Florida Senate - 2023                                    SB 2510
       By the Committee on Appropriations
       576-03180-23                                          20232510__
    1                        A bill to be entitled                      
    2         An act relating to health; amending s. 296.37, F.S.;
    3         increasing the income threshold for certain
    4         contributions required by residents of veterans’
    5         nursing homes; amending s. 409.814, F.S.; revising
    6         eligibility conditions for participation in the
    7         Florida Kidcare program; amending s. 409.908, F.S.;
    8         revising the payment methodology for a certain
    9         component of the state Title XIX Long-Term Care
   10         Reimbursement Plan for nursing home care; amending s.
   11         409.909, F.S.; establishing the Slots for Doctors
   12         Program for a specified purpose; requiring the Agency
   13         for Health Care Administration to allocate a specified
   14         amount to hospitals and qualifying institutions for
   15         certain newly created resident positions for specified
   16         physician specialties or subspecialties; providing
   17         construction; prohibiting the use of allocated funds
   18         under the program for resident positions that have
   19         previously received certain other funding; amending s.
   20         409.967, F.S.; revising the criteria for determining
   21         achieved savings rebates for purposes of Medicaid
   22         prepaid plans; amending s. 430.204, F.S.; authorizing
   23         area agencies on aging to carry forward a specified
   24         percentage of documented unexpended state funds to a
   25         subsequent fiscal year, subject to certain conditions;
   26         requiring the remainder of such state funds to be
   27         returned to the Department of Elderly Affairs;
   28         providing an effective date.
   30  Be It Enacted by the Legislature of the State of Florida:
   32         Section 1. Subsection (1) of section 296.37, Florida
   33  Statutes, is amended to read:
   34         296.37 Residents; contribution to support.—
   35         (1) Every resident of the home who receives a pension,
   36  compensation, or gratuity from the United States Government, or
   37  income from any other source of more than $160 $130 per month,
   38  shall contribute to his or her maintenance and support while a
   39  resident of the home in accordance with a schedule of payment
   40  determined by the administrator and approved by the director.
   41  The total amount of such contributions shall be to the fullest
   42  extent possible but may not exceed the actual cost of operating
   43  and maintaining the home.
   44         Section 2. Subsection (7) of section 409.814, Florida
   45  Statutes, is amended to read:
   46         409.814 Eligibility.—A child who has not reached 19 years
   47  of age whose family income is equal to or below 200 percent of
   48  the federal poverty level is eligible for the Florida Kidcare
   49  program as provided in this section. If an enrolled individual
   50  is determined to be ineligible for coverage, he or she must be
   51  immediately disenrolled from the respective Florida Kidcare
   52  program component.
   53         (7) A child whose family income is above 200 percent of the
   54  federal poverty level or a child who is excluded under the
   55  provisions of subsection (5) may participate in the Florida
   56  Kidcare program as provided in s. 409.8132 or, if the child is
   57  ineligible for Medikids by reason of age, in the Florida Healthy
   58  Kids program, subject to the following:
   59         (a) The family is not eligible for premium assistance
   60  payments and must pay the full cost of the combined-risk
   61  premium, including any administrative costs.
   62         (b) The board of directors of the Florida Healthy Kids
   63  Corporation may offer a reduced benefit package to these
   64  children in order to limit program costs for such families.
   65         Section 3. Paragraph (b) of subsection (2) of section
   66  409.908, Florida Statutes, is amended to read:
   67         409.908 Reimbursement of Medicaid providers.—Subject to
   68  specific appropriations, the agency shall reimburse Medicaid
   69  providers, in accordance with state and federal law, according
   70  to methodologies set forth in the rules of the agency and in
   71  policy manuals and handbooks incorporated by reference therein.
   72  These methodologies may include fee schedules, reimbursement
   73  methods based on cost reporting, negotiated fees, competitive
   74  bidding pursuant to s. 287.057, and other mechanisms the agency
   75  considers efficient and effective for purchasing services or
   76  goods on behalf of recipients. If a provider is reimbursed based
   77  on cost reporting and submits a cost report late and that cost
   78  report would have been used to set a lower reimbursement rate
   79  for a rate semester, then the provider’s rate for that semester
   80  shall be retroactively calculated using the new cost report, and
   81  full payment at the recalculated rate shall be effected
   82  retroactively. Medicare-granted extensions for filing cost
   83  reports, if applicable, shall also apply to Medicaid cost
   84  reports. Payment for Medicaid compensable services made on
   85  behalf of Medicaid-eligible persons is subject to the
   86  availability of moneys and any limitations or directions
   87  provided for in the General Appropriations Act or chapter 216.
   88  Further, nothing in this section shall be construed to prevent
   89  or limit the agency from adjusting fees, reimbursement rates,
   90  lengths of stay, number of visits, or number of services, or
   91  making any other adjustments necessary to comply with the
   92  availability of moneys and any limitations or directions
   93  provided for in the General Appropriations Act, provided the
   94  adjustment is consistent with legislative intent.
   95         (2)
   96         (b) Subject to any limitations or directions in the General
   97  Appropriations Act, the agency shall establish and implement a
   98  state Title XIX Long-Term Care Reimbursement Plan for nursing
   99  home care in order to provide care and services in conformance
  100  with the applicable state and federal laws, rules, regulations,
  101  and quality and safety standards and to ensure that individuals
  102  eligible for medical assistance have reasonable geographic
  103  access to such care.
  104         1. The agency shall amend the long-term care reimbursement
  105  plan and cost reporting system to create direct care and
  106  indirect care subcomponents of the patient care component of the
  107  per diem rate. These two subcomponents together shall equal the
  108  patient care component of the per diem rate. Separate prices
  109  shall be calculated for each patient care subcomponent,
  110  initially based on the September 2016 rate setting cost reports
  111  and subsequently based on the most recently audited cost report
  112  used during a rebasing year. The direct care subcomponent of the
  113  per diem rate for any providers still being reimbursed on a cost
  114  basis shall be limited by the cost-based class ceiling, and the
  115  indirect care subcomponent may be limited by the lower of the
  116  cost-based class ceiling, the target rate class ceiling, or the
  117  individual provider target. The ceilings and targets apply only
  118  to providers being reimbursed on a cost-based system. Effective
  119  October 1, 2018, a prospective payment methodology shall be
  120  implemented for rate setting purposes with the following
  121  parameters:
  122         a. Peer Groups, including:
  123         (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
  124  Counties; and
  125         (II) South-SMMC Regions 10-11, plus Palm Beach and
  126  Okeechobee Counties.
  127         b. Percentage of Median Costs based on the cost reports
  128  used for September 2016 rate setting:
  129         (I) Direct Care Costs........................100 percent.
  130         (II) Indirect Care Costs......................92 percent.
  131         (III) Operating Costs.........................86 percent.
  132         c. Floors:
  133         (I) Direct Care Component.....................95 percent.
  134         (II) Indirect Care Component................92.5 percent.
  135         (III) Operating Component...........................None.
  136         d. Pass-through Payments..................Real Estate and
  137  ...............................................Personal Property
  138  ...................................Taxes and Property Insurance.
  139         e. Quality Incentive Program Payment
  140  Pool...................................10 6 percent of September
  141  .......................................2016 non-property related
  142  ................................payments of included facilities.
  143         f. Quality Score Threshold to Quality for Quality Incentive
  144  Payment..................20th percentile of included facilities.
  145         g. Fair Rental Value System Payment Parameters:
  146         (I) Building Value per Square Foot based on 2018 RS Means.
  147         (II) Land Valuation...10 percent of Gross Building value.
  148         (III) Facility Square Footage......Actual Square Footage.
  149         (IV) Moveable Equipment Allowance.........$8,000 per bed.
  150         (V) Obsolescence Factor......................1.5 percent.
  151         (VI) Fair Rental Rate of Return................8 percent.
  152         (VII) Minimum Occupancy.......................90 percent.
  153         (VIII) Maximum Facility Age.....................40 years.
  154         (IX) Minimum Square Footage per Bed..................350.
  155         (X) Maximum Square Footage for Bed...................500.
  156         (XI) Minimum Cost of a renovation/replacements$500 per bed.
  157         h. Ventilator Supplemental payment of $200 per Medicaid day
  158  of 40,000 ventilator Medicaid days per fiscal year.
  159         2. The direct care subcomponent shall include salaries and
  160  benefits of direct care staff providing nursing services
  161  including registered nurses, licensed practical nurses, and
  162  certified nursing assistants who deliver care directly to
  163  residents in the nursing home facility, allowable therapy costs,
  164  and dietary costs. This excludes nursing administration, staff
  165  development, the staffing coordinator, and the administrative
  166  portion of the minimum data set and care plan coordinators. The
  167  direct care subcomponent also includes medically necessary
  168  dental care, vision care, hearing care, and podiatric care.
  169         3. All other patient care costs shall be included in the
  170  indirect care cost subcomponent of the patient care per diem
  171  rate, including complex medical equipment, medical supplies, and
  172  other allowable ancillary costs. Costs may not be allocated
  173  directly or indirectly to the direct care subcomponent from a
  174  home office or management company.
  175         4. On July 1 of each year, the agency shall report to the
  176  Legislature direct and indirect care costs, including average
  177  direct and indirect care costs per resident per facility and
  178  direct care and indirect care salaries and benefits per category
  179  of staff member per facility.
  180         5. Every fourth year, the agency shall rebase nursing home
  181  prospective payment rates to reflect changes in cost based on
  182  the most recently audited cost report for each participating
  183  provider.
  184         6. A direct care supplemental payment may be made to
  185  providers whose direct care hours per patient day are above the
  186  80th percentile and who provide Medicaid services to a larger
  187  percentage of Medicaid patients than the state average.
  188         7. For the period beginning on October 1, 2018, and ending
  189  on September 30, 2021, the agency shall reimburse providers the
  190  greater of their September 2016 cost-based rate or their
  191  prospective payment rate. Effective October 1, 2021, the agency
  192  shall reimburse providers the greater of 95 percent of their
  193  cost-based rate or their rebased prospective payment rate, using
  194  the most recently audited cost report for each facility. This
  195  subparagraph shall expire September 30, 2023.
  196         8. Pediatric, Florida Department of Veterans Affairs, and
  197  government-owned facilities are exempt from the pricing model
  198  established in this subsection and shall remain on a cost-based
  199  prospective payment system. Effective October 1, 2018, the
  200  agency shall set rates for all facilities remaining on a cost
  201  based prospective payment system using each facility’s most
  202  recently audited cost report, eliminating retroactive
  203  settlements.
  205  It is the intent of the Legislature that the reimbursement plan
  206  achieve the goal of providing access to health care for nursing
  207  home residents who require large amounts of care while
  208  encouraging diversion services as an alternative to nursing home
  209  care for residents who can be served within the community. The
  210  agency shall base the establishment of any maximum rate of
  211  payment, whether overall or component, on the available moneys
  212  as provided for in the General Appropriations Act. The agency
  213  may base the maximum rate of payment on the results of
  214  scientifically valid analysis and conclusions derived from
  215  objective statistical data pertinent to the particular maximum
  216  rate of payment. The agency shall base the rates of payments in
  217  accordance with the minimum wage requirements as provided in the
  218  General Appropriations Act.
  219         Section 4. Present subsections (6) and (7) of section
  220  409.909, Florida Statutes, are redesignated as subsections (7)
  221  and (8), respectively, and a new subsection (6) is added to that
  222  section, to read:
  223         409.909 Statewide Medicaid Residency Program.—
  224         (6) The Slots for Doctors Program is established to address
  225  the physician workforce shortage by increasing the supply of
  226  highly trained physicians through the creation of new resident
  227  positions, which will increase access to care and improve health
  228  outcomes for Medicaid recipients.
  229         (a) The agency shall allocate $100,000 to hospitals and
  230  qualifying institutions for each newly created resident position
  231  that is accredited by the Accreditation Council for Graduate
  232  Medical Education or the Osteopathic Postdoctoral Training
  233  Institution in an initial or established accredited training
  234  program which is in a physician specialty or subspecialty in a
  235  statewide supply-and-demand deficit.
  236         (b) This program is designed to generate matching funds
  237  under Medicaid and distribute such funds to participating
  238  hospitals and qualifying institutions on a quarterly basis in
  239  each fiscal year for which an appropriation is made.
  240         (c) For purposes of this subsection, physician specialties
  241  and subspecialties, both adult and pediatric, in statewide
  242  supply-and-demand deficit are those identified as such in the
  243  General Appropriations Act.
  244         (d) Funds allocated pursuant to this subsection may not be
  245  used for resident positions that have previously received
  246  funding pursuant to subsection (1).
  247         Section 5. Paragraph (f) of subsection (3) of section
  248  409.967, Florida Statutes, is amended to read:
  249         409.967 Managed care plan accountability.—
  250         (3) ACHIEVED SAVINGS REBATE.—
  251         (f) Achieved savings rebates validated by the certified
  252  public accountant are due within 30 days after the report is
  253  submitted. Except as provided in paragraph (h), the achieved
  254  savings rebate is established by determining pretax income as a
  255  percentage of revenues and applying the following income sharing
  256  ratios:
  257         1. One hundred percent of income up to and including 5
  258  percent of revenue shall be retained by the plan.
  259         2. Fifty percent of income above 5 percent and up to 10
  260  percent shall be retained by the plan, and the other 50 percent
  261  shall be refunded to the state and adjusted for the Federal
  262  Medical Assistance Percentages. The state share shall be
  263  transferred to the General Revenue Fund, unallocated, and the
  264  federal share shall be transferred to the Medical Care Trust
  265  Fund, unallocated.
  266         3. One hundred percent of income above 10 percent of
  267  revenue shall be refunded to the state and adjusted for the
  268  Federal Medical Assistance Percentages. The state share shall be
  269  transferred to the General Revenue Fund, unallocated, and the
  270  federal share shall be transferred to the Medical Care Trust
  271  Fund, unallocated.
  272         Section 6. Subsection (10) is added to section 430.204,
  273  Florida Statutes, to read:
  274         430.204 Community-care-for-the-elderly core services;
  275  departmental powers and duties.—
  276         (10) An area agency on aging may carry forward documented
  277  unexpended state funds from one fiscal year to the next;
  278  however, the cumulative amount carried forward may not exceed 10
  279  percent of the area agency’s planning and service area
  280  allocation for the community care for the elderly program. Any
  281  unexpended state funds in excess of that percentage must be
  282  returned to the department.
  283         (a)The funds carried forward may not be used in any manner
  284  that would create increased recurring future obligations, and
  285  such funds may not be used for any type of program or service
  286  that is not currently authorized by existing contracts.
  287         (b) Expenditures of funds carried forward must be
  288  separately reported to the department.
  289         (c)Any unexpended funds that remain at the end of the
  290  contract period must be returned to the department.
  291         (d)Funds carried forward may be retained through any
  292  contract renewals and any new procurements as long as the same
  293  area agency on aging is retained by the department.
  294         Section 7. This act shall take effect July 1, 2023.