Florida Senate - 2022                                    SB 2526
       
       
        
       By the Committee on Appropriations
       
       
       
       
       
       576-02897-22                                          20222526__
    1                        A bill to be entitled                      
    2         An act relating to health; amending s. 210.201, F.S.;
    3         providing an appropriation to the Board of Directors
    4         of the H. Lee Moffitt Cancer Center and Research
    5         Institute for a specified purpose; authorizing such
    6         appropriation to be used to secure certain financing;
    7         providing construction; amending s. 381.02035, F.S.;
    8         authorizing pharmacists and wholesalers employed by or
    9         under contract with forensic facilities managed by the
   10         Agency for Persons with Disabilities to import
   11         prescription drugs under the Canadian Prescription
   12         Drug Importation Program for dispensing to clients in
   13         such facilities; amending s. 394.9082, F.S.; requiring
   14         that the Department of Children and Families’
   15         contracts with managing entities be made available on
   16         the department’s website; requiring the department to
   17         conduct a specified review of managing entities every
   18         2 years; requiring the department to submit the review
   19         to the Governor and the Legislature by a specified
   20         date; requiring managing entities to provide notice to
   21         providers before removing the provider from the
   22         provider network; amending s. 408.062, F.S.; deleting
   23         a requirement that the Agency for Health Care
   24         Administration collect and publish on its website
   25         certain data related to the retail prices of specified
   26         prescribed medicines; amending s. 409.908, F.S.;
   27         requiring the agency to base its rate of payments for
   28         nursing home care in its Title XIX Long-Term Care
   29         Reimbursement Plan in accordance with specified
   30         minimum wage requirements; providing an effective
   31         date.
   32          
   33  Be It Enacted by the Legislature of the State of Florida:
   34  
   35         Section 1. Section 210.201, Florida Statutes, is amended to
   36  read:
   37         210.201 H. Lee Moffitt Cancer Center and Research Institute
   38  facilities; establishment; funding.—
   39         (1) The Board of Directors of the H. Lee Moffitt Cancer
   40  Center and Research Institute shall construct, furnish, and
   41  equip, and shall covenant to complete, the cancer research and
   42  clinical and related facilities of the H. Lee Moffitt Cancer
   43  Center and Research Institute funded with proceeds from the
   44  Cigarette Tax Collection Trust Fund pursuant to s. 210.20.
   45  Moneys transferred to the Board of Directors of the H. Lee
   46  Moffitt Cancer Center and Research Institute pursuant to s.
   47  210.20 may be used to secure financing to pay costs related to
   48  constructing, furnishing, equipping, operating, and maintaining
   49  cancer research and clinical and related facilities; furnishing,
   50  equipping, operating, and maintaining other leased or owned
   51  properties; and paying costs incurred in connection with
   52  purchasing, financing, operating, and maintaining such
   53  equipment, facilities, and properties as provided in s. 210.20.
   54  Such financing may include the issuance of tax-exempt bonds or
   55  other forms of indebtedness by a local authority, municipality,
   56  or county pursuant to parts II and III of chapter 159. Such
   57  bonds shall not constitute state bonds for purposes of s. 11,
   58  Art. VII of the State Constitution, but shall constitute bonds
   59  of a local agency,” as defined in s. 159.27(4). The cigarette
   60  tax dollars pledged to facilities pursuant to s. 210.20 may be
   61  replaced annually by the Legislature from tobacco litigation
   62  settlement proceeds.
   63         (2) Beginning in the 2022-2023 fiscal year, and annually
   64  through the 2052-2053 fiscal year, the sum of $20 million is
   65  appropriated and shall be transferred to the Board of Directors
   66  of the H. Lee Moffitt Cancer Center and Research Institute for
   67  construction and development of Moffitt’s Pasco County life
   68  sciences park. Moneys transferred to the Board of Directors of
   69  the H. Lee Moffitt Cancer Center and Research Institute pursuant
   70  to this subsection may be used to secure financing to pay costs
   71  related to the construction and development of Moffitt’s Pasco
   72  County life sciences park. Such financing may include the
   73  issuance of tax-exempt bonds or other forms of indebtedness by a
   74  local authority, municipality, or county pursuant to parts II
   75  and III of chapter 159. Such bonds shall not constitute state
   76  bonds for purposes of s. 11, Art. VII of the State Constitution,
   77  but shall constitute bonds of a local agency as defined in s.
   78  159.27(4).
   79         Section 2. Paragraph (f) is added to subsection (7) of
   80  section 381.02035, Florida Statutes, to read:
   81         381.02035 Canadian Prescription Drug Importation Program.—
   82         (7) ELIGIBLE IMPORTERS.—The following entities may import
   83  prescription drugs from an eligible Canadian supplier under the
   84  program:
   85         (f) A pharmacist or wholesaler employed by or under
   86  contract with a forensic facility, as defined in s. 916.106,
   87  that is managed by the Agency for Persons with Disabilities, for
   88  dispensing to clients treated in such facility.
   89         Section 3. Paragraph (i) of subsection (5) of section
   90  394.9082, Florida Statutes, is amended, and paragraphs (k) and
   91  (l) are added to subsection (4) of that section, to read:
   92         394.9082 Behavioral health managing entities.—
   93         (4) CONTRACT WITH MANAGING ENTITIES.—
   94         (k) The department’s contracts with managing entities must
   95  be made available in a publicly accessible format on the
   96  department’s website.
   97         (l) Every 2 years, the department shall conduct a
   98  comprehensive, multiyear review of the revenues, expenditures,
   99  and financial positions of managing entities covering the most
  100  recent 2 consecutive fiscal years. The review must include a
  101  comprehensive system-of-care analysis. The department shall
  102  submit the review to the Governor, the President of the Senate,
  103  and the Speaker of the House of Representatives by November 1 of
  104  every other year, beginning in 2023.
  105         (5) MANAGING ENTITY DUTIES.—A managing entity shall:
  106         (i) Develop a comprehensive provider network of qualified
  107  providers to deliver behavioral health services. The managing
  108  entity is not required to competitively procure network
  109  providers but shall publicize opportunities to join the provider
  110  network and evaluate providers in the network to determine if
  111  they may remain in the network. A managing entity must provide
  112  notice to a provider before the provider is removed from the
  113  network. The managing entity shall publish these processes on
  114  its website. The managing entity shall ensure continuity of care
  115  for clients if a provider ceases to provide a service or leaves
  116  the network.
  117         Section 4. Paragraph (h) of subsection (1) of section
  118  408.062, Florida Statutes, is amended to read:
  119         408.062 Research, analyses, studies, and reports.—
  120         (1) The agency shall conduct research, analyses, and
  121  studies relating to health care costs and access to and quality
  122  of health care services as access and quality are affected by
  123  changes in health care costs. Such research, analyses, and
  124  studies shall include, but not be limited to:
  125         (h) The collection of a statistically valid sample of data
  126  on the retail prices charged by pharmacies for the 300 most
  127  frequently prescribed medicines from any pharmacy licensed by
  128  this state. If the drug is available generically, price data
  129  shall be reported for the generic drug and price data of a
  130  brand-named drug for which the generic drug is the equivalent
  131  shall be reported. The agency shall make available on its
  132  Internet website for each pharmacy drug prices for a 30-day
  133  supply at a standard dose. The data collected shall be reported
  134  for each drug by pharmacy and by metropolitan statistical area
  135  or region and updated monthly.
  136         Section 5. Subsection (2) of section 409.908, Florida
  137  Statutes, is amended to read:
  138         409.908 Reimbursement of Medicaid providers.—Subject to
  139  specific appropriations, the agency shall reimburse Medicaid
  140  providers, in accordance with state and federal law, according
  141  to methodologies set forth in the rules of the agency and in
  142  policy manuals and handbooks incorporated by reference therein.
  143  These methodologies may include fee schedules, reimbursement
  144  methods based on cost reporting, negotiated fees, competitive
  145  bidding pursuant to s. 287.057, and other mechanisms the agency
  146  considers efficient and effective for purchasing services or
  147  goods on behalf of recipients. If a provider is reimbursed based
  148  on cost reporting and submits a cost report late and that cost
  149  report would have been used to set a lower reimbursement rate
  150  for a rate semester, then the provider’s rate for that semester
  151  shall be retroactively calculated using the new cost report, and
  152  full payment at the recalculated rate shall be effected
  153  retroactively. Medicare-granted extensions for filing cost
  154  reports, if applicable, shall also apply to Medicaid cost
  155  reports. Payment for Medicaid compensable services made on
  156  behalf of Medicaid-eligible persons is subject to the
  157  availability of moneys and any limitations or directions
  158  provided for in the General Appropriations Act or chapter 216.
  159  Further, nothing in this section shall be construed to prevent
  160  or limit the agency from adjusting fees, reimbursement rates,
  161  lengths of stay, number of visits, or number of services, or
  162  making any other adjustments necessary to comply with the
  163  availability of moneys and any limitations or directions
  164  provided for in the General Appropriations Act, provided the
  165  adjustment is consistent with legislative intent.
  166         (2)(a)1. Reimbursement to nursing homes licensed under part
  167  II of chapter 400 and state-owned-and-operated intermediate care
  168  facilities for the developmentally disabled licensed under part
  169  VIII of chapter 400 must be made prospectively.
  170         2. Unless otherwise limited or directed in the General
  171  Appropriations Act, reimbursement to hospitals licensed under
  172  part I of chapter 395 for the provision of swing-bed nursing
  173  home services must be made on the basis of the average statewide
  174  nursing home payment, and reimbursement to a hospital licensed
  175  under part I of chapter 395 for the provision of skilled nursing
  176  services must be made on the basis of the average nursing home
  177  payment for those services in the county in which the hospital
  178  is located. When a hospital is located in a county that does not
  179  have any community nursing homes, reimbursement shall be
  180  determined by averaging the nursing home payments in counties
  181  that surround the county in which the hospital is located.
  182  Reimbursement to hospitals, including Medicaid payment of
  183  Medicare copayments, for skilled nursing services shall be
  184  limited to 30 days, unless a prior authorization has been
  185  obtained from the agency. Medicaid reimbursement may be extended
  186  by the agency beyond 30 days, and approval must be based upon
  187  verification by the patient’s physician that the patient
  188  requires short-term rehabilitative and recuperative services
  189  only, in which case an extension of no more than 15 days may be
  190  approved. Reimbursement to a hospital licensed under part I of
  191  chapter 395 for the temporary provision of skilled nursing
  192  services to nursing home residents who have been displaced as
  193  the result of a natural disaster or other emergency may not
  194  exceed the average county nursing home payment for those
  195  services in the county in which the hospital is located and is
  196  limited to the period of time which the agency considers
  197  necessary for continued placement of the nursing home residents
  198  in the hospital.
  199         (b) Subject to any limitations or directions in the General
  200  Appropriations Act, the agency shall establish and implement a
  201  state Title XIX Long-Term Care Reimbursement Plan for nursing
  202  home care in order to provide care and services in conformance
  203  with the applicable state and federal laws, rules, regulations,
  204  and quality and safety standards and to ensure that individuals
  205  eligible for medical assistance have reasonable geographic
  206  access to such care.
  207         1. The agency shall amend the long-term care reimbursement
  208  plan and cost reporting system to create direct care and
  209  indirect care subcomponents of the patient care component of the
  210  per diem rate. These two subcomponents together shall equal the
  211  patient care component of the per diem rate. Separate prices
  212  shall be calculated for each patient care subcomponent,
  213  initially based on the September 2016 rate setting cost reports
  214  and subsequently based on the most recently audited cost report
  215  used during a rebasing year. The direct care subcomponent of the
  216  per diem rate for any providers still being reimbursed on a cost
  217  basis shall be limited by the cost-based class ceiling, and the
  218  indirect care subcomponent may be limited by the lower of the
  219  cost-based class ceiling, the target rate class ceiling, or the
  220  individual provider target. The ceilings and targets apply only
  221  to providers being reimbursed on a cost-based system. Effective
  222  October 1, 2018, a prospective payment methodology shall be
  223  implemented for rate setting purposes with the following
  224  parameters:
  225         a. Peer Groups, including:
  226         (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
  227  Counties; and
  228         (II) South-SMMC Regions 10-11, plus Palm Beach and
  229  Okeechobee Counties.
  230         b. Percentage of Median Costs based on the cost reports
  231  used for September 2016 rate setting:
  232         (I) Direct Care Costs........................100 percent.
  233         (II) Indirect Care Costs......................92 percent.
  234         (III) Operating Costs.........................86 percent.
  235         c. Floors:
  236         (I) Direct Care Component.....................95 percent.
  237         (II) Indirect Care Component................92.5 percent.
  238         (III) Operating Component...........................None.
  239         d. Pass-through Payments..................Real Estate and
  240  ...............................................Personal Property
  241  ...................................Taxes and Property Insurance.
  242         e. Quality Incentive Program Payment
  243  Pool......................................6 percent of September
  244  .......................................2016 non-property related
  245  ................................payments of included facilities.
  246         f. Quality Score Threshold to Quality for Quality Incentive
  247  Payment..................20th percentile of included facilities.
  248         g. Fair Rental Value System Payment Parameters:
  249         (I) Building Value per Square Foot based on 2018 RS Means.
  250         (II) Land Valuation...10 percent of Gross Building value.
  251         (III) Facility Square Footage......Actual Square Footage.
  252         (IV) Moveable Equipment Allowance.........$8,000 per bed.
  253         (V) Obsolescence Factor......................1.5 percent.
  254         (VI) Fair Rental Rate of Return................8 percent.
  255         (VII) Minimum Occupancy.......................90 percent.
  256         (VIII) Maximum Facility Age.....................40 years.
  257         (IX) Minimum Square Footage per Bed..................350.
  258         (X) Maximum Square Footage for Bed...................500.
  259         (XI) Minimum Cost of a renovation/replacements$500 per bed.
  260         h. Ventilator Supplemental payment of $200 per Medicaid day
  261  of 40,000 ventilator Medicaid days per fiscal year.
  262         2. The direct care subcomponent shall include salaries and
  263  benefits of direct care staff providing nursing services
  264  including registered nurses, licensed practical nurses, and
  265  certified nursing assistants who deliver care directly to
  266  residents in the nursing home facility, allowable therapy costs,
  267  and dietary costs. This excludes nursing administration, staff
  268  development, the staffing coordinator, and the administrative
  269  portion of the minimum data set and care plan coordinators. The
  270  direct care subcomponent also includes medically necessary
  271  dental care, vision care, hearing care, and podiatric care.
  272         3. All other patient care costs shall be included in the
  273  indirect care cost subcomponent of the patient care per diem
  274  rate, including complex medical equipment, medical supplies, and
  275  other allowable ancillary costs. Costs may not be allocated
  276  directly or indirectly to the direct care subcomponent from a
  277  home office or management company.
  278         4. On July 1 of each year, the agency shall report to the
  279  Legislature direct and indirect care costs, including average
  280  direct and indirect care costs per resident per facility and
  281  direct care and indirect care salaries and benefits per category
  282  of staff member per facility.
  283         5. Every fourth year, the agency shall rebase nursing home
  284  prospective payment rates to reflect changes in cost based on
  285  the most recently audited cost report for each participating
  286  provider.
  287         6. A direct care supplemental payment may be made to
  288  providers whose direct care hours per patient day are above the
  289  80th percentile and who provide Medicaid services to a larger
  290  percentage of Medicaid patients than the state average.
  291         7. For the period beginning on October 1, 2018, and ending
  292  on September 30, 2021, the agency shall reimburse providers the
  293  greater of their September 2016 cost-based rate or their
  294  prospective payment rate. Effective October 1, 2021, the agency
  295  shall reimburse providers the greater of 95 percent of their
  296  cost-based rate or their rebased prospective payment rate, using
  297  the most recently audited cost report for each facility. This
  298  subparagraph shall expire September 30, 2023.
  299         8. Pediatric, Florida Department of Veterans Affairs, and
  300  government-owned facilities are exempt from the pricing model
  301  established in this subsection and shall remain on a cost-based
  302  prospective payment system. Effective October 1, 2018, the
  303  agency shall set rates for all facilities remaining on a cost
  304  based prospective payment system using each facility’s most
  305  recently audited cost report, eliminating retroactive
  306  settlements.
  307  
  308  It is the intent of the Legislature that the reimbursement plan
  309  achieve the goal of providing access to health care for nursing
  310  home residents who require large amounts of care while
  311  encouraging diversion services as an alternative to nursing home
  312  care for residents who can be served within the community. The
  313  agency shall base the establishment of any maximum rate of
  314  payment, whether overall or component, on the available moneys
  315  as provided for in the General Appropriations Act. The agency
  316  may base the maximum rate of payment on the results of
  317  scientifically valid analysis and conclusions derived from
  318  objective statistical data pertinent to the particular maximum
  319  rate of payment. The agency shall base the rates of payments in
  320  accordance with the minimum wage requirements as provided in the
  321  General Appropriations Act.
  322         Section 6. This act shall take effect July 1, 2022.