Senate Bill 0484

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    Florida Senate - 1998                                   SB 484

    By the Committee on Health Care





    317-535A-98

  1                      A bill to be entitled

  2         An act relating to public assistance; amending

  3         s. 409.908, F.S.; requiring the agency to

  4         establish a reimbursement methodology for

  5         long-term-care services for Medicaid-eligible

  6         nursing home residents; specifying requirements

  7         for the methodology; providing legislative

  8         intent; providing certain limitations on

  9         payments made by the agency for Medicare

10         services rendered to Medicaid-eligible persons;

11         amending s. 409.912, F.S.; authorizing the

12         agency to include disease-management

13         initiatives in providing and monitoring

14         Medicaid services; authorizing the agency to

15         competitively negotiate home health services;

16         authorizing the agency to seek necessary

17         federal waivers that relate to the competitive

18         negotiation of such services; amending s.

19         409.9122, F.S.; specifying the departments that

20         are required to make certain information

21         available to Medicaid recipients; extending the

22         period during which a Medicaid recipient may

23         disenroll from a managed care plan or MediPass

24         provider; deleting authorization for the agency

25         to request a federal waiver from the

26         requirement that a Medicaid managed care plan

27         include a specified ratio of enrollees;

28         amending s. 409.910, F.S.; requiring that

29         certain third-party benefits received by a

30         Medicaid recipient be remitted within a

31         specified period; amending s. 414.28, F.S.;

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  1         revising the order under which a claim may be

  2         made against the estate of a recipient of

  3         public assistance; amending s. 198.30, F.S.;

  4         requiring that each circuit judge provide a

  5         report of decedents to the Agency for Health

  6         Care Administration; amending s. 733.212, F.S.;

  7         requiring that a personal representative serve

  8         a copy of the notice of administration on the

  9         agency; providing an effective date.

10

11  Be It Enacted by the Legislature of the State of Florida:

12

13         Section 1.  Subsections (2) and (13) of section

14  409.908, Florida Statutes, are amended to read:

15         409.908  Reimbursement of Medicaid providers.--Subject

16  to specific appropriations, the agency shall reimburse

17  Medicaid providers, in accordance with state and federal law,

18  according to methodologies set forth in the rules of the

19  agency and in policy manuals and handbooks incorporated by

20  reference therein.  These methodologies may include fee

21  schedules, reimbursement methods based on cost reporting,

22  negotiated fees, competitive bidding pursuant to s. 287.057,

23  and other mechanisms the agency considers efficient and

24  effective for purchasing services or goods on behalf of

25  recipients.  Payment for Medicaid compensable services made on

26  behalf of Medicaid eligible persons is subject to the

27  availability of moneys and any limitations or directions

28  provided for in the General Appropriations Act or chapter 216.

29  Further, nothing in this section shall be construed to prevent

30  or limit the agency from adjusting fees, reimbursement rates,

31  lengths of stay, number of visits, or number of services, or

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  1  making any other adjustments necessary to comply with the

  2  availability of moneys and any limitations or directions

  3  provided for in the General Appropriations Act, provided the

  4  adjustment is consistent with legislative intent.

  5         (2)(a)1.  Reimbursement to nursing homes licensed under

  6  part II of chapter 400 and state-owned-and-operated

  7  intermediate care facilities for the developmentally disabled

  8  licensed under chapter 393 must be made prospectively.

  9         2.  Unless otherwise limited or directed in the General

10  Appropriations Act, reimbursement to hospitals licensed under

11  part I of chapter 395 for the provision of swing-bed nursing

12  home services must be made on the basis of the average

13  statewide nursing home payment, and reimbursement to a

14  hospital licensed under part I of chapter 395 for the

15  provision of skilled nursing services must be made on the

16  basis of the average nursing home payment for those services

17  in the county in which the hospital is located. When a

18  hospital is located in a county that does not have any

19  community nursing homes, reimbursement must be determined by

20  averaging the nursing home payments, in counties that surround

21  the county in which the hospital is located. Reimbursement to

22  hospitals, including Medicaid payment of Medicare copayments,

23  for skilled nursing services shall be limited to 30 days,

24  unless a prior authorization has been obtained from the

25  agency. Medicaid reimbursement may be extended by the agency

26  beyond 30 days, and approval must be based upon verification

27  by the patient's physician that the patient requires

28  short-term rehabilitative and recuperative services only, in

29  which case an extension of no more than 15 days may be

30  approved. Reimbursement to a hospital licensed under part I of

31  chapter 395 for the temporary provision of skilled nursing

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  1  services to nursing home residents who have been displaced as

  2  the result of a natural disaster or other emergency may not

  3  exceed the average county nursing home payment for those

  4  services in the county in which the hospital is located and is

  5  limited to the period of time which the agency considers

  6  necessary for continued placement of the nursing home

  7  residents in the hospital.

  8         (b)  Subject to any limitations or directions provided

  9  for in the General Appropriations Act, the agency shall

10  establish and implement a Florida Title XIX Long-Term Care

11  Reimbursement Plan (Medicaid) for nursing home care in order

12  to provide care and services in conformance with the

13  applicable state and federal laws, rules, regulations, and

14  quality and safety standards and to ensure that individuals

15  eligible for medical assistance have reasonable geographic

16  access to such care. Effective not later than the rate-setting

17  period beginning January 1, 1999, the agency shall establish a

18  case-mix reimbursement methodology for the rate of payment for

19  long-term-care services for nursing home residents. The agency

20  shall compute a per diem rate for Medicaid residents, adjusted

21  for case mix, which is based on a resident classification

22  system that accounts for the relative resource utilization by

23  different types of residents and which is based on

24  level-of-care data and other appropriate data. In developing

25  the reimbursement methodology, the agency shall evaluate and

26  modify other aspects of the reimbursement plan as necessary to

27  improve the overall effectiveness of the plan with respect to

28  the costs of patient care, operating costs, and property

29  costs. The agency shall work with the Department of Elderly

30  Affairs, the Florida Health Care Association, and the Florida

31  Association of Homes for the Aging in developing the

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  1  methodology. It is the intent of the Legislature that the

  2  reimbursement plan achieve the goal of providing access to

  3  health care for nursing home residents who require large

  4  amounts of care while encouraging diversion services as an

  5  alternative to nursing home care for residents who can be

  6  served within the community.  The agency shall base the

  7  establishment of any maximum rate of payment, whether overall

  8  or component, on the available moneys as provided for in the

  9  General Appropriations Act. The agency may base the maximum

10  rate of payment on the results of scientifically valid

11  analysis and conclusions derived from objective statistical

12  data pertinent to the particular maximum rate of payment.

13         (13)  Premiums, deductibles, and coinsurance for

14  Medicare services rendered to Medicaid-eligible Medicaid

15  eligible persons shall be reimbursed in accordance with fees

16  established by Title XVIII of the Social Security Act.

17  However, any payment by the agency for deductibles,

18  coinsurance, or copayments for a Medicare service rendered to

19  a Medicaid-eligible person may not exceed the amount that may

20  be made for such service under the Medicaid state plan.

21         Section 2.  Subsection (13) of section 409.912, Florida

22  Statutes, is amended, and subsection (34) is added to that

23  section, to read:

24         409.912  Cost-effective purchasing of health care.--The

25  agency shall purchase goods and services for Medicaid

26  recipients in the most cost-effective manner consistent with

27  the delivery of quality medical care.  The agency shall

28  maximize the use of prepaid per capita and prepaid aggregate

29  fixed-sum basis services when appropriate and other

30  alternative service delivery and reimbursement methodologies,

31  including competitive bidding pursuant to s. 287.057, designed

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  1  to facilitate the cost-effective purchase of a case-managed

  2  continuum of care. The agency shall also require providers to

  3  minimize the exposure of recipients to the need for acute

  4  inpatient, custodial, and other institutional care and the

  5  inappropriate or unnecessary use of high-cost services.

  6         (13)  The agency shall identify health care utilization

  7  and price patterns within the Medicaid program which that are

  8  not cost-effective or medically appropriate and assess the

  9  effectiveness of new or alternate methods of providing and

10  monitoring service, and may implement such methods as it

11  considers appropriate. Such methods may include

12  disease-management initiatives, an integrated and systematic

13  approach for managing the health care needs of recipients who

14  are at risk of or diagnosed with a specific disease by using

15  best practices, prevention strategies, clinical-practice

16  improvement, clinical interventions and protocols, outcomes

17  research, information technology, and other tools and

18  resources to reduce overall costs and improve measurable

19  outcomes.

20         (34)  The agency may provide for cost-effective

21  purchasing of home health services through competitive

22  negotiation pursuant to s. 287.057. The agency may request

23  appropriate waivers from the federal Health Care Financing

24  Administration in order to competitively bid home health

25  services.

26         Section 3.  Subsection (2) of section 409.9122, Florida

27  Statutes, is amended to read:

28         409.9122  Mandatory Medicaid managed care enrollment;

29  programs and procedures.--

30         (2)(a)  The agency shall enroll in a managed care plan

31  or MediPass all Medicaid recipients, except those Medicaid

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    Florida Senate - 1998                                   SB 484
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  1  recipients who are: in an institution; enrolled in the

  2  Medicaid medically needy program; or eligible for both

  3  Medicaid and Medicare.  However, to the extent permitted by

  4  federal law, the agency may enroll in a managed care plan or

  5  MediPass a Medicaid recipient who is exempt from mandatory

  6  managed care enrollment, provided that:

  7         1.  The recipient's decision to enroll in a managed

  8  care plan or MediPass is voluntary;

  9         2.  If the recipient chooses to enroll in a managed

10  care plan, the agency has determined that the managed care

11  plan provides specific programs and services which address the

12  special health needs of the recipient; and

13         3.  The agency receives any necessary waivers from the

14  federal Health Care Financing Administration.

15

16  The agency shall develop rules to establish policies by which

17  exceptions to the mandatory managed care enrollment

18  requirement may be made on a case-by-case basis.  The rules

19  shall include the specific criteria to be applied when making

20  a determination as to whether to exempt a recipient from

21  mandatory enrollment in a managed care plan or MediPass.

22  School districts participating in the certified school match

23  program pursuant to ss. 236.0812 and 409.908(21) shall be

24  reimbursed by Medicaid, subject to the limitations of s.

25  236.0812(1) and (2), for a Medicaid-eligible child

26  participating in the services as authorized in s. 236.0812, as

27  provided for in s. 409.9071, regardless of whether the child

28  is enrolled in MediPass or a managed care plan. Managed care

29  plans shall make a good faith effort to execute agreements

30  with school districts and county health departments regarding

31  the coordinated provision of services authorized under s.

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  1  236.0812. To ensure continuity of care for Medicaid patients,

  2  the agency and the Department of Education shall develop

  3  procedures for ensuring that a student's managed care plan or

  4  MediPass provider receives information relating to services

  5  provided in accordance with ss. 236.0812 and 409.9071.

  6         (b)  A Medicaid recipient shall not be enrolled in or

  7  assigned to a managed care plan or MediPass unless the managed

  8  care plan or MediPass has complied with the quality-of-care

  9  standards specified in paragraphs (3)(a) and (b),

10  respectively.

11         (c)  Medicaid recipients shall have a choice of managed

12  care plans or MediPass.  The Agency for Health Care

13  Administration, the Department of Health and Rehabilitative

14  Services, the Department of Children and Family Services, and

15  the Department of Elderly Affairs shall cooperate to ensure

16  that each Medicaid recipient receives clear and easily

17  understandable information that meets the following

18  requirements:

19         1.  Explains the concept of managed care, including

20  MediPass.

21         2.  Provides information on the comparative performance

22  of managed care plans and MediPass in the areas of quality,

23  credentialing, preventive health programs, network size and

24  availability, and patient satisfaction.

25         3.  Explains where additional information on each

26  managed care plan and MediPass in the recipient's area can be

27  obtained.

28         4.  Explains that recipients have the right to choose

29  their own managed care plans or MediPass.  However, if a

30  recipient does not choose a managed care plan or MediPass, the

31

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  1  agency will assign the recipient to a managed care plan or

  2  MediPass according to the criteria specified in this section.

  3         5.  Explains the recipient's right to complain, file a

  4  grievance, or change managed care plans or MediPass providers

  5  if the recipient is not satisfied with the managed care plan

  6  or MediPass.

  7         (d)  The agency shall develop a mechanism for providing

  8  information to Medicaid recipients for the purpose of making a

  9  managed care plan or MediPass selection.  Examples of such

10  mechanisms may include, but not be limited to, interactive

11  information systems, mailings, and mass marketing materials.

12  Managed care plans and MediPass providers are prohibited from

13  providing inducements to Medicaid recipients to select their

14  plans or from prejudicing Medicaid recipients against other

15  managed care plans or MediPass providers.

16         (e)  Prior to requesting a Medicaid recipient who is

17  subject to mandatory managed care enrollment to make a choice

18  between a managed care plan or MediPass, the agency shall

19  contact and provide choice counseling to the recipient.

20  Medicaid recipients who are already enrolled in a managed care

21  plan or MediPass shall be offered the opportunity to change

22  managed care plans or MediPass providers on a staggered basis,

23  as defined by the agency.  All Medicaid recipients shall have

24  90 days in which to make a choice of managed care plans or

25  MediPass providers.  Those Medicaid recipients who do not make

26  a choice shall be assigned to a managed care plan or MediPass

27  in accordance with paragraph (f).  To facilitate continuity of

28  care, for a Medicaid recipient who is also a recipient of

29  Supplemental Security Income (SSI), prior to assigning the SSI

30  recipient to a managed care plan or MediPass, the agency shall

31  determine whether the SSI recipient has an ongoing

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  1  relationship with a MediPass provider or managed care plan,

  2  and if so, the agency shall assign the SSI recipient to that

  3  MediPass provider or managed care plan.  Those SSI recipients

  4  who do not have such a provider relationship shall be assigned

  5  to a managed care plan or MediPass provider in accordance with

  6  paragraph (f).

  7         (f)  When a Medicaid recipient does not choose a

  8  managed care plan or MediPass provider, the agency shall

  9  assign the Medicaid recipient to a managed care plan or

10  MediPass provider.  In the first period that assignment

11  begins, the assignments shall be divided equally between the

12  MediPass program and managed care plans.  Thereafter,

13  assignment of Medicaid recipients who fail to make a choice

14  shall be based proportionally on the preferences of recipients

15  who have made a choice in the previous period.  Such

16  proportions shall be revised at least quarterly to reflect an

17  update of the preferences of Medicaid recipients.  When making

18  assignments, the agency shall take into account the following

19  criteria:

20         1.  A managed care plan has sufficient network capacity

21  to meet the need of members.

22         2.  The managed care plan or MediPass has previously

23  enrolled the recipient as a member, or one of the managed care

24  plan's primary care providers or MediPass providers has

25  previously provided health care to the recipient.

26         3.  The agency has knowledge that the member has

27  previously expressed a preference for a particular managed

28  care plan or MediPass provider as indicated by Medicaid

29  fee-for-service claims data, but has failed to make a choice.

30

31

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  1         4.  The managed care plan's or MediPass primary care

  2  providers are geographically accessible to the recipient's

  3  residence.

  4         (g)  When more than one managed care plan or MediPass

  5  provider meets the criteria specified in paragraph (f), the

  6  agency shall make recipient assignments consecutively by

  7  family unit.

  8         (h)  The agency may not engage in practices that are

  9  designed to favor one managed care plan over another or that

10  are designed to influence Medicaid recipients to enroll in

11  MediPass rather than in a managed care plan or to enroll in a

12  managed care plan rather than in MediPass.  This subsection

13  does not prohibit the agency from reporting on the performance

14  of MediPass or any managed care plan, as measured by

15  performance criteria developed by the agency.

16         (i)  After a recipient has made a selection or has been

17  enrolled in a managed care plan or MediPass, the recipient

18  shall have 90 60 days in which to voluntarily disenroll and

19  select another managed care plan or MediPass provider.  After

20  90 60 days, no further changes may be made except for cause.

21  Cause shall include, but not be limited to, poor quality of

22  care, lack of access to necessary specialty services, an

23  unreasonable delay or denial of service, or fraudulent

24  enrollment.  The agency shall develop criteria for good cause

25  disenrollment for chronically ill and disabled populations who

26  are assigned to managed care plans if more appropriate care is

27  available through the MediPass program.  The agency must make

28  a determination as to whether cause exists.  However, the

29  agency may require a recipient to use the managed care plan's

30  or MediPass grievance process prior to the agency's

31  determination of cause, except in cases in which immediate

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  1  risk of permanent damage to the recipient's health is alleged.

  2  The grievance process, when utilized, must be completed in

  3  time to permit the recipient to disenroll no later than the

  4  first day of the second month after the month the

  5  disenrollment request was made. If the managed care plan or

  6  MediPass, as a result of the grievance process, approves an

  7  enrollee's request to disenroll, the agency is not required to

  8  make a determination in the case.  The agency must make a

  9  determination and take final action on a recipient's request

10  so that disenrollment occurs no later than the first day of

11  the second month after the month the request was made.  If the

12  agency fails to act within the specified timeframe, the

13  recipient's request to disenroll is deemed to be approved as

14  of the date agency action was required.  Recipients who

15  disagree with the agency's finding that cause does not exist

16  for disenrollment shall be advised of their right to pursue a

17  Medicaid fair hearing to dispute the agency's finding.

18         (j)  The agency shall apply for a federal waiver from

19  the Health Care Financing Administration to lock eligible

20  Medicaid recipients into a managed care plan or MediPass for

21  12 months after an open enrollment period. After 12 months'

22  enrollment, a recipient may select another managed care plan

23  or MediPass provider.  However, nothing shall prevent a

24  Medicaid recipient from changing primary care providers within

25  the managed care plan or MediPass program during the 12-month

26  period.

27         (k)  In order to provide increased access to managed

28  care, the agency may request from the Health Care Financing

29  Administration a waiver of the regulation requiring health

30  maintenance organizations to have one commercial enrollee for

31  each three Medicaid enrollees.

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  1         Section 4.  Subsection (18) of section 409.910, Florida

  2  Statutes, is amended to read:

  3         409.910  Responsibility for payments on behalf of

  4  Medicaid-eligible persons when other parties are liable.--

  5         (18)  A recipient or his or her legal representative or

  6  any person representing, or acting as agent for, a recipient

  7  or the recipient's legal representative, who has notice,

  8  excluding notice charged solely by reason of the recording of

  9  the lien pursuant to paragraph (6)(d), or who has actual

10  knowledge of the department's rights to third-party benefits

11  under this section, who receives any third-party benefit or

12  proceeds therefrom for a covered illness or injury, is

13  required either to pay the department the full amount of the

14  third-party benefits, but not in excess of the total medical

15  assistance provided by Medicaid within 30 days after

16  settlement, or to place the full amount of the third-party

17  benefits in an interest-bearing a trust account for the

18  benefit of the department pending judicial or administrative

19  determination of the department's right thereto. Proof that

20  any such person had notice or knowledge that the recipient had

21  received medical assistance from Medicaid, and that

22  third-party benefits or proceeds therefrom were in any way

23  related to a covered illness or injury for which Medicaid had

24  provided medical assistance, and that any such person

25  knowingly obtained possession or control of, or used,

26  third-party benefits or proceeds and failed either to pay the

27  department the full amount required by this section or to hold

28  the full amount of third-party benefits or proceeds in trust

29  pending judicial or administrative determination, unless

30  adequately explained, gives rise to an inference that such

31  person knowingly failed to credit the state or its agent for

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  1  payments received from social security, insurance, or other

  2  sources, pursuant to s. 414.39(4)(b), and acted with the

  3  intent set forth in s. 812.014(1).

  4         (a)  The department is authorized to investigate and to

  5  request appropriate officers or agencies of the state to

  6  investigate suspected criminal violations or fraudulent

  7  activity related to third-party benefits, including, without

  8  limitation, ss. 409.325 and 812.014. Such requests may be

  9  directed, without limitation, to the Medicaid Fraud Control

10  Unit of the Office of the Attorney General, or to any state

11  attorney. Pursuant to s. 409.913, the Attorney General has

12  primary responsibility to investigate and control Medicaid

13  fraud.

14         (b)  In carrying out duties and responsibilities

15  related to Medicaid fraud control, the department may subpoena

16  witnesses or materials within or outside the state and,

17  through any duly designated employee, administer oaths and

18  affirmations and collect evidence for possible use in either

19  civil or criminal judicial proceedings.

20         (c)  All information obtained and documents prepared

21  pursuant to an investigation of a Medicaid recipient, the

22  recipient's legal representative, or any other person relating

23  to an allegation of recipient fraud or theft is confidential

24  and exempt from s. 119.07(1):

25         1.  Until such time as the department takes final

26  agency action;

27         2.  Until such time as the Attorney General refers the

28  case for criminal prosecution;

29         3.  Until such time as an indictment or criminal

30  information is filed by a state attorney in a criminal case;

31  or

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  1         4.  At all times if otherwise protected by law.

  2         Section 5.  Subsection (1) of section 414.28, Florida

  3  Statutes, is amended to read:

  4         414.28  Public assistance payments to constitute debt

  5  of recipient.--

  6         (1)  CLAIMS.--The acceptance of public assistance

  7  creates a debt of the person accepting assistance, which debt

  8  is enforceable only after the death of the recipient.  The

  9  debt thereby created is enforceable only by claim filed

10  against the estate of the recipient after his or her death or

11  by suit to set aside a fraudulent conveyance, as defined in

12  subsection (3). After the death of the recipient and within

13  the time prescribed by law, the department may file a claim

14  against the estate of the recipient for the total amount of

15  public assistance paid to or for the benefit of such

16  recipient, reimbursement for which has not been made.  Claims

17  so filed shall take priority as class 3 class 7 claims as

18  provided by s. 733.707(1)(g).

19         Section 6.  Section 198.30, Florida Statutes, is

20  amended to read:

21         198.30  Circuit judge to furnish department with names

22  of decedents, etc.--Each circuit judge of this state shall, on

23  or before the 10th day of every month, notify the department

24  of the names of all decedents; the names and addresses of the

25  respective personal representatives, administrators, or

26  curators appointed; the amount of the bonds, if any, required

27  by the court; and the probable value of the estates, in all

28  estates of decedents whose wills have been probated or

29  propounded for probate before the circuit judge or upon which

30  letters testamentary or upon whose estates letters of

31  administration or curatorship have been sought or granted,

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  1  during the preceding month; and such report shall contain any

  2  other information which the circuit judge may have concerning

  3  the estates of such decedents. In addition, a copy of this

  4  report shall be provided to the Agency for Health Care

  5  Administration. A circuit judge shall also furnish forthwith

  6  such further information, from the records and files of the

  7  circuit court in regard to such estates, as the department may

  8  from time to time require.

  9         Section 7.  Subsection (3) of section 733.212, Florida

10  Statutes, is amended to read:

11         733.212  Notice of administration; filing of objections

12  and claims.--

13         (3)  The personal representative shall serve a copy of

14  the notice on the following persons who are known to the

15  personal representative:

16         (a)  The decedent's surviving spouse;

17         (b)  Beneficiaries; and

18         (c)  The trustee of any trust described in s.

19  733.707(3), of which the decedent was grantor; and

20         (d)  The Agency for Health Care Administration

21

22  in the manner provided for service of formal notice, unless

23  served under s. 733.2123.  The personal representative may

24  similarly serve a copy of the notice on any devisees under a

25  known prior will or heirs.

26         Section 8.  This act shall take effect July 1, 1998.

27

28

29

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  1            *****************************************

  2                          SENATE SUMMARY

  3    Requires that the Agency for Health Care Administration
      establish a methodology for reimbursing providers under
  4    the Medicaid program. Provides certain limitations on the
      amount of payment that may be made for a Medicare service
  5    on behalf of a person who is also eligible for Medicaid.
      Authorizes the agency to competitively negotiate the
  6    purchase of home health services for Medicaid recipients.
      Provides that a Medicaid recipient has 90 days rather
  7    than 60 days within which to select another managed care
      plan or MediPass provider after voluntarily disenrolling
  8    from a managed care plan or MediPass. Requires that
      third-party benefits received by a Medicaid recipient
  9    must be remitted to the agency within 30 days after
      settlement. Provides for public assistance payments to
10    take priority in recovery against the estate of a
      deceased person as a class 3 claim rather than as a class
11    7 claim. Requires circuit judges and personal
      representatives to notify the Agency for Health Care
12    Administration on the administration of estates. (See
      bill for details.)
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