Florida Senate - 2021 SB 1242
By Senator Book
32-01322-21 20211242__
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 entities applying to
7 deliver PACE services in the state; requiring
8 applications to be reviewed and considered on a
9 continuous basis; requiring notice of applications to
10 be published in the Florida Administrative Register;
11 providing specified application requirements for such
12 prospective PACE organizations; requiring existing
13 PACE organizations to meet specified requirements
14 under certain circumstances; requiring prospective
15 PACE organizations to submit a complete application to
16 the agency and the Centers for Medicare and Medicaid
17 Services within a specified period; requiring that
18 PACE organizations meet certain federal quality and
19 performance standards; requiring the agency to oversee
20 and monitor the PACE program and organizations;
21 providing that a PACE organization is exempt from
22 certain requirements; providing an effective date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
26 Section 1. Section 430.84, Florida Statutes, is created to
27 read:
28 430.84 Program of All-Inclusive Care for the Elderly.—
29 (1) DEFINITIONS.—As used in this section, the term:
30 (a) “Agency” means the Agency for Health Care
31 Administration.
32 (b) “Applicant” means an entity that has filed an
33 application with the agency for consideration as a Program of
34 All-Inclusive Care for the Elderly (PACE) organization.
35 (c) “CMS” means the Centers for Medicare and Medicaid
36 Services within the United States Department of Health and Human
37 Services.
38 (d) “Department” means the Department of Elderly Affairs.
39 (e) “PACE organization” means an entity under contract with
40 the agency to deliver PACE services.
41 (f) “Participant” means an individual receiving services
42 from a PACE organization who has been determined by the
43 department to need the level of care required under the state
44 Medicaid plan for coverage of nursing facility services.
45 (2) PROGRAM CREATION.—The agency, in consultation with the
46 department, may approve entities that have submitted
47 applications required by the CMS to the agency for review and
48 consideration which contain the data and information required in
49 subsection (3) to provide benefits pursuant to the PACE program
50 as established in 42 U.S.C. s. 1395eee and in accordance with
51 the requirements set forth in this section.
52 (3) PACE ORGANIZATION SELECTION.—The agency, in
53 consultation with the department, shall, on a continuous basis,
54 review and consider applications required by the CMS for PACE
55 that have been submitted to the agency by entities seeking
56 initial, state approval to become PACE organizations. Notice of
57 such applications shall be published in the Florida
58 Administrative Register.
59 (a) A prospective PACE organization shall submit
60 application documents to the agency before requesting program
61 funding. Application documents submitted to and reviewed by the
62 agency, in consultation with the department, must include all of
63 the following:
64 1. Evidence that the applicant has the ability to meet all
65 of the applicable federal regulations and requirements,
66 established by the CMS, for participation as a PACE organization
67 by the proposed implementation date.
68 2. Market studies, including an estimate of the number of
69 potential participants and the geographic service area in which
70 the applicant proposes to serve.
71 3. A business plan of operation, including pro forma
72 financial statements and projections, based on the proposed
73 implementation date.
74 (b) Each applicant must propose to serve a unique and
75 defined geographic service area without duplication of services
76 or target populations. No more than one PACE organization may be
77 authorized to provide services within any unique and defined
78 geographic service area.
79 (c) An existing PACE organization seeking authority to
80 serve an additional geographic service area not previously
81 authorized by the agency or Legislature shall meet the
82 requirements set forth in paragraphs (a) and (b).
83 (d) Any prospective PACE organization that is granted
84 initial state approval by the agency, in consultation with the
85 department, shall submit its complete federal PACE application,
86 in accordance with the application process and guidelines
87 established by the CMS, to the agency and the CMS within 12
88 months after the date of initial state approval, or such
89 approval is void.
90 (4) ACCOUNTABILITY.—All PACE organizations must meet
91 specific quality and performance standards established by the
92 CMS for the PACE program. The agency shall oversee and monitor
93 the PACE program and organizations based upon data and reports
94 periodically submitted by PACE organizations to the agency and
95 the CMS. A PACE organization is exempt from the requirements of
96 chapter 641.
97 Section 2. This act shall take effect July 1, 2021.