Florida Senate - 2023             CONFERENCE COMMITTEE AMENDMENT
       Bill No. SB 2510
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                 Floor: AD/CR          .           Floor: AD            
             05/05/2023 09:35 AM       .      05/05/2023 10:44 AM       

       The Conference Committee on SB 2510 recommended the following:
    1         Senate Conference Committee Amendment (with title
    2  amendment)
    4         Delete everything after the enacting clause
    5  and insert:
    6         Section 1. Subsection (1) of section 296.37, Florida
    7  Statutes, is amended to read:
    8         296.37 Residents; contribution to support.—
    9         (1) Every resident of the home who receives a pension,
   10  compensation, or gratuity from the United States Government, or
   11  income from any other source of more than $160 $130 per month,
   12  shall contribute to his or her maintenance and support while a
   13  resident of the home in accordance with a schedule of payment
   14  determined by the administrator and approved by the director.
   15  The total amount of such contributions shall be to the fullest
   16  extent possible but may not exceed the actual cost of operating
   17  and maintaining the home.
   18         Section 2. Subsection (7) of section 409.814, Florida
   19  Statutes, is amended to read:
   20         409.814 Eligibility.—A child who has not reached 19 years
   21  of age whose family income is equal to or below 200 percent of
   22  the federal poverty level is eligible for the Florida Kidcare
   23  program as provided in this section. If an enrolled individual
   24  is determined to be ineligible for coverage, he or she must be
   25  immediately disenrolled from the respective Florida Kidcare
   26  program component.
   27         (7) A child whose family income is above 200 percent of the
   28  federal poverty level or a child who is excluded under the
   29  provisions of subsection (5) may participate in the Florida
   30  Kidcare program as provided in s. 409.8132 or, if the child is
   31  ineligible for Medikids by reason of age, in the Florida Healthy
   32  Kids program, subject to the following:
   33         (a) The family is not eligible for premium assistance
   34  payments and must pay the full cost of the combined-risk
   35  premium, including any administrative costs.
   36         (b) The board of directors of the Florida Healthy Kids
   37  Corporation may offer a reduced benefit package to these
   38  children in order to limit program costs for such families.
   39         Section 3. Paragraph (b) of subsection (2) of section
   40  409.908, Florida Statutes, is amended to read:
   41         409.908 Reimbursement of Medicaid providers.—Subject to
   42  specific appropriations, the agency shall reimburse Medicaid
   43  providers, in accordance with state and federal law, according
   44  to methodologies set forth in the rules of the agency and in
   45  policy manuals and handbooks incorporated by reference therein.
   46  These methodologies may include fee schedules, reimbursement
   47  methods based on cost reporting, negotiated fees, competitive
   48  bidding pursuant to s. 287.057, and other mechanisms the agency
   49  considers efficient and effective for purchasing services or
   50  goods on behalf of recipients. If a provider is reimbursed based
   51  on cost reporting and submits a cost report late and that cost
   52  report would have been used to set a lower reimbursement rate
   53  for a rate semester, then the provider’s rate for that semester
   54  shall be retroactively calculated using the new cost report, and
   55  full payment at the recalculated rate shall be effected
   56  retroactively. Medicare-granted extensions for filing cost
   57  reports, if applicable, shall also apply to Medicaid cost
   58  reports. Payment for Medicaid compensable services made on
   59  behalf of Medicaid-eligible persons is subject to the
   60  availability of moneys and any limitations or directions
   61  provided for in the General Appropriations Act or chapter 216.
   62  Further, nothing in this section shall be construed to prevent
   63  or limit the agency from adjusting fees, reimbursement rates,
   64  lengths of stay, number of visits, or number of services, or
   65  making any other adjustments necessary to comply with the
   66  availability of moneys and any limitations or directions
   67  provided for in the General Appropriations Act, provided the
   68  adjustment is consistent with legislative intent.
   69         (2)
   70         (b) Subject to any limitations or directions in the General
   71  Appropriations Act, the agency shall establish and implement a
   72  state Title XIX Long-Term Care Reimbursement Plan for nursing
   73  home care in order to provide care and services in conformance
   74  with the applicable state and federal laws, rules, regulations,
   75  and quality and safety standards and to ensure that individuals
   76  eligible for medical assistance have reasonable geographic
   77  access to such care.
   78         1. The agency shall amend the long-term care reimbursement
   79  plan and cost reporting system to create direct care and
   80  indirect care subcomponents of the patient care component of the
   81  per diem rate. These two subcomponents together shall equal the
   82  patient care component of the per diem rate. Separate prices
   83  shall be calculated for each patient care subcomponent,
   84  initially based on the September 2016 rate setting cost reports
   85  and subsequently based on the most recently audited cost report
   86  used during a rebasing year. The direct care subcomponent of the
   87  per diem rate for any providers still being reimbursed on a cost
   88  basis shall be limited by the cost-based class ceiling, and the
   89  indirect care subcomponent may be limited by the lower of the
   90  cost-based class ceiling, the target rate class ceiling, or the
   91  individual provider target. The ceilings and targets apply only
   92  to providers being reimbursed on a cost-based system. Effective
   93  October 1, 2018, a prospective payment methodology shall be
   94  implemented for rate setting purposes with the following
   95  parameters:
   96         a. Peer Groups, including:
   97         (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
   98  Counties; and
   99         (II) South-SMMC Regions 10-11, plus Palm Beach and
  100  Okeechobee Counties.
  101         b. Percentage of Median Costs based on the cost reports
  102  used for September 2016 rate setting:
  103         (I) Direct Care Costs........................100 percent.
  104         (II) Indirect Care Costs......................92 percent.
  105         (III) Operating Costs.........................86 percent.
  106         c. Floors:
  107         (I) Direct Care Component.....................95 percent.
  108         (II) Indirect Care Component................92.5 percent.
  109         (III) Operating Component...........................None.
  110         d. Pass-through Payments..................Real Estate and
  111  ...............................................Personal Property
  112  ...................................Taxes and Property Insurance.
  113         e. Quality Incentive Program Payment
  114  Pool...................................10 6 percent of September
  115  .......................................2016 non-property related
  116  ................................payments of included facilities.
  117         f. Quality Score Threshold to Quality for Quality Incentive
  118  Payment..................20th percentile of included facilities.
  119         g. Fair Rental Value System Payment Parameters:
  120         (I) Building Value per Square Foot based on 2018 RS Means.
  121         (II) Land Valuation...10 percent of Gross Building value.
  122         (III) Facility Square Footage......Actual Square Footage.
  123         (IV) Moveable Equipment Allowance.........$8,000 per bed.
  124         (V) Obsolescence Factor......................1.5 percent.
  125         (VI) Fair Rental Rate of Return................8 percent.
  126         (VII) Minimum Occupancy.......................90 percent.
  127         (VIII) Maximum Facility Age.....................40 years.
  128         (IX) Minimum Square Footage per Bed..................350.
  129         (X) Maximum Square Footage for Bed...................500.
  130         (XI) Minimum Cost of a renovation/replacements$500 per bed.
  131         h. Ventilator Supplemental payment of $200 per Medicaid day
  132  of 40,000 ventilator Medicaid days per fiscal year.
  133         2. The direct care subcomponent shall include salaries and
  134  benefits of direct care staff providing nursing services
  135  including registered nurses, licensed practical nurses, and
  136  certified nursing assistants who deliver care directly to
  137  residents in the nursing home facility, allowable therapy costs,
  138  and dietary costs. This excludes nursing administration, staff
  139  development, the staffing coordinator, and the administrative
  140  portion of the minimum data set and care plan coordinators. The
  141  direct care subcomponent also includes medically necessary
  142  dental care, vision care, hearing care, and podiatric care.
  143         3. All other patient care costs shall be included in the
  144  indirect care cost subcomponent of the patient care per diem
  145  rate, including complex medical equipment, medical supplies, and
  146  other allowable ancillary costs. Costs may not be allocated
  147  directly or indirectly to the direct care subcomponent from a
  148  home office or management company.
  149         4. On July 1 of each year, the agency shall report to the
  150  Legislature direct and indirect care costs, including average
  151  direct and indirect care costs per resident per facility and
  152  direct care and indirect care salaries and benefits per category
  153  of staff member per facility.
  154         5. Every fourth year, the agency shall rebase nursing home
  155  prospective payment rates to reflect changes in cost based on
  156  the most recently audited cost report for each participating
  157  provider.
  158         6. A direct care supplemental payment may be made to
  159  providers whose direct care hours per patient day are above the
  160  80th percentile and who provide Medicaid services to a larger
  161  percentage of Medicaid patients than the state average.
  162         7. For the period beginning on October 1, 2018, and ending
  163  on September 30, 2021, the agency shall reimburse providers the
  164  greater of their September 2016 cost-based rate or their
  165  prospective payment rate. Effective October 1, 2021, the agency
  166  shall reimburse providers the greater of 95 percent of their
  167  cost-based rate or their rebased prospective payment rate, using
  168  the most recently audited cost report for each facility. This
  169  subparagraph shall expire September 30, 2023.
  170         8. Pediatric, Florida Department of Veterans Affairs, and
  171  government-owned facilities are exempt from the pricing model
  172  established in this subsection and shall remain on a cost-based
  173  prospective payment system. Effective October 1, 2018, the
  174  agency shall set rates for all facilities remaining on a cost
  175  based prospective payment system using each facility’s most
  176  recently audited cost report, eliminating retroactive
  177  settlements.
  179  It is the intent of the Legislature that the reimbursement plan
  180  achieve the goal of providing access to health care for nursing
  181  home residents who require large amounts of care while
  182  encouraging diversion services as an alternative to nursing home
  183  care for residents who can be served within the community. The
  184  agency shall base the establishment of any maximum rate of
  185  payment, whether overall or component, on the available moneys
  186  as provided for in the General Appropriations Act. The agency
  187  may base the maximum rate of payment on the results of
  188  scientifically valid analysis and conclusions derived from
  189  objective statistical data pertinent to the particular maximum
  190  rate of payment. The agency shall base the rates of payments in
  191  accordance with the minimum wage requirements as provided in the
  192  General Appropriations Act.
  193         Section 4. Present subsections (6) and (7) of section
  194  409.909, Florida Statutes, are redesignated as subsections (7)
  195  and (8), respectively, a new subsection (6) is added to that
  196  section, and subsection (5) of that section is amended, to read:
  197         409.909 Statewide Medicaid Residency Program.—
  198         (5) The Graduate Medical Education Startup Bonus Program is
  199  established to provide resources for the education and training
  200  of physicians in specialties which are in a statewide supply
  201  and-demand deficit. Hospitals and qualifying institutions as
  202  defined in paragraph (2)(c) eligible for participation in
  203  subsection (1) or subsection (6) are eligible to participate in
  204  the Graduate Medical Education Startup Bonus Program established
  205  under this subsection. Notwithstanding subsection (4) or an
  206  FTE’s residency period, and in any state fiscal year in which
  207  funds are appropriated for the startup bonus program, the agency
  208  shall allocate a $100,000 startup bonus for each newly created
  209  resident position that is authorized by the Accreditation
  210  Council for Graduate Medical Education or Osteopathic
  211  Postdoctoral Training Institution in an initial or established
  212  accredited training program that is in a physician specialty in
  213  statewide supply-and-demand deficit. In any year in which
  214  funding is not sufficient to provide $100,000 for each newly
  215  created resident position, funding shall be reduced pro rata
  216  across all newly created resident positions in physician
  217  specialties in statewide supply-and-demand deficit.
  218         (a) Hospitals and qualifying institutions as defined in
  219  paragraph (2)(c) applying for a startup bonus must submit to the
  220  agency by March 1 their Accreditation Council for Graduate
  221  Medical Education or Osteopathic Postdoctoral Training
  222  Institution approval validating the new resident positions
  223  approved on or after March 2 of the prior fiscal year through
  224  March 1 of the current fiscal year for the physician specialties
  225  identified in a statewide supply-and-demand deficit as provided
  226  in the current fiscal year’s General Appropriations Act. An
  227  applicant hospital or qualifying institution as defined in
  228  paragraph (2)(c) may validate a change in the number of
  229  residents by comparing the number in the prior period
  230  Accreditation Council for Graduate Medical Education or
  231  Osteopathic Postdoctoral Training Institution approval to the
  232  number in the current year.
  233         (b) Any unobligated startup bonus funds on April 15 of each
  234  fiscal year shall be proportionally allocated to hospitals and
  235  to qualifying institutions as defined in paragraph (2)(c)
  236  participating under subsection (3) for existing FTE residents in
  237  the physician specialties in statewide supply-and-demand
  238  deficit. This nonrecurring allocation shall be in addition to
  239  the funds allocated in subsection (4). Notwithstanding
  240  subsection (4), the allocation under this subsection may not
  241  exceed $100,000 per FTE resident.
  242         (c) For purposes of this subsection, physician specialties
  243  and subspecialties, both adult and pediatric, in statewide
  244  supply-and-demand deficit are those identified in the General
  245  Appropriations Act.
  246         (d) The agency shall distribute all funds authorized under
  247  the Graduate Medical Education Startup Bonus Program on or
  248  before the final business day of the fourth quarter of a state
  249  fiscal year.
  250         (6) The Slots for Doctors Program is established to address
  251  the physician workforce shortage by increasing the supply of
  252  highly trained physicians through the creation of new resident
  253  positions, which will increase access to care and improve health
  254  outcomes for Medicaid recipients.
  255         (a) Notwithstanding subsection (4), the agency shall
  256  annually allocate $100,000 to hospitals and qualifying
  257  institutions for each newly created resident position that is
  258  first filled on or after June 1, 2023, and filled thereafter,
  259  and that is accredited by the Accreditation Council for Graduate
  260  Medical Education or the Osteopathic Postdoctoral Training
  261  Institution in an initial or established accredited training
  262  program which is in a physician specialty or subspecialty in a
  263  statewide supply-and-demand deficit.
  264         (b) This program is designed to generate matching funds
  265  under Medicaid and distribute such funds to participating
  266  hospitals and qualifying institutions on a quarterly basis in
  267  each fiscal year for which an appropriation is made. Resident
  268  positions created under this subsection are not eligible for
  269  concurrent funding pursuant to subsection (1).
  270         (c) For purposes of this subsection, physician specialties
  271  and subspecialties, both adult and pediatric, in statewide
  272  supply-and-demand deficit are those identified as such in the
  273  General Appropriations Act.
  274         (d) Funds allocated pursuant to this subsection may not be
  275  used for resident positions that have previously received
  276  funding pursuant to subsection (1).
  277         Section 5. Paragraph (f) of subsection (3) of section
  278  409.967, Florida Statutes, is amended to read:
  279         409.967 Managed care plan accountability.—
  280         (3) ACHIEVED SAVINGS REBATE.—
  281         (f) Achieved savings rebates validated by the certified
  282  public accountant are due within 30 days after the report is
  283  submitted. Except as provided in paragraph (h), the achieved
  284  savings rebate is established by determining pretax income as a
  285  percentage of revenues and applying the following income sharing
  286  ratios:
  287         1. One hundred percent of income up to and including 5
  288  percent of revenue shall be retained by the plan.
  289         2. Fifty percent of income above 5 percent and up to 10
  290  percent shall be retained by the plan, and the other 50 percent
  291  shall be refunded to the state and adjusted for the Federal
  292  Medical Assistance Percentages. The state share shall be
  293  transferred to the General Revenue Fund, unallocated, and the
  294  federal share shall be transferred to the Medical Care Trust
  295  Fund, unallocated.
  296         3. One hundred percent of income above 10 percent of
  297  revenue shall be refunded to the state and adjusted for the
  298  Federal Medical Assistance Percentages. The state share shall be
  299  transferred to the General Revenue Fund, unallocated, and the
  300  federal share shall be transferred to the Medical Care Trust
  301  Fund, unallocated.
  302         Section 6. Effective upon becoming a law, section 409.9855,
  303  Florida Statutes, is created to read:
  304         409.9855Pilot program for individuals with developmental
  305  disabilities.—
  307         (a)Using a managed care model, the agency shall implement
  308  a pilot program for individuals with developmental disabilities
  309  in Statewide Medicaid Managed Care Regions D and I to provide
  310  coverage of comprehensive services.
  311         (b)The agency may seek federal approval through a state
  312  plan amendment or Medicaid waiver as necessary to implement the
  313  pilot program. The agency shall submit a request for any federal
  314  approval needed to implement the pilot program by September 1,
  315  2023.
  316         (c)Pursuant to s. 409.963, the agency shall administer the
  317  pilot program in consultation with the Agency for Persons with
  318  Disabilities.
  319         (d)The agency shall make capitated payments to managed
  320  care organizations for comprehensive coverage, including
  321  community-based services described in s. 393.066(3) and approved
  322  through the state’s home and community-based services Medicaid
  323  waiver program for individuals with developmental disabilities.
  324  Unless otherwise specified, ss. 409.961-409.969 apply to the
  325  pilot program.
  326         (e)The agency shall evaluate the feasibility of statewide
  327  implementation of the capitated managed care model used by the
  328  pilot program to serve individuals with developmental
  329  disabilities.
  331         (a)Participation in the pilot program is voluntary and
  332  limited to the maximum number of enrollees specified in the
  333  General Appropriations Act.
  334         (b)The Agency for Persons with Disabilities shall approve
  335  a needs assessment methodology to determine functional,
  336  behavioral, and physical needs of prospective enrollees. The
  337  assessment methodology may be administered by persons who have
  338  completed such training as may be offered by the agency.
  339  Eligibility to participate in the pilot program is determined
  340  based on all of the following criteria:
  341         1.Whether the individual is eligible for Medicaid.
  342         2.Whether the individual is 18 years of age or older and
  343  is on the waiting list for individual budget waiver services
  344  under chapter 393 and assigned to one of categories 1 through 6
  345  as specified in s. 393.065(5).
  346         3.Whether the individual resides in a pilot program
  347  region.
  348         (c)The agency shall enroll individuals in the pilot
  349  program based on verification that the individual has met the
  350  criteria in paragraph (b).
  351         (d)Notwithstanding any provisions of s. 393.065 to the
  352  contrary, an enrollee must be afforded an opportunity to enroll
  353  in any appropriate existing Medicaid waiver program if any of
  354  the following conditions occur:
  355         1.At any point during the operation of the pilot program,
  356  an enrollee declares an intent to voluntarily disenroll,
  357  provided that he or she has been covered for the entire previous
  358  plan year by the pilot program.
  359         2.The agency determines the enrollee has a good cause
  360  reason to disenroll.
  361         3.The pilot program ceases to operate.
  363  Such enrollees must receive an individualized transition plan to
  364  assist him or her in accessing sufficient services and supports
  365  for the enrollee’s safety, well-being, and continuity of care.
  366         (3)PILOT PROGRAM BENEFITS.—
  367         (a)Plans participating in the pilot program must, at a
  368  minimum, cover the following:
  369         1.All benefits included in s. 409.973.
  370         2.All benefits included in s. 409.98.
  371         3.All benefits included in s. 393.066(3), and all of the
  372  following:
  373         a.Adult day training.
  374         b.Behavior analysis services.
  375         c.Behavior assistant services.
  376         d.Companion services.
  377         e.Consumable medical supplies.
  378         f.Dietitian services.
  379         g.Durable medical equipment and supplies.
  380         h.Environmental accessibility adaptations.
  381         i.Occupational therapy.
  382         j.Personal emergency response systems.
  383         k.Personal supports.
  384         l.Physical therapy.
  385         m.Prevocational services.
  386         n.Private duty nursing.
  387         o.Residential habilitation, including the following
  388  levels:
  389         (I)Standard level.
  390         (II)Behavior-focused level.
  391         (III)Intensive-behavior level.
  392         (IV)Enhanced intensive-behavior level.
  393         p.Residential nursing services.
  394         q.Respiratory therapy.
  395         r.Respite care.
  396         s.Skilled nursing.
  397         t.Specialized medical home care.
  398         u.Specialized mental health counseling.
  399         v.Speech therapy.
  400         w.Support coordination.
  401         x.Supported employment.
  402         y.Supported living coaching.
  403         z.Transportation.
  404         (b)All providers of the services listed under paragraph
  405  (a) must meet the provider qualifications outlined in the
  406  Florida Medicaid Developmental Disabilities Individual Budgeting
  407  Waiver Services Coverage and Limitations Handbook as adopted by
  408  reference in rule 59G-13.070, Florida Administrative Code.
  409         (c)Support coordination services must maximize the use of
  410  natural supports and community partnerships.
  411         (d)The plans participating in the pilot program must
  412  provide all categories of benefits through a single, integrated
  413  model of care.
  414         (e)Services must be provided to enrollees in accordance
  415  with an individualized care plan which is evaluated and updated
  416  at least quarterly and as warranted by changes in an enrollee’s
  417  circumstances.
  419         (a)To be eligible to participate in the pilot program, a
  420  plan must have been awarded a contract to provide long-term care
  421  services pursuant to s. 409.981 as a result of an invitation to
  422  negotiate.
  423         (b)The agency shall select, as provided in s. 287.057(1),
  424  one plan to participate in the pilot program for each of the two
  425  regions. The director of the Agency for Persons with
  426  Disabilities or his or her designee must be a member of the
  427  negotiating team.
  428         1.The invitation to negotiate must specify the criteria
  429  and the relative weight assigned to each criterion that will be
  430  used for determining the acceptability of submitted responses
  431  and guiding the selection of the plans with which the agency and
  432  the Agency for Persons with Disabilities negotiate. In addition
  433  to any other criteria established by the agency, in consultation
  434  with the Agency for Persons with Disabilities, the agency shall
  435  consider the following factors in the selection of eligible
  436  plans:
  437         a.Experience serving similar populations, including the
  438  plan’s record in achieving specific quality standards with
  439  similar populations.
  440         b.Establishment of community partnerships with providers
  441  which create opportunities for reinvestment in community-based
  442  services.
  443         c.Provision of additional benefits, particularly
  444  behavioral health services, the coordination of dental care, and
  445  other initiatives that improve overall well-being.
  446         d.Provision of and capacity to provide mental health
  447  therapies and analysis designed to meet the needs of individuals
  448  with developmental disabilities.
  449         e.Evidence that an eligible plan has written agreements or
  450  signed contracts or has made substantial progress in
  451  establishing relationships with providers before submitting its
  452  response.
  453         f.Experience in the provision of person-centered planning
  454  as described in 42 C.F.R. s. 441.301(c)(1).
  455         g.Experience in robust provider development programs that
  456  result in increased availability of Medicaid providers to serve
  457  the developmental disabilities community.
  458         2.After negotiations are conducted, the agency shall
  459  select the eligible plans that are determined to be responsive
  460  and provide the best value to the state. Preference must be
  461  given to plans that:
  462         a.Have signed contracts in sufficient numbers to meet the
  463  specific standards established under s. 409.967(2)(c), including
  464  contracts for personal supports, skilled nursing, residential
  465  habilitation, adult day training, mental health services,
  466  respite care, companion services, and supported employment, as
  467  those services are defined in the Florida Medicaid Developmental
  468  Disabilities Individual Budgeting Waiver Services Coverage and
  469  Limitations Handbook as adopted by reference in rule 59G-13.070,
  470  Florida Administrative Code.
  471         b.Have well-defined programs for recognizing patient
  472  centered medical homes and providing increased compensation to
  473  recognized medical homes, as defined by the plan.
  474         c.Have well-defined programs related to person-centered
  475  planning as described in 42 C.F.R. s. 441.301(c)(1).
  476         d.Have robust and innovative programs for provider
  477  development and collaboration with the Agency for Persons with
  478  Disabilities.
  479         (5)PAYMENT.—
  480         (a)The selected plans must receive a per-member, per-month
  481  payment based on a rate developed specifically for the unique
  482  needs of the developmentally disabled population.
  483         (b)The agency must ensure that the rate for the integrated
  484  system is actuarially sound.
  485         (c)The revenues and expenditures of the selected plan
  486  which are associated with the implementation of the pilot
  487  program must be included in the reporting and regulatory
  488  requirements established in s. 409.967(3).
  490         (a)The agency shall select participating plans and begin
  491  enrollment no later than January 31, 2024, with coverage for
  492  enrollees becoming effective upon authorization and availability
  493  of sufficient state and federal resources.
  494         (b)Upon implementation of the program, the agency, in
  495  consultation with the Agency for Persons with Disabilities,
  496  shall conduct audits of the selected plans’ implementation of
  497  person-centered planning.
  498         (c)The agency, in consultation with the Agency for Persons
  499  with Disabilities, shall submit progress reports to the
  500  Governor, the President of the Senate, and the Speaker of the
  501  House of Representatives upon the federal approval,
  502  implementation, and operation of the pilot program, as follows:
  503         1.By December 31, 2023, a status report on progress made
  504  toward federal approval of the waiver or waiver amendment needed
  505  to implement the pilot program.
  506         2.By December 31, 2024, a status report on implementation
  507  of the pilot program.
  508         3.By December 31, 2025, and annually thereafter, a status
  509  report on the operation of the pilot program, including, but not
  510  limited to, all of the following:
  511         a.Program enrollment, including the number and
  512  demographics of enrollees.
  513         b.Any complaints received.
  514         c.Access to approved services.
  515         (d)The agency, in consultation with the Agency for Persons
  516  with Disabilities, shall establish specific measures of access,
  517  quality, and costs of the pilot program. The agency may contract
  518  with an independent evaluator to conduct such evaluation. The
  519  evaluation must include assessments of cost savings; consumer
  520  education, choice, and access to services; plans for future
  521  capacity and the enrollment of new Medicaid providers;
  522  coordination of care; person-centered planning and person
  523  centered well-being outcomes; health and quality-of-life
  524  outcomes; and quality of care by each eligibility category and
  525  managed care plan in each pilot program site. The evaluation
  526  must describe any administrative or legal barriers to the
  527  implementation and operation of the pilot program in each
  528  region.
  529         1.The agency, in consultation with the Agency for Persons
  530  with Disabilities, shall conduct quality assurance monitoring of
  531  the pilot program to include client satisfaction with services,
  532  client health and safety outcomes, client well-being outcomes,
  533  and service delivery in accordance with the client’s care plan.
  534         2.The agency shall submit the results of the evaluation to
  535  the Governor, the President of the Senate, and the Speaker of
  536  the House of Representatives by October 1, 2029.
  537         (7) MANAGED CARE PLAN ACCOUNTABILITY.—Plans participating
  538  in the pilot program must consult with the Agency for Persons
  539  with Disabilities for the express purpose of ensuring adequate
  540  provider capacity before placing an enrollee of the pilot
  541  program in a group home licensed by the Agency for Persons with
  542  Disabilities.
  543         Section 7. The Agency for Health Care Administration shall
  544  distinguish private duty nursing services and attendant nursing
  545  care services from skilled home health services in its Medicaid
  546  provider enrollment process. As of October 1, 2021, the agency
  547  may not require a home health agency that does not provide
  548  Medicaid-skilled home health services and provides only
  549  attendant nursing care services or private duty nursing
  550  services, or both, to meet the requirements of Medicare
  551  certification or its accreditation equivalents for participation
  552  in the Medicaid program.
  553         Section 8. Except as otherwise expressly provided in this
  554  act and except for this section, which shall take effect upon
  555  this act becoming a law, this act shall take effect July 1,
  556  2023.
  558  ================= T I T L E  A M E N D M E N T ================
  559  And the title is amended as follows:
  560         Delete everything before the enacting clause
  561  and insert:
  562                        A bill to be entitled                      
  563         An act relating to health; amending s. 296.37, F.S.;
  564         increasing the income threshold for certain
  565         contributions required by residents of veterans’
  566         nursing homes; amending s. 409.814, F.S.; revising
  567         eligibility conditions for participation in the
  568         Florida Kidcare program; amending s. 409.908, F.S.;
  569         revising the payment methodology for a certain
  570         component of the state Title XIX Long-Term Care
  571         Reimbursement Plan for nursing home care; amending s.
  572         409.909, F.S.; revising the hospitals and qualifying
  573         institutions that are eligible for participation in
  574         the Graduate Medical Education Startup Bonus Program;
  575         establishing the Slots for Doctors Program for a
  576         specified purpose; requiring the Agency for Health
  577         Care Administration to allocate a specified amount to
  578         hospitals and qualifying institutions for certain
  579         newly created resident positions for specified
  580         physician specialties or subspecialties; providing
  581         construction; prohibiting the use of allocated funds
  582         under the program for resident positions that have
  583         previously received certain other funding; amending s.
  584         409.967, F.S.; revising the criteria for determining
  585         achieved savings rebates for purposes of Medicaid
  586         prepaid plans; creating s. 409.9855, F.S.; requiring
  587         the Agency for Health Care Administration to implement
  588         a pilot program for individuals with developmental
  589         disabilities in specified Statewide Medicaid Managed
  590         Care regions to provide coverage of comprehensive
  591         services; authorizing the agency to seek federal
  592         approval as needed to implement the program; requiring
  593         the agency to submit a request for federal approval by
  594         a specified date; requiring the agency to administer
  595         the pilot program in consultation with the Agency for
  596         Persons with Disabilities; requiring the Agency for
  597         Health Care Administration to make specified payments
  598         to certain organizations for comprehensive services
  599         for individuals with developmental disabilities;
  600         providing applicability; requiring the agency to
  601         evaluate the feasibility of implementing a statewide
  602         capitated managed care model used by the pilot program
  603         for certain individuals; providing that participation
  604         in the pilot program is voluntary and subject to
  605         specific appropriation; requiring the Agency for
  606         Persons with Disabilities to approve a needs
  607         assessment methodology to determine certain needs for
  608         prospective enrollees; providing program enrollment
  609         eligibility requirements; requiring that enrollees be
  610         afforded an opportunity to enroll in any appropriate
  611         existing Medicaid waiver program under certain
  612         circumstances; requiring participating plans to cover
  613         specified benefits; providing requirements for
  614         providers of services; providing eligibility
  615         requirements for plans; providing a selection process;
  616         requiring the Agency for Health Care Administration to
  617         give preference to certain plans; requiring that plan
  618         payments be based on rates specifically developed for
  619         a certain population; requiring the agency to ensure
  620         that the rate be actuarially sound; requiring that the
  621         revenues and expenditures of the selected plan be
  622         included in specified reporting and regulatory
  623         requirements; requiring the agency to select
  624         participating plans and begin enrollment by a
  625         specified date; requiring the agency, in consultation
  626         with the Agency for Persons with Disabilities, to
  627         conduct certain audits of the selected plans’
  628         implementation of person-centered planning and to
  629         submit specified progress reports to the Governor and
  630         the Legislature by specified dates throughout the
  631         program approval and implementation process; providing
  632         requirements for the respective reports; requiring the
  633         Agency for Health Care Administration, in consultation
  634         with the Agency for Persons with Disabilities, to
  635         conduct an evaluation of the pilot program;
  636         authorizing the Agency for Health Care Administration
  637         to contract with an independent evaluator to conduct
  638         such evaluation; providing requirements for the
  639         evaluation; requiring the Agency for Health Care
  640         Administration, in consultation with the Agency for
  641         Persons with Disabilities, to conduct quality
  642         assurance monitoring of the pilot program; requiring
  643         the Agency for Health Care Administration to submit
  644         the results of the evaluation to the Governor and the
  645         Legislature by a specified date; requiring
  646         participating plans to consult with the Agency for
  647         Persons with Disabilities regarding capacity limits;
  648         requiring the Agency for Health Care Administration to
  649         distinguish certain services in its Medicaid provider
  650         enrollment process; prohibiting the agency from
  651         requiring certain home health agencies to meet certain
  652         requirements for participation in the Medicaid
  653         program; providing effective dates.