Senate Bill 2242c1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
By the Committee on Health, Aging and Long-Term Care; and
Senator Saunders
317-1993A-00
1 A bill to be entitled
2 An act relating to health care; amending s.
3 409.212, F.S.; providing for periodic increase
4 in the optional state supplementation rate;
5 amending s. 409.901, F.S.; amending definitions
6 of terms used in ss. 409.910-409.920, F.S.;
7 amending s. 409.902, F.S.; providing that the
8 Department of Children and Family Services is
9 responsible for Medicaid eligibility
10 determinations; amending s. 409.903, F.S.;
11 providing responsibility for determinations of
12 eligibility for payments for medical assistance
13 and related services; amending s. 409.905,
14 F.S.; increasing the maximum amount that may be
15 paid under Medicaid for hospital outpatient
16 services; amending s. 409.906, F.S.; allowing
17 the Department of Children and Family Services
18 to transfer funds to the Agency for Health Care
19 Administration to cover state match
20 requirements as specified; amending s. 409.907,
21 F.S.; revising requirements relating to the
22 minimum amount of the surety bond which each
23 provider is required to maintain; specifying
24 grounds on which provider applications may be
25 denied; amending s. 409.908, F.S.; increasing
26 the maximum amount of reimbursement allowable
27 to Medicaid providers for hospital inpatient
28 care; creating s. 409.9119, F.S.; creating a
29 disproportionate share program for children's
30 hospitals; providing formulas governing
31 payments made to hospitals under the program;
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 providing for withholding payments from a
2 hospital that is not complying with agency
3 rules; amending s. 409.912, F.S.; providing for
4 the transfer of certain unexpended Medicaid
5 funds from the Department of Elderly Affairs to
6 the Agency for Health Care Administration;
7 providing for the adoption and the transfer of
8 certain rules relating to the determination of
9 Medicaid eligibility; authorizing developmental
10 research schools to participate in Medicaid
11 certified school match program; providing for
12 the Agency for Health Care Administration to
13 seek a federal waiver allowing the agency to
14 undertake a pilot project that involves
15 contracting with skilled nursing facilities for
16 the provision of rehabilitation services to
17 adult ventilator dependent patients; providing
18 for evaluation of the pilot program; repealing
19 s. 409.912(4)(b), F.S., relating to the
20 authorization of the agency to contract with
21 certain prepaid health care services providers;
22 providing an effective date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
26 Section 1. Present subsection (6) of section 409.212,
27 Florida Statutes, is redesignated as subsection (7), and a new
28 subsection (6) is added to that subsection, to read:
29 409.212 Optional supplementation.--
30 (6) The optional state supplementation rate shall be
31 increased by the cost-of-living adjustment to the federal
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 benefits rate provided that the average state optional
2 supplementation contribution does not increase as a result.
3 Section 2. Subsections (3), (15), and (18) of section
4 409.901, Florida Statutes, are amended to read:
5 409.901 Definitions.--As used in ss. 409.901-409.920,
6 except as otherwise specifically provided, the term:
7 (3) "Applicant" means an individual whose written
8 application for medical assistance provided by Medicaid under
9 ss. 409.903-409.906 has been submitted to the Department of
10 Children and Family Services agency, or to the Social Security
11 Administration if the application is for Supplemental Security
12 Income, but has not received final action. This term includes
13 an individual, who need not be alive at the time of
14 application, whose application is submitted through a
15 representative or a person acting for the individual.
16 (15) "Medicaid program" means the program authorized
17 under Title XIX of the federal Social Security Act which
18 provides for payments for medical items or services, or both,
19 on behalf of any person who is determined by the Department of
20 Children and Family Services, or, for Supplemental Security
21 Income, by the Social Security Administration, to be eligible
22 on the date of service for Medicaid assistance.
23 (18) "Medicaid recipient" or "recipient" means an
24 individual whom the Department of Children and Family
25 Services, or, for Supplemental Security Income, the Social
26 Security Administration, determines is eligible, pursuant to
27 federal and state law, to receive medical assistance and
28 related services for which the agency may make payments under
29 the Medicaid program. For the purposes of determining
30 third-party liability, the term includes an individual
31 formerly determined to be eligible for Medicaid, an individual
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 who has received medical assistance under the Medicaid
2 program, or an individual on whose behalf Medicaid has become
3 obligated.
4 Section 3. Section 409.902, Florida Statutes, is
5 amended to read:
6 409.902 Designated single state agency; payment
7 requirements; program title.--The Agency for Health Care
8 Administration is designated as the single state agency
9 authorized to make payments for medical assistance and related
10 services under Title XIX of the Social Security Act. These
11 payments shall be made, subject to any limitations or
12 directions provided for in the General Appropriations Act,
13 only for services included in the program, shall be made only
14 on behalf of eligible individuals, and shall be made only to
15 qualified providers in accordance with federal requirements
16 for Title XIX of the Social Security Act and the provisions of
17 state law. This program of medical assistance is designated
18 the "Medicaid program." The Department of Children and Family
19 Services is responsible for Medicaid eligibility
20 determinations, including policy, rules, and the agreement
21 with the Social Security Administration for Medicaid
22 eligibility determinations for Supplemental Security Income
23 recipients, as well as the actual determination of
24 eligibility.
25 Section 4. Section 409.903, Florida Statutes, is
26 amended to read:
27 409.903 Mandatory payments for eligible persons.--The
28 agency shall make payments for medical assistance and related
29 services on behalf of the following persons who the
30 department, or the Social Security Administration by contract
31 with the Department of Children and Family Services, agency
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 determines to be eligible, subject to the income, assets, and
2 categorical eligibility tests set forth in federal and state
3 law. Payment on behalf of these Medicaid eligible persons is
4 subject to the availability of moneys and any limitations
5 established by the General Appropriations Act or chapter 216.
6 (1) Low-income families with children are eligible for
7 Medicaid provided they meet the following requirements:
8 (a) The family includes a dependent child who is
9 living with a caretaker relative.
10 (b) The family's income does not exceed the gross
11 income test limit.
12 (c) The family's countable income and resources do not
13 exceed the applicable Aid to Families with Dependent Children
14 (AFDC) income and resource standards under the AFDC state plan
15 in effect in July 1996, except as amended in the Medicaid
16 state plan to conform as closely as possible to the
17 requirements of the WAGES Program as created in s. 414.015, to
18 the extent permitted by federal law.
19 (2) A person who receives payments from, who is
20 determined eligible for, or who was eligible for but lost cash
21 benefits from the federal program known as the Supplemental
22 Security Income program (SSI). This category includes a
23 low-income person age 65 or over and a low-income person under
24 age 65 considered to be permanently and totally disabled.
25 (3) A child under age 21 living in a low-income,
26 two-parent family, and a child under age 7 living with a
27 nonrelative, if the income and assets of the family or child,
28 as applicable, do not exceed the resource limits under the
29 WAGES Program.
30 (4) A child who is eligible under Title IV-E of the
31 Social Security Act for subsidized board payments, foster
5
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 care, or adoption subsidies, and a child for whom the state
2 has assumed temporary or permanent responsibility and who does
3 not qualify for Title IV-E assistance but is in foster care,
4 shelter or emergency shelter care, or subsidized adoption.
5 (5) A pregnant woman for the duration of her pregnancy
6 and for the post partum period as defined in federal law and
7 rule, or a child under age 1, if either is living in a family
8 that has an income which is at or below 150 percent of the
9 most current federal poverty level, or, effective January 1,
10 1992, that has an income which is at or below 185 percent of
11 the most current federal poverty level. Such a person is not
12 subject to an assets test. Further, a pregnant woman who
13 applies for eligibility for the Medicaid program through a
14 qualified Medicaid provider must be offered the opportunity,
15 subject to federal rules, to be made presumptively eligible
16 for the Medicaid program.
17 (6) A child born after September 30, 1983, living in a
18 family that has an income which is at or below 100 percent of
19 the current federal poverty level, who has attained the age of
20 6, but has not attained the age of 19. In determining the
21 eligibility of such a child, an assets test is not required.
22 (7) A child living in a family that has an income
23 which is at or below 133 percent of the current federal
24 poverty level, who has attained the age of 1, but has not
25 attained the age of 6. In determining the eligibility of such
26 a child, an assets test is not required.
27 (8) A person who is age 65 or over or is determined by
28 the agency to be disabled, whose income is at or below 100
29 percent of the most current federal poverty level and whose
30 assets do not exceed limitations established by the agency.
31 However, the agency may only pay for premiums, coinsurance,
6
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 and deductibles, as required by federal law, unless additional
2 coverage is provided for any or all members of this group by
3 s. 409.904(1).
4 Section 5. Subsection (6) of section 409.905, Florida
5 Statutes, is amended to read:
6 409.905 Mandatory Medicaid services.--The agency may
7 make payments for the following services, which are required
8 of the state by Title XIX of the Social Security Act,
9 furnished by Medicaid providers to recipients who are
10 determined to be eligible on the dates on which the services
11 were provided. Any service under this section shall be
12 provided only when medically necessary and in accordance with
13 state and federal law. Nothing in this section shall be
14 construed to prevent or limit the agency from adjusting fees,
15 reimbursement rates, lengths of stay, number of visits, number
16 of services, or any other adjustments necessary to comply with
17 the availability of moneys and any limitations or directions
18 provided for in the General Appropriations Act or chapter 216.
19 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
20 pay for preventive, diagnostic, therapeutic, or palliative
21 care and other services provided to a recipient in the
22 outpatient portion of a hospital licensed under part I of
23 chapter 395, and provided under the direction of a licensed
24 physician or licensed dentist, except that payment for such
25 care and services is limited to $1,500 $1,000 per state fiscal
26 year per recipient, unless an exception has been made by the
27 agency, and with the exception of a Medicaid recipient under
28 age 21, in which case the only limitation is medical
29 necessity.
30 Section 6. Subsection (5) of section 409.906, Florida
31 Statutes, is amended to read:
7
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 409.906 Optional Medicaid services.--Subject to
2 specific appropriations, the agency may make payments for
3 services which are optional to the state under Title XIX of
4 the Social Security Act and are furnished by Medicaid
5 providers to recipients who are determined to be eligible on
6 the dates on which the services were provided. Any optional
7 service that is provided shall be provided only when medically
8 necessary and in accordance with state and federal law.
9 Nothing in this section shall be construed to prevent or limit
10 the agency from adjusting fees, reimbursement rates, lengths
11 of stay, number of visits, or number of services, or making
12 any other adjustments necessary to comply with the
13 availability of moneys and any limitations or directions
14 provided for in the General Appropriations Act or chapter 216.
15 If necessary to safeguard the state's systems of providing
16 services to elderly and disabled persons and subject to the
17 notice and review provisions of s. 216.177, the Governor may
18 direct the Agency for Health Care Administration to amend the
19 Medicaid state plan to delete the optional Medicaid service
20 known as "Intermediate Care Facilities for the Developmentally
21 Disabled." Optional services may include:
22 (5) CASE MANAGEMENT SERVICES.--The agency may pay for
23 primary care case management services rendered to a recipient
24 pursuant to a federally approved waiver, and targeted case
25 management services for specific groups of targeted
26 recipients, for which funding has been provided and which are
27 rendered pursuant to federal guidelines. The agency is
28 authorized to limit reimbursement for targeted case management
29 services in order to comply with any limitations or directions
30 provided for in the General Appropriations Act.
31 Notwithstanding s. 216.292, the Department of Children and
8
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 Family Services may transfer general funds to the Agency for
2 Health Care Administration to cover state matching
3 requirements exceeding the amount specified in the General
4 Appropriations Act for targeted case management services.
5 Section 7. Subsections (7), (9), and (10) of section
6 409.907, Florida Statutes, are amended to read:
7 409.907 Medicaid provider agreements.--The agency may
8 make payments for medical assistance and related services
9 rendered to Medicaid recipients only to an individual or
10 entity who has a provider agreement in effect with the agency,
11 who is performing services or supplying goods in accordance
12 with federal, state, and local law, and who agrees that no
13 person shall, on the grounds of handicap, race, color, or
14 national origin, or for any other reason, be subjected to
15 discrimination under any program or activity for which the
16 provider receives payment from the agency.
17 (7) The agency may require, as a condition of
18 participating in the Medicaid program and before entering into
19 the provider agreement, that the provider submit information
20 concerning the professional, business, and personal background
21 of the provider and permit an onsite inspection of the
22 provider's service location by agency staff or other personnel
23 designated by the agency to perform assist in this function.
24 Before entering into the provider agreement, or as a condition
25 of continuing participation in the Medicaid program, the
26 agency and may also require that Medicaid providers reimbursed
27 on a fee-for-services basis or fee schedule basis which is not
28 cost-based, post a surety bond from the provider not to exceed
29 $50,000 or the total amount billed by the provider to the
30 program during the current or most recent calendar year,
31 whichever is greater. For new providers, the amount of the
9
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 surety bond shall be determined by the agency based on the
2 provider's estimate of its first year's billing. If the
3 provider's billing during the first year exceeds the bond
4 amount, the agency may require the provider to acquire an
5 additional bond equal to the actual billing level of the
6 provider. A provider's bond shall not exceed $50,000 if a
7 physician or group of physicians licensed under chapter 458,
8 chapter 459, or chapter 460 has a 50 percent or greater
9 ownership interest in the provider or if the provider is an
10 assisted living facility licensed under part III of chapter
11 400. The bonds permitted by this section are in addition to
12 the bonds referenced in s. 400.179(4)(d). If the provider is a
13 corporation, partnership, association, or other entity, the
14 agency may require the provider to submit information
15 concerning the background of that entity and of any principal
16 of the entity, including any partner or shareholder having an
17 ownership interest in the entity equal to 5 percent or
18 greater, and any treating provider who participates in or
19 intends to participate in Medicaid through the entity. The
20 information must include:
21 (a) Proof of holding a valid license or operating
22 certificate, as applicable, if required by the state or local
23 jurisdiction in which the provider is located or if required
24 by the Federal Government.
25 (b) Information concerning any prior violation, fine,
26 suspension, termination, or other administrative action taken
27 under the Medicaid laws, rules, or regulations of this state
28 or of any other state or the Federal Government; any prior
29 violation of the laws, rules, or regulations relating to the
30 Medicare program; any prior violation of the rules or
31 regulations of any other public or private insurer; and any
10
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 prior violation of the laws, rules, or regulations of any
2 regulatory body of this or any other state.
3 (c) Full and accurate disclosure of any financial or
4 ownership interest that the provider, or any principal,
5 partner, or major shareholder thereof, may hold in any other
6 Medicaid provider or health care related entity or any other
7 entity that is licensed by the state to provide health or
8 residential care and treatment to persons.
9 (d) If a group provider, identification of all members
10 of the group and attestation that all members of the group are
11 enrolled in or have applied to enroll in the Medicaid program.
12 (9) Upon receipt of a completed, signed, and dated
13 application, and completion of any necessary background
14 investigation and criminal history record check, the agency
15 must either:
16 (a) Enroll the applicant as a Medicaid provider; or
17 (b) Deny the application if the agency determines
18 that, based on the grounds listed in subsection (10), it is in
19 the best interest of the Medicaid program to do so, specifying
20 the reasons for denial. The agency may consider the factors
21 listed in subsection (10), as well as any other factor that
22 could affect the effective and efficient administration of the
23 program, including, but not limited to, the current
24 availability of medical care, services, or supplies to
25 recipients, taking into account geographic location and
26 reasonable travel time.
27 (10) The agency may consider whether deny enrollment
28 in the Medicaid program to a provider if the provider, or any
29 officer, director, agent, managing employee, or affiliated
30 person, or any partner or shareholder having an ownership
31 interest equal to 5 percent or greater in the provider if the
11
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 provider is a corporation, partnership, or other business
2 entity, has:
3 (a) Made a false representation or omission of any
4 material fact in making the application, including the
5 submission of an application that conceals the controlling or
6 ownership interest of any officer, director, agent, managing
7 employee, affiliated person, or partner or shareholder who may
8 not be eligible to participate;
9 (b) Been or is currently excluded, suspended,
10 terminated from, or has involuntarily withdrawn from
11 participation in, Florida's Medicaid program or any other
12 state's Medicaid program, or from participation in any other
13 governmental or private health care or health insurance
14 program;
15 (c) Been convicted of a criminal offense relating to
16 the delivery of any goods or services under Medicaid or
17 Medicare or any other public or private health care or health
18 insurance program including the performance of management or
19 administrative services relating to the delivery of goods or
20 services under any such program;
21 (d) Been convicted under federal or state law of a
22 criminal offense related to the neglect or abuse of a patient
23 in connection with the delivery of any health care goods or
24 services;
25 (e) Been convicted under federal or state law of a
26 criminal offense relating to the unlawful manufacture,
27 distribution, prescription, or dispensing of a controlled
28 substance;
29 (f) Been convicted of any criminal offense relating to
30 fraud, theft, embezzlement, breach of fiduciary
31 responsibility, or other financial misconduct;
12
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 (g) Been convicted under federal or state law of a
2 crime punishable by imprisonment of a year or more which
3 involves moral turpitude;
4 (h) Been convicted in connection with the interference
5 or obstruction of any investigation into any criminal offense
6 listed in this subsection;
7 (i) Been found to have violated federal or state laws,
8 rules, or regulations governing Florida's Medicaid program or
9 any other state's Medicaid program, the Medicare program, or
10 any other publicly funded federal or state health care or
11 health insurance program, and been sanctioned accordingly;
12 (j) Been previously found by a licensing, certifying,
13 or professional standards board or agency to have violated the
14 standards or conditions relating to licensure or certification
15 or the quality of services provided; or
16 (k) Failed to pay any fine or overpayment properly
17 assessed under the Medicaid program in which no appeal is
18 pending or after resolution of the proceeding by stipulation
19 or agreement, unless the agency has issued a specific letter
20 of forgiveness or has approved a repayment schedule to which
21 the provider agrees to adhere.
22 Section 8. Paragraph (a) of subsection (1) of section
23 409.908, Florida Statutes, is amended to read:
24 409.908 Reimbursement of Medicaid providers.--Subject
25 to specific appropriations, the agency shall reimburse
26 Medicaid providers, in accordance with state and federal law,
27 according to methodologies set forth in the rules of the
28 agency and in policy manuals and handbooks incorporated by
29 reference therein. These methodologies may include fee
30 schedules, reimbursement methods based on cost reporting,
31 negotiated fees, competitive bidding pursuant to s. 287.057,
13
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 and other mechanisms the agency considers efficient and
2 effective for purchasing services or goods on behalf of
3 recipients. Payment for Medicaid compensable services made on
4 behalf of Medicaid eligible persons is subject to the
5 availability of moneys and any limitations or directions
6 provided for in the General Appropriations Act or chapter 216.
7 Further, nothing in this section shall be construed to prevent
8 or limit the agency from adjusting fees, reimbursement rates,
9 lengths of stay, number of visits, or number of services, or
10 making any other adjustments necessary to comply with the
11 availability of moneys and any limitations or directions
12 provided for in the General Appropriations Act, provided the
13 adjustment is consistent with legislative intent.
14 (1) Reimbursement to hospitals licensed under part I
15 of chapter 395 must be made prospectively or on the basis of
16 negotiation.
17 (a) Reimbursement for inpatient care is limited as
18 provided for in s. 409.905(5). Reimbursement for hospital
19 outpatient care is limited to $1,500 $1,000 per state fiscal
20 year per recipient, except for:
21 1. Such care provided to a Medicaid recipient under
22 age 21, in which case the only limitation is medical
23 necessity;
24 2. Renal dialysis services; and
25 3. Other exceptions made by the agency.
26 (b) Hospitals that provide services to a
27 disproportionate share of low-income Medicaid recipients, or
28 that participate in the regional perinatal intensive care
29 center program under chapter 383, or that participate in the
30 statutory teaching hospital disproportionate share program, or
31 that participate in the extraordinary disproportionate share
14
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 program, may receive additional reimbursement. The total
2 amount of payment for disproportionate share hospitals shall
3 be fixed by the General Appropriations Act. The computation of
4 these payments must be made in compliance with all federal
5 regulations and the methodologies described in ss. 409.911,
6 409.9112, and 409.9113.
7 (c) The agency is authorized to limit inflationary
8 increases for outpatient hospital services as directed by the
9 General Appropriations Act.
10 Section 9. Section 409.9119, Florida Statutes, is
11 created to read:
12 409.9119 Disproportionate share program for children's
13 hospitals.--In addition to the payments made under s. 409.911,
14 the Agency for Health Care Administration shall develop and
15 implement a system under which disproportionate share payments
16 are made to those hospitals that are licensed by the state as
17 a children's hospital. This system of payments must conform to
18 federal requirements and must distribute funds in each fiscal
19 year for which an appropriation is made by making quarterly
20 Medicaid payments. Notwithstanding s. 409.915, counties are
21 exempt from contributing toward the cost of this special
22 reimbursement for hospitals that serve a disproportionate
23 share of low-income patients.
24 (1) The agency shall use the following formula to
25 calculate the total amount earned for hospitals that
26 participate in the children's hospital disproportionate share
27 program:
28 TAE = DSR x BMPD x MD
29 Where:
30 TAE = total amount earned by a children's hospital.
31 DSR = disproportionate share rate.
15
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 BMPD = base Medicaid per diem.
2 MD = Medicaid days.
3 (2) The agency shall calculate the total additional
4 payment for hospitals that participate in the children's
5 hospital disproportionate share program as follows:
6
7 TAP = (TAE x TA)
8
9 STAE
10 Where:
11 TAP = total additional payment for a children's
12 hospital.
13 TAE = total amount earned by a children's hospital.
14 STAE = sum of total amount earned by each hospital that
15 participates in the children's hospital disproportionate share
16 program.
17 TA = total appropriation for the children's hospital
18 disproportionate share program.
19
20 (3) A hospital may not receive any payments under this
21 section until it achieves full compliance with the applicable
22 rules of the agency. A hospital that is not in compliance for
23 two or more consecutive quarters may not receive its share of
24 the funds. Any forfeited funds must be distributed to the
25 remaining participating children's hospitals that are in
26 compliance.
27 Section 10. Subsection (9) of section 409.912, Florida
28 Statutes, is amended to read:
29 409.912 Cost-effective purchasing of health care.--The
30 agency shall purchase goods and services for Medicaid
31 recipients in the most cost-effective manner consistent with
16
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 the delivery of quality medical care. The agency shall
2 maximize the use of prepaid per capita and prepaid aggregate
3 fixed-sum basis services when appropriate and other
4 alternative service delivery and reimbursement methodologies,
5 including competitive bidding pursuant to s. 287.057, designed
6 to facilitate the cost-effective purchase of a case-managed
7 continuum of care. The agency shall also require providers to
8 minimize the exposure of recipients to the need for acute
9 inpatient, custodial, and other institutional care and the
10 inappropriate or unnecessary use of high-cost services.
11 (9) The agency, after notifying the Legislature, may
12 apply for waivers of applicable federal laws and regulations
13 as necessary to implement more appropriate systems of health
14 care for Medicaid recipients and reduce the cost of the
15 Medicaid program to the state and federal governments and
16 shall implement such programs, after legislative approval,
17 within a reasonable period of time after federal approval.
18 These programs must be designed primarily to reduce the need
19 for inpatient care, custodial care and other long-term or
20 institutional care, and other high-cost services.
21 (a) Before Prior to seeking legislative approval of
22 such a waiver as authorized by this subsection, the agency
23 must shall provide notice and an opportunity for public
24 comment. Notice must shall be provided to all persons who
25 have made requests of the agency for advance notice and must
26 shall be published in the Florida Administrative Weekly not
27 less than 28 days before prior to the intended action.
28 (b) Notwithstanding s. 216.292, funds that are
29 appropriated to the Department of Elderly Affairs for the
30 Assisted Living for the Elderly Medicaid waiver and are not
31
17
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 expended must be transferred to the agency to fund
2 Medicaid-reimbursed nursing home care.
3 Section 11. Section 409.919, Florida Statutes, is
4 amended to read:
5 409.919 Rules.--The agency shall adopt any rules
6 necessary to comply with or administer ss. 409.901-409.920 and
7 all rules necessary to comply with federal requirements. In
8 addition, the Department of Children and Family Services shall
9 adopt and accept transfer of any rules necessary to carry out
10 its responsibilities for receiving and processing Medicaid
11 applications and determining Medicaid eligibility, and for
12 assuring compliance with and administering ss. 409.901-409.906
13 and any other provisions related to responsibility for the
14 determination of Medicaid eligibility.
15 Section 12. Notwithstanding the provisions of sections
16 236.0812, 409.9071, and 409.908(21), Florida Statutes,
17 developmental research schools, as authorized under section
18 228.053, Florida Statutes, shall be authorized to participate
19 in the Medicaid certified school match program subject to the
20 provisions of sections 236.0812, 409.9071, and 409.908(21),
21 Florida Statutes.
22 Section 13. (1) The Agency for Health Care
23 Administration is directed to submit to the Health Care
24 Financing Administration a request for a waiver that will
25 allow the agency to undertake a pilot project that would
26 implement a coordinated system of care for adult ventilator
27 dependent patients. Under this pilot program, the agency shall
28 identify a network of skilled nursing facilities that have
29 respiratory departments geared towards intensive treatment and
30 rehabilitation of adult ventilator patients and will contract
31 with such a network for respiratory or other services. The
18
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 2000 CS for SB 2242
317-1993A-00
1 pilot project must allow the agency to evaluate a coordinated
2 and focused system of care for adult ventilator dependent
3 patients to determine the overall cost-effectiveness and
4 improved outcomes for participants.
5 (2) The agency must submit the waiver by September 1,
6 2000. The agency must forward a preliminary report of the
7 pilot project's findings to the Governor, the Speaker of the
8 House of Representatives, and the President of the Senate six
9 months after project implementation. The agency must submit a
10 final report of the pilot project's findings to these same
11 recipients no later than February 15, 2002.
12 Section 14. Paragraph (b) of subsection (4) of section
13 409.912, Florida Statutes, is repealed.
14 Section 15. This act shall take effect July 1, 2000.
15
16 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
17 Senate Bill 2242
18
19 The Committee Substitute requires that the optional state
supplementation rate increase by the cost-of-living adjustment
20 to the federal benefits rate; limits provider types who can be
required to post a surety bond in excess of $50,000 to those
21 providers which are reimbursed on a fee-for-service basis or
fee schedule basis which is not cost based, excluding
22 providers in which physicians or physician groups licensed
under chapters 458, 458, or 460 have greater that 50 percent
23 ownership interest or if the provider is an assisted living
facility licensed under chapter 400, Part III; authorizes
24 university laboratory schools to participate in Medicaid
certified school match funding; and repeals paragraph (b) of
25 subsection (4) of 409.912, F.S., relating to exemption from
the HMO licensure requirements of part 1 of chapter 641, F.S.,
26 for entities providing only Medicaid services on a prepaid
basis.
27
28
29
30
31
19