Senate Bill 0484er
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1
2 An act relating to health care; providing an
3 important state interest; amending ss. 154.301,
4 154.302, 154.304, 154.306, 154.308, 154.309,
5 154.31, 154.3105, 154.312, 154.314, and
6 154.316, F.S., relating to health care
7 responsibility for indigents; revising short
8 title; revising definitions; limiting the
9 maximum amount a county may be required to pay
10 an out-of-county hospital; providing hospitals
11 additional time to notify counties of admission
12 or treatment of out-of-county patients;
13 revising language and conforming references;
14 providing penalties; amending s. 154.504, F.S.;
15 limiting applicability of copayments under the
16 Primary Care for Children and Families
17 Challenge Grant Program; amending s. 198.30,
18 F.S.; requiring certain reports of estates of
19 decedents to be provided to the Agency for
20 Health Care Administration; amending ss.
21 240.4075 and 240.4076, F.S., relating the
22 Nursing Student Loan Forgiveness Program, the
23 Nursing Student Loan Forgiveness Trust Fund,
24 and the nursing scholarship program;
25 transferring powers, duties, and functions with
26 respect thereto from the Department of Health
27 to the Department of Education; creating ss.
28 381.0022 and 402.115, F.S.; authorizing the
29 Department of Health and the Department of
30 Children and Family Services to share
31 confidential and exempt information; amending
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1 s. 381.004, F.S., relating to HIV testing;
2 providing a penalty and increasing existing
3 penalties; amending s. 384.34, F.S., relating
4 to sexually transmissible diseases; providing a
5 penalty and increasing existing penalties;
6 amending s. 414.028, F.S.; providing for a
7 representative of a county health department or
8 Healthy Start Coalition to serve on the local
9 WAGES coalition; amending s. 766.101, F.S.;
10 redefining the term "medical review committee"
11 to include a committee of the Department of
12 Health; amending s. 383.011, F.S.; providing
13 that the Department of Health is the designated
14 state agency for receiving federal funds for
15 the Child Care Food Program; requiring the
16 department to adopt rules for administering the
17 program; amending s. 383.04, F.S.; revising the
18 requirements for the prophylactic to be used
19 for the eyes of infants; repealing s. 383.05,
20 F.S., relating to the free distribution of such
21 prophylactic; amending s. 409.903, F.S.;
22 providing Medicaid eligibility standards for
23 certain persons; conforming references;
24 amending s. 409.908, F.S.; requiring the agency
25 to establish a reimbursement methodology for
26 long-term-care services for Medicaid-eligible
27 nursing home residents; specifying requirements
28 for the methodology; providing legislative
29 intent; prescribing guidelines for Medicaid
30 payment of Medicare deductibles and
31 coinsurance; eliminating a prohibition on
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1 specified contracts; repealing redundant
2 provisions; amending s. 409.912, F.S.;
3 authorizing the agency to include
4 disease-management initiatives in providing and
5 monitoring Medicaid services; authorizing the
6 agency to competitively negotiate home health
7 services; authorizing the agency to seek
8 necessary federal waivers that relate to the
9 competitive negotiation of such services;
10 directing the Agency for Health Care
11 Administration to establish an outpatient
12 specialty services pilot project; providing
13 definitions; providing criteria for
14 participation; requiring an evaluation and a
15 report to the Governor and Legislature;
16 modifying the licensure requirements for a
17 provider of services under a pilot project;
18 amending s. 409.9122, F.S.; requiring the
19 Agency for Health Care Administration to
20 reimburse county health departments for
21 school-based services; requiring Medicaid
22 managed-care contractors to attempt to enter
23 agreements with school districts and county
24 health departments for specified services;
25 specifying the departments that are required to
26 make certain information available to Medicaid
27 recipients; extending the period during which a
28 Medicaid recipient may disenroll from a managed
29 care plan or MediPass provider; deleting
30 authorization for the agency to request a
31 federal waiver from the requirement that a
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1 Medicaid managed care plan include a specified
2 ratio of enrollees; amending requirements for
3 the mandatory assignment of Medicaid
4 recipients; amending s. 409.910, F.S.;
5 providing for the distribution of amounts
6 recovered in certain tort suits involving
7 intervention by the Agency for Health Care
8 Administration; requiring that certain
9 third-party benefits received by a Medicaid
10 recipient be remitted within a specified
11 period; amending s. 414.28, F.S.; revising the
12 order under which a claim may be made against
13 the estate of a recipient of public assistance;
14 amending s. 627.912, F.S.; revising reporting
15 requirements by certain insurers; requiring
16 certain self-insurers to report certain
17 information to the Department of Insurance;
18 naming the Carl S. Lytle, M.D., Memorial Health
19 Facility in Marion County; providing an
20 appropriation to be matched by federal Medicaid
21 funds; providing effective dates.
22
23 Be It Enacted by the Legislature of the State of Florida:
24
25 Section 1. The Legislature finds that the provisions
26 of this act which amend sections 154.301 through 154.316,
27 Florida Statutes, fulfill the important state interest of
28 promoting the legislative intent of the Florida Health Care
29 Responsibility Act, as that intent is expressed in section
30 154.302, Florida Statutes.
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1 Section 2. Section 154.301, Florida Statutes, is
2 amended to read:
3 154.301 Short title.--Sections 154.301-154.316 may be
4 cited as "The Florida Health Care Responsibility Act of 1988."
5 Section 3. Section 154.302, Florida Statutes, is
6 amended to read:
7 154.302 Legislative intent.--The Legislature finds
8 that certain hospitals provide a disproportionate share of
9 charity care for persons who are indigent, and not able to pay
10 their medical bills, and who are not eligible for
11 government-funded programs. The burden of absorbing the cost
12 of this uncompensated charity care is borne by the hospital,
13 the private pay patients, and, many times, by the taxpayers in
14 the county when the hospital is subsidized by tax revenues.
15 The Legislature further finds that it is inequitable for
16 hospitals and taxpayers of one county to be expected to
17 subsidize the care of out-of-county indigent persons. Finally,
18 the Legislature declares that the state and the counties must
19 share the responsibility of assuring that adequate and
20 affordable health care is available to all Floridians.
21 Therefore, it is the intent of the Legislature to place the
22 ultimate financial obligation for the out-of-county hospital
23 care of qualified indigent patients on the county in which the
24 indigent patient resides.
25 Section 4. Section 154.304, Florida Statutes, is
26 amended to read:
27 154.304 Definitions.--As used in this part, the term
28 For the purpose of this act:
29 (1) "Agency" means the Agency for Health Care
30 Administration.
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1 (1) "Board" means the Health Care Board as established
2 in chapter 408.
3 (2) "Certification determination procedures" means the
4 process used by the county of residence or the agency
5 department to determine a person's county of residence.
6 (3) "Certified resident" means a United States citizen
7 or lawfully admitted alien who has been certified as a
8 resident of the county by a person designated by the county
9 governing body to provide certification determination
10 procedures for the county in which the patient resides; by the
11 agency department if such county does not make a determination
12 of residency within 60 days after of receiving a certified
13 letter from the treating hospital; or by the agency department
14 if the hospital appeals the decision of the county making such
15 determination.
16 (4) "Charity care obligation" means the minimum amount
17 of uncompensated charity care as reported to the agency for
18 Health Care Administration, based on the hospital's most
19 recent audited actual experience, which must be provided by a
20 participating hospital or a regional referral hospital before
21 the hospital is eligible to be reimbursed by a county under
22 the provisions of this part act. That amount shall be the
23 ratio of uncompensated charity care days compared to total
24 acute care inpatient days, which shall be equal to or greater
25 than 2 percent.
26 (5) "Department" means the Department of Health.
27 (6) "Eligibility determination procedures" means the
28 process used by a county or the agency department to evaluate
29 a person's financial eligibility, eligibility for state-funded
30 or federally funded programs, and the availability of
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1 insurance, in order to document a person as a qualified
2 indigent for the purpose of this part act.
3 (7) "Hospital," for the purposes of this act, means an
4 establishment as defined in s. 395.002 and licensed by the
5 agency department which qualifies as either a participating
6 hospital or as a regional referral hospital pursuant to this
7 section; except that, hospitals operated by the department
8 shall not be considered participating hospitals for purposes
9 of this part act.
10 (8) "Participating hospital" means a hospital which is
11 eligible to receive reimbursement under the provisions of this
12 part act because it has been certified by the agency board as
13 having met its charity care obligation and has either:
14 (a) A formal signed agreement with a county or
15 counties to treat such county's indigent patients; or
16 (b) Demonstrated to the agency board that at least 2.5
17 percent of its uncompensated charity care, as reported to the
18 agency board, is generated by out-of-county residents.
19 (9) "Qualified indigent person" or "qualified indigent
20 patient" means a person who has been determined pursuant to s.
21 154.308 to have an average family income, for the 12 months
22 preceding the determination, which is below 100 percent of the
23 federal nonfarm poverty level; who is not eligible to
24 participate in any other government program that which
25 provides hospital care; who has no private insurance or has
26 inadequate private insurance; and who does not reside in a
27 public institution as defined under the medical assistance
28 program for the needy under Title XIX of the Social Security
29 Act, as amended.
30 (10) "Regional referral hospital" means any hospital
31 that which is eligible to receive reimbursement under the
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1 provision of this part act because it has met its charity care
2 obligation and it meets the definition of teaching hospital as
3 defined in s. 408.07.
4 Section 5. Section 154.306, Florida Statutes, is
5 amended to read:
6 154.306 Financial responsibility for certified
7 residents who are qualified indigent patients treated at an
8 out-of-county participating hospital or regional referral
9 hospital.--Ultimate financial responsibility for treatment
10 received at a participating hospital or a regional referral
11 hospital by a qualified indigent patient who is a certified
12 resident of a county in the State of Florida, but is not a
13 resident of the county in which the participating hospital or
14 regional referral hospital is located, is shall be the
15 obligation of the county of which the qualified indigent
16 patient is a resident. Each county shall is directed to
17 reimburse participating hospitals or regional referral
18 hospitals as provided for in this part act, and shall provide
19 or arrange for indigent eligibility determination procedures
20 and resident certification determination procedures as
21 provided for in rules developed to implement this part act.
22 The agency department, or any county determining eligibility
23 of a qualified indigent, shall provide to the county of
24 residence, upon request, a copy of any documents, forms, or
25 other information, as determined by rule, which may be used in
26 making an eligibility determination.
27 (1) A county's financial obligation for each certified
28 resident who qualifies as an indigent patient under this part
29 act, and who has received treatment at an out-of-county
30 hospital, shall not exceed 45 days per county fiscal year at a
31 rate of payment equivalent to 100 percent of the per diem
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1 reimbursement rate currently in effect for the out-of-county
2 hospital under the medical assistance program for the needy
3 under Title XIX of the Social Security Act, as amended, except
4 that those counties that are at their 10-mill cap on October
5 1, 1991, shall reimburse hospitals for such services at not
6 less than 80 percent of the hospital Medicaid per diem.
7 However, nothing in this section shall preclude a hospital
8 that which has a formal signed agreement with a county to
9 treat such county's indigents from negotiating a higher or
10 lower per diem rate with the county. In addition, No county
11 shall be required by this act to pay more than the equivalent
12 of $4 per capita in the county's fiscal year. The agency
13 department shall calculate and certify to each county by March
14 1 of each year, the maximum amount the county may be required
15 to pay under this act by multiplying the most recent official
16 state population estimate for the total population of the
17 county by $4 per capita. Each county shall certify to the
18 agency department within 60 days after of the end of the
19 county's fiscal year, or upon reaching the $4 per capita
20 threshold, should that occur before the end of the fiscal
21 year, the amount of reimbursement it paid to all out-
22 of-county hospitals under this part act. The maximum amount a
23 county may be required to pay to out-of-county hospitals for
24 care provided to qualified indigent residents may be reduced
25 by up to one-half, provided that the amount not paid has or is
26 being spent for in-county hospital care provided to qualified
27 indigent residents.
28 (2) No county shall be required to pay for any
29 elective or nonemergency admissions or services at an
30 out-of-county hospital for a qualified indigent who is a
31 certified resident of the county if when the county provides
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1 funding for such services and the services are available at a
2 local hospital in the county where the indigent resides; or
3 the out-of-county hospital has not obtained prior written
4 authorization and approval for such hospital admission or
5 service, provided that the resident county has established a
6 procedure to authorize and approve such admissions.
7 (3) The county where the indigent resides shall, in
8 all instances, be liable for the cost of treatment provided to
9 a qualified indigent patient at an out-of-county hospital for
10 any emergency medical condition which will deteriorate from
11 failure to provide such treatment if and when such condition
12 is determined and documented by the attending physician to be
13 of an emergency nature; provided that the patient has been
14 certified to be a resident of such county pursuant to s.
15 154.309.
16 (4) No county shall be liable for payment for
17 treatment of a qualified indigent who is a certified resident
18 and has received services at an out-of-county participating
19 hospital or regional referral hospital, until such time as
20 that hospital has documented to the agency board and the
21 agency board has determined that it has met its charity care
22 obligation based on the most recent audited actual experience.
23 Section 6. Section 154.308, Florida Statutes, is
24 amended to read:
25 154.308 Determination of patient's eligibility;
26 spend-down program.--
27 (1) The agency department, pursuant to s. 154.3105,
28 shall adopt rules which provide statewide eligibility
29 determination procedures, forms, and criteria which shall be
30 used by all counties for determining whether a person
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1 financially qualifies as indigent for the purposes of this
2 part act.
3 (a) The criteria used to determine eligibility must
4 shall be uniform statewide and shall include, at a minimum,
5 which assets, if any, may be included in the determination,
6 which verification of income shall be required, which
7 categories of persons shall be eligible, and any other
8 criteria which may be determined as necessary.
9 (b) The methodology for determining by which to
10 determine financial eligibility must shall also be uniform
11 statewide such that any county or the state could determine
12 whether a person is would be a qualified indigent under this
13 act.
14 (2) Determination of financial eligibility as a
15 qualified indigent may occur either prior to a person's
16 admission to a participating hospital or a regional referral
17 hospital or subsequent to such admission.
18 (3) Determination of whether a hospital patient not
19 already determined eligible meets or does not meet eligibility
20 standards to financially qualify as indigent for the purpose
21 of this act shall be made within 60 days following
22 notification by the hospital requesting a determination of
23 indigency, by certified letter, to the county known or
24 believed to be the county of residence or to the agency
25 department. If, for any reason, the county or agency
26 department is unable to determine a patient's eligibility
27 within the allotted timeframe, the hospital shall be notified
28 in writing of the reason or reasons.
29 (4) A patient determined eligible as a qualified
30 indigent for the purpose of this act subsequent to his or her
31 admission to a participating hospital or a regional referral
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1 hospital shall be considered to have been qualified upon
2 admission. Such determination shall be made by a person
3 designated by the governing board of the county to make such a
4 determination or by the agency department.
5 (5) Notwithstanding any other provision of this part
6 within this act, any county may establish thresholds of
7 financial eligibility to qualify indigents under this act
8 which are less restrictive than 100 percent of the federal
9 poverty line. However, a no county may not establish
10 eligibility thresholds which are more restrictive than 100
11 percent of the federal poverty line.
12 (6) Notwithstanding any other provision of this part
13 act, there is hereby established a spend-down program for
14 persons who would otherwise qualify as qualified indigent
15 persons, but whose average family income, for the 12 months
16 preceding the determination, is between 100 percent and 150
17 percent of the federal poverty level. The agency department
18 shall adopt, by rule, procedures for the spend-down program.
19 The rule shall require that in order to qualify for the
20 spend-down program, a person must have incurred bills for
21 hospital care which would otherwise have qualified for payment
22 under this part. This subsection does not apply to persons
23 who are residents of counties that are at their 10-mill cap on
24 October 1, 1991.
25 Section 7. Section 154.309, Florida Statutes, is
26 amended to read:
27 154.309 Certification of county of residence.--
28 (1) The agency department, pursuant to s. 154.3105,
29 shall adopt rules for certification determination procedures
30 which provide criteria to be used for determining a qualified
31 indigent's county of residence. Such criteria must shall
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1 include, at a minimum, how and to what extent residency shall
2 be verified and how a hospital shall be notified of a
3 patient's certification or the inability to certify a patient.
4 (2) In all instances, the county known or thought to
5 be the county of residence shall be given first opportunity to
6 certify a resident. If the county known or thought to be the
7 county of residence fails to, or is unable to, make such
8 determination within 60 days following written notification by
9 a hospital, the agency department shall determine residency
10 utilizing the same criteria required by rule as the county,
11 and the agency's department's determination of residency shall
12 be binding on the county of residence. The county determined
13 as the residence of any qualified indigent under this act
14 shall be liable to reimburse the treating hospital pursuant to
15 s. 154.306. If, for any reason, a county or the agency
16 department is unable to determine an indigent's residency, the
17 hospital shall be notified in writing of such reason or
18 reasons.
19 Section 8. Section 154.31, Florida Statutes, is
20 amended to read:
21 154.31 Obligation of participating hospital or
22 regional referral hospital.--As a condition of participation
23 accepting the procedures of this act, each participating
24 hospital or regional referral hospital in Florida shall be
25 obligated to admit for emergency treatment all Florida
26 residents, without regard to county of residence, who meet the
27 eligibility standards established pursuant to s. 154.308 and
28 who meet the medical standards for admission to such
29 institutions. If the agency department determines that a
30 participating hospital or a regional referral hospital has
31 failed to meet the requirements of this section, the agency
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1 department may impose an administrative fine, not to exceed
2 $5,000 per incident, and suspend the hospital from eligibility
3 for reimbursement under the provisions of this part act.
4 Section 9. Section 154.3105, Florida Statutes, is
5 amended to read:
6 154.3105 Rules.--Rules governing the Health Care
7 Responsibility Act of 1988 shall be developed by the agency
8 department based on recommendations of a work group consisting
9 of equal representation by the agency department, the hospital
10 industry, and the counties. County representatives to this
11 work group shall be appointed by the Florida Association of
12 Counties. Hospital representatives to this work group shall
13 be appointed by the associations representing those hospitals
14 which best represent the positions of the hospitals most
15 likely to be eligible for reimbursement. Rules governing the
16 various aspects of this part act shall be adopted by the
17 agency. department. Such rules shall address, at a minimum:
18 (1) Eligibility determination procedures and criteria.
19 (2) Certification determination procedures and methods
20 of notification to hospitals.
21 Section 10. Section 154.312, Florida Statutes, is
22 amended to read:
23 154.312 Procedure for settlement of disputes.--All
24 disputes among counties, the board, the agency department, a
25 participating hospital, or a regional referral hospital shall
26 be resolved by order as provided in chapter 120. Hearings held
27 under this provision shall be conducted in the same manner as
28 provided in ss. 120.569 and 120.57, except that the presiding
29 officer's order shall be final agency action. Cases filed
30 under chapter 120 may combine all disputes between parties.
31 Notwithstanding any other provisions of this part, if when a
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1 county alleges that a residency determination or eligibility
2 determination made by the agency department is incorrect, the
3 burden of proof shall be on the county to demonstrate that
4 such determination is, in light of the total record, not
5 supported by the evidence.
6 Section 11. Section 154.314, Florida Statutes, is
7 amended to read:
8 154.314 Certification of the State of Florida.--
9 (1) In the event payment for the costs of services
10 rendered by a participating hospital or a regional referral
11 hospital is not received from the responsible county within 90
12 days of receipt of a statement for services rendered to a
13 qualified indigent who is a certified resident of the county,
14 or if the payment is disputed and said payment is not received
15 from the county determined to be responsible within 60 days of
16 the date of exhaustion of all administrative and legal
17 remedies as provided in chapter 120, the hospital shall
18 certify to the Comptroller the amount owed by the county.
19 (2) The Comptroller shall have no not longer than 45
20 days from the date of receiving the hospital's certified
21 notice to forward the amount delinquent to the appropriate
22 hospital from any funds due to the county under any
23 revenue-sharing or tax-sharing fund established by the state,
24 except as otherwise provided by the State Constitution. The
25 Comptroller shall provide the Governor and the fiscal
26 appropriations and finance and tax committees in the House of
27 Representatives and the Senate with a quarterly accounting of
28 the amounts certified by hospitals as owed by counties and the
29 amount paid to hospitals out of any revenue or tax sharing
30 funds due to the county.
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1 Section 12. Section 154.316, Florida Statutes, is
2 amended to read:
3 154.316 Hospital's responsibility to notify of
4 admission of indigent patients.--
5 (1) Any hospital admitting or treating any
6 out-of-county patient who may qualify as indigent under this
7 part act shall, within 30 10 days after admitting or treating
8 such patient, notify the county known, or thought to be, the
9 county of residency of such admission, or such hospital
10 forfeits its right to reimbursement.
11 (2) It shall be the responsibility of any
12 participating hospital or regional referral hospital to
13 initiate any eligibility or certification determination
14 procedures with any appropriate state or county agency which
15 can determine financial eligibility or certify an indigent as
16 a resident under this part act.
17 Section 13. Subsection (1) of section 154.504, Florida
18 Statutes, is amended to read:
19 154.504 Eligibility and benefits.--
20 (1) Any county or counties may apply for a primary
21 care for children and families challenge grant to provide
22 primary health care services to children and families with
23 incomes of up to 150 percent of the federal poverty level.
24 Participants shall pay no monthly premium for participation,
25 but shall be required to pay a copayment at the time a service
26 is provided. Copayments may be paid from sources other than
27 the participant, including, but not limited to, the child's or
28 parent's employer, or other private sources. As used in s.
29 766.1115, the term "copayment" may not be considered and may
30 not be used as compensation for services to health care
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1 providers, and all funds generated from copayments shall be
2 used by the governmental contractor.
3 Section 14. Section 198.30, Florida Statutes, is
4 amended to read:
5 198.30 Circuit judge to furnish department with names
6 of decedents, etc.--Each circuit judge of this state shall, on
7 or before the 10th day of every month, notify the department
8 of the names of all decedents; the names and addresses of the
9 respective personal representatives, administrators, or
10 curators appointed; the amount of the bonds, if any, required
11 by the court; and the probable value of the estates, in all
12 estates of decedents whose wills have been probated or
13 propounded for probate before the circuit judge or upon which
14 letters testamentary or upon whose estates letters of
15 administration or curatorship have been sought or granted,
16 during the preceding month; and such report shall contain any
17 other information which the circuit judge may have concerning
18 the estates of such decedents. In addition, a copy of this
19 report shall be provided to the Agency for Health Care
20 Administration. A circuit judge shall also furnish forthwith
21 such further information, from the records and files of the
22 circuit court in regard to such estates, as the department may
23 from time to time require.
24 Section 15. Section 240.4075, Florida Statutes, is
25 amended to read:
26 240.4075 Nursing Student Loan Forgiveness Program.--
27 (1) To encourage qualified personnel to seek
28 employment in areas of this state in which critical nursing
29 shortages exist, there is established the Nursing Student Loan
30 Forgiveness Program. The primary function of the program is
31 to increase employment and retention of registered nurses and
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1 licensed practical nurses in nursing homes and hospitals in
2 the state and in state-operated medical and health care
3 facilities, birth centers, federally sponsored community
4 health centers and teaching hospitals by making repayments
5 toward loans received by students from federal or state
6 programs or commercial lending institutions for the support of
7 postsecondary study in accredited or approved nursing
8 programs.
9 (2) To be eligible, a candidate must have graduated
10 from an accredited or approved nursing program and have
11 received a Florida license as a licensed practical nurse or a
12 registered nurse or a Florida certificate as an advanced
13 registered nurse practitioner.
14 (3) Only loans to pay the costs of tuition, books, and
15 living expenses shall be covered, at an amount not to exceed
16 $4,000 for each year of education towards the degree obtained.
17 (4) Receipt of funds pursuant to this program shall be
18 contingent upon continued proof of employment in the
19 designated facilities in this state. Loan principal payments
20 shall be made by the Department of Education Health directly
21 to the federal or state programs or commercial lending
22 institutions holding the loan as follows:
23 (a) Twenty-five percent of the loan principal and
24 accrued interest shall be retired after the first year of
25 nursing;
26 (b) Fifty percent of the loan principal and accrued
27 interest shall be retired after the second year of nursing;
28 (c) Seventy-five percent of the loan principal and
29 accrued interest shall be retired after the third year of
30 nursing; and
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1 (d) The remaining loan principal and accrued interest
2 shall be retired after the fourth year of nursing.
3
4 In no case may payment for any nurse exceed $4,000 in any
5 12-month period.
6 (5) There is created the Nursing Student Loan
7 Forgiveness Trust Fund to be administered by the Department of
8 Education Health pursuant to this section and s. 240.4076 and
9 department rules. The Comptroller shall authorize
10 expenditures from the trust fund upon receipt of vouchers
11 approved by the Department of Education Health. All moneys
12 collected from the private health care industry and other
13 private sources for the purposes of this section shall be
14 deposited into the Nursing Student Loan Forgiveness Trust
15 Fund. Any balance in the trust fund at the end of any fiscal
16 year shall remain therein and shall be available for carrying
17 out the purposes of this section and s. 240.4076.
18 (6) In addition to licensing fees imposed under
19 chapter 464, there is hereby levied and imposed an additional
20 fee of $5, which fee shall be paid upon licensure or renewal
21 of nursing licensure. Revenues collected from the fee imposed
22 in this subsection shall be deposited in the Nursing Student
23 Loan Forgiveness Trust Fund of the Department of Education
24 Health and will be used solely for the purpose of carrying out
25 the provisions of this section and s. 240.4076. Up to 50
26 percent of the revenues appropriated to implement this
27 subsection may be used for the nursing scholarship program
28 established pursuant to s. 240.4076.
29 (7)(a) Funds contained in the Nursing Student Loan
30 Forgiveness Trust Fund which are to be used for loan
31 forgiveness for those nurses employed by hospitals, birth
19
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1 centers, and nursing homes must be matched on a
2 dollar-for-dollar basis by contributions from the employing
3 institutions, except that this provision shall not apply to
4 state-operated medical and health care facilities, county
5 health departments, federally sponsored community health
6 centers, or teaching hospitals as defined in s. 408.07.
7 (b) All Nursing Student Loan Forgiveness Trust Fund
8 moneys shall be invested pursuant to s. 18.125. Interest
9 income accruing to that portion of the trust fund not matched
10 shall increase the total funds available for loan forgiveness
11 and scholarships. Pledged contributions shall not be eligible
12 for matching prior to the actual collection of the total
13 private contribution for the year.
14 (8) The Department of Education Health may solicit
15 technical assistance relating to the conduct of this program
16 from the Department of Health Education.
17 (9) The Department of Education Health is authorized
18 to recover from the Nursing Student Loan Forgiveness Trust
19 Fund its costs for administering the Nursing Student Loan
20 Forgiveness Program.
21 (10) The Department of Education Health may adopt
22 rules necessary to administer this program.
23 (11) This section shall be implemented only as
24 specifically funded.
25 Section 16. Section 240.4076, Florida Statutes, is
26 amended to read:
27 240.4076 Nursing scholarship program.--
28 (1) There is established within the Department of
29 Education Health a scholarship program for the purpose of
30 attracting capable and promising students to the nursing
31 profession.
20
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1 (2) A scholarship applicant shall be enrolled as a
2 full-time or part-time student in the upper division of an
3 approved nursing program leading to the award of a
4 baccalaureate or any advanced registered nurse practitioner
5 degree or be enrolled as a full-time or part-time student in
6 an approved program leading to the award of an associate
7 degree in nursing or a diploma in nursing.
8 (3) A scholarship may be awarded for no more than 2
9 years, in an amount not to exceed $8,000 per year. However,
10 registered nurses pursuing an advanced registered nurse
11 practitioner degree may receive up to $12,000 per year.
12 Beginning July 1, 1998, these amounts shall be adjusted by the
13 amount of increase or decrease in the consumer price index for
14 urban consumers published by the United States Department of
15 Commerce.
16 (4) Credit for repayment of a scholarship shall be as
17 follows:
18 (a) For each full year of scholarship assistance, the
19 recipient agrees to work for 12 months at a health care
20 facility in a medically underserved area as approved by the
21 Department of Education Health. Scholarship recipients who
22 attend school on a part-time basis shall have their employment
23 service obligation prorated in proportion to the amount of
24 scholarship payments received.
25 (b) Eligible health care facilities include
26 state-operated medical or health care facilities, county
27 health departments, federally sponsored community health
28 centers, or teaching hospitals as defined in s. 408.07. The
29 recipient shall be encouraged to complete the service
30 obligation at a single employment site. If continuous
31 employment at the same site is not feasible, the recipient may
21
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1 apply to the department for a transfer to another approved
2 health care facility.
3 (c) Any recipient who does not complete an appropriate
4 program of studies or who does not become licensed shall repay
5 to the Department of Education Health, on a schedule to be
6 determined by the department, the entire amount of the
7 scholarship plus 18 percent interest accruing from the date of
8 the scholarship payment. Moneys repaid shall be deposited into
9 the Nursing Student Loan Forgiveness Trust Fund established in
10 s. 240.4075. However, the department may provide additional
11 time for repayment if the department finds that circumstances
12 beyond the control of the recipient caused or contributed to
13 the default.
14 (d) Any recipient who does not accept employment as a
15 nurse at an approved health care facility or who does not
16 complete 12 months of approved employment for each year of
17 scholarship assistance received shall repay to the Department
18 of Education Health an amount equal to two times the entire
19 amount of the scholarship plus interest accruing from the date
20 of the scholarship payment at the maximum allowable interest
21 rate permitted by law. Repayment shall be made within 1 year
22 of notice that the recipient is considered to be in default.
23 However, the department may provide additional time for
24 repayment if the department finds that circumstances beyond
25 the control of the recipient caused or contributed to the
26 default.
27 (5) Scholarship payments shall be transmitted to the
28 recipient upon receipt of documentation that the recipient is
29 enrolled in an approved nursing program. The Department of
30 Education Health shall develop a formula to prorate payments
31
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1 to scholarship recipients so as not to exceed the maximum
2 amount per academic year.
3 (6) The Department of Education Health shall adopt
4 rules, including rules to address extraordinary circumstances
5 that may cause a recipient to default on either the school
6 enrollment or employment contractual agreement, to implement
7 this section and may solicit technical assistance relating to
8 the conduct of this program from the Department of Health
9 Education.
10 (7) The Department of Education Health is authorized
11 to recover from the Nursing Student Loan Forgiveness Trust
12 Fund its costs for administering the nursing scholarship
13 program.
14 Section 17. All statutory powers, duties and
15 functions, records, rules, personnel, property, and unexpended
16 balances of appropriations, allocations, or other funds, of
17 the Department of Health relating to the Nursing Student Loan
18 Forgiveness Program and the Nursing Student Loan Forgiveness
19 Trust Fund, as created in section 240.4075, Florida Statutes,
20 and the nursing scholarship program, as created in section
21 240.4076, Florida Statutes, are transferred by a type two
22 transfer, as provided for in section 20.06(2), Florida
23 Statutes, from the Department of Health to the Department of
24 Education. Such transfer shall take effect July 1, 1998. Any
25 rules adopted by or for the Department of Health for the
26 administration and operation of the Nursing Student Loan
27 Forgiveness Program, the Nursing Student Loan Forgiveness
28 Trust Fund, and the nursing scholarship program are included
29 in such transfer.
30 Section 18. Section 381.0022, Florida Statutes, is
31 created to read:
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1 381.0022 Sharing confidential or exempt
2 information.--Notwithstanding any other provision of law to
3 the contrary, the Department of Health and the Department of
4 Children and Family Services may share confidential
5 information or information exempt from disclosure under
6 chapter 119 on any individual who is or has been the subject
7 of a program within the jurisdiction of each agency.
8 Information so exchanged remains confidential or exempt as
9 provided by law.
10 Section 19. Section 402.115, Florida Statutes, is
11 created to read:
12 402.115 Sharing confidential or exempt
13 information.--Notwithstanding any other provision of law to
14 the contrary, the Department of Health and the Department of
15 Children and Family Services may share confidential
16 information or information exempt from disclosure under
17 chapter 119 on any individual who is or has been the subject
18 of a program within the jurisdiction of each agency.
19 Information so exchanged remains confidential or exempt as
20 provided by law.
21 Section 20. Subsection (6) of section 381.004, Florida
22 Statutes, is amended to read:
23 381.004 Testing for human immunodeficiency virus.--
24 (6) PENALTIES.--
25 (a) Any violation of this section by a facility or
26 licensed health care provider shall be a ground for
27 disciplinary action contained in the facility's or
28 professional's respective licensing chapter.
29 (b) Any person who violates the confidentiality
30 provisions of this section and s. 951.27 commits a misdemeanor
31
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1 of the first degree, punishable as provided in s. 775.082 or
2 s. 775.083.
3 (c) Any person who obtains information that identifies
4 an individual who has a sexually transmissible disease
5 including human immunodeficiency virus or acquired
6 immunodeficiency syndrome, who knew or should have known the
7 nature of the information and maliciously, or for monetary
8 gain, disseminates this information or otherwise makes this
9 information known to any other person, except by providing it
10 either to a physician or nurse employed by the department or
11 to a law enforcement agency, commits a felony of the third
12 degree, punishable as provided in ss. 775.082 or 775.083.
13 Section 21. Section 384.34, Florida Statutes, is
14 amended to read:
15 384.34 Penalties.--
16 (1) Any person who violates the provisions of s.
17 384.24(1) commits a misdemeanor of the first degree,
18 punishable as provided in s. 775.082 or s. 775.083.
19 (2) Any person who violates the provisions of s.
20 384.26 or s. 384.29 commits a misdemeanor of the first degree,
21 punishable as provided in s. 775.082 or s. 775.083.
22 (3) Any person who maliciously disseminates any false
23 information or report concerning the existence of any sexually
24 transmissible disease commits a felony of the third is guilty
25 of a misdemeanor of the second degree, punishable as provided
26 in ss. s. 775.082, or s. 775.083, and 775.084.
27 (4) Any person who violates the provisions of the
28 department's rules pertaining to sexually transmissible
29 diseases may be punished by a fine not to exceed $500 for each
30 violation. Any penalties enforced under this subsection shall
31 be in addition to other penalties provided by this act.
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1 (5) Any person who violates the provisions of s.
2 384.24(2) commits a felony of the third degree, punishable as
3 provided in ss. 775.082, 775.083, 775.084, and 775.0877(7).
4 Any person who commits multiple violations of the provisions
5 of s. 384.24(2) commits a felony of the first degree,
6 punishable as provided in ss. 775.082, 775.083, 775.084, and
7 775.0877(7).
8 (6) Any person who obtains information that identifies
9 an individual who has a sexually transmissible disease, who
10 knew or should have known the nature of the information and
11 maliciously, or for monetary gain, disseminates this
12 information or otherwise makes this information known to any
13 other person, except by providing it either to a physician or
14 nurse employed by the Department of Health or to a law
15 enforcement agency, commits a felony of the third degree,
16 punishable as provided in ss. 775.082, 775.083, or 775.084.
17 Section 22. Paragraph (e) is added to subsection (1)
18 of section 414.028, Florida Statutes, to read:
19 414.028 Local WAGES coalitions.--The WAGES Program
20 State Board of Directors shall create and charter local WAGES
21 coalitions to plan and coordinate the delivery of services
22 under the WAGES Program at the local level. The boundaries of
23 the service area for a local WAGES coalition shall conform to
24 the boundaries of the service area for the regional workforce
25 development board established under the Enterprise Florida
26 workforce development board. The local delivery of services
27 under the WAGES Program shall be coordinated, to the maximum
28 extent possible, with the local services and activities of the
29 local service providers designated by the regional workforce
30 development boards.
31 (1)
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1 (e) A representative of a county health department or
2 a representative of a Healthy Start Coalition shall serve as
3 an ex officio, nonvoting member of the coalition.
4 Section 23. Paragraph (a) of subsection (1) of section
5 766.101, Florida Statutes, is amended to read:
6 766.101 Medical review committee, immunity from
7 liability.--
8 (1) As used in this section:
9 (a) The term "medical review committee" or "committee"
10 means:
11 1.a. A committee of a hospital or ambulatory surgical
12 center licensed under chapter 395 or a health maintenance
13 organization certificated under part I of chapter 641,
14 b. A committee of a state or local professional
15 society of health care providers,
16 c. A committee of a medical staff of a licensed
17 hospital or nursing home, provided the medical staff operates
18 pursuant to written bylaws that have been approved by the
19 governing board of the hospital or nursing home,
20 d. A committee of the Department of Corrections or the
21 Correctional Medical Authority as created under s. 945.602, or
22 employees, agents, or consultants of either the department or
23 the authority or both,
24 e. A committee of a professional service corporation
25 formed under chapter 621 or a corporation organized under
26 chapter 607 or chapter 617, which is formed and operated for
27 the practice of medicine as defined in s. 458.305(3), and
28 which has at least 25 health care providers who routinely
29 provide health care services directly to patients,
30 f. A committee of a mental health treatment facility
31 licensed under chapter 394 or a community mental health center
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1 as defined in s. 394.907, provided the quality assurance
2 program operates pursuant to the guidelines which have been
3 approved by the governing board of the agency,
4 g. A committee of a substance abuse treatment and
5 education prevention program licensed under chapter 397
6 provided the quality assurance program operates pursuant to
7 the guidelines which have been approved by the governing board
8 of the agency,
9 h. A peer review or utilization review committee
10 organized under chapter 440, or
11 i. A committee of the Department of Health, a county
12 health department, healthy start coalition, or certified rural
13 health network, when reviewing quality of care, or employees
14 of these entities when reviewing mortality records,
15
16 which committee is formed to evaluate and improve the quality
17 of health care rendered by providers of health service or to
18 determine that health services rendered were professionally
19 indicated or were performed in compliance with the applicable
20 standard of care or that the cost of health care rendered was
21 considered reasonable by the providers of professional health
22 services in the area; or
23 2. A committee of an insurer, self-insurer, or joint
24 underwriting association of medical malpractice insurance, or
25 other persons conducting review under s. 766.106.
26 Section 24. Paragraph (i) is added to subsection (1)
27 of section 383.011, Florida Statutes, and subsection (2) of
28 that section is amended, to read:
29 383.011 Administration of maternal and child health
30 programs.--
31
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1 (1) The Department of Health is designated as the
2 state agency for:
3 (i) Receiving federal funds for children eligible for
4 assistance through the child portion of the federal Child and
5 Adult Care Food Program, which is referred to as the Child
6 Care Food Program, and for establishing and administering this
7 program. The purpose of the Child Care Food Program is to
8 provide nutritious meals and snacks for children in
9 nonresidential day care. To ensure the quality and integrity
10 of the program, the department shall develop standards and
11 procedures that govern sponsoring organizations, day care
12 homes, child care centers, and centers that operate outside
13 school hours. Standards and procedures must address the
14 following: participation criteria for sponsoring
15 organizations, which may include administrative budgets,
16 staffing requirements, requirements for experience in
17 operating similar programs, operating hours and availability,
18 bonding requirements, geographic coverage, and a required
19 minimum number of homes or centers; procedures for
20 investigating complaints and allegations of noncompliance;
21 application and renewal requirements; audit requirements; meal
22 pattern requirements; requirements for managing funds;
23 participant eligibility for free and reduced-price meals; food
24 storage and preparation; food service companies;
25 reimbursements; use of commodities; administrative reviews and
26 monitoring; training requirements; recordkeeping requirements;
27 and criteria pertaining to imposing sanctions and penalties,
28 including the denial, termination, and appeal of program
29 eligibility.
30 (2) The Department of Health shall follow federal
31 requirements and may adopt any rules necessary for the
29
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1 implementation of the maternal and child health care program,
2 or the WIC program, and the Child Care Food Program. With
3 respect to the Child Care Food Program, the department shall
4 adopt rules that interpret and implement relevant federal
5 regulations, including 7 C.F.R., part 226. The rules must
6 address at least those program requirements and procedures
7 identified in paragraph (1)(i).
8 Section 25. Section 383.04, Florida Statutes, is
9 amended to read:
10 383.04 Prophylactic required for eyes of
11 infants.--Every physician, midwife, or other person in
12 attendance at the birth of a child in the state is required to
13 instill or have instilled into the eyes of the baby within 1
14 hour after birth an effective prophylactic recommended by the
15 Committee on Infectious Diseases of the American Academy of
16 Pediatrics a 1-percent fresh solution of silver nitrate (with
17 date of manufacture marked on container), two drops of the
18 solution to be dropped into each eye after the eyelids have
19 been opened, or some equally effective prophylactic approved
20 by the Department of Health, for the prevention of neonatal
21 blindness from ophthalmia neonatorum. This section does shall
22 not apply to cases where the parents shall file with the
23 physician, midwife, or other person in attendance at the birth
24 of a child written objections on account of religious beliefs
25 contrary to the use of drugs. In such case the physician,
26 midwife, or other person in attendance shall maintain a record
27 that such measures were or were not employed and attach
28 thereto any written objection.
29 Section 26. Section 383.05, Florida Statutes, is
30 repealed.
31
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1 Section 27. Section 409.903, Florida Statutes, is
2 amended to read:
3 409.903 Mandatory payments for eligible persons.--The
4 agency department shall make payments for medical assistance
5 and related services on behalf of the following persons who
6 the agency department determines to be eligible, subject to
7 the income, assets, and categorical eligibility tests set
8 forth in federal and state law. Payment on behalf of these
9 Medicaid eligible persons is subject to the availability of
10 moneys and any limitations established by the General
11 Appropriations Act or chapter 216.
12 (1) Low-income families with children are eligible for
13 Medicaid provided they meet the following requirements:
14 Persons who receive payments from or are determined eligible
15 to participate in the WAGES Program, and certain persons who
16 would be eligible but do not meet certain technical
17 requirements. This group includes, but is not limited to:
18 (a) The family includes a dependent child who is
19 living with a caretaker relative. Low-income, single-parent
20 families and their children.
21 (b) The family's income does not exceed the gross
22 income test limit. Low-income, two-parent families in which at
23 least one parent is disabled or otherwise incapacitated.
24 (c) The family's countable income and resources do not
25 exceed the applicable aid-to-families-with-dependent-children
26 (AFDC) income and resource standards under the AFDC state plan
27 in effect in July 1996, except as amended in the Medicaid
28 state plan to conform as closely as possible to the
29 requirements of the WAGES Program as created in s. 414.015, to
30 the extent permitted by federal law. Certain unemployed
31 two-parent families and their children.
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1 (2) A person who receives payments from, who is
2 determined eligible for, or who was eligible for but lost cash
3 benefits from the federal program known as the Supplemental
4 Security Income program (SSI). This category includes a
5 low-income person age 65 or over and a low-income person under
6 age 65 considered to be permanently and totally disabled.
7 (3) A child under age 21 living in a low-income,
8 two-parent family, and a child under age 7 living with a
9 nonrelative, if the income and assets of the family or child,
10 as applicable, do not exceed the resource limits under the
11 WAGES Program.
12 (4) A child who is eligible under Title IV-E of the
13 Social Security Act for subsidized board payments, foster
14 care, or adoption subsidies, and a child for whom the state
15 has assumed temporary or permanent responsibility and who does
16 not qualify for Title IV-E assistance but is in foster care,
17 shelter or emergency shelter care, or subsidized adoption.
18 (5) A pregnant woman for the duration of her pregnancy
19 and for the post partum period as defined in federal law and
20 rule, or a child under age 1, if either is living in a family
21 that has an income which is at or below 150 percent of the
22 most current federal poverty level, or, effective January 1,
23 1992, that has an income which is at or below 185 percent of
24 the most current federal poverty level. Such a person is not
25 subject to an assets test. Further, a pregnant woman who
26 applies for eligibility for the Medicaid program through a
27 qualified Medicaid provider must be offered the opportunity,
28 subject to federal rules, to be made presumptively eligible
29 for the Medicaid program.
30 (6) A child born after September 30, 1983, living in a
31 family that has an income which is at or below 100 percent of
32
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1 the current federal poverty level, who has attained the age of
2 6, but has not attained the age of 19. In determining the
3 eligibility of such a child, an assets test is not required.
4 (7) A child living in a family that has an income
5 which is at or below 133 percent of the current federal
6 poverty level, who has attained the age of 1, but has not
7 attained the age of 6. In determining the eligibility of such
8 a child, an assets test is not required.
9 (8) A person who is age 65 or over or is determined by
10 the agency department to be disabled, whose income is at or
11 below 100 percent of the most current federal poverty level
12 and whose assets do not exceed limitations established by the
13 agency department. However, the agency department may only
14 pay for premiums, coinsurance, and deductibles, as required by
15 federal law, unless additional coverage is provided for any or
16 all members of this group by s. 409.904(1).
17 Section 28. Subsections (2) and (13) of section
18 409.908, Florida Statutes, are amended to read:
19 409.908 Reimbursement of Medicaid providers.--Subject
20 to specific appropriations, the agency shall reimburse
21 Medicaid providers, in accordance with state and federal law,
22 according to methodologies set forth in the rules of the
23 agency and in policy manuals and handbooks incorporated by
24 reference therein. These methodologies may include fee
25 schedules, reimbursement methods based on cost reporting,
26 negotiated fees, competitive bidding pursuant to s. 287.057,
27 and other mechanisms the agency considers efficient and
28 effective for purchasing services or goods on behalf of
29 recipients. Payment for Medicaid compensable services made on
30 behalf of Medicaid eligible persons is subject to the
31 availability of moneys and any limitations or directions
33
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1 provided for in the General Appropriations Act or chapter 216.
2 Further, nothing in this section shall be construed to prevent
3 or limit the agency from adjusting fees, reimbursement rates,
4 lengths of stay, number of visits, or number of services, or
5 making any other adjustments necessary to comply with the
6 availability of moneys and any limitations or directions
7 provided for in the General Appropriations Act, provided the
8 adjustment is consistent with legislative intent.
9 (2)(a)1. Reimbursement to nursing homes licensed under
10 part II of chapter 400 and state-owned-and-operated
11 intermediate care facilities for the developmentally disabled
12 licensed under chapter 393 must be made prospectively.
13 2. Unless otherwise limited or directed in the General
14 Appropriations Act, reimbursement to hospitals licensed under
15 part I of chapter 395 for the provision of swing-bed nursing
16 home services must be made on the basis of the average
17 statewide nursing home payment, and reimbursement to a
18 hospital licensed under part I of chapter 395 for the
19 provision of skilled nursing services must be made on the
20 basis of the average nursing home payment for those services
21 in the county in which the hospital is located. When a
22 hospital is located in a county that does not have any
23 community nursing homes, reimbursement must be determined by
24 averaging the nursing home payments, in counties that surround
25 the county in which the hospital is located. Reimbursement to
26 hospitals, including Medicaid payment of Medicare copayments,
27 for skilled nursing services shall be limited to 30 days,
28 unless a prior authorization has been obtained from the
29 agency. Medicaid reimbursement may be extended by the agency
30 beyond 30 days, and approval must be based upon verification
31 by the patient's physician that the patient requires
34
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1 short-term rehabilitative and recuperative services only, in
2 which case an extension of no more than 15 days may be
3 approved. Reimbursement to a hospital licensed under part I of
4 chapter 395 for the temporary provision of skilled nursing
5 services to nursing home residents who have been displaced as
6 the result of a natural disaster or other emergency may not
7 exceed the average county nursing home payment for those
8 services in the county in which the hospital is located and is
9 limited to the period of time which the agency considers
10 necessary for continued placement of the nursing home
11 residents in the hospital.
12 (b) Subject to any limitations or directions provided
13 for in the General Appropriations Act, the agency shall
14 establish and implement a Florida Title XIX Long-Term Care
15 Reimbursement Plan (Medicaid) for nursing home care in order
16 to provide care and services in conformance with the
17 applicable state and federal laws, rules, regulations, and
18 quality and safety standards and to ensure that individuals
19 eligible for medical assistance have reasonable geographic
20 access to such care. Effective no earlier than the
21 rate-setting period beginning April 1, 1999, the agency shall
22 establish a case-mix reimbursement methodology for the rate of
23 payment for long-term-care services for nursing home
24 residents. The agency shall compute a per diem rate for
25 Medicaid residents, adjusted for case mix, which is based on a
26 resident classification system that accounts for the relative
27 resource utilization by different types of residents and which
28 is based on level-of-care data and other appropriate data. The
29 case-mix methodology developed by the agency shall take into
30 account the medical, behavioral, and cognitive deficits of
31 residents. In developing the reimbursement methodology, the
35
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1 agency shall evaluate and modify other aspects of the
2 reimbursement plan as necessary to improve the overall
3 effectiveness of the plan with respect to the costs of patient
4 care, operating costs, and property costs. In the event
5 adequate data are not available, the agency is authorized to
6 adjust the patient's care component or the per diem rate to
7 more adequately cover the cost of services provided in the
8 patient's care component. The agency shall work with the
9 Department of Elderly Affairs, the Florida Health Care
10 Association, and the Florida Association of Homes for the
11 Aging in developing the methodology. It is the intent of the
12 Legislature that the reimbursement plan achieve the goal of
13 providing access to health care for nursing home residents who
14 require large amounts of care while encouraging diversion
15 services as an alternative to nursing home care for residents
16 who can be served within the community. The agency shall base
17 the establishment of any maximum rate of payment, whether
18 overall or component, on the available moneys as provided for
19 in the General Appropriations Act. The agency may base the
20 maximum rate of payment on the results of scientifically valid
21 analysis and conclusions derived from objective statistical
22 data pertinent to the particular maximum rate of payment.
23 (13) Medicare premiums for persons eligible for both
24 Medicare and Medicaid coverage shall be paid at the rates
25 established by Title XVIII of the Social Security Act. For
26 Medicare services rendered to Medicaid-eligible persons,
27 Medicaid shall pay Medicare deductibles and coinsurance as
28 follows:
29 (a) Medicaid shall make no payment toward deductibles
30 and coinsurance for any service that is not covered by
31 Medicaid.
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1 (b) Medicaid's financial obligation for deductibles
2 and coinsurance payments shall be based on Medicare allowable
3 fees, not on a provider's billed charges.
4 (c) Medicaid will pay no portion of Medicare
5 deductibles and coinsurance when payment that Medicare has
6 made for the service equals or exceeds what Medicaid would
7 have paid if it had been the sole payor. The combined payment
8 of Medicare and Medicaid shall not exceed the amount Medicaid
9 would have paid had it been the sole payor.
10 (d) The following provisions are exceptions to
11 paragraphs (a)-(c):
12 1. Medicaid payments for Nursing Home Medicare Part A
13 coinsurance shall be the lesser of the Medicare coinsurance
14 amount or the Medicaid nursing home per diem rate.
15 2. Medicaid shall pay all deductibles and coinsurance
16 for Nursing Home Medicare Part B services.
17 3. Medicaid shall pay all deductibles and coinsurance
18 for Medicare-eligible recipients receiving freestanding end
19 stage renal dialysis center services.
20 4. Medicaid shall pay all deductibles and coinsurance
21 for hospital outpatient Medicare Part B services.
22 5. Medicaid payments for general hospital inpatient
23 services shall be limited to the Medicare deductible per spell
24 of illness. Medicaid shall make no payment toward coinsurance
25 for Medicare general hospital inpatient services.
26 6. Medicaid shall pay all deductibles and coinsurance
27 for Medicare emergency transportation services provided by
28 ambulances licensed pursuant to chapter 401. Premiums,
29 deductibles, and coinsurance for Medicare services rendered to
30 Medicaid eligible persons shall be reimbursed in accordance
31
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1 with fees established by Title XVIII of the Social Security
2 Act.
3 Section 29. Paragraph (c) of subsection (4) of section
4 409.912, Florida Statutes, is repealed, paragraph (b) of
5 subsection (3) and subsection (13) of that section are
6 amended, and subsections (34) and (35) are added to that
7 section, to read:
8 409.912 Cost-effective purchasing of health care.--The
9 agency shall purchase goods and services for Medicaid
10 recipients in the most cost-effective manner consistent with
11 the delivery of quality medical care. The agency shall
12 maximize the use of prepaid per capita and prepaid aggregate
13 fixed-sum basis services when appropriate and other
14 alternative service delivery and reimbursement methodologies,
15 including competitive bidding pursuant to s. 287.057, designed
16 to facilitate the cost-effective purchase of a case-managed
17 continuum of care. The agency shall also require providers to
18 minimize the exposure of recipients to the need for acute
19 inpatient, custodial, and other institutional care and the
20 inappropriate or unnecessary use of high-cost services.
21 (3) The agency may contract with:
22 (b) An entity that is providing comprehensive
23 inpatient and outpatient mental health care services to
24 certain Medicaid recipients in Hillsborough, Highlands,
25 Hardee, Manatee, and Polk Counties, through a capitated,
26 prepaid arrangement pursuant to the federal waiver provided
27 for by s. 409.905(5). Such an entity must become licensed
28 under chapter 624, chapter 636, or chapter 641 by December 31,
29 1998, and is exempt from the provisions of part I of chapter
30 641 until then. However, if the entity assumes risk, the
31 Department of Insurance shall develop appropriate regulatory
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1 requirements by rule under the insurance code before the
2 entity becomes operational.
3 (13) The agency shall identify health care utilization
4 and price patterns within the Medicaid program which that are
5 not cost-effective or medically appropriate and assess the
6 effectiveness of new or alternate methods of providing and
7 monitoring service, and may implement such methods as it
8 considers appropriate. Such methods may include
9 disease-management initiatives, an integrated and systematic
10 approach for managing the health care needs of recipients who
11 are at risk of or diagnosed with a specific disease by using
12 best practices, prevention strategies, clinical-practice
13 improvement, clinical interventions and protocols, outcomes
14 research, information technology, and other tools and
15 resources to reduce overall costs and improve measurable
16 outcomes.
17 (34) The agency may provide for cost-effective
18 purchasing of home health services through competitive
19 negotiation pursuant to s. 287.057. The agency may request
20 appropriate waivers from the federal Health Care Financing
21 Administration in order to competitively bid home health
22 services.
23 (35) The Agency for Health Care Administration is
24 directed to issue a request for proposal or intent to
25 negotiate to implement on a demonstration basis an outpatient
26 specialty services pilot project in a rural and urban county
27 in the state. As used in this subsection, the term
28 "outpatient specialty services" means clinical laboratory,
29 diagnostic imaging, and specified home medical services to
30 include durable medical equipment, prosthetics and orthotics,
31 and infusion therapy.
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1 (a) The entity that is awarded the contract to provide
2 Medicaid managed care outpatient specialty services must, at a
3 minimum, meet the following criteria:
4 1. The entity must be licensed by the Department of
5 Insurance under part II of chapter 641.
6 2. The entity must be experienced in providing
7 outpatient specialty services.
8 3. The entity must demonstrate to the satisfaction of
9 the agency that it provides high-quality services to its
10 patients.
11 4. The entity must demonstrate that it has in place a
12 complaints and grievance process to assist Medicaid recipients
13 enrolled in the pilot managed care program to resolve
14 complaints and grievances.
15 (b) The pilot managed care program shall operate for a
16 period of 3 years. The objective of the pilot program shall
17 be to determine the cost-effectiveness and effects on
18 utilization, access, and quality of providing outpatient
19 specialty services to Medicaid recipients on a prepaid,
20 capitated basis.
21 (c) The agency shall conduct a quality-assurance
22 review of the prepaid health clinic each year that the
23 demonstration program is in effect. The prepaid health clinic
24 is responsible for all expenses incurred by the agency in
25 conducting a quality assurance review.
26 (d) The entity that is awarded the contract to provide
27 outpatient specialty services to Medicaid recipients shall
28 report data required by the agency in a format specified by
29 the agency, for the purpose of conducting the evaluation
30 required in paragraph (e).
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1 (e) The agency shall conduct an evaluation of the
2 pilot managed care program and report its findings to the
3 Governor and the Legislature by no later than January 1, 2001.
4 (f) Nothing in this subsection is intended to conflict
5 with the provision of the 1997-1998 General Appropriations Act
6 which authorizes competitive bidding for Medicaid home health,
7 clinical laboratory, or x-ray services.
8 Section 30. Effective January 1, 1999, paragraph (d)
9 of subsection (3) of section 409.912, Florida Statutes, is
10 amended to read:
11 409.912 Cost-effective purchasing of health care.--The
12 agency shall purchase goods and services for Medicaid
13 recipients in the most cost-effective manner consistent with
14 the delivery of quality medical care. The agency shall
15 maximize the use of prepaid per capita and prepaid aggregate
16 fixed-sum basis services when appropriate and other
17 alternative service delivery and reimbursement methodologies,
18 including competitive bidding pursuant to s. 287.057, designed
19 to facilitate the cost-effective purchase of a case-managed
20 continuum of care. The agency shall also require providers to
21 minimize the exposure of recipients to the need for acute
22 inpatient, custodial, and other institutional care and the
23 inappropriate or unnecessary use of high-cost services.
24 (3) The agency may contract with:
25 (d) No more than four provider service networks for
26 demonstration projects to test Medicaid direct contracting.
27 However, no such demonstration project shall be established
28 with a federally qualified health center nor shall any
29 provider service network under contract with the agency
30 pursuant to this paragraph include a federally qualified
31 health center in its provider network. One demonstration
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1 project must be located in Orange County. The demonstration
2 projects may be reimbursed on a fee-for-service or prepaid
3 basis. A provider service network which is reimbursed by the
4 agency on a prepaid basis shall be exempt from parts I and III
5 of chapter 641, but must meet appropriate financial reserve,
6 quality assurance, and patient rights requirements as
7 established by the agency. The agency shall award contracts
8 on a competitive bid basis and shall select bidders based upon
9 price and quality of care. Medicaid recipients assigned to a
10 demonstration project shall be chosen equally from those who
11 would otherwise have been assigned to prepaid plans and
12 MediPass. The agency is authorized to seek federal Medicaid
13 waivers as necessary to implement the provisions of this
14 section. A demonstration project awarded pursuant to this
15 paragraph shall be for 2 years from the date of
16 implementation.
17 Section 31. Paragraphs (a), (c), (f), (i), and (k) of
18 subsection (2) of section 409.9122, Florida Statutes, are
19 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. County health departments delivering school-based
25 services pursuant to ss. 381.0056 and 381.0057 shall be
26 reimbursed by Medicaid for the federal share for a
27 Medicaid-eligible child who receives Medicaid-covered services
28 in a school setting, regardless of whether the child is
29 enrolled in MediPass or a managed care plan. Managed care
30 plans shall make a good faith effort to execute agreements
31 with county health departments regarding the coordinated
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1 provision of services to a Medicaid-eligible child. To ensure
2 continuity of care for Medicaid patients, the agency, the
3 Department of Health, and the Department of Education shall
4 develop procedures for ensuring that a student's managed care
5 plan or MediPass provider receives information relating to
6 services provided in accordance with ss. 236.0812, 381.0056,
7 381.0057, and 409.9071.
8 (c) Medicaid recipients shall have a choice of managed
9 care plans or MediPass. The Agency for Health Care
10 Administration, the Department of Health and Rehabilitative
11 Services, the Department of Children and Family Services, and
12 the Department of Elderly Affairs shall cooperate to ensure
13 that each Medicaid recipient receives clear and easily
14 understandable information that meets the following
15 requirements:
16 1. Explains the concept of managed care, including
17 MediPass.
18 2. Provides information on the comparative performance
19 of managed care plans and MediPass in the areas of quality,
20 credentialing, preventive health programs, network size and
21 availability, and patient satisfaction.
22 3. Explains where additional information on each
23 managed care plan and MediPass in the recipient's area can be
24 obtained.
25 4. Explains that recipients have the right to choose
26 their own managed care plans or MediPass. However, if a
27 recipient does not choose a managed care plan or MediPass, the
28 agency will assign the recipient to a managed care plan or
29 MediPass according to the criteria specified in this section.
30 5. Explains the recipient's right to complain, file a
31 grievance, or change managed care plans or MediPass providers
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1 if the recipient is not satisfied with the managed care plan
2 or MediPass.
3 (f) When a Medicaid recipient does not choose a
4 managed care plan or MediPass provider, the agency shall
5 assign the Medicaid recipient to a managed care plan or
6 MediPass provider. Medicaid recipients who are subject to
7 mandatory assignment but who fail to make a choice shall be
8 assigned to managed care plans or provider service networks
9 until an equal enrollment of 50 percent in MediPass and
10 provider service networks and 50 percent in managed care plans
11 is achieved. Once equal enrollment is achieved, the
12 assignments shall be divided in order to maintain an equal
13 enrollment in MediPass and managed care plans for the 1998-99
14 fiscal year. In the first period that assignment begins, the
15 assignments shall be divided equally between the MediPass
16 program and managed care plans. Thereafter, assignment of
17 Medicaid recipients who fail to make a choice shall be based
18 proportionally on the preferences of recipients who have made
19 a choice in the previous period. Such proportions shall be
20 revised at least quarterly to reflect an update of the
21 preferences of Medicaid recipients. When making assignments,
22 the agency shall take into account the following criteria:
23 1. A managed care plan has sufficient network capacity
24 to meet the need of members.
25 2. The managed care plan or MediPass has previously
26 enrolled the recipient as a member, or one of the managed care
27 plan's primary care providers or MediPass providers has
28 previously provided health care to the recipient.
29 3. The agency has knowledge that the member has
30 previously expressed a preference for a particular managed
31
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1 care plan or MediPass provider as indicated by Medicaid
2 fee-for-service claims data, but has failed to make a choice.
3 4. The managed care plan's or MediPass primary care
4 providers are geographically accessible to the recipient's
5 residence.
6 (i) After a recipient has made a selection or has been
7 enrolled in a managed care plan or MediPass, the recipient
8 shall have 90 60 days in which to voluntarily disenroll and
9 select another managed care plan or MediPass provider. After
10 90 60 days, no further changes may be made except for cause.
11 Cause shall include, but not be limited to, poor quality of
12 care, lack of access to necessary specialty services, an
13 unreasonable delay or denial of service, or fraudulent
14 enrollment. The agency shall develop criteria for good cause
15 disenrollment for chronically ill and disabled populations who
16 are assigned to managed care plans if more appropriate care is
17 available through the MediPass program. The agency must make
18 a determination as to whether cause exists. However, the
19 agency may require a recipient to use the managed care plan's
20 or MediPass grievance process prior to the agency's
21 determination of cause, except in cases in which immediate
22 risk of permanent damage to the recipient's health is alleged.
23 The grievance process, when utilized, must be completed in
24 time to permit the recipient to disenroll no later than the
25 first day of the second month after the month the
26 disenrollment request was made. If the managed care plan or
27 MediPass, as a result of the grievance process, approves an
28 enrollee's request to disenroll, the agency is not required to
29 make a determination in the case. The agency must make a
30 determination and take final action on a recipient's request
31 so that disenrollment occurs no later than the first day of
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1 the second month after the month the request was made. If the
2 agency fails to act within the specified timeframe, the
3 recipient's request to disenroll is deemed to be approved as
4 of the date agency action was required. Recipients who
5 disagree with the agency's finding that cause does not exist
6 for disenrollment shall be advised of their right to pursue a
7 Medicaid fair hearing to dispute the agency's finding.
8 (k) In order to provide increased access to managed
9 care, the agency may request from the Health Care Financing
10 Administration a waiver of the regulation requiring health
11 maintenance organizations to have one commercial enrollee for
12 each three Medicaid enrollees.
13 Section 32. Paragraph (f) of subsection (12) and
14 subsection (18) of section 409.910, Florida Statutes, are
15 amended to read:
16 409.910 Responsibility for payments on behalf of
17 Medicaid-eligible persons when other parties are liable.--
18 (12) The department may, as a matter of right, in
19 order to enforce its rights under this section, institute,
20 intervene in, or join any legal or administrative proceeding
21 in its own name in one or more of the following capacities:
22 individually, as subrogee of the recipient, as assignee of the
23 recipient, or as lienholder of the collateral.
24 (f) Notwithstanding any provision in this section to
25 the contrary, in the event of an action in tort against a
26 third party in which the recipient or his or her legal
27 representative is a party which results in a and in which the
28 amount of any judgment, award, or settlement from a third
29 party, third-party benefits, excluding medical coverage as
30 defined in subparagraph 4., after reasonable costs and
31 expenses of litigation, is an amount equal to or less than 200
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1 percent of the amount of medical assistance provided by
2 Medicaid less any medical coverage paid or payable to the
3 department, then distribution of the amount recovered shall be
4 distributed as follows:
5 1. After attorney's fees and taxable costs as defined
6 by the Florida Rules of Civil Procedure, one-half of the
7 remaining recovery shall be paid to the department up to the
8 total amount of medical assistance provided by Medicaid.
9 2. The remaining amount of the recovery shall be paid
10 to the recipient.
11 3. For purposes of calculating the department's
12 recovery of medical assistance benefits paid, the fee for
13 services of an attorney retained by the recipient or his or
14 her legal representative shall be calculated at 25 percent of
15 the judgment, award, or settlement.
16 4. Notwithstanding any provision of this section to
17 the contrary, the department shall be entitled to all medical
18 coverage benefits up to the total amount of medical assistance
19 provided by Medicaid.
20 1. Any fee for services of an attorney retained by the
21 recipient or his or her legal representative shall not exceed
22 an amount equal to 25 percent of the recovery, after
23 reasonable costs and expenses of litigation, from the
24 judgment, award, or settlement.
25 2. After attorney's fees, two-thirds of the remaining
26 recovery shall be designated for past medical care and paid to
27 the department for medical assistance provided by Medicaid.
28 3. The remaining amount from the recovery shall be
29 paid to the recipient.
30 4. For purposes of this paragraph, "medical coverage"
31 means any benefits under health insurance, a health
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1 maintenance organization, a preferred provider arrangement, or
2 a prepaid health clinic, and the portion of benefits
3 designated for medical payments under coverage for workers'
4 compensation, personal injury protection, and casualty.
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, within 60 days after
14 receipt of settlement proceeds, the full amount of the
15 third-party benefits, but not in excess of the total medical
16 assistance provided by Medicaid, or to place the full amount
17 of the third-party benefits in a trust account for the benefit
18 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 33. 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 34. Subsection (1) of section 627.912, Florida
20 Statutes, is amended, and subsection (5) is added to said
21 section, to read:
22 627.912 Professional liability claims and actions;
23 reports by insurers.--
24 (1) Each self-insurer authorized under s. 627.357 and
25 each insurer or joint underwriting association providing
26 professional liability insurance to a practitioner of medicine
27 licensed under chapter 458, to a practitioner of osteopathic
28 medicine licensed under chapter 459, to a podiatrist licensed
29 under chapter 461, to a dentist licensed under chapter 466, to
30 a hospital licensed under chapter 395, to a crisis
31 stabilization unit licensed under part IV of chapter 394, to a
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1 health maintenance organization certificated under part I of
2 chapter 641, to clinics included in chapter 390, to an
3 ambulatory surgical center as defined in s. 395.002, or to a
4 member of The Florida Bar shall report in duplicate to the
5 Department of Insurance any claim or action for damages for
6 personal injuries claimed to have been caused by error,
7 omission, or negligence in the performance of such insured's
8 professional services or based on a claimed performance of
9 professional services without consent, if the claim resulted
10 in:
11 (a) A final judgment in any amount.
12 (b) A settlement in any amount.
13 (c) A final disposition not resulting in payment on
14 behalf of the insured.
15
16 Reports shall be filed with the department and, if the insured
17 party is licensed under chapter 458, chapter 459, chapter 461,
18 or chapter 466, with the Agency for Health Care
19 Administration, no later than 30 days following the occurrence
20 of any event listed in paragraph (a) or, paragraph (b), or
21 paragraph (c). The Agency for Health Care Administration shall
22 review each report and determine whether any of the incidents
23 that resulted in the claim potentially involved conduct by the
24 licensee that is subject to disciplinary action, in which case
25 the provisions of s. 455.225 shall apply. The Agency for
26 Health Care Administration, as part of the annual report
27 required by s. 455.2285, shall publish annual statistics,
28 without identifying licensees, on the reports it receives,
29 including final action taken on such reports by the agency or
30 the appropriate regulatory board.
31
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1 (5) Any self-insurance program established under s.
2 240.213 shall report in duplicate to the Department of
3 Insurance any claim or action for damages for personal
4 injuries claimed to have been caused by error, omission, or
5 negligence in the performance of professional services
6 provided by the Board of Regents through an employee or agent
7 of the Board of Regents, including practitioners of medicine
8 licensed under chapter 458, practitioners of osteopathic
9 medicine licensed under chapter 459, podiatrists licensed
10 under chapter 461, and dentists licensed under chapter 466, or
11 based on a claimed performance of professional services
12 without consent if the claim resulted in a final judgment in
13 any amount, or a settlement in any amount. The reports
14 required by this subsection shall contain the information
15 required by subsection (3) and the name, address, and
16 specialty of the employee or agent of the Board of Regents
17 whose performance or professional services is alleged in the
18 claim or action to have caused personal injury.
19 Section 35. Upon completion, the Marion County Health
20 Department building to be constructed in Belleview, Florida,
21 shall be known as the "Carl S. Lytle, M.D., Memorial Health
22 Facility."
23 Section 36. The amount of $2 million is appropriated
24 from tobacco settlement revenues to the Grants and Donations
25 Trust Fund of the Agency for Health Care Administration to be
26 matched at an appropriate level with federal Medicaid funds
27 available under Title XIX of the Social Security Act to
28 provide prosthetic and orthotic devices for Medicaid
29 recipients when such devices are prescribed by licensed
30 practitioners participating in the Medicaid program.
31
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1 Section 37. Except as otherwise provided herein, this
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