395eee and in accordance with
   49  the requirements set forth in this section.
   50         (3)PACE ORGANIZATION SELECTION.—The agency, in
   51  consultation with the department, shall on a continuous basis
   52  review and consider applications required by the CMS for PACE
   53  which have been submitted to the agency by entities seeking
   54  initial state approval to become PACE organizations. Notice of
   55  such applications must be published in the Florida
   56  Administrative Register.
   57         (a)A prospective PACE organization shall submit
   58  application documents to the agency before requesting program
   59  funding. Application documents submitted to and reviewed by the
   60  agency, in consultation with the department, must include all of
   61  the following:
   62         1.Evidence that the applicant is able to meet all of the
   63  applicable federal regulations and requirements established by
   64  the CMS for participation as a PACE organization by the proposed
   65  implementation date.
   66         2.Market studies, including an estimate of the number of
   67  potential participants and the geographic service area in which
   68  the applicant proposes to serve.
   69         3.A business plan of operation, including pro forma
   70  financial statements and projections, based on the proposed
   71  implementation date.
   72         (b)Each applicant must propose to serve a unique and
   73  defined geographic service area without duplication of services
   74  or target populations. No more than one PACE organization may be
   75  authorized to provide services within any unique and defined
   76  geographic service area. The proposed geographic service area
   77  must not overlap with or include any part of a geographic
   78  service area that was previously authorized by the Legislature
   79  and that is specific to another prospective PACE organization.
   80         (c)An existing PACE organization seeking authority to
   81  serve an additional geographic service area not previously
   82  authorized by the agency or the Legislature must meet the
   83  requirements set forth in paragraphs (a) and (b).
   84         (d)Any prospective PACE organization that is granted
   85  initial state approval by the agency, in consultation with the
   86  department, shall submit its complete federal PACE application,
   87  in accordance with the application process and guidelines
   88  established by the CMS, to the agency and the CMS within 12
   89  months after the date of initial state approval, or such
   90  approval is void.
   91         (4)ACCOUNTABILITY.—All PACE organizations must meet
   92  specific quality and performance standards established by the
   93  CMS for the PACE program. The agency shall oversee and monitor
   94  the PACE program and organizations based upon data and reports
   95  periodically submitted by PACE organizations to the agency and
   96  the CMS. A PACE organization is exempt from the requirements of
   97  chapter 641.
   99  Any person whom the agency has approved to enroll participants
  100  residing in a specific geographic area in a Program of All
  101  Inclusive Care for the Elderly may transfer such approval, and
  102  assign its PACE contract, to any other person meeting federal
  103  requirements upon the prior approval of the agency and subject
  104  to any other required federal approval. Such approved transfer
  105  must include the transfer of any funds the Legislature
  106  appropriated to such Program of All-Inclusive Care for the
  107  Elderly, and all future appropriations with respect to such
  108  Program of All-Inclusive Care for the Elderly must be made to
  109  the approved transferee.
  110         (6)CONSTRUCTION.—This section is subject to, and does not
  111  repeal or alter, any law in effect on June 30, 2020, which
  112  authorized a geographic service area and initial enrollees for a
  113  prospective PACE organization.
  114         Section 2. This act shall take effect July 1, 2020.