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