Senate Bill 0484c1
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Florida Senate - 1998 CS for SB 484
By the Committee on Health Care
317-898-98
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; amending s. 409.912, F.S.; authorizing
9 the agency to include disease-management
10 initiatives in providing and monitoring
11 Medicaid services; authorizing the agency to
12 competitively negotiate home health services;
13 authorizing the agency to seek necessary
14 federal waivers that relate to the competitive
15 negotiation of such services; amending s.
16 409.9122, F.S.; specifying the departments that
17 are required to make certain information
18 available to Medicaid recipients; extending the
19 period during which a Medicaid recipient may
20 disenroll from a managed care plan or MediPass
21 provider; deleting authorization for the agency
22 to request a federal waiver from the
23 requirement that a Medicaid managed care plan
24 include a specified ratio of enrollees;
25 amending s. 409.910, F.S.; providing for the
26 distribution of amounts recovered in certain
27 tort suits involving intervention by the Agency
28 for Health Care Administration; 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; providing an effective
7 date.
8
9 Be It Enacted by the Legislature of the State of Florida:
10
11 Section 1. Subsection (2) of section 409.908, Florida
12 Statutes, is amended to read:
13 409.908 Reimbursement of Medicaid providers.--Subject
14 to specific appropriations, the agency shall reimburse
15 Medicaid providers, in accordance with state and federal law,
16 according to methodologies set forth in the rules of the
17 agency and in policy manuals and handbooks incorporated by
18 reference therein. These methodologies may include fee
19 schedules, reimbursement methods based on cost reporting,
20 negotiated fees, competitive bidding pursuant to s. 287.057,
21 and other mechanisms the agency considers efficient and
22 effective for purchasing services or goods on behalf of
23 recipients. Payment for Medicaid compensable services made on
24 behalf of Medicaid eligible persons is subject to the
25 availability of moneys and any limitations or directions
26 provided for in the General Appropriations Act or chapter 216.
27 Further, nothing in this section shall be construed to prevent
28 or limit the agency from adjusting fees, reimbursement rates,
29 lengths of stay, number of visits, or number of services, or
30 making any other adjustments necessary to comply with the
31 availability of moneys and any limitations or directions
2
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1 provided for in the General Appropriations Act, provided the
2 adjustment is consistent with legislative intent.
3 (2)(a)1. Reimbursement to nursing homes licensed under
4 part II of chapter 400 and state-owned-and-operated
5 intermediate care facilities for the developmentally disabled
6 licensed under chapter 393 must be made prospectively.
7 2. Unless otherwise limited or directed in the General
8 Appropriations Act, reimbursement to hospitals licensed under
9 part I of chapter 395 for the provision of swing-bed nursing
10 home services must be made on the basis of the average
11 statewide nursing home payment, and reimbursement to a
12 hospital licensed under part I of chapter 395 for the
13 provision of skilled nursing services must be made on the
14 basis of the average nursing home payment for those services
15 in the county in which the hospital is located. When a
16 hospital is located in a county that does not have any
17 community nursing homes, reimbursement must be determined by
18 averaging the nursing home payments, in counties that surround
19 the county in which the hospital is located. Reimbursement to
20 hospitals, including Medicaid payment of Medicare copayments,
21 for skilled nursing services shall be limited to 30 days,
22 unless a prior authorization has been obtained from the
23 agency. Medicaid reimbursement may be extended by the agency
24 beyond 30 days, and approval must be based upon verification
25 by the patient's physician that the patient requires
26 short-term rehabilitative and recuperative services only, in
27 which case an extension of no more than 15 days may be
28 approved. Reimbursement to a hospital licensed under part I of
29 chapter 395 for the temporary provision of skilled nursing
30 services to nursing home residents who have been displaced as
31 the result of a natural disaster or other emergency may not
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1 exceed the average county nursing home payment for those
2 services in the county in which the hospital is located and is
3 limited to the period of time which the agency considers
4 necessary for continued placement of the nursing home
5 residents in the hospital.
6 (b) Subject to any limitations or directions provided
7 for in the General Appropriations Act, the agency shall
8 establish and implement a Florida Title XIX Long-Term Care
9 Reimbursement Plan (Medicaid) for nursing home care in order
10 to provide care and services in conformance with the
11 applicable state and federal laws, rules, regulations, and
12 quality and safety standards and to ensure that individuals
13 eligible for medical assistance have reasonable geographic
14 access to such care. Effective not later than the rate-setting
15 period beginning July 1, 1999, the agency shall establish a
16 case-mix reimbursement methodology for the rate of payment for
17 long-term-care services for nursing home residents. The agency
18 shall compute a per diem rate for Medicaid residents, adjusted
19 for case mix, which is based on a resident classification
20 system that accounts for the relative resource utilization by
21 different types of residents and which is based on
22 level-of-care data and other appropriate data. The case-mix
23 methodology developed by the agency shall take into account
24 the medical, behavioral, and cognitive deficits of residents.
25 In developing the reimbursement methodology, the agency shall
26 evaluate and modify other aspects of the reimbursement plan as
27 necessary to improve the overall effectiveness of the plan
28 with respect to the costs of patient care, operating costs,
29 and property costs. The agency shall work with the Department
30 of Elderly Affairs, the Florida Health Care Association, and
31 the Florida Association of Homes for the Aging in developing
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1 the 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 Section 2. Subsection (13) of section 409.912, Florida
14 Statutes, is amended, and subsection (34) is added to that
15 section, to read:
16 409.912 Cost-effective purchasing of health care.--The
17 agency shall purchase goods and services for Medicaid
18 recipients in the most cost-effective manner consistent with
19 the delivery of quality medical care. The agency shall
20 maximize the use of prepaid per capita and prepaid aggregate
21 fixed-sum basis services when appropriate and other
22 alternative service delivery and reimbursement methodologies,
23 including competitive bidding pursuant to s. 287.057, designed
24 to facilitate the cost-effective purchase of a case-managed
25 continuum of care. The agency shall also require providers to
26 minimize the exposure of recipients to the need for acute
27 inpatient, custodial, and other institutional care and the
28 inappropriate or unnecessary use of high-cost services.
29 (13) The agency shall identify health care utilization
30 and price patterns within the Medicaid program which that are
31 not cost-effective or medically appropriate and assess the
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1 effectiveness of new or alternate methods of providing and
2 monitoring service, and may implement such methods as it
3 considers appropriate. Such methods may include
4 disease-management initiatives, an integrated and systematic
5 approach for managing the health care needs of recipients who
6 are at risk of or diagnosed with a specific disease by using
7 best practices, prevention strategies, clinical-practice
8 improvement, clinical interventions and protocols, outcomes
9 research, information technology, and other tools and
10 resources to reduce overall costs and improve measurable
11 outcomes.
12 (34) The agency may provide for cost-effective
13 purchasing of home health services through competitive
14 negotiation pursuant to s. 287.057. The agency may request
15 appropriate waivers from the federal Health Care Financing
16 Administration in order to competitively bid home health
17 services.
18 Section 3. Subsection (2) of section 409.9122, Florida
19 Statutes, is amended to read:
20 409.9122 Mandatory Medicaid managed care enrollment;
21 programs and procedures.--
22 (2)(a) The agency shall enroll in a managed care plan
23 or MediPass all Medicaid recipients, except those Medicaid
24 recipients who are: in an institution; enrolled in the
25 Medicaid medically needy program; or eligible for both
26 Medicaid and Medicare. However, to the extent permitted by
27 federal law, the agency may enroll in a managed care plan or
28 MediPass a Medicaid recipient who is exempt from mandatory
29 managed care enrollment, provided that:
30 1. The recipient's decision to enroll in a managed
31 care plan or MediPass is voluntary;
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1 2. If the recipient chooses to enroll in a managed
2 care plan, the agency has determined that the managed care
3 plan provides specific programs and services which address the
4 special health needs of the recipient; and
5 3. The agency receives any necessary waivers from the
6 federal Health Care Financing Administration.
7
8 The agency shall develop rules to establish policies by which
9 exceptions to the mandatory managed care enrollment
10 requirement may be made on a case-by-case basis. The rules
11 shall include the specific criteria to be applied when making
12 a determination as to whether to exempt a recipient from
13 mandatory enrollment in a managed care plan or MediPass.
14 School districts participating in the certified school match
15 program pursuant to ss. 236.0812 and 409.908(21) shall be
16 reimbursed by Medicaid, subject to the limitations of s.
17 236.0812(1) and (2), for a Medicaid-eligible child
18 participating in the services as authorized in s. 236.0812, as
19 provided for in s. 409.9071, regardless of whether the child
20 is enrolled in MediPass or a managed care plan. Managed care
21 plans shall make a good faith effort to execute agreements
22 with school districts and county health departments regarding
23 the coordinated provision of services authorized under s.
24 236.0812. To ensure continuity of care for Medicaid patients,
25 the agency and the Department of Education shall develop
26 procedures for ensuring that a student's managed care plan or
27 MediPass provider receives information relating to services
28 provided in accordance with ss. 236.0812 and 409.9071.
29 (b) A Medicaid recipient shall not be enrolled in or
30 assigned to a managed care plan or MediPass unless the managed
31 care plan or MediPass has complied with the quality-of-care
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1 standards specified in paragraphs (3)(a) and (b),
2 respectively.
3 (c) Medicaid recipients shall have a choice of managed
4 care plans or MediPass. The Agency for Health Care
5 Administration, the Department of Health and Rehabilitative
6 Services, the Department of Children and Family Services, and
7 the Department of Elderly Affairs shall cooperate to ensure
8 that each Medicaid recipient receives clear and easily
9 understandable information that meets the following
10 requirements:
11 1. Explains the concept of managed care, including
12 MediPass.
13 2. Provides information on the comparative performance
14 of managed care plans and MediPass in the areas of quality,
15 credentialing, preventive health programs, network size and
16 availability, and patient satisfaction.
17 3. Explains where additional information on each
18 managed care plan and MediPass in the recipient's area can be
19 obtained.
20 4. Explains that recipients have the right to choose
21 their own managed care plans or MediPass. However, if a
22 recipient does not choose a managed care plan or MediPass, the
23 agency will assign the recipient to a managed care plan or
24 MediPass according to the criteria specified in this section.
25 5. Explains the recipient's right to complain, file a
26 grievance, or change managed care plans or MediPass providers
27 if the recipient is not satisfied with the managed care plan
28 or MediPass.
29 (d) The agency shall develop a mechanism for providing
30 information to Medicaid recipients for the purpose of making a
31 managed care plan or MediPass selection. Examples of such
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1 mechanisms may include, but not be limited to, interactive
2 information systems, mailings, and mass marketing materials.
3 Managed care plans and MediPass providers are prohibited from
4 providing inducements to Medicaid recipients to select their
5 plans or from prejudicing Medicaid recipients against other
6 managed care plans or MediPass providers.
7 (e) Prior to requesting a Medicaid recipient who is
8 subject to mandatory managed care enrollment to make a choice
9 between a managed care plan or MediPass, the agency shall
10 contact and provide choice counseling to the recipient.
11 Medicaid recipients who are already enrolled in a managed care
12 plan or MediPass shall be offered the opportunity to change
13 managed care plans or MediPass providers on a staggered basis,
14 as defined by the agency. All Medicaid recipients shall have
15 90 days in which to make a choice of managed care plans or
16 MediPass providers. Those Medicaid recipients who do not make
17 a choice shall be assigned to a managed care plan or MediPass
18 in accordance with paragraph (f). To facilitate continuity of
19 care, for a Medicaid recipient who is also a recipient of
20 Supplemental Security Income (SSI), prior to assigning the SSI
21 recipient to a managed care plan or MediPass, the agency shall
22 determine whether the SSI recipient has an ongoing
23 relationship with a MediPass provider or managed care plan,
24 and if so, the agency shall assign the SSI recipient to that
25 MediPass provider or managed care plan. Those SSI recipients
26 who do not have such a provider relationship shall be assigned
27 to a managed care plan or MediPass provider in accordance with
28 paragraph (f).
29 (f) When a Medicaid recipient does not choose a
30 managed care plan or MediPass provider, the agency shall
31 assign the Medicaid recipient to a managed care plan or
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1 MediPass provider. In the first period that assignment
2 begins, the assignments shall be divided equally between the
3 MediPass program and managed care plans. Thereafter,
4 assignment of Medicaid recipients who fail to make a choice
5 shall be based proportionally on the preferences of recipients
6 who have made a choice in the previous period. Such
7 proportions shall be revised at least quarterly to reflect an
8 update of the preferences of Medicaid recipients. When making
9 assignments, the agency shall take into account the following
10 criteria:
11 1. A managed care plan has sufficient network capacity
12 to meet the need of members.
13 2. The managed care plan or MediPass has previously
14 enrolled the recipient as a member, or one of the managed care
15 plan's primary care providers or MediPass providers has
16 previously provided health care to the recipient.
17 3. The agency has knowledge that the member has
18 previously expressed a preference for a particular managed
19 care plan or MediPass provider as indicated by Medicaid
20 fee-for-service claims data, but has failed to make a choice.
21 4. The managed care plan's or MediPass primary care
22 providers are geographically accessible to the recipient's
23 residence.
24 (g) When more than one managed care plan or MediPass
25 provider meets the criteria specified in paragraph (f), the
26 agency shall make recipient assignments consecutively by
27 family unit.
28 (h) The agency may not engage in practices that are
29 designed to favor one managed care plan over another or that
30 are designed to influence Medicaid recipients to enroll in
31 MediPass rather than in a managed care plan or to enroll in a
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1 managed care plan rather than in MediPass. This subsection
2 does not prohibit the agency from reporting on the performance
3 of MediPass or any managed care plan, as measured by
4 performance criteria developed by the agency.
5 (i) After a recipient has made a selection or has been
6 enrolled in a managed care plan or MediPass, the recipient
7 shall have 90 60 days in which to voluntarily disenroll and
8 select another managed care plan or MediPass provider. After
9 90 60 days, no further changes may be made except for cause.
10 Cause shall include, but not be limited to, poor quality of
11 care, lack of access to necessary specialty services, an
12 unreasonable delay or denial of service, or fraudulent
13 enrollment. The agency shall develop criteria for good cause
14 disenrollment for chronically ill and disabled populations who
15 are assigned to managed care plans if more appropriate care is
16 available through the MediPass program. The agency must make
17 a determination as to whether cause exists. However, the
18 agency may require a recipient to use the managed care plan's
19 or MediPass grievance process prior to the agency's
20 determination of cause, except in cases in which immediate
21 risk of permanent damage to the recipient's health is alleged.
22 The grievance process, when utilized, must be completed in
23 time to permit the recipient to disenroll no later than the
24 first day of the second month after the month the
25 disenrollment request was made. If the managed care plan or
26 MediPass, as a result of the grievance process, approves an
27 enrollee's request to disenroll, the agency is not required to
28 make a determination in the case. The agency must make a
29 determination and take final action on a recipient's request
30 so that disenrollment occurs no later than the first day of
31 the second month after the month the request was made. If the
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1 agency fails to act within the specified timeframe, the
2 recipient's request to disenroll is deemed to be approved as
3 of the date agency action was required. Recipients who
4 disagree with the agency's finding that cause does not exist
5 for disenrollment shall be advised of their right to pursue a
6 Medicaid fair hearing to dispute the agency's finding.
7 (j) The agency shall apply for a federal waiver from
8 the Health Care Financing Administration to lock eligible
9 Medicaid recipients into a managed care plan or MediPass for
10 12 months after an open enrollment period. After 12 months'
11 enrollment, a recipient may select another managed care plan
12 or MediPass provider. However, nothing shall prevent a
13 Medicaid recipient from changing primary care providers within
14 the managed care plan or MediPass program during the 12-month
15 period.
16 (k) In order to provide increased access to managed
17 care, the agency may request from the Health Care Financing
18 Administration a waiver of the regulation requiring health
19 maintenance organizations to have one commercial enrollee for
20 each three Medicaid enrollees.
21 Section 4. Paragraph (f) of subsection (12) and
22 subsection (18) of section 409.910, Florida Statutes, are
23 amended to read:
24 409.910 Responsibility for payments on behalf of
25 Medicaid-eligible persons when other parties are liable.--
26 (12) The department may, as a matter of right, in
27 order to enforce its rights under this section, institute,
28 intervene in, or join any legal or administrative proceeding
29 in its own name in one or more of the following capacities:
30 individually, as subrogee of the recipient, as assignee of the
31 recipient, or as lienholder of the collateral.
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1 (f) Notwithstanding any provision in this section to
2 the contrary, the department shall reduce its recovery to take
3 account of the cost of procuring the judgment, award, or
4 settlement amount as provided in this section.
5 1. In the event of an action in tort against a third
6 party in which the recipient or his or her legal
7 representative is a party and in which the amount of any
8 judgment, award, or settlement from third-party benefits,
9 excluding medical coverage as defined in sub-subparagraph d.
10 subparagraph 4., after reasonable costs and expenses of
11 litigation, is an amount equal to or less than 200 percent of
12 the amount of medical assistance provided by Medicaid less any
13 medical coverage paid or payable to the department, then
14 distribution of the amount recovered shall be as follows:
15 a.1. Any fee for services of an attorney retained by
16 the recipient or his or her legal representative shall not
17 exceed an amount equal to 25 percent of the recovery, after
18 reasonable costs and expenses of litigation, from the
19 judgment, award, or settlement.
20 b.2. After attorney's fees, two-thirds of the
21 remaining recovery shall be designated for past medical care
22 and paid to the department for medical assistance provided by
23 Medicaid.
24 c.3. The remaining amount from the recovery shall be
25 paid to the recipient.
26 d. As used in 4. For purposes of this paragraph, the
27 term "medical coverage" means any benefits under health
28 insurance, a health maintenance organization, a preferred
29 provider arrangement, or a prepaid health clinic, and the
30 portion of benefits designated for medical payments under
31
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1 coverage for workers' compensation, personal injury
2 protection, and casualty.
3 2. In the event of an action in tort against a third
4 party in which the recipient or his or her legal
5 representative is a party and in which the amount of any
6 judgment, award, or settlement from the third-party benefits,
7 excluding medical coverage as defined in sub-subparagraph
8 1.d., after reasonable costs and expenses of litigation, is an
9 amount more than 200 percent of the amount of medical
10 assistance provided by Medicaid, less any medical coverage
11 paid or payable to the department, then distribution of the
12 amount of recovery must be computed as follows:
13 a. Determine the ratio of the procurement costs to the
14 total judgment or settlement payment. Procurement costs must
15 include reasonable costs and expenses of litigation and
16 attorney's fees. The total amount of attorney's fees used to
17 determine the procurement costs attributable to Medicaid must
18 not exceed 25 percent of the award, judgment, or settlement
19 from third-party benefits, excluding medical coverage as
20 defined in sub-subparagraph 1.d., and after reasonable costs
21 and expenses of litigation.
22 b. Apply the ratio to the Medicaid payment. The
23 product is the Medicaid share of procurement costs.
24 c. Subtract the Medicaid share of procurement costs
25 from the Medicaid payments. The remainder is the department's
26 recovery amount.
27 (18) A recipient or his or her legal representative or
28 any person representing, or acting as agent for, a recipient
29 or the recipient's legal representative, who has notice,
30 excluding notice charged solely by reason of the recording of
31 the lien pursuant to paragraph (6)(d), or who has actual
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1 knowledge of the department's rights to third-party benefits
2 under this section, who receives any third-party benefit or
3 proceeds therefrom for a covered illness or injury, is
4 required either to pay the department, within 60 days after
5 receipt of settlement proceeds, the full amount of the
6 third-party benefits, but not in excess of the total medical
7 assistance provided by Medicaid, or to place the full amount
8 of the third-party benefits in a trust account for the benefit
9 of the department pending judicial or administrative
10 determination of the department's right thereto. Proof that
11 any such person had notice or knowledge that the recipient had
12 received medical assistance from Medicaid, and that
13 third-party benefits or proceeds therefrom were in any way
14 related to a covered illness or injury for which Medicaid had
15 provided medical assistance, and that any such person
16 knowingly obtained possession or control of, or used,
17 third-party benefits or proceeds and failed either to pay the
18 department the full amount required by this section or to hold
19 the full amount of third-party benefits or proceeds in trust
20 pending judicial or administrative determination, unless
21 adequately explained, gives rise to an inference that such
22 person knowingly failed to credit the state or its agent for
23 payments received from social security, insurance, or other
24 sources, pursuant to s. 414.39(4)(b), and acted with the
25 intent set forth in s. 812.014(1).
26 (a) The department is authorized to investigate and to
27 request appropriate officers or agencies of the state to
28 investigate suspected criminal violations or fraudulent
29 activity related to third-party benefits, including, without
30 limitation, ss. 409.325 and 812.014. Such requests may be
31 directed, without limitation, to the Medicaid Fraud Control
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1 Unit of the Office of the Attorney General, or to any state
2 attorney. Pursuant to s. 409.913, the Attorney General has
3 primary responsibility to investigate and control Medicaid
4 fraud.
5 (b) In carrying out duties and responsibilities
6 related to Medicaid fraud control, the department may subpoena
7 witnesses or materials within or outside the state and,
8 through any duly designated employee, administer oaths and
9 affirmations and collect evidence for possible use in either
10 civil or criminal judicial proceedings.
11 (c) All information obtained and documents prepared
12 pursuant to an investigation of a Medicaid recipient, the
13 recipient's legal representative, or any other person relating
14 to an allegation of recipient fraud or theft is confidential
15 and exempt from s. 119.07(1):
16 1. Until such time as the department takes final
17 agency action;
18 2. Until such time as the Attorney General refers the
19 case for criminal prosecution;
20 3. Until such time as an indictment or criminal
21 information is filed by a state attorney in a criminal case;
22 or
23 4. At all times if otherwise protected by law.
24 Section 5. Subsection (1) of section 414.28, Florida
25 Statutes, is amended to read:
26 414.28 Public assistance payments to constitute debt
27 of recipient.--
28 (1) CLAIMS.--The acceptance of public assistance
29 creates a debt of the person accepting assistance, which debt
30 is enforceable only after the death of the recipient. The
31 debt thereby created is enforceable only by claim filed
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1 against the estate of the recipient after his or her death or
2 by suit to set aside a fraudulent conveyance, as defined in
3 subsection (3). After the death of the recipient and within
4 the time prescribed by law, the department may file a claim
5 against the estate of the recipient for the total amount of
6 public assistance paid to or for the benefit of such
7 recipient, reimbursement for which has not been made. Claims
8 so filed shall take priority as class 3 class 7 claims as
9 provided by s. 733.707(1)(g).
10 Section 6. Section 198.30, Florida Statutes, is
11 amended to read:
12 198.30 Circuit judge to furnish department with names
13 of decedents, etc.--Each circuit judge of this state shall, on
14 or before the 10th day of every month, notify the department
15 of the names of all decedents; the names and addresses of the
16 respective personal representatives, administrators, or
17 curators appointed; the amount of the bonds, if any, required
18 by the court; and the probable value of the estates, in all
19 estates of decedents whose wills have been probated or
20 propounded for probate before the circuit judge or upon which
21 letters testamentary or upon whose estates letters of
22 administration or curatorship have been sought or granted,
23 during the preceding month; and such report shall contain any
24 other information which the circuit judge may have concerning
25 the estates of such decedents. In addition, a copy of this
26 report shall be provided to the Agency for Health Care
27 Administration. A circuit judge shall also furnish forthwith
28 such further information, from the records and files of the
29 circuit court in regard to such estates, as the department may
30 from time to time require.
31 Section 7. This act shall take effect July 1, 1998.
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 484
3
4 1. Requires the Agency for Health Care Administration (AHCA)
to transition to a case-mix reimbursement methodology for
5 Medicaid nursing home services no later than the rate
setting period beginning July 1, rather than January
6 1,1999. Specifies that the methodology must take into
account the medical, behavioral, and cognitive deficits
7 of residents.
8 2. Deletes modifications to existing statutory language
relating to Medicaid reimbursement of certain costs for
9 persons eligible for both Medicare and Medicaid.
10 3. Specifies the distribution of recoveries from third party
benefits in cases where the recovery is more than 200
11 percent of the amount of medical assistance provided by
Medicaid, less any medical coverage paid or payable to
12 Medicaid.
13 4. Changes from 30 days after settlement to 60 days after
receipt of settlement proceeds the period of time during
14 which recovered funds are to be paid to Medicaid.
15 5. Deletes a requirement that settlement proceeds must be
deposited in an interest-bearing trust account.
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6. Deletes a requirement that an estate personal
17 representative serve a copy of the notice of estate
administration to AHCA.
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