Florida Senate - 2023 SB 1504
By Senator Hutson
7-01800A-23 20231504__
1 A bill to be entitled
2 An act relating to the administration of the Program
3 of All-Inclusive Care for the Elderly; amending s.
4 430.84, F.S.; deleting the definition of the term
5 “department”; revising the definition of the term
6 “participant”; deleting provisions requiring the
7 Agency for Health Care Administration to consult with
8 the Department of Elderly Affairs regarding
9 administration of the Program of All-Inclusive Care
10 for the Elderly (PACE); revising application
11 requirements for a prospective PACE organization to
12 request program funding; requiring the agency to
13 execute certain agreements or contracts with PACE
14 organizations; authorizing the agency to adopt rules;
15 providing an effective date.
16
17 Be It Enacted by the Legislature of the State of Florida:
18
19 Section 1. Section 430.84, Florida Statutes, is amended to
20 read:
21 430.84 Program of All-Inclusive Care for the Elderly.—
22 (1) DEFINITIONS.—As used in this section, the term:
23 (a) “Agency” means the Agency for Health Care
24 Administration.
25 (b) “Applicant” means an entity that has filed an
26 application with the agency for consideration as a Program of
27 All-Inclusive Care for the Elderly (PACE) organization.
28 (c) “CMS” means the Centers for Medicare and Medicaid
29 Services within the United States Department of Health and Human
30 Services.
31 (d) “Department” means the Department of Elderly Affairs.
32 (e) “PACE organization” means an entity under contract with
33 the agency to deliver PACE services.
34 (e)(f) “Participant” means an individual receiving services
35 from a PACE organization who has been determined by the agency
36 department to need the level of care required under the state
37 Medicaid plan for coverage of nursing facility services.
38 (2) PROGRAM CREATION.—The agency, in consultation with the
39 department, may approve entities that have submitted
40 applications required by the CMS to the agency for review and
41 consideration which contain the data and information required in
42 subsection (3) to provide benefits pursuant to the PACE program
43 as established in 42 U.S.C. s. 1395eee and in accordance with
44 the requirements set forth in this section.
45 (3) PACE ORGANIZATION SELECTION.—The agency, in
46 consultation with the department, shall, on a continuous basis,
47 review and consider applications required by the CMS for PACE
48 that have been submitted to the agency by entities seeking
49 initial state approval to become PACE organizations. Notice of
50 such applications must shall be published in the Florida
51 Administrative Register.
52 (a) A prospective PACE organization must shall submit
53 application documents to the agency before requesting program
54 funding. Application documents submitted to and reviewed by the
55 agency, in consultation with the department, must include all of
56 the following:
57 1. Evidence that the applicant has the ability to meet all
58 of the applicable federal regulations and requirements,
59 established by the CMS, for participation as a PACE organization
60 by the proposed implementation date.
61 2. Market studies, including an estimate of the number of
62 potential participants and the geographic service area in which
63 the applicant proposes to serve.
64 3. A business plan of operation, including pro forma
65 financial statements and projections, based on the proposed
66 implementation date.
67 (b) Each applicant must propose to serve a unique and
68 defined geographic service area without duplication of services
69 or target populations. No more than one PACE organization may be
70 authorized to provide services within any unique and defined
71 geographic service area.
72 (c) Upon agency approval, a PACE organization that is
73 authorized to provide and has received funding for PACE slots in
74 a given geographic area may use such slots and funding to serve
75 the needs of participants in a contiguous geographic area if
76 such PACE organization is authorized to provide PACE services in
77 that area.
78 (c)(d) An existing PACE organization seeking authority to
79 serve an additional geographic service area not previously
80 authorized by the agency or Legislature shall meet the
81 requirements of paragraph (a) set forth in paragraphs (a) and
82 (b).
83 (d)(e) 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 and the state administering agency for the PACE program.
93 (a) The agency shall do all of the following:
94 1. Oversee and monitor the PACE program and organizations
95 based upon data and reports periodically submitted by PACE
96 organizations to the agency and the CMS.
97 2. Execute two-way agreements or contracts with PACE
98 organizations to enhance oversight and monitoring of the PACE
99 program.
100 (b) A PACE organization is exempt from the requirements of
101 chapter 641.
102 (5) RULES.—The agency may adopt rules to administer this
103 section.
104 Section 2. This act shall take effect July 1, 2023.