CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
CHAMBER ACTION
Senate House
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5 ORIGINAL STAMP BELOW
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11 Representative(s) Albright offered the following:
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13 Amendment (with title amendment)
14 Remove from the bill: Everything after the enacting clause
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16 and insert in lieu thereof:
17 Section 1. The Legislature finds that the provisions
18 of this act which amend ss. 154.301 through 154.316, Florida
19 Statutes, fulfill the important state interest of promoting
20 the legislative intent of the Florida Health Care
21 Responsibility Act, as that intent is expressed in s. 154.302,
22 Florida Statutes.
23 Section 2. Section 154.301, Florida Statutes, is
24 amended to read:
25 154.301 Short title.--Sections 154.301-154.316 may be
26 cited as "The Florida Health Care Responsibility Act of 1988."
27 Section 3. Section 154.302, Florida Statutes, is
28 amended to read:
29 154.302 Legislative intent.--The Legislature finds
30 that certain hospitals provide a disproportionate share of
31 charity care for persons who are indigent, and not able to pay
1
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 their medical bills, and who are not eligible for
2 government-funded programs. The burden of absorbing the cost
3 of this uncompensated charity care is borne by the hospital,
4 the private pay patients, and, many times, by the taxpayers in
5 the county when the hospital is subsidized by tax revenues.
6 The Legislature further finds that it is inequitable for
7 hospitals and taxpayers of one county to be expected to
8 subsidize the care of out-of-county indigent persons. Finally,
9 the Legislature declares that the state and the counties must
10 share the responsibility of assuring that adequate and
11 affordable health care is available to all Floridians.
12 Therefore, it is the intent of the Legislature to place the
13 ultimate financial obligation for the out-of-county hospital
14 care of qualified indigent patients on the county in which the
15 indigent patient resides.
16 Section 4. Section 154.304, Florida Statutes, is
17 amended to read:
18 154.304 Definitions.--As used in this part, the term
19 For the purpose of this act:
20 (1) "Agency" means the Agency for Health Care
21 Administration.
22 (1) "Board" means the Health Care Board as established
23 in chapter 408.
24 (2) "Certification determination procedures" means the
25 process used by the county of residence or the agency
26 department to determine a person's county of residence.
27 (3) "Certified resident" means a United States citizen
28 or lawfully admitted alien who has been certified as a
29 resident of the county by a person designated by the county
30 governing body to provide certification determination
31 procedures for the county in which the patient resides; by the
2
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 agency department if such county does not make a determination
2 of residency within 60 days after of receiving a certified
3 letter from the treating hospital; or by the agency department
4 if the hospital appeals the decision of the county making such
5 determination.
6 (4) "Charity care obligation" means the minimum amount
7 of uncompensated charity care as reported to the agency for
8 Health Care Administration, based on the hospital's most
9 recent audited actual experience, which must be provided by a
10 participating hospital or a regional referral hospital before
11 the hospital is eligible to be reimbursed by a county under
12 the provisions of this part act. That amount shall be the
13 ratio of uncompensated charity care days compared to total
14 acute care inpatient days, which shall be equal to or greater
15 than 2 percent.
16 (5) "Department" means the Department of Health.
17 (6) "Eligibility determination procedures" means the
18 process used by a county or the agency department to evaluate
19 a person's financial eligibility, eligibility for state-funded
20 or federally funded programs, and the availability of
21 insurance, in order to document a person as a qualified
22 indigent for the purpose of this part act.
23 (7) "Hospital," for the purposes of this act, means an
24 establishment as defined in s. 395.002 and licensed by the
25 agency department which qualifies as either a participating
26 hospital or as a regional referral hospital pursuant to this
27 section; except that, hospitals operated by the department
28 shall not be considered participating hospitals for purposes
29 of this part act.
30 (8) "Participating hospital" means a hospital which is
31 eligible to receive reimbursement under the provisions of this
3
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 part act because it has been certified by the agency board as
2 having met its charity care obligation and has either:
3 (a) A formal signed agreement with a county or
4 counties to treat such county's indigent patients; or
5 (b) Demonstrated to the agency board that at least 2.5
6 percent of its uncompensated charity care, as reported to the
7 agency board, is generated by out-of-county residents.
8 (9) "Qualified indigent person" or "qualified indigent
9 patient" means a person who has been determined pursuant to s.
10 154.308 to have an average family income, for the 12 months
11 preceding the determination, which is below 100 percent of the
12 federal nonfarm poverty level; who is not eligible to
13 participate in any other government program that which
14 provides hospital care; who has no private insurance or has
15 inadequate private insurance; and who does not reside in a
16 public institution as defined under the medical assistance
17 program for the needy under Title XIX of the Social Security
18 Act, as amended.
19 (10) "Regional referral hospital" means any hospital
20 that which is eligible to receive reimbursement under the
21 provision of this part act because it has met its charity care
22 obligation and it meets the definition of teaching hospital as
23 defined in s. 408.07.
24 Section 5. Section 154.306, Florida Statutes, is
25 amended to read:
26 154.306 Financial responsibility for certified
27 residents who are qualified indigent patients treated at an
28 out-of-county participating hospital or regional referral
29 hospital.--Ultimate financial responsibility for treatment
30 received at a participating hospital or a regional referral
31 hospital by a qualified indigent patient who is a certified
4
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 resident of a county in the State of Florida, but is not a
2 resident of the county in which the participating hospital or
3 regional referral hospital is located, is shall be the
4 obligation of the county of which the qualified indigent
5 patient is a resident. Each county shall is directed to
6 reimburse participating hospitals or regional referral
7 hospitals as provided for in this part act, and shall provide
8 or arrange for indigent eligibility determination procedures
9 and resident certification determination procedures as
10 provided for in rules developed to implement this part act.
11 The agency department, or any county determining eligibility
12 of a qualified indigent, shall provide to the county of
13 residence, upon request, a copy of any documents, forms, or
14 other information, as determined by rule, which may be used in
15 making an eligibility determination.
16 (1) A county's financial obligation for each certified
17 resident who qualifies as an indigent patient under this part
18 act, and who has received treatment at an out-of-county
19 hospital, shall not exceed 45 days per county fiscal year at a
20 rate of payment equivalent to 100 percent of the per diem
21 reimbursement rate currently in effect for the out-of-county
22 hospital under the medical assistance program for the needy
23 under Title XIX of the Social Security Act, as amended, except
24 that those counties that are at their 10-mill cap on October
25 1, 1991, shall reimburse hospitals for such services at not
26 less than 80 percent of the hospital Medicaid per diem.
27 However, nothing in this section shall preclude a hospital
28 that which has a formal signed agreement with a county to
29 treat such county's indigents from negotiating a higher or
30 lower per diem rate with the county. In addition, No county
31 shall be required by this act to pay more than the equivalent
5
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 of $4 per capita in the county's fiscal year. The agency
2 department shall calculate and certify to each county by March
3 1 of each year, the maximum amount the county may be required
4 to pay under this act by multiplying the most recent official
5 state population estimate for the total population of the
6 county by $4 per capita. Each county shall certify to the
7 agency department within 60 days after of the end of the
8 county's fiscal year, or upon reaching the $4 per capita
9 threshold, should that occur before the end of the fiscal
10 year, the amount of reimbursement it paid to all out-
11 of-county hospitals under this part act. The maximum amount a
12 county may be required to pay to out-of-county hospitals for
13 care provided to qualified indigent residents may be reduced
14 by up to one-half, provided that the amount not paid has or is
15 being spent for in-county hospital care provided to qualified
16 indigent residents.
17 (2) No county shall be required to pay for any
18 elective or nonemergency admissions or services at an
19 out-of-county hospital for a qualified indigent who is a
20 certified resident of the county if when the county provides
21 funding for such services and the services are available at a
22 local hospital in the county where the indigent resides; or
23 the out-of-county hospital has not obtained prior written
24 authorization and approval for such hospital admission or
25 service, provided that the resident county has established a
26 procedure to authorize and approve such admissions.
27 (3) The county where the indigent resides shall, in
28 all instances, be liable for the cost of treatment provided to
29 a qualified indigent patient at an out-of-county hospital for
30 any emergency medical condition which will deteriorate from
31 failure to provide such treatment if and when such condition
6
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 is determined and documented by the attending physician to be
2 of an emergency nature; provided that the patient has been
3 certified to be a resident of such county pursuant to s.
4 154.309.
5 (4) No county shall be liable for payment for
6 treatment of a qualified indigent who is a certified resident
7 and has received services at an out-of-county participating
8 hospital or regional referral hospital, until such time as
9 that hospital has documented to the agency board and the
10 agency board has determined that it has met its charity care
11 obligation based on the most recent audited actual experience.
12 Section 6. Section 154.308, Florida Statutes, is
13 amended to read:
14 154.308 Determination of patient's eligibility;
15 spend-down program.--
16 (1) The agency department, pursuant to s. 154.3105,
17 shall adopt rules which provide statewide eligibility
18 determination procedures, forms, and criteria which shall be
19 used by all counties for determining whether a person
20 financially qualifies as indigent for the purposes of this
21 part act.
22 (a) The criteria used to determine eligibility must
23 shall be uniform statewide and shall include, at a minimum,
24 which assets, if any, may be included in the determination,
25 which verification of income shall be required, which
26 categories of persons shall be eligible, and any other
27 criteria which may be determined as necessary.
28 (b) The methodology for determining by which to
29 determine financial eligibility must shall also be uniform
30 statewide such that any county or the state could determine
31 whether a person is would be a qualified indigent under this
7
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 act.
2 (2) Determination of financial eligibility as a
3 qualified indigent may occur either prior to a person's
4 admission to a participating hospital or a regional referral
5 hospital or subsequent to such admission.
6 (3) Determination of whether a hospital patient not
7 already determined eligible meets or does not meet eligibility
8 standards to financially qualify as indigent for the purpose
9 of this act shall be made within 60 days following
10 notification by the hospital requesting a determination of
11 indigency, by certified letter, to the county known or
12 believed to be the county of residence or to the agency
13 department. If, for any reason, the county or agency
14 department is unable to determine a patient's eligibility
15 within the allotted timeframe, the hospital shall be notified
16 in writing of the reason or reasons.
17 (4) A patient determined eligible as a qualified
18 indigent for the purpose of this act subsequent to his or her
19 admission to a participating hospital or a regional referral
20 hospital shall be considered to have been qualified upon
21 admission. Such determination shall be made by a person
22 designated by the governing board of the county to make such a
23 determination or by the agency department.
24 (5) Notwithstanding any other provision of this part
25 within this act, any county may establish thresholds of
26 financial eligibility to qualify indigents under this act
27 which are less restrictive than 100 percent of the federal
28 poverty line. However, a no county may not establish
29 eligibility thresholds which are more restrictive than 100
30 percent of the federal poverty line.
31 (6) Notwithstanding any other provision of this part
8
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 act, there is hereby established a spend-down program for
2 persons who would otherwise qualify as qualified indigent
3 persons, but whose average family income, for the 12 months
4 preceding the determination, is between 100 percent and 150
5 percent of the federal poverty level. The agency department
6 shall adopt, by rule, procedures for the spend-down program.
7 The rule shall require that in order to qualify for the
8 spend-down program, a person must have incurred bills for
9 hospital care which would otherwise have qualified for payment
10 under this part. This subsection does not apply to persons
11 who are residents of counties that are at their 10-mill cap on
12 October 1, 1991.
13 Section 7. Section 154.309, Florida Statutes, is
14 amended to read:
15 154.309 Certification of county of residence.--
16 (1) The agency department, pursuant to s. 154.3105,
17 shall adopt rules for certification determination procedures
18 which provide criteria to be used for determining a qualified
19 indigent's county of residence. Such criteria must shall
20 include, at a minimum, how and to what extent residency shall
21 be verified and how a hospital shall be notified of a
22 patient's certification or the inability to certify a patient.
23 (2) In all instances, the county known or thought to
24 be the county of residence shall be given first opportunity to
25 certify a resident. If the county known or thought to be the
26 county of residence fails to, or is unable to, make such
27 determination within 60 days following written notification by
28 a hospital, the agency department shall determine residency
29 utilizing the same criteria required by rule as the county,
30 and the agency's department's determination of residency shall
31 be binding on the county of residence. The county determined
9
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 as the residence of any qualified indigent under this act
2 shall be liable to reimburse the treating hospital pursuant to
3 s. 154.306. If, for any reason, a county or the agency
4 department is unable to determine an indigent's residency, the
5 hospital shall be notified in writing of such reason or
6 reasons.
7 Section 8. Section 154.31, Florida Statutes, is
8 amended to read:
9 154.31 Obligation of participating hospital or
10 regional referral hospital.--As a condition of participation
11 accepting the procedures of this act, each participating
12 hospital or regional referral hospital in Florida shall be
13 obligated to admit for emergency treatment all Florida
14 residents, without regard to county of residence, who meet the
15 eligibility standards established pursuant to s. 154.308 and
16 who meet the medical standards for admission to such
17 institutions. If the agency department determines that a
18 participating hospital or a regional referral hospital has
19 failed to meet the requirements of this section, the agency
20 department may impose an administrative fine, not to exceed
21 $5,000 per incident, and suspend the hospital from eligibility
22 for reimbursement under the provisions of this part act.
23 Section 9. Section 154.3105, Florida Statutes, is
24 amended to read:
25 154.3105 Rules.--Rules governing the Health Care
26 Responsibility Act of 1988 shall be developed by the agency
27 department based on recommendations of a work group consisting
28 of equal representation by the agency department, the hospital
29 industry, and the counties. County representatives to this
30 work group shall be appointed by the Florida Association of
31 Counties. Hospital representatives to this work group shall
10
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Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 be appointed by the associations representing those hospitals
2 which best represent the positions of the hospitals most
3 likely to be eligible for reimbursement. Rules governing the
4 various aspects of this part act shall be adopted by the
5 agency. department. Such rules shall address, at a minimum:
6 (1) Eligibility determination procedures and criteria.
7 (2) Certification determination procedures and methods
8 of notification to hospitals.
9 Section 10. Section 154.312, Florida Statutes, is
10 amended to read:
11 154.312 Procedure for settlement of disputes.--All
12 disputes among counties, the board, the agency department, a
13 participating hospital, or a regional referral hospital shall
14 be resolved by order as provided in chapter 120. Hearings held
15 under this provision shall be conducted in the same manner as
16 provided in ss. 120.569 and 120.57, except that the presiding
17 officer's order shall be final agency action. Cases filed
18 under chapter 120 may combine all disputes between parties.
19 Notwithstanding any other provisions of this part, if when a
20 county alleges that a residency determination or eligibility
21 determination made by the agency department is incorrect, the
22 burden of proof shall be on the county to demonstrate that
23 such determination is, in light of the total record, not
24 supported by the evidence.
25 Section 11. Section 154.314, Florida Statutes, is
26 amended to read:
27 154.314 Certification of the State of Florida.--
28 (1) In the event payment for the costs of services
29 rendered by a participating hospital or a regional referral
30 hospital is not received from the responsible county within 90
31 days of receipt of a statement for services rendered to a
11
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 qualified indigent who is a certified resident of the county,
2 or if the payment is disputed and said payment is not received
3 from the county determined to be responsible within 60 days of
4 the date of exhaustion of all administrative and legal
5 remedies as provided in chapter 120, the hospital shall
6 certify to the Comptroller the amount owed by the county.
7 (2) The Comptroller shall have no not longer than 45
8 days from the date of receiving the hospital's certified
9 notice to forward the amount delinquent to the appropriate
10 hospital from any funds due to the county under any
11 revenue-sharing or tax-sharing fund established by the state,
12 except as otherwise provided by the State Constitution. The
13 Comptroller shall provide the Governor and the fiscal
14 appropriations and finance and tax committees in the House of
15 Representatives and the Senate with a quarterly accounting of
16 the amounts certified by hospitals as owed by counties and the
17 amount paid to hospitals out of any revenue or tax sharing
18 funds due to the county.
19 Section 12. Section 154.316, Florida Statutes, is
20 amended to read:
21 154.316 Hospital's responsibility to notify of
22 admission of indigent patients.--
23 (1) Any hospital admitting or treating any
24 out-of-county patient who may qualify as indigent under this
25 part act shall, within 30 10 days after admitting or treating
26 such patient, notify the county known, or thought to be, the
27 county of residency of such admission, or such hospital
28 forfeits its right to reimbursement.
29 (2) It shall be the responsibility of any
30 participating hospital or regional referral hospital to
31 initiate any eligibility or certification determination
12
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Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 procedures with any appropriate state or county agency which
2 can determine financial eligibility or certify an indigent as
3 a resident under this part act.
4 Section 13. Subsection (1) of section 154.504, Florida
5 Statutes, is amended to read:
6 154.504 Eligibility and benefits.--
7 (1) Any county or counties may apply for a primary
8 care for children and families challenge grant to provide
9 primary health care services to children and families with
10 incomes of up to 150 percent of the federal poverty level.
11 Participants shall pay no monthly premium for participation,
12 but shall be required to pay a copayment at the time a service
13 is provided. Copayments may be paid from sources other than
14 the participant, including, but not limited to, the child's or
15 parent's employer, or other private sources. As used in s.
16 766.1115, the term "copayment" may not be considered and may
17 not be used as compensation for services to health care
18 providers, and all funds generated from copayments shall be
19 used by the governmental contractor.
20 Section 14. Section 198.30, Florida Statutes, is
21 amended to read:
22 198.30 Circuit judge to furnish department with names
23 of decedents, etc.--Each circuit judge of this state shall, on
24 or before the 10th day of every month, notify the department
25 of the names of all decedents; the names and addresses of the
26 respective personal representatives, administrators, or
27 curators appointed; the amount of the bonds, if any, required
28 by the court; and the probable value of the estates, in all
29 estates of decedents whose wills have been probated or
30 propounded for probate before the circuit judge or upon which
31 letters testamentary or upon whose estates letters of
13
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 administration or curatorship have been sought or granted,
2 during the preceding month; and such report shall contain any
3 other information which the circuit judge may have concerning
4 the estates of such decedents. In addition, a copy of this
5 report shall be provided to the Agency for Health Care
6 Administration. A circuit judge shall also furnish forthwith
7 such further information, from the records and files of the
8 circuit court in regard to such estates, as the department may
9 from time to time require.
10 Section 15. Section 240.4075, Florida Statutes, is
11 amended to read:
12 240.4075 Nursing Student Loan Forgiveness Program.--
13 (1) To encourage qualified personnel to seek
14 employment in areas of this state in which critical nursing
15 shortages exist, there is established the Nursing Student Loan
16 Forgiveness Program. The primary function of the program is
17 to increase employment and retention of registered nurses and
18 licensed practical nurses in nursing homes and hospitals in
19 the state and in state-operated medical and health care
20 facilities, birth centers, federally sponsored community
21 health centers and teaching hospitals by making repayments
22 toward loans received by students from federal or state
23 programs or commercial lending institutions for the support of
24 postsecondary study in accredited or approved nursing
25 programs.
26 (2) To be eligible, a candidate must have graduated
27 from an accredited or approved nursing program and have
28 received a Florida license as a licensed practical nurse or a
29 registered nurse or a Florida certificate as an advanced
30 registered nurse practitioner.
31 (3) Only loans to pay the costs of tuition, books, and
14
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Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 living expenses shall be covered, at an amount not to exceed
2 $4,000 for each year of education towards the degree obtained.
3 (4) Receipt of funds pursuant to this program shall be
4 contingent upon continued proof of employment in the
5 designated facilities in this state. Loan principal payments
6 shall be made by the Department of Education Health directly
7 to the federal or state programs or commercial lending
8 institutions holding the loan as follows:
9 (a) Twenty-five percent of the loan principal and
10 accrued interest shall be retired after the first year of
11 nursing;
12 (b) Fifty percent of the loan principal and accrued
13 interest shall be retired after the second year of nursing;
14 (c) Seventy-five percent of the loan principal and
15 accrued interest shall be retired after the third year of
16 nursing; and
17 (d) The remaining loan principal and accrued interest
18 shall be retired after the fourth year of nursing.
19
20 In no case may payment for any nurse exceed $4,000 in any
21 12-month period.
22 (5) There is created the Nursing Student Loan
23 Forgiveness Trust Fund to be administered by the Department of
24 Education Health pursuant to this section and s. 240.4076 and
25 department rules. The Comptroller shall authorize
26 expenditures from the trust fund upon receipt of vouchers
27 approved by the Department of Education Health. All moneys
28 collected from the private health care industry and other
29 private sources for the purposes of this section shall be
30 deposited into the Nursing Student Loan Forgiveness Trust
31 Fund. Any balance in the trust fund at the end of any fiscal
15
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Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 year shall remain therein and shall be available for carrying
2 out the purposes of this section and s. 240.4076.
3 (6) In addition to licensing fees imposed under
4 chapter 464, there is hereby levied and imposed an additional
5 fee of $5, which fee shall be paid upon licensure or renewal
6 of nursing licensure. Revenues collected from the fee imposed
7 in this subsection shall be deposited in the Nursing Student
8 Loan Forgiveness Trust Fund of the Department of Education
9 Health and will be used solely for the purpose of carrying out
10 the provisions of this section and s. 240.4076. Up to 50
11 percent of the revenues appropriated to implement this
12 subsection may be used for the nursing scholarship program
13 established pursuant to s. 240.4076.
14 (7)(a) Funds contained in the Nursing Student Loan
15 Forgiveness Trust Fund which are to be used for loan
16 forgiveness for those nurses employed by hospitals, birth
17 centers, and nursing homes must be matched on a
18 dollar-for-dollar basis by contributions from the employing
19 institutions, except that this provision shall not apply to
20 state-operated medical and health care facilities, county
21 health departments, federally sponsored community health
22 centers, or teaching hospitals as defined in s. 408.07.
23 (b) All Nursing Student Loan Forgiveness Trust Fund
24 moneys shall be invested pursuant to s. 18.125. Interest
25 income accruing to that portion of the trust fund not matched
26 shall increase the total funds available for loan forgiveness
27 and scholarships. Pledged contributions shall not be eligible
28 for matching prior to the actual collection of the total
29 private contribution for the year.
30 (8) The Department of Education Health may solicit
31 technical assistance relating to the conduct of this program
16
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 from the Department of Health Education.
2 (9) The Department of Education Health is authorized
3 to recover from the Nursing Student Loan Forgiveness Trust
4 Fund its costs for administering the Nursing Student Loan
5 Forgiveness Program.
6 (10) The Department of Education Health may adopt
7 rules necessary to administer this program.
8 (11) This section shall be implemented only as
9 specifically funded.
10 Section 16. Section 240.4076, Florida Statutes, is
11 amended to read:
12 240.4076 Nursing scholarship program.--
13 (1) There is established within the Department of
14 Education Health a scholarship program for the purpose of
15 attracting capable and promising students to the nursing
16 profession.
17 (2) A scholarship applicant shall be enrolled as a
18 full-time or part-time student in the upper division of an
19 approved nursing program leading to the award of a
20 baccalaureate or any advanced registered nurse practitioner
21 degree or be enrolled as a full-time or part-time student in
22 an approved program leading to the award of an associate
23 degree in nursing or a diploma in nursing.
24 (3) A scholarship may be awarded for no more than 2
25 years, in an amount not to exceed $8,000 per year. However,
26 registered nurses pursuing an advanced registered nurse
27 practitioner degree may receive up to $12,000 per year.
28 Beginning July 1, 1998, these amounts shall be adjusted by the
29 amount of increase or decrease in the consumer price index for
30 urban consumers published by the United States Department of
31 Commerce.
17
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 (4) Credit for repayment of a scholarship shall be as
2 follows:
3 (a) For each full year of scholarship assistance, the
4 recipient agrees to work for 12 months at a health care
5 facility in a medically underserved area as approved by the
6 Department of Education Health. Scholarship recipients who
7 attend school on a part-time basis shall have their employment
8 service obligation prorated in proportion to the amount of
9 scholarship payments received.
10 (b) Eligible health care facilities include
11 state-operated medical or health care facilities, county
12 health departments, federally sponsored community health
13 centers, or teaching hospitals as defined in s. 408.07. The
14 recipient shall be encouraged to complete the service
15 obligation at a single employment site. If continuous
16 employment at the same site is not feasible, the recipient may
17 apply to the department for a transfer to another approved
18 health care facility.
19 (c) Any recipient who does not complete an appropriate
20 program of studies or who does not become licensed shall repay
21 to the Department of Education Health, on a schedule to be
22 determined by the department, the entire amount of the
23 scholarship plus 18 percent interest accruing from the date of
24 the scholarship payment. Moneys repaid shall be deposited into
25 the Nursing Student Loan Forgiveness Trust Fund established in
26 s. 240.4075. However, the department may provide additional
27 time for repayment if the department finds that circumstances
28 beyond the control of the recipient caused or contributed to
29 the default.
30 (d) Any recipient who does not accept employment as a
31 nurse at an approved health care facility or who does not
18
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Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 complete 12 months of approved employment for each year of
2 scholarship assistance received shall repay to the Department
3 of Education Health an amount equal to two times the entire
4 amount of the scholarship plus interest accruing from the date
5 of the scholarship payment at the maximum allowable interest
6 rate permitted by law. Repayment shall be made within 1 year
7 of notice that the recipient is considered to be in default.
8 However, the department may provide additional time for
9 repayment if the department finds that circumstances beyond
10 the control of the recipient caused or contributed to the
11 default.
12 (5) Scholarship payments shall be transmitted to the
13 recipient upon receipt of documentation that the recipient is
14 enrolled in an approved nursing program. The Department of
15 Education Health shall develop a formula to prorate payments
16 to scholarship recipients so as not to exceed the maximum
17 amount per academic year.
18 (6) The Department of Education Health shall adopt
19 rules, including rules to address extraordinary circumstances
20 that may cause a recipient to default on either the school
21 enrollment or employment contractual agreement, to implement
22 this section and may solicit technical assistance relating to
23 the conduct of this program from the Department of Health
24 Education.
25 (7) The Department of Education Health is authorized
26 to recover from the Nursing Student Loan Forgiveness Trust
27 Fund its costs for administering the nursing scholarship
28 program.
29 Section 17. All statutory powers, duties and
30 functions, records, rules, personnel, property, and unexpended
31 balances of appropriations, allocations, or other funds, of
19
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 the Department of Health relating to the Nursing Student Loan
2 Forgiveness Program and the Nursing Student Loan Forgiveness
3 Trust Fund, as created in s. 240.4075, Florida Statutes, and
4 the Nursing scholarship program, as created in s. 240.4076,
5 Florida Statutes, are transferred by a type two transfer, as
6 provided for in s. 20.06(2), Florida Statutes, from the
7 Department of Health to the Department of Education. Such
8 transfer shall take effect July 1, 1998. Any rules adopted by
9 or for the Department of Health for the administration and
10 operation of the Nursing Student Loan Forgiveness Program, the
11 Nursing Student Loan Forgiveness Trust Fund, and the nursing
12 scholarship program are included in such transfer.
13 Section 18. Section 381.0022, Florida Statutes, is
14 created to read:
15 381.0022 Sharing confidential or exempt
16 information.--Notwithstanding any other provision of law to
17 the contrary, the Department of Health and the Department of
18 Children and Family Services may share confidential
19 information or information exempt from disclosure under
20 chapter 119 on any individual who is or has been the subject
21 of a program within the jurisdiction of each agency.
22 Information so exchanged remains confidential or exempt as
23 provided by law.
24 Section 19. Section 402.115, Florida Statutes, is
25 created to read:
26 402.115 Sharing confidential or exempt
27 information.--Notwithstanding any other provision of law to
28 the contrary, the Department of Health and the Department of
29 Children and Family Services may share confidential
30 information or information exempt from disclosure under
31 chapter 119 on any individual who is or has been the subject
20
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 of a program within the jurisdiction of each agency.
2 Information so exchanged remains confidential or exempt as
3 provided by law.
4 Section 20. Paragraph (e) is added to subsection (1)
5 of section 414.028, Florida Statutes, to read:
6 414.028 Local WAGES coalitions.--The WAGES Program
7 State Board of Directors shall create and charter local WAGES
8 coalitions to plan and coordinate the delivery of services
9 under the WAGES Program at the local level. The boundaries of
10 the service area for a local WAGES coalition shall conform to
11 the boundaries of the service area for the regional workforce
12 development board established under the Enterprise Florida
13 workforce development board. The local delivery of services
14 under the WAGES Program shall be coordinated, to the maximum
15 extent possible, with the local services and activities of the
16 local service providers designated by the regional workforce
17 development boards.
18 (1)
19 (e) A representative of a county health department or
20 a representative of a Healthy Start Coalition shall serve as
21 an ex officio, nonvoting member of the coalition.
22 Section 21. Paragraph (a) of subsection (1) of section
23 766.101, Florida Statutes, is amended to read:
24 766.101 Medical review committee, immunity from
25 liability.--
26 (1) As used in this section:
27 (a) The term "medical review committee" or "committee"
28 means:
29 1.a. A committee of a hospital or ambulatory surgical
30 center licensed under chapter 395 or a health maintenance
31 organization certificated under part I of chapter 641,
21
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 b. A committee of a state or local professional
2 society of health care providers,
3 c. A committee of a medical staff of a licensed
4 hospital or nursing home, provided the medical staff operates
5 pursuant to written bylaws that have been approved by the
6 governing board of the hospital or nursing home,
7 d. A committee of the Department of Corrections or the
8 Correctional Medical Authority as created under s. 945.602, or
9 employees, agents, or consultants of either the department or
10 the authority or both,
11 e. A committee of a professional service corporation
12 formed under chapter 621 or a corporation organized under
13 chapter 607 or chapter 617, which is formed and operated for
14 the practice of medicine as defined in s. 458.305(3), and
15 which has at least 25 health care providers who routinely
16 provide health care services directly to patients,
17 f. A committee of a mental health treatment facility
18 licensed under chapter 394 or a community mental health center
19 as defined in s. 394.907, provided the quality assurance
20 program operates pursuant to the guidelines which have been
21 approved by the governing board of the agency,
22 g. A committee of a substance abuse treatment and
23 education prevention program licensed under chapter 397
24 provided the quality assurance program operates pursuant to
25 the guidelines which have been approved by the governing board
26 of the agency,
27 h. A peer review or utilization review committee
28 organized under chapter 440, or
29 i. A committee of the Department of Health, a county
30 health department, healthy start coalition, or certified rural
31 health network, when reviewing quality of care, or employees
22
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 of these entities when reviewing mortality records,
2
3 which committee is formed to evaluate and improve the quality
4 of health care rendered by providers of health service or to
5 determine that health services rendered were professionally
6 indicated or were performed in compliance with the applicable
7 standard of care or that the cost of health care rendered was
8 considered reasonable by the providers of professional health
9 services in the area; or
10 2. A committee of an insurer, self-insurer, or joint
11 underwriting association of medical malpractice insurance, or
12 other persons conducting review under s. 766.106.
13 Section 22. Paragraph (i) is added to subsection (1)
14 of section 383.011, Florida Statutes, and subsection (2) of
15 that section is amended, to read:
16 383.011 Administration of maternal and child health
17 programs.--
18 (1) The Department of Health is designated as the
19 state agency for:
20 (i) Receiving federal funds for children eligible for
21 assistance through the child portion of the federal Child and
22 Adult Care Food Program, which is referred to as the Child
23 Care Food Program, and for establishing and administering this
24 program. The purpose of the Child Care Food Program is to
25 provide nutritious meals and snacks for children in
26 nonresidential day care. To ensure the quality and integrity
27 of the program, the department shall develop standards and
28 procedures that govern sponsoring organizations, day care
29 homes, child care centers, and centers that operate outside
30 school hours. Standards and procedures must address the
31 following: participation criteria for sponsoring
23
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 organizations, which may include administrative budgets,
2 staffing requirements, requirements for experience in
3 operating similar programs, operating hours and availability,
4 bonding requirements, geographic coverage, and a required
5 minimum number of homes or centers; procedures for
6 investigating complaints and allegations of noncompliance;
7 application and renewal requirements; audit requirements; meal
8 pattern requirements; requirements for managing funds;
9 participant eligibility for free and reduced-price meals; food
10 storage and preparation; food service companies;
11 reimbursements; use of commodities; administrative reviews and
12 monitoring; training requirements; recordkeeping requirements;
13 and criteria pertaining to imposing sanctions and penalties,
14 including the denial, termination, and appeal of program
15 eligibility.
16 (2) The Department of Health shall follow federal
17 requirements and may adopt any rules necessary for the
18 implementation of the maternal and child health care program,
19 or the WIC program, and the Child Care Food Program. With
20 respect to the Child Care Food Program, the department shall
21 adopt rules that interpret and implement relevant federal
22 regulations, including 7 C.F.R., part 226. The rules must
23 address at least those program requirements and procedures
24 identified in paragraph (1)(i).
25 Section 23. Section 383.04, Florida Statutes, is
26 amended to read:
27 383.04 Prophylactic required for eyes of
28 infants.--Every physician, midwife, or other person in
29 attendance at the birth of a child in the state is required to
30 instill or have instilled into the eyes of the baby within 1
31 hour after birth an effective prophylactic recommended by the
24
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 Committee on Infectious Diseases of the American Academy of
2 Pediatrics a 1-percent fresh solution of silver nitrate (with
3 date of manufacture marked on container), two drops of the
4 solution to be dropped into each eye after the eyelids have
5 been opened, or some equally effective prophylactic approved
6 by the Department of Health, for the prevention of neonatal
7 blindness from ophthalmia neonatorum. This section does shall
8 not apply to cases where the parents shall file with the
9 physician, midwife, or other person in attendance at the birth
10 of a child written objections on account of religious beliefs
11 contrary to the use of drugs. In such case the physician,
12 midwife, or other person in attendance shall maintain a record
13 that such measures were or were not employed and attach
14 thereto any written objection.
15 Section 24. Section 383.05, Florida Statutes, is
16 repealed.
17 Section 25. Section 409.903, Florida Statutes, is
18 amended to read:
19 409.903 Mandatory payments for eligible persons.--The
20 agency department shall make payments for medical assistance
21 and related services on behalf of the following persons who
22 the agency department determines to be eligible, subject to
23 the income, assets, and categorical eligibility tests set
24 forth in federal and state law. Payment on behalf of these
25 Medicaid eligible persons is subject to the availability of
26 moneys and any limitations established by the General
27 Appropriations Act or chapter 216.
28 (1) Low-income families with children are eligible for
29 Medicaid provided they meet the following requirements:
30 Persons who receive payments from or are determined eligible
31 to participate in the WAGES Program, and certain persons who
25
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 would be eligible but do not meet certain technical
2 requirements. This group includes, but is not limited to:
3 (a) The family includes a dependent child who is
4 living with a caretaker relative. Low-income, single-parent
5 families and their children.
6 (b) The family's income does not exceed the gross
7 income test limit. Low-income, two-parent families in which at
8 least one parent is disabled or otherwise incapacitated.
9 (c) The family's countable income and resources do not
10 exceed the applicable aid-to-families-with-dependent-children
11 (AFDC) income and resource standards under the AFDC state plan
12 in effect in July 1996, except as amended in the Medicaid
13 state plan to conform as closely as possible to the
14 requirements of the WAGES Program as created in s. 414.015, to
15 the extent permitted by federal law. Certain unemployed
16 two-parent families and their children.
17 (2) A person who receives payments from, who is
18 determined eligible for, or who was eligible for but lost cash
19 benefits from the federal program known as the Supplemental
20 Security Income program (SSI). This category includes a
21 low-income person age 65 or over and a low-income person under
22 age 65 considered to be permanently and totally disabled.
23 (3) A child under age 21 living in a low-income,
24 two-parent family, and a child under age 7 living with a
25 nonrelative, if the income and assets of the family or child,
26 as applicable, do not exceed the resource limits under the
27 WAGES Program.
28 (4) A child who is eligible under Title IV-E of the
29 Social Security Act for subsidized board payments, foster
30 care, or adoption subsidies, and a child for whom the state
31 has assumed temporary or permanent responsibility and who does
26
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 not qualify for Title IV-E assistance but is in foster care,
2 shelter or emergency shelter care, or subsidized adoption.
3 (5) A pregnant woman for the duration of her pregnancy
4 and for the post partum period as defined in federal law and
5 rule, or a child under age 1, if either is living in a family
6 that has an income which is at or below 150 percent of the
7 most current federal poverty level, or, effective January 1,
8 1992, that has an income which is at or below 185 percent of
9 the most current federal poverty level. Such a person is not
10 subject to an assets test. Further, a pregnant woman who
11 applies for eligibility for the Medicaid program through a
12 qualified Medicaid provider must be offered the opportunity,
13 subject to federal rules, to be made presumptively eligible
14 for the Medicaid program.
15 (6) A child born after September 30, 1983, living in a
16 family that has an income which is at or below 100 percent of
17 the current federal poverty level, who has attained the age of
18 6, but has not attained the age of 19. In determining the
19 eligibility of such a child, an assets test is not required.
20 (7) A child living in a family that has an income
21 which is at or below 133 percent of the current federal
22 poverty level, who has attained the age of 1, but has not
23 attained the age of 6. In determining the eligibility of such
24 a child, an assets test is not required.
25 (8) A person who is age 65 or over or is determined by
26 the agency department to be disabled, whose income is at or
27 below 100 percent of the most current federal poverty level
28 and whose assets do not exceed limitations established by the
29 agency department. However, the agency department may only
30 pay for premiums, coinsurance, and deductibles, as required by
31 federal law, unless additional coverage is provided for any or
27
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 all members of this group by s. 409.904(1).
2 Section 26. Subsections (2) and (13) of section
3 409.908, Florida Statutes, are amended to read:
4 409.908 Reimbursement of Medicaid providers.--Subject
5 to specific appropriations, the agency shall reimburse
6 Medicaid providers, in accordance with state and federal law,
7 according to methodologies set forth in the rules of the
8 agency and in policy manuals and handbooks incorporated by
9 reference therein. These methodologies may include fee
10 schedules, reimbursement methods based on cost reporting,
11 negotiated fees, competitive bidding pursuant to s. 287.057,
12 and other mechanisms the agency considers efficient and
13 effective for purchasing services or goods on behalf of
14 recipients. Payment for Medicaid compensable services made on
15 behalf of Medicaid eligible persons is subject to the
16 availability of moneys and any limitations or directions
17 provided for in the General Appropriations Act or chapter 216.
18 Further, nothing in this section shall be construed to prevent
19 or limit the agency from adjusting fees, reimbursement rates,
20 lengths of stay, number of visits, or number of services, or
21 making any other adjustments necessary to comply with the
22 availability of moneys and any limitations or directions
23 provided for in the General Appropriations Act, provided the
24 adjustment is consistent with legislative intent.
25 (2)(a)1. Reimbursement to nursing homes licensed under
26 part II of chapter 400 and state-owned-and-operated
27 intermediate care facilities for the developmentally disabled
28 licensed under chapter 393 must be made prospectively.
29 2. Unless otherwise limited or directed in the General
30 Appropriations Act, reimbursement to hospitals licensed under
31 part I of chapter 395 for the provision of swing-bed nursing
28
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 home services must be made on the basis of the average
2 statewide nursing home payment, and reimbursement to a
3 hospital licensed under part I of chapter 395 for the
4 provision of skilled nursing services must be made on the
5 basis of the average nursing home payment for those services
6 in the county in which the hospital is located. When a
7 hospital is located in a county that does not have any
8 community nursing homes, reimbursement must be determined by
9 averaging the nursing home payments, in counties that surround
10 the county in which the hospital is located. Reimbursement to
11 hospitals, including Medicaid payment of Medicare copayments,
12 for skilled nursing services shall be limited to 30 days,
13 unless a prior authorization has been obtained from the
14 agency. Medicaid reimbursement may be extended by the agency
15 beyond 30 days, and approval must be based upon verification
16 by the patient's physician that the patient requires
17 short-term rehabilitative and recuperative services only, in
18 which case an extension of no more than 15 days may be
19 approved. Reimbursement to a hospital licensed under part I of
20 chapter 395 for the temporary provision of skilled nursing
21 services to nursing home residents who have been displaced as
22 the result of a natural disaster or other emergency may not
23 exceed the average county nursing home payment for those
24 services in the county in which the hospital is located and is
25 limited to the period of time which the agency considers
26 necessary for continued placement of the nursing home
27 residents in the hospital.
28 (b) Subject to any limitations or directions provided
29 for in the General Appropriations Act, the agency shall
30 establish and implement a Florida Title XIX Long-Term Care
31 Reimbursement Plan (Medicaid) for nursing home care in order
29
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 to provide care and services in conformance with the
2 applicable state and federal laws, rules, regulations, and
3 quality and safety standards and to ensure that individuals
4 eligible for medical assistance have reasonable geographic
5 access to such care. Effective no earlier than the
6 rate-setting period beginning April 1, 1999, the agency shall
7 establish a case-mix reimbursement methodology for the rate of
8 payment for long-term-care services for nursing home
9 residents. The agency shall compute a per diem rate for
10 Medicaid residents, adjusted for case mix, which is based on a
11 resident classification system that accounts for the relative
12 resource utilization by different types of residents and which
13 is based on level-of-care data and other appropriate data. The
14 case-mix methodology developed by the agency shall take into
15 account the medical, behavioral, and cognitive deficits of
16 residents. In developing the reimbursement methodology, the
17 agency shall evaluate and modify other aspects of the
18 reimbursement plan as necessary to improve the overall
19 effectiveness of the plan with respect to the costs of patient
20 care, operating costs, and property costs. In the event
21 adequate data are not available, the agency is authorized to
22 adjust the patient's care component or the per diem rate to
23 more adequately cover the cost of services provided in the
24 patient's care component. The agency shall work with the
25 Department of Elderly Affairs, the Florida Health Care
26 Association, and the Florida Association of Homes for the
27 Aging in developing the methodology. It is the intent of the
28 Legislature that the reimbursement plan achieve the goal of
29 providing access to health care for nursing home residents who
30 require large amounts of care while encouraging diversion
31 services as an alternative to nursing home care for residents
30
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 who can be served within the community. The agency shall base
2 the establishment of any maximum rate of payment, whether
3 overall or component, on the available moneys as provided for
4 in the General Appropriations Act. The agency may base the
5 maximum rate of payment on the results of scientifically valid
6 analysis and conclusions derived from objective statistical
7 data pertinent to the particular maximum rate of payment.
8 (13) Medicare premiums for persons eligible for both
9 Medicare and Medicaid coverage shall be paid at the rates
10 established by Title XVIII of the Social Security Act. For
11 Medicare services rendered to Medicaid-eligible persons,
12 Medicaid shall pay Medicare deductibles and coinsurance as
13 follows:
14 (a) Medicaid shall make no payment toward deductibles
15 and coinsurance for any service that is not covered by
16 Medicaid.
17 (b) Medicaid's financial obligation for deductibles
18 and coinsurance payments shall be based on Medicare allowable
19 fees, not on a provider's billed charges.
20 (c) Medicaid will pay no portion of Medicare
21 deductibles and coinsurance when payment that Medicare has
22 made for the service equals or exceeds what Medicaid would
23 have paid if it had been the sole payor. The combined payment
24 of Medicare and Medicaid shall not exceed the amount Medicaid
25 would have paid had it been the sole payor.
26 (d) The following provisions are exceptions to
27 paragraphs (a)-(c):
28 1. Medicaid payments for Nursing Home Medicare Part A
29 coinsurance shall be the lesser of the Medicare coinsurance
30 amount or the Medicaid nursing home per diem rate.
31 2. Medicaid shall pay all deductibles and coinsurance
31
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 for Nursing Home Medicare Part B services.
2 3. Medicaid shall pay all deductibles and coinsurance
3 for Medicare-eligible recipients receiving freestanding end
4 stage renal dialysis center services.
5 4. Medicaid shall pay all deductibles and coinsurance
6 for hospital outpatient Medicare Part B services.
7 5. Medicaid payments for general hospital inpatient
8 services shall be limited to the Medicare deductible per spell
9 of illness. Medicaid shall make no payment toward coinsurance
10 for Medicare general hospital inpatient services.
11 6. Medicaid shall pay all deductibles and coinsurance
12 for Medicare emergency transportation services provided by
13 ambulances licensed pursuant to chapter 401. Premiums,
14 deductibles, and coinsurance for Medicare services rendered to
15 Medicaid eligible persons shall be reimbursed in accordance
16 with fees established by Title XVIII of the Social Security
17 Act.
18 Section 27. Paragraph (c) of subsection (4) of section
19 409.912, Florida Statutes, is repealed, paragraph (b) of
20 subsection (3) and subsection (13) of that section are
21 amended, and subsections (34) and (35) are added to that
22 section, to read:
23 409.912 Cost-effective purchasing of health care.--The
24 agency shall purchase goods and services for Medicaid
25 recipients in the most cost-effective manner consistent with
26 the delivery of quality medical care. The agency shall
27 maximize the use of prepaid per capita and prepaid aggregate
28 fixed-sum basis services when appropriate and other
29 alternative service delivery and reimbursement methodologies,
30 including competitive bidding pursuant to s. 287.057, designed
31 to facilitate the cost-effective purchase of a case-managed
32
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 continuum of care. The agency shall also require providers to
2 minimize the exposure of recipients to the need for acute
3 inpatient, custodial, and other institutional care and the
4 inappropriate or unnecessary use of high-cost services.
5 (3) The agency may contract with:
6 (b) An entity that is providing comprehensive
7 inpatient and outpatient mental health care services to
8 certain Medicaid recipients in Hillsborough, Highlands,
9 Hardee, Manatee, and Polk Counties, through a capitated,
10 prepaid arrangement pursuant to the federal waiver provided
11 for by s. 409.905(5). Such an entity must become licensed
12 under chapter 624, chapter 636, or chapter 641 by December 31,
13 1998, and is exempt from the provisions of part I of chapter
14 641 until then. However, if the entity assumes risk, the
15 Department of Insurance shall develop appropriate regulatory
16 requirements by rule under the insurance code before the
17 entity becomes operational.
18 (13) The agency shall identify health care utilization
19 and price patterns within the Medicaid program which that are
20 not cost-effective or medically appropriate and assess the
21 effectiveness of new or alternate methods of providing and
22 monitoring service, and may implement such methods as it
23 considers appropriate. Such methods may include
24 disease-management initiatives, an integrated and systematic
25 approach for managing the health care needs of recipients who
26 are at risk of or diagnosed with a specific disease by using
27 best practices, prevention strategies, clinical-practice
28 improvement, clinical interventions and protocols, outcomes
29 research, information technology, and other tools and
30 resources to reduce overall costs and improve measurable
31 outcomes.
33
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 (34) The agency may provide for cost-effective
2 purchasing of home health services through competitive
3 negotiation pursuant to s. 287.057. The agency may request
4 appropriate waivers from the federal Health Care Financing
5 Administration in order to competitively bid home health
6 services.
7 (35) The Agency for Health Care Administration is
8 directed to issue a request for proposal or intent to
9 negotiate to implement on a demonstration basis an outpatient
10 specialty services pilot project in a rural and urban county
11 in the state. As used in this subsection, the term
12 "outpatient specialty services" means clinical laboratory,
13 diagnostic imaging, and specified home medical services to
14 include durable medical equipment, prosthetics and orthotics,
15 and infusion therapy.
16 (a) The entity that is awarded the contract to provide
17 Medicaid managed care outpatient specialty services must, at a
18 minimum, meet the following criteria:
19 1. The entity must be licensed by the Department of
20 Insurance under part II of chapter 641.
21 2. The entity must be experienced in providing
22 outpatient specialty services.
23 3. The entity must demonstrate to the satisfaction of
24 the agency that it provides high-quality services to its
25 patients.
26 4. The entity must demonstrate that it has in place a
27 complaints and grievance process to assist Medicaid recipients
28 enrolled in the pilot managed care program to resolve
29 complaints and grievances.
30 (b) The pilot managed care program shall operate for a
31 period of 3 years. The objective of the pilot program shall
34
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 be to determine the cost-effectiveness and effects on
2 utilization, access, and quality of providing outpatient
3 specialty services to Medicaid recipients on a prepaid,
4 capitated basis.
5 (c) The agency shall conduct a quality-assurance
6 review of the prepaid health clinic each year that the
7 demonstration program is in effect. The prepaid health clinic
8 is responsible for all expenses incurred by the agency in
9 conducting a quality assurance review.
10 (d) The entity that is awarded the contract to provide
11 outpatient specialty services to Medicaid recipients shall
12 report data required by the agency in a format specified by
13 the agency, for the purpose of conducting the evaluation
14 required in paragraph (e).
15 (e) The agency shall conduct an evaluation of the
16 pilot managed care program and report its findings to the
17 Governor and the Legislature by no later than January 1, 2001.
18 (f) Nothing in this subsection is intended to conflict
19 with the provision of the 1997-1998 General Appropriations Act
20 which authorizes competitive bidding for Medicaid home health,
21 clinical laboratory, or x-ray services.
22 Section 28. Effective January 1, 1999, paragraph (d)
23 of subsection (3) of section 409.912, Florida Statutes, is
24 amended to read:
25 409.912 Cost-effective purchasing of health care.--The
26 agency shall purchase goods and services for Medicaid
27 recipients in the most cost-effective manner consistent with
28 the delivery of quality medical care. The agency shall
29 maximize the use of prepaid per capita and prepaid aggregate
30 fixed-sum basis services when appropriate and other
31 alternative service delivery and reimbursement methodologies,
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 including competitive bidding pursuant to s. 287.057, designed
2 to facilitate the cost-effective purchase of a case-managed
3 continuum of care. The agency shall also require providers to
4 minimize the exposure of recipients to the need for acute
5 inpatient, custodial, and other institutional care and the
6 inappropriate or unnecessary use of high-cost services.
7 (3) The agency may contract with:
8 (d) No more than four provider service networks for
9 demonstration projects to test Medicaid direct contracting.
10 However, no such demonstration project shall be established
11 with a federally qualified health center nor shall any
12 provider service network under contract with the agency
13 pursuant to this paragraph include a federally qualified
14 health center in its provider network. One demonstration
15 project must be located in Orange County. The demonstration
16 projects may be reimbursed on a fee-for-service or prepaid
17 basis. A provider service network which is reimbursed by the
18 agency on a prepaid basis shall be exempt from parts I and III
19 of chapter 641, but must meet appropriate financial reserve,
20 quality assurance, and patient rights requirements as
21 established by the agency. The agency shall award contracts
22 on a competitive bid basis and shall select bidders based upon
23 price and quality of care. Medicaid recipients assigned to a
24 demonstration project shall be chosen equally from those who
25 would otherwise have been assigned to prepaid plans and
26 MediPass. The agency is authorized to seek federal Medicaid
27 waivers as necessary to implement the provisions of this
28 section. A demonstration project awarded pursuant to this
29 paragraph shall be for 2 years from the date of
30 implementation.
31 Section 29. Paragraphs (a), (c), (f), (i), and (k) of
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 subsection (2) of section 409.9122, Florida Statutes, are
2 amended to read:
3 409.9122 Mandatory Medicaid managed care enrollment;
4 programs and procedures.--
5 (2)(a) The agency shall enroll in a managed care plan
6 or MediPass all Medicaid recipients, except those Medicaid
7 recipients who are: in an institution; enrolled in the
8 Medicaid medically needy program; or eligible for both
9 Medicaid and Medicare. However, to the extent permitted by
10 federal law, the agency may enroll in a managed care plan or
11 MediPass a Medicaid recipient who is exempt from mandatory
12 managed care enrollment, provided that:
13 1. The recipient's decision to enroll in a managed
14 care plan or MediPass is voluntary;
15 2. If the recipient chooses to enroll in a managed
16 care plan, the agency has determined that the managed care
17 plan provides specific programs and services which address the
18 special health needs of the recipient; and
19 3. The agency receives any necessary waivers from the
20 federal Health Care Financing Administration.
21
22 The agency shall develop rules to establish policies by which
23 exceptions to the mandatory managed care enrollment
24 requirement may be made on a case-by-case basis. The rules
25 shall include the specific criteria to be applied when making
26 a determination as to whether to exempt a recipient from
27 mandatory enrollment in a managed care plan or MediPass.
28 School districts participating in the certified school match
29 program pursuant to ss. 236.0812 and 409.908(21) shall be
30 reimbursed by Medicaid, subject to the limitations of s.
31 236.0812(1) and (2), for a Medicaid-eligible child
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 participating in the services as authorized in s. 236.0812, as
2 provided for in s. 409.9071, regardless of whether the child
3 is enrolled in MediPass or a managed care plan. Managed care
4 plans shall make a good faith effort to execute agreements
5 with school districts and county health departments regarding
6 the coordinated provision of services authorized under s.
7 236.0812. County health departments delivering school-based
8 services pursuant to ss. 381.0056 and 381.0057 shall be
9 reimbursed by Medicaid for the federal share for a
10 Medicaid-eligible child who receives Medicaid-covered services
11 in a school setting, regardless of whether the child is
12 enrolled in MediPass or a managed care plan. Managed care
13 plans shall make a good faith effort to execute agreements
14 with county health departments regarding the coordinated
15 provision of services to a Medicaid-eligible child. To ensure
16 continuity of care for Medicaid patients, the agency, the
17 Department of Health, and the Department of Education shall
18 develop procedures for ensuring that a student's managed care
19 plan or MediPass provider receives information relating to
20 services provided in accordance with ss. 236.0812, 381.0056,
21 381.0057, and 409.9071.
22 (c) Medicaid recipients shall have a choice of managed
23 care plans or MediPass. The Agency for Health Care
24 Administration, the Department of Health and Rehabilitative
25 Services, the Department of Children and Family Services, and
26 the Department of Elderly Affairs shall cooperate to ensure
27 that each Medicaid recipient receives clear and easily
28 understandable information that meets the following
29 requirements:
30 1. Explains the concept of managed care, including
31 MediPass.
38
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 2. Provides information on the comparative performance
2 of managed care plans and MediPass in the areas of quality,
3 credentialing, preventive health programs, network size and
4 availability, and patient satisfaction.
5 3. Explains where additional information on each
6 managed care plan and MediPass in the recipient's area can be
7 obtained.
8 4. Explains that recipients have the right to choose
9 their own managed care plans or MediPass. However, if a
10 recipient does not choose a managed care plan or MediPass, the
11 agency will assign the recipient to a managed care plan or
12 MediPass according to the criteria specified in this section.
13 5. Explains the recipient's right to complain, file a
14 grievance, or change managed care plans or MediPass providers
15 if the recipient is not satisfied with the managed care plan
16 or MediPass.
17 (f) When a Medicaid recipient does not choose a
18 managed care plan or MediPass provider, the agency shall
19 assign the Medicaid recipient to a managed care plan or
20 MediPass provider. Medicaid recipients who are subject to
21 mandatory assignment but who fail to make a choice shall be
22 assigned to managed care plans or provider service networks
23 until an equal enrollment of 50 percent in MediPass and
24 provider service networks and 50 percent in managed care plans
25 is achieved. Once equal enrollment is achieved, the
26 assignments shall be divided in order to maintain an equal
27 enrollment in MediPass and managed care plans for the 1998-99
28 fiscal year. In the first period that assignment begins, the
29 assignments shall be divided equally between the MediPass
30 program and managed care plans. Thereafter, assignment of
31 Medicaid recipients who fail to make a choice shall be based
39
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 proportionally on the preferences of recipients who have made
2 a choice in the previous period. Such proportions shall be
3 revised at least quarterly to reflect an update of the
4 preferences of Medicaid recipients. When making assignments,
5 the agency shall take into account the following criteria:
6 1. A managed care plan has sufficient network capacity
7 to meet the need of members.
8 2. The managed care plan or MediPass has previously
9 enrolled the recipient as a member, or one of the managed care
10 plan's primary care providers or MediPass providers has
11 previously provided health care to the recipient.
12 3. The agency has knowledge that the member has
13 previously expressed a preference for a particular managed
14 care plan or MediPass provider as indicated by Medicaid
15 fee-for-service claims data, but has failed to make a choice.
16 4. The managed care plan's or MediPass primary care
17 providers are geographically accessible to the recipient's
18 residence.
19 (i) After a recipient has made a selection or has been
20 enrolled in a managed care plan or MediPass, the recipient
21 shall have 90 60 days in which to voluntarily disenroll and
22 select another managed care plan or MediPass provider. After
23 90 60 days, no further changes may be made except for cause.
24 Cause shall include, but not be limited to, poor quality of
25 care, lack of access to necessary specialty services, an
26 unreasonable delay or denial of service, or fraudulent
27 enrollment. The agency shall develop criteria for good cause
28 disenrollment for chronically ill and disabled populations who
29 are assigned to managed care plans if more appropriate care is
30 available through the MediPass program. The agency must make
31 a determination as to whether cause exists. However, the
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 agency may require a recipient to use the managed care plan's
2 or MediPass grievance process prior to the agency's
3 determination of cause, except in cases in which immediate
4 risk of permanent damage to the recipient's health is alleged.
5 The grievance process, when utilized, must be completed in
6 time to permit the recipient to disenroll no later than the
7 first day of the second month after the month the
8 disenrollment request was made. If the managed care plan or
9 MediPass, as a result of the grievance process, approves an
10 enrollee's request to disenroll, the agency is not required to
11 make a determination in the case. The agency must make a
12 determination and take final action on a recipient's request
13 so that disenrollment occurs no later than the first day of
14 the second month after the month the request was made. If the
15 agency fails to act within the specified timeframe, the
16 recipient's request to disenroll is deemed to be approved as
17 of the date agency action was required. Recipients who
18 disagree with the agency's finding that cause does not exist
19 for disenrollment shall be advised of their right to pursue a
20 Medicaid fair hearing to dispute the agency's finding.
21 (k) In order to provide increased access to managed
22 care, the agency may request from the Health Care Financing
23 Administration a waiver of the regulation requiring health
24 maintenance organizations to have one commercial enrollee for
25 each three Medicaid enrollees.
26 Section 30. Paragraph (f) of subsection (12) and
27 subsection (18) of section 409.910, Florida Statutes, are
28 amended to read:
29 409.910 Responsibility for payments on behalf of
30 Medicaid-eligible persons when other parties are liable.--
31 (12) The department may, as a matter of right, in
41
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 order to enforce its rights under this section, institute,
2 intervene in, or join any legal or administrative proceeding
3 in its own name in one or more of the following capacities:
4 individually, as subrogee of the recipient, as assignee of the
5 recipient, or as lienholder of the collateral.
6 (f) Notwithstanding any provision in this section to
7 the contrary, in the event of an action in tort against a
8 third party in which the recipient or his or her legal
9 representative is a party which results in a and in which the
10 amount of any judgment, award, or settlement from a third
11 party, third-party benefits, excluding medical coverage as
12 defined in subparagraph 4., after reasonable costs and
13 expenses of litigation, is an amount equal to or less than 200
14 percent of the amount of medical assistance provided by
15 Medicaid less any medical coverage paid or payable to the
16 department, then distribution of the amount recovered shall be
17 distributed as follows:
18 1. After attorney's fees and taxable costs as defined
19 by the Florida Rules of Civil Procedure, one-half of the
20 remaining recovery shall be paid to the department up to the
21 total amount of medical assistance provided by Medicaid.
22 2. The remaining amount of the recovery shall be paid
23 to the recipient.
24 3. For purposes of calculating the department's
25 recovery of medical assistance benefits paid, the fee for
26 services of an attorney retained by the recipient or his or
27 her legal representative shall be calculated at 25 percent of
28 the judgment, award, or settlement.
29 4. Notwithstanding any provision of this section to
30 the contrary, the department shall be entitled to all medical
31 coverage benefits up to the total amount of medical assistance
42
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 provided by Medicaid.
2 1. Any fee for services of an attorney retained by the
3 recipient or his or her legal representative shall not exceed
4 an amount equal to 25 percent of the recovery, after
5 reasonable costs and expenses of litigation, from the
6 judgment, award, or settlement.
7 2. After attorney's fees, two-thirds of the remaining
8 recovery shall be designated for past medical care and paid to
9 the department for medical assistance provided by Medicaid.
10 3. The remaining amount from the recovery shall be
11 paid to the recipient.
12 4. For purposes of this paragraph, "medical coverage"
13 means any benefits under health insurance, a health
14 maintenance organization, a preferred provider arrangement, or
15 a prepaid health clinic, and the portion of benefits
16 designated for medical payments under coverage for workers'
17 compensation, personal injury protection, and casualty.
18 (18) A recipient or his or her legal representative or
19 any person representing, or acting as agent for, a recipient
20 or the recipient's legal representative, who has notice,
21 excluding notice charged solely by reason of the recording of
22 the lien pursuant to paragraph (6)(d), or who has actual
23 knowledge of the department's rights to third-party benefits
24 under this section, who receives any third-party benefit or
25 proceeds therefrom for a covered illness or injury, is
26 required either to pay the department, within 60 days after
27 receipt of settlement proceeds, the full amount of the
28 third-party benefits, but not in excess of the total medical
29 assistance provided by Medicaid, or to place the full amount
30 of the third-party benefits in a trust account for the benefit
31 of the department pending judicial or administrative
43
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 determination of the department's right thereto. Proof that
2 any such person had notice or knowledge that the recipient had
3 received medical assistance from Medicaid, and that
4 third-party benefits or proceeds therefrom were in any way
5 related to a covered illness or injury for which Medicaid had
6 provided medical assistance, and that any such person
7 knowingly obtained possession or control of, or used,
8 third-party benefits or proceeds and failed either to pay the
9 department the full amount required by this section or to hold
10 the full amount of third-party benefits or proceeds in trust
11 pending judicial or administrative determination, unless
12 adequately explained, gives rise to an inference that such
13 person knowingly failed to credit the state or its agent for
14 payments received from social security, insurance, or other
15 sources, pursuant to s. 414.39(4)(b), and acted with the
16 intent set forth in s. 812.014(1).
17 (a) The department is authorized to investigate and to
18 request appropriate officers or agencies of the state to
19 investigate suspected criminal violations or fraudulent
20 activity related to third-party benefits, including, without
21 limitation, ss. 409.325 and 812.014. Such requests may be
22 directed, without limitation, to the Medicaid Fraud Control
23 Unit of the Office of the Attorney General, or to any state
24 attorney. Pursuant to s. 409.913, the Attorney General has
25 primary responsibility to investigate and control Medicaid
26 fraud.
27 (b) In carrying out duties and responsibilities
28 related to Medicaid fraud control, the department may subpoena
29 witnesses or materials within or outside the state and,
30 through any duly designated employee, administer oaths and
31 affirmations and collect evidence for possible use in either
44
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 civil or criminal judicial proceedings.
2 (c) All information obtained and documents prepared
3 pursuant to an investigation of a Medicaid recipient, the
4 recipient's legal representative, or any other person relating
5 to an allegation of recipient fraud or theft is confidential
6 and exempt from s. 119.07(1):
7 1. Until such time as the department takes final
8 agency action;
9 2. Until such time as the Attorney General refers the
10 case for criminal prosecution;
11 3. Until such time as an indictment or criminal
12 information is filed by a state attorney in a criminal case;
13 or
14 4. At all times if otherwise protected by law.
15 Section 31. Subsection (1) of section 414.28, Florida
16 Statutes, is amended to read:
17 414.28 Public assistance payments to constitute debt
18 of recipient.--
19 (1) CLAIMS.--The acceptance of public assistance
20 creates a debt of the person accepting assistance, which debt
21 is enforceable only after the death of the recipient. The
22 debt thereby created is enforceable only by claim filed
23 against the estate of the recipient after his or her death or
24 by suit to set aside a fraudulent conveyance, as defined in
25 subsection (3). After the death of the recipient and within
26 the time prescribed by law, the department may file a claim
27 against the estate of the recipient for the total amount of
28 public assistance paid to or for the benefit of such
29 recipient, reimbursement for which has not been made. Claims
30 so filed shall take priority as class 3 class 7 claims as
31 provided by s. 733.707(1)(g).
45
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 Section 32. Subsection (1) of section 627.912, Florida
2 Statutes, is amended, and subsection (5) is added to said
3 section, to read:
4 627.912 Professional liability claims and actions;
5 reports by insurers.--
6 (1) Each self-insurer authorized under s. 627.357 and
7 each insurer or joint underwriting association providing
8 professional liability insurance to a practitioner of medicine
9 licensed under chapter 458, to a practitioner of osteopathic
10 medicine licensed under chapter 459, to a podiatrist licensed
11 under chapter 461, to a dentist licensed under chapter 466, to
12 a hospital licensed under chapter 395, to a crisis
13 stabilization unit licensed under part IV of chapter 394, to a
14 health maintenance organization certificated under part I of
15 chapter 641, to clinics included in chapter 390, to an
16 ambulatory surgical center as defined in s. 395.002, or to a
17 member of The Florida Bar shall report in duplicate to the
18 Department of Insurance any claim or action for damages for
19 personal injuries claimed to have been caused by error,
20 omission, or negligence in the performance of such insured's
21 professional services or based on a claimed performance of
22 professional services without consent, if the claim resulted
23 in:
24 (a) A final judgment in any amount.
25 (b) A settlement in any amount.
26 (c) A final disposition not resulting in payment on
27 behalf of the insured.
28
29 Reports shall be filed with the department and, if the insured
30 party is licensed under chapter 458, chapter 459, chapter 461,
31 or chapter 466, with the Agency for Health Care
46
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 Administration, no later than 30 days following the occurrence
2 of any event listed in paragraph (a) or, paragraph (b), or
3 paragraph (c). The Agency for Health Care Administration shall
4 review each report and determine whether any of the incidents
5 that resulted in the claim potentially involved conduct by the
6 licensee that is subject to disciplinary action, in which case
7 the provisions of s. 455.225 shall apply. The Agency for
8 Health Care Administration, as part of the annual report
9 required by s. 455.2285, shall publish annual statistics,
10 without identifying licensees, on the reports it receives,
11 including final action taken on such reports by the agency or
12 the appropriate regulatory board.
13 (5) Any self-insurance program established under s.
14 240.213 shall report in duplicate to the Department of
15 Insurance any claim or action for damages for personal
16 injuries claimed to have been caused by error, omission, or
17 negligence in the performance of professional services
18 provided by the Board of Regents through an employee or agent
19 of the Board of Regents, including practitioners of medicine
20 licensed under chapter 458, practitioners of osteopathic
21 medicine licensed under chapter 459, podiatrists licensed
22 under chapter 461, and dentists licensed under chapter 466, or
23 based on a claimed performance of professional services
24 without consent if the claim resulted in a final judgment in
25 any amount, or a settlement in any amount. The reports
26 required by this subsection shall contain the information
27 required by subsection (3) and the name, address, and
28 specialty of the employee or agent of the Board of Regents
29 whose performance or professional services is alleged in the
30 claim or action to have caused personal injury.
31 Section 33. Upon completion, the Marion County Health
47
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 Department building to be constructed in Belleview, Florida,
2 shall be known as the "Carl S. Lytle, M.D., Memorial Health
3 Facility."
4 Section 34. The amount of $2 million is appropriated
5 from tobacco settlement revenues to the Grants and Donations
6 Trust Fund of the Agency for Health Care Administration to be
7 matched at an appropriate level with federal Medicaid funds
8 available under Title XIX of the Social Security Act to
9 provide prosthetic and orthotic devices for Medicaid
10 recipients when such devices are prescribed by licensed
11 practitioners participating in the Medicaid program.
12 Section 35. Except as otherwise provided herein, this
13 act shall take effect July 1 of the year in which enacted.
14
15
16 ================ T I T L E A M E N D M E N T ===============
17 And the title is amended as follows:
18 On page ,
19 remove from the title of the bill: the entire title
20
21 and insert in lieu thereof:
22 An act relating to health care; providing an
23 important state interest; amending ss. 154.301,
24 154.302, 154.304, 154.306, 154.308, 154.309,
25 154.31, 154.3105, 154.312, 154.314, and
26 154.316, F.S., relating to health care
27 responsibility for indigents; revising short
28 title; revising definitions; limiting the
29 maximum amount a county may be required to pay
30 an out-of-county hospital; providing hospitals
31 additional time to notify counties of admission
48
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 or treatment of out-of-county patients;
2 revising language and conforming references;
3 providing penalties; amending s. 154.504, F.S.;
4 limiting applicability of copayments under the
5 Primary Care for Children and Families
6 Challenge Grant Program; amending s. 198.30,
7 F.S.; requiring certain reports of estates of
8 decedents to be provided to the Agency for
9 Health Care Administration; amending ss.
10 240.4075 and 240.4076, F.S., relating the
11 Nursing Student Loan Forgiveness Program, the
12 Nursing Student Loan Forgiveness Trust Fund,
13 and the nursing scholarship program;
14 transferring powers, duties, and functions with
15 respect thereto from the Department of Health
16 to the Department of Education; creating ss.
17 381.0022 and 402.115, F.S.; authorizing the
18 Department of Health and the Department of
19 Children and Family Services to share
20 confidential and exempt information; amending
21 s. 414.028, F.S.; providing for a
22 representative of a county health department or
23 Healthy Start Coalition to serve on the local
24 WAGES coalition; amending s. 766.101, F.S.;
25 redefining the term "medical review committee"
26 to include a committee of the Department of
27 Health; amending s. 383.011, F.S.; providing
28 that the Department of Health is the designated
29 state agency for receiving federal funds for
30 the Child Care Food Program; requiring the
31 department to adopt rules for administering the
49
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 program; amending s. 383.04, F.S.; revising the
2 requirements for the prophylactic to be used
3 for the eyes of infants; repealing s. 383.05,
4 F.S., relating to the free distribution of such
5 prophylactic; amending s. 409.903, F.S.;
6 providing Medicaid eligibility standards for
7 certain persons; conforming references;
8 amending s. 409.908, F.S.; requiring the agency
9 to establish a reimbursement methodology for
10 long-term-care services for Medicaid-eligible
11 nursing home residents; specifying requirements
12 for the methodology; providing legislative
13 intent; prescribing guidelines for Medicaid
14 payment of Medicare deductibles and
15 coinsurance; eliminating a prohibition on
16 specified contracts; repealing redundant
17 provisions; amending s. 409.912, F.S.;
18 authorizing the agency to include
19 disease-management initiatives in providing and
20 monitoring Medicaid services; authorizing the
21 agency to competitively negotiate home health
22 services; authorizing the agency to seek
23 necessary federal waivers that relate to the
24 competitive negotiation of such services;
25 directing the Agency for Health Care
26 Administration to establish an outpatient
27 specialty services pilot project; providing
28 definitions; providing criteria for
29 participation; requiring an evaluation and a
30 report to the Governor and Legislature;
31 modifying the licensure requirements for a
50
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 provider of services under a pilot project;
2 amending s. 409.9122, F.S.; requiring the
3 Agency for Health Care Administration to
4 reimburse county health departments for
5 school-based services; requiring Medicaid
6 managed-care contractors to attempt to enter
7 agreements with school districts and county
8 health departments for specified services;
9 specifying the departments that are required to
10 make certain information available to Medicaid
11 recipients; extending the period during which a
12 Medicaid recipient may disenroll from a managed
13 care plan or MediPass provider; deleting
14 authorization for the agency to request a
15 federal waiver from the requirement that a
16 Medicaid managed care plan include a specified
17 ratio of enrollees; amending requirements for
18 the mandatory assignment of Medicaid
19 recipients; amending s. 409.910, F.S.;
20 providing for the distribution of amounts
21 recovered in certain tort suits involving
22 intervention by the Agency for Health Care
23 Administration; requiring that certain
24 third-party benefits received by a Medicaid
25 recipient be remitted within a specified
26 period; amending s. 414.28, F.S.; revising the
27 order under which a claim may be made against
28 the estate of a recipient of public assistance;
29 amending s. 627.912, F.S.; revising reporting
30 requirements by certain insurers; requiring
31 certain self-insurers to report certain
51
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HOUSE AMENDMENT
Bill No. CS for CS for SB 484, 1st Eng.
Amendment No. (for drafter's use only)
1 information to the Department of Insurance;
2 naming the Carl S. Lytle, M.D., Memorial Health
3 Facility in Marion County; providing an
4 appropriation to be matched by federal Medicaid
5 funds; providing effective dates.
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