House Bill 2329e1
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HB 2329, First Engrossed
1 A bill to be entitled
2 An act relating to health care; amending s.
3 394.4615, F.S.; requiring that clinical records
4 be furnished to the unit upon request; amending
5 s. 395.3025, F.S.; allowing patient records to
6 be furnished to the unit; amending s. 400.0077,
7 F.S.; providing that certain confidentiality
8 provisions do not limit the subpoena power of
9 the Attorney General; amending s. 400.494,
10 F.S.; providing that certain confidentiality
11 provisions relating to home health agencies do
12 not apply to information requested by the unit;
13 amending s. 409.9071, F.S.; waiving
14 confidentiality and requiring that certain
15 information regarding Medicaid provider
16 agreements with school districts be provided to
17 the unit; amending s. 409.920, F.S.; clarifying
18 the Attorney General's power to subpoena
19 medical records relating to Medicaid
20 recipients; amending s. 409.9205, F.S.;
21 authorizing investigators employed by the unit
22 to serve process; amending s. 430.608, F.S.;
23 providing that certain confidentiality
24 provisions pertaining to the Department of
25 Elderly Affairs do not limit the subpoena
26 authority of the unit; amending s. 455.667,
27 F.S.; providing that certain confidential
28 records held by the Department of Health must
29 be provided to the unit; amending s. 409.212,
30 F.S.; providing for periodic increase in the
31 optional state supplementation rate; amending
1
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HB 2329, First Engrossed
1 s. 409.901, F.S.; amending definitions of terms
2 used in ss. 409.910-409.920, F.S.; amending s.
3 409.902, F.S.; providing that the Department of
4 Children and Family Services is responsible for
5 Medicaid eligibility determinations; amending
6 s. 409.903, F.S.; providing responsibility for
7 determinations of eligibility for payments for
8 medical assistance and related services;
9 amending s. 409.905, F.S.; increasing the
10 maximum amount that may be paid under Medicaid
11 for hospital outpatient services; amending s.
12 409.906, F.S.; allowing the Department of
13 Children and Family Services to transfer funds
14 to the Agency for Health Care Administration to
15 cover state match requirements as specified;
16 amending s. 409.907, F.S.; revising
17 requirements relating to the minimum amount of
18 the surety bond which each provider is required
19 to maintain; specifying grounds on which
20 provider applications may be denied; amending
21 s. 409.908, F.S.; increasing the maximum amount
22 of reimbursement allowable to Medicaid
23 providers for hospital inpatient care;
24 prohibiting interim rate adjustments that
25 reflect increases in the cost of general or
26 professional liability insurance; creating s.
27 409.9119, F.S.; creating a disproportionate
28 share program for children's hospitals;
29 providing formulas governing payments made to
30 hospitals under the program; providing for
31 withholding payments from a hospital that is
2
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HB 2329, First Engrossed
1 not complying with agency rules; amending s.
2 409.912, F.S.; providing for the transfer of
3 certain unexpended Medicaid funds from the
4 Department of Elderly Affairs to the Agency for
5 Health Care Administration; amending s.
6 409.919, F.S.; providing for the adoption and
7 the transfer of certain rules relating to the
8 determination of Medicaid eligibility;
9 authorizing developmental research schools to
10 participate in the Medicaid certified school
11 match program; providing for the Agency for
12 Health Care Administration to seek a federal
13 waiver allowing the agency to undertake a pilot
14 project that involves contracting with skilled
15 nursing facilities for the provision of
16 rehabilitation services to adult ventilator
17 dependent patients; providing for evaluation of
18 the pilot program; providing for a report;
19 amending s. 430.703, F.S.; defining "other
20 qualified provider"; amending s. 430.707, F.S.;
21 authorizing the Department of Elderly Affairs
22 to contract with other qualified providers to
23 provide long-term care within community
24 diversion pilot project areas; repealing s.
25 409.912(4)(b), F.S., relating to the
26 authorization of the agency to contract with
27 certain prepaid health care services providers;
28 providing an effective date.
29
30 Be It Enacted by the Legislature of the State of Florida:
31
3
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HB 2329, First Engrossed
1 Section 1. Present subsections (6) through (10) of
2 section 394.4615, Florida Statutes, are redesignated as
3 subsections (7) through (11), respectively, and a new
4 subsection (6) is added to that section to read:
5 394.4615 Clinical records; confidentiality.--
6 (6) Clinical records relating to a Medicaid recipient
7 shall be furnished to the Medicaid Fraud Control Unit in the
8 Department of Legal Affairs, upon request.
9 Section 2. Paragraph (k) is added to subsection (5) of
10 section 395.3025, Florida Statutes, to read:
11 395.3025 Patient and personnel records; copies;
12 examination.--
13 (4) Patient records are confidential and must not be
14 disclosed without the consent of the person to whom they
15 pertain, but appropriate disclosure may be made without such
16 consent to:
17 (k) The Medicaid Fraud Control Unit in the Department
18 of Legal Affairs pursuant to s. 409.920.
19 Section 3. Subsection (6) is added to section
20 400.0077, Florida Statutes, to read:
21 400.0077 Confidentiality.--
22 (6) This section does not limit the subpoena power of
23 the Attorney General pursuant to s. 409.920(8)(b).
24 Section 4. Section 400.494, Florida Statutes, is
25 amended to read:
26 400.494 Information about patients confidential.--
27 (1) Information about patients received by persons
28 employed by, or providing services to, a home health agency or
29 received by the licensing agency through reports or inspection
30 shall be confidential and exempt from the provisions of s.
31 119.07(1) and shall not be disclosed to any person other than
4
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HB 2329, First Engrossed
1 the patient without the written consent of that patient or the
2 patient's guardian.
3 (2) This section does not apply to information
4 lawfully requested by the Medicaid Fraud Control Unit of the
5 Department of Legal Affairs.
6 Section 5. Subsection (7) is added to section
7 409.9071, Florida Statutes, to read:
8 409.9071 Medicaid provider agreements for school
9 districts certifying state match.--
10 (7) The agency's and school districts' confidentiality
11 is waived. They shall provide any information or documents
12 relating to this section to the Medicaid Fraud Control Unit in
13 the Department of Legal Affairs, upon request pursuant to its
14 authority under s. 409.920.
15 Section 6. Paragraph (b) of subsection (8) of section
16 409.920, Florida Statutes, is amended to read:
17 409.920 Medicaid provider fraud.--
18 (8) In carrying out the duties and responsibilities
19 under this subsection, the Attorney General may:
20 (b) Subpoena witnesses or materials, including medical
21 records relating to Medicaid recipients, within or outside the
22 state and, through any duly designated employee, administer
23 oaths and affirmations and collect evidence for possible use
24 in either civil or criminal judicial proceedings.
25 Section 7. Section 409.9205, Florida Statutes, is
26 amended to read:
27 409.9205 Medicaid Fraud Control Unit; law enforcement
28 officers.--All investigators employed by the Medicaid Fraud
29 Control Unit who have been certified under s. 943.1395 are law
30 enforcement officers of the state. Such investigators have
31 the authority to conduct criminal investigations, bear arms,
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HB 2329, First Engrossed
1 make arrests, and apply for, serve, and execute search
2 warrants, arrest warrants, and capias, and other process
3 throughout the state pertaining to Medicaid fraud as described
4 in this chapter. The Attorney General shall provide
5 reasonable notice of criminal investigations conducted by the
6 Medicaid Fraud Control Unit to, and coordinate those
7 investigations with, the sheriffs of the respective counties.
8 Investigators employed by the Medicaid Fraud Control Unit are
9 not eligible for membership in the Special Risk Class of the
10 Florida Retirement System under s. 121.0515.
11 Section 8. Section 430.608, Florida Statutes, is
12 amended to read:
13 430.608 Confidentiality of information.--Identifying
14 information about elderly persons who receive services under
15 ss. 430.601-430.606, which is received through files, reports,
16 inspection, or otherwise by the department or by authorized
17 departmental employees, by persons who volunteer services, or
18 by persons who provide services to elderly persons under ss.
19 430.601-430.606 through contracts with the department, is
20 confidential and exempt from the provisions of s. 119.07(1)
21 and s. 24(a), Art. I of the State Constitution. Such
22 information may not be disclosed publicly in such a manner as
23 to identify an elderly person, unless that person or the
24 person's legal guardian provides written consent.
25 (2) This section does not, however, limit the subpoena
26 authority of the Medicaid Fraud Control Unit of the Department
27 of Legal Affairs pursuant to s. 409.920(8)(b).
28 Section 9. Subsection (8) of subsection 455.667,
29 Florida Statutes, is amended to read:
30 455.667 Ownership and control of patient records;
31 report or copies of records to be furnished.--
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HB 2329, First Engrossed
1 (8)(a) All patient records obtained by the department
2 and any other documents maintained by the department which
3 identify the patient by name are confidential and exempt from
4 s. 119.07(1) and shall be used solely for the purpose of the
5 department and the appropriate regulatory board in its
6 investigation, prosecution, and appeal of disciplinary
7 proceedings. The records shall not be available to the public
8 as part of the record of investigation for and prosecution in
9 disciplinary proceedings made available to the public by the
10 department or the appropriate board.
11 (b) Notwithstanding paragraph (a), all patient records
12 obtained by the department and any other documents maintained
13 by the department which relate to a current or former Medicaid
14 recipient shall be provided to the Medicaid Fraud Control Unit
15 in the Department of Legal Affairs, upon request.
16 Section 10. Subsection (6) of section 409.212, Florida
17 Statutes, is renumbered as subsection (7) and a new subsection
18 (6) is added to said section, to read:
19 409.212 Optional supplementation.--
20 (6) The optional state supplementation rate shall be
21 increased by the cost-of-living adjustment to the federal
22 benefits rate provided the average state optional
23 supplementation contribution does not increase as a result.
24 Section 11. Subsections (3), (15), and (18) of section
25 409.901, Florida Statutes, are amended to read:
26 409.901 Definitions.--As used in ss. 409.901-409.920,
27 except as otherwise specifically provided, the term:
28 (3) "Applicant" means an individual whose written
29 application for medical assistance provided by Medicaid under
30 ss. 409.903-409.906 has been submitted to the Department of
31 Children and Family Services agency, or to the Social Security
7
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HB 2329, First Engrossed
1 Administration if the application is for Supplemental Security
2 Income, but has not received final action. This term includes
3 an individual, who need not be alive at the time of
4 application, whose application is submitted through a
5 representative or a person acting for the individual.
6 (15) "Medicaid program" means the program authorized
7 under Title XIX of the federal Social Security Act which
8 provides for payments for medical items or services, or both,
9 on behalf of any person who is determined by the Department of
10 Children and Family Services, or, for Supplemental Security
11 Income, by the Social Security Administration, to be eligible
12 on the date of service for Medicaid assistance.
13 (18) "Medicaid recipient" or "recipient" means an
14 individual whom the Department of Children and Family
15 Services, or, for Supplemental Security Income, by the Social
16 Security Administration, determines is eligible, pursuant to
17 federal and state law, to receive medical assistance and
18 related services for which the agency may make payments under
19 the Medicaid program. For the purposes of determining
20 third-party liability, the term includes an individual
21 formerly determined to be eligible for Medicaid, an individual
22 who has received medical assistance under the Medicaid
23 program, or an individual on whose behalf Medicaid has become
24 obligated.
25 Section 12. Section 409.902, Florida Statutes, is
26 amended to read:
27 409.902 Designated single state agency; payment
28 requirements; program title.--The Agency for Health Care
29 Administration is designated as the single state agency
30 authorized to make payments for medical assistance and related
31 services under Title XIX of the Social Security Act. These
8
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HB 2329, First Engrossed
1 payments shall be made, subject to any limitations or
2 directions provided for in the General Appropriations Act,
3 only for services included in the program, shall be made only
4 on behalf of eligible individuals, and shall be made only to
5 qualified providers in accordance with federal requirements
6 for Title XIX of the Social Security Act and the provisions of
7 state law. This program of medical assistance is designated
8 the "Medicaid program." The Department of Children and Family
9 Services is responsible for Medicaid eligibility
10 determinations, including, but not limited to, policy, rules,
11 and the agreement with the Social Security Administration for
12 Medicaid eligibility determinations for Supplemental Security
13 Income recipients, as well as the actual determination of
14 eligibility.
15 Section 13. Section 409.903, Florida Statutes, is
16 amended to read:
17 409.903 Mandatory payments for eligible persons.--The
18 agency shall make payments for medical assistance and related
19 services on behalf of the following persons who the
20 department, or the Social Security Administration by contract
21 with the Department of Children and Family Services, agency
22 determines to be eligible, subject to the income, assets, and
23 categorical eligibility tests set forth in federal and state
24 law. Payment on behalf of these Medicaid eligible persons is
25 subject to the availability of moneys and any limitations
26 established by the General Appropriations Act or chapter 216.
27 (1) Low-income families with children are eligible for
28 Medicaid provided they meet the following requirements:
29 (a) The family includes a dependent child who is
30 living with a caretaker relative.
31
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HB 2329, First Engrossed
1 (b) The family's income does not exceed the gross
2 income test limit.
3 (c) The family's countable income and resources do not
4 exceed the applicable Aid to Families with Dependent Children
5 (AFDC) income and resource standards under the AFDC state plan
6 in effect in July 1996, except as amended in the Medicaid
7 state plan to conform as closely as possible to the
8 requirements of the WAGES Program as created in s. 414.015, to
9 the extent permitted by federal law.
10 (2) A person who receives payments from, who is
11 determined eligible for, or who was eligible for but lost cash
12 benefits from the federal program known as the Supplemental
13 Security Income program (SSI). This category includes a
14 low-income person age 65 or over and a low-income person under
15 age 65 considered to be permanently and totally disabled.
16 (3) A child under age 21 living in a low-income,
17 two-parent family, and a child under age 7 living with a
18 nonrelative, if the income and assets of the family or child,
19 as applicable, do not exceed the resource limits under the
20 WAGES Program.
21 (4) A child who is eligible under Title IV-E of the
22 Social Security Act for subsidized board payments, foster
23 care, or adoption subsidies, and a child for whom the state
24 has assumed temporary or permanent responsibility and who does
25 not qualify for Title IV-E assistance but is in foster care,
26 shelter or emergency shelter care, or subsidized adoption.
27 (5) A pregnant woman for the duration of her pregnancy
28 and for the post partum period as defined in federal law and
29 rule, or a child under age 1, if either is living in a family
30 that has an income which is at or below 150 percent of the
31 most current federal poverty level, or, effective January 1,
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HB 2329, First Engrossed
1 1992, that has an income which is at or below 185 percent of
2 the most current federal poverty level. Such a person is not
3 subject to an assets test. Further, a pregnant woman who
4 applies for eligibility for the Medicaid program through a
5 qualified Medicaid provider must be offered the opportunity,
6 subject to federal rules, to be made presumptively eligible
7 for the Medicaid program.
8 (6) A child born after September 30, 1983, living in a
9 family that has an income which is at or below 100 percent of
10 the current federal poverty level, who has attained the age of
11 6, but has not attained the age of 19. In determining the
12 eligibility of such a child, an assets test is not required.
13 (7) A child living in a family that has an income
14 which is at or below 133 percent of the current federal
15 poverty level, who has attained the age of 1, but has not
16 attained the age of 6. In determining the eligibility of such
17 a child, an assets test is not required.
18 (8) A person who is age 65 or over or is determined by
19 the agency to be disabled, whose income is at or below 100
20 percent of the most current federal poverty level and whose
21 assets do not exceed limitations established by the agency.
22 However, the agency may only pay for premiums, coinsurance,
23 and deductibles, as required by federal law, unless additional
24 coverage is provided for any or all members of this group by
25 s. 409.904(1).
26 Section 14. Subsection (6) of section 409.905, Florida
27 Statutes, is amended to read:
28 409.905 Mandatory Medicaid services.--The agency may
29 make payments for the following services, which are required
30 of the state by Title XIX of the Social Security Act,
31 furnished by Medicaid providers to recipients who are
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HB 2329, First Engrossed
1 determined to be eligible on the dates on which the services
2 were provided. Any service under this section shall be
3 provided only when medically necessary and in accordance with
4 state and federal law. Nothing in this section shall be
5 construed to prevent or limit the agency from adjusting fees,
6 reimbursement rates, lengths of stay, number of visits, number
7 of services, or any other adjustments necessary to comply with
8 the availability of moneys and any limitations or directions
9 provided for in the General Appropriations Act or chapter 216.
10 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
11 pay for preventive, diagnostic, therapeutic, or palliative
12 care and other services provided to a recipient in the
13 outpatient portion of a hospital licensed under part I of
14 chapter 395, and provided under the direction of a licensed
15 physician or licensed dentist, except that payment for such
16 care and services is limited to $1,500 $1,000 per state fiscal
17 year per recipient, unless an exception has been made by the
18 agency, and with the exception of a Medicaid recipient under
19 age 21, in which case the only limitation is medical
20 necessity.
21 Section 15. Subsection (5) of section 409.906, Florida
22 Statutes, is amended to read:
23 409.906 Optional Medicaid services.--Subject to
24 specific appropriations, the agency may make payments for
25 services which are optional to the state under Title XIX of
26 the Social Security Act and are furnished by Medicaid
27 providers to recipients who are determined to be eligible on
28 the dates on which the services were provided. Any optional
29 service that is provided shall be provided only when medically
30 necessary and in accordance with state and federal law.
31 Nothing in this section shall be construed to prevent or limit
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HB 2329, First Engrossed
1 the agency from adjusting fees, reimbursement rates, lengths
2 of stay, number of visits, or number of services, or making
3 any other adjustments necessary to comply with the
4 availability of moneys and any limitations or directions
5 provided for in the General Appropriations Act or chapter 216.
6 If necessary to safeguard the state's systems of providing
7 services to elderly and disabled persons and subject to the
8 notice and review provisions of s. 216.177, the Governor may
9 direct the Agency for Health Care Administration to amend the
10 Medicaid state plan to delete the optional Medicaid service
11 known as "Intermediate Care Facilities for the Developmentally
12 Disabled." Optional services may include:
13 (5) CASE MANAGEMENT SERVICES.--The agency may pay for
14 primary care case management services rendered to a recipient
15 pursuant to a federally approved waiver, and targeted case
16 management services for specific groups of targeted
17 recipients, for which funding has been provided and which are
18 rendered pursuant to federal guidelines. The agency is
19 authorized to limit reimbursement for targeted case management
20 services in order to comply with any limitations or directions
21 provided for in the General Appropriations Act.
22 Notwithstanding s. 216.292, the Department of Children and
23 Family Services may transfer general funds to the Agency for
24 Health Care Administration to fund state match requirements
25 exceeding the amount specified in the General Appropriations
26 Act for targeted case management services.
27 Section 16. Subsections (7), (9), and (10) of section
28 409.907, Florida Statutes, are amended to read:
29 409.907 Medicaid provider agreements.--The agency may
30 make payments for medical assistance and related services
31 rendered to Medicaid recipients only to an individual or
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HB 2329, First Engrossed
1 entity who has a provider agreement in effect with the agency,
2 who is performing services or supplying goods in accordance
3 with federal, state, and local law, and who agrees that no
4 person shall, on the grounds of handicap, race, color, or
5 national origin, or for any other reason, be subjected to
6 discrimination under any program or activity for which the
7 provider receives payment from the agency.
8 (7) The agency may require, as a condition of
9 participating in the Medicaid program and before entering into
10 the provider agreement, that the provider submit information
11 concerning the professional, business, and personal background
12 of the provider and permit an onsite inspection of the
13 provider's service location by agency staff or other personnel
14 designated by the agency to perform assist in this function.
15 Before entering into the provider agreement, or as a condition
16 of continuing participation in the Medicaid program, the
17 agency and may also require that Medicaid providers reimbursed
18 on a fee-for-services basis or fee schedule basis which is not
19 cost-based, post a surety bond from the provider not to exceed
20 $50,000 or the total amount billed by the provider to the
21 program during the current or most recent calendar year,
22 whichever is greater. For new providers, the amount of the
23 surety bond shall be determined by the agency based on the
24 provider's estimate of its first year's billing. If the
25 provider's billing during the first year exceeds the bond
26 amount, the agency may require the provider to acquire an
27 additional bond equal to the actual billing level of the
28 provider. A provider's bond shall not exceed $50,000 if a
29 physician or group of physicians licensed under chapter 458,
30 chapter 459, or chapter 460 has a 50 percent or greater
31 ownership interest in the provider or if the provider is an
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HB 2329, First Engrossed
1 assisted living facility licensed under part III of chapter
2 400. The bonds permitted by this section are in addition to
3 the bonds referenced in s. 400.179(4)(d). If the provider is a
4 corporation, partnership, association, or other entity, the
5 agency may require the provider to submit information
6 concerning the background of that entity and of any principal
7 of the entity, including any partner or shareholder having an
8 ownership interest in the entity equal to 5 percent or
9 greater, and any treating provider who participates in or
10 intends to participate in Medicaid through the entity. The
11 information must include:
12 (a) Proof of holding a valid license or operating
13 certificate, as applicable, if required by the state or local
14 jurisdiction in which the provider is located or if required
15 by the Federal Government.
16 (b) Information concerning any prior violation, fine,
17 suspension, termination, or other administrative action taken
18 under the Medicaid laws, rules, or regulations of this state
19 or of any other state or the Federal Government; any prior
20 violation of the laws, rules, or regulations relating to the
21 Medicare program; any prior violation of the rules or
22 regulations of any other public or private insurer; and any
23 prior violation of the laws, rules, or regulations of any
24 regulatory body of this or any other state.
25 (c) Full and accurate disclosure of any financial or
26 ownership interest that the provider, or any principal,
27 partner, or major shareholder thereof, may hold in any other
28 Medicaid provider or health care related entity or any other
29 entity that is licensed by the state to provide health or
30 residential care and treatment to persons.
31
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1 (d) If a group provider, identification of all members
2 of the group and attestation that all members of the group are
3 enrolled in or have applied to enroll in the Medicaid program.
4 (9) Upon receipt of a completed, signed, and dated
5 application, and completion of any necessary background
6 investigation and criminal history record check, the agency
7 must either:
8 (a) Enroll the applicant as a Medicaid provider; or
9 (b) Deny the application if the agency finds that,
10 based on the grounds listed in subsection (10), it is in the
11 best interest of the Medicaid program to do so, specifying the
12 reasons for denial. The agency may consider the factors listed
13 in subsection (10), as well as any other factor that could
14 affect the effective and efficient administration of the
15 program, including, but not limited to, the current
16 availability of medical care, services, or supplies to
17 recipients, taking into account geographic location and
18 reasonable travel time.
19 (10) The agency may consider whether deny enrollment
20 in the Medicaid program to a provider if the provider, or any
21 officer, director, agent, managing employee, or affiliated
22 person, or any partner or shareholder having an ownership
23 interest equal to 5 percent or greater in the provider if the
24 provider is a corporation, partnership, or other business
25 entity, has:
26 (a) Made a false representation or omission of any
27 material fact in making the application, including the
28 submission of an application that conceals the controlling or
29 ownership interest of any officer, director, agent, managing
30 employee, affiliated person, or partner or shareholder who may
31 not be eligible to participate;
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1 (b) Been or is currently excluded, suspended,
2 terminated from, or has involuntarily withdrawn from
3 participation in, Florida's Medicaid program or any other
4 state's Medicaid program, or from participation in any other
5 governmental or private health care or health insurance
6 program;
7 (c) Been convicted of a criminal offense relating to
8 the delivery of any goods or services under Medicaid or
9 Medicare or any other public or private health care or health
10 insurance program including the performance of management or
11 administrative services relating to the delivery of goods or
12 services under any such program;
13 (d) Been convicted under federal or state law of a
14 criminal offense related to the neglect or abuse of a patient
15 in connection with the delivery of any health care goods or
16 services;
17 (e) Been convicted under federal or state law of a
18 criminal offense relating to the unlawful manufacture,
19 distribution, prescription, or dispensing of a controlled
20 substance;
21 (f) Been convicted of any criminal offense relating to
22 fraud, theft, embezzlement, breach of fiduciary
23 responsibility, or other financial misconduct;
24 (g) Been convicted under federal or state law of a
25 crime punishable by imprisonment of a year or more which
26 involves moral turpitude;
27 (h) Been convicted in connection with the interference
28 or obstruction of any investigation into any criminal offense
29 listed in this subsection;
30 (i) Been found to have violated federal or state laws,
31 rules, or regulations governing Florida's Medicaid program or
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1 any other state's Medicaid program, the Medicare program, or
2 any other publicly funded federal or state health care or
3 health insurance program, and been sanctioned accordingly;
4 (j) Been previously found by a licensing, certifying,
5 or professional standards board or agency to have violated the
6 standards or conditions relating to licensure or certification
7 or the quality of services provided; or
8 (k) Failed to pay any fine or overpayment properly
9 assessed under the Medicaid program in which no appeal is
10 pending or after resolution of the proceeding by stipulation
11 or agreement, unless the agency has issued a specific letter
12 of forgiveness or has approved a repayment schedule to which
13 the provider agrees to adhere.
14 Section 17. Paragraph (a) of subsection (1) and
15 paragraph (b) of subsection (2) of section 409.908, Florida
16 Statutes, are amended to read:
17 409.908 Reimbursement of Medicaid providers.--Subject
18 to specific appropriations, the agency shall reimburse
19 Medicaid providers, in accordance with state and federal law,
20 according to methodologies set forth in the rules of the
21 agency and in policy manuals and handbooks incorporated by
22 reference therein. These methodologies may include fee
23 schedules, reimbursement methods based on cost reporting,
24 negotiated fees, competitive bidding pursuant to s. 287.057,
25 and other mechanisms the agency considers efficient and
26 effective for purchasing services or goods on behalf of
27 recipients. Payment for Medicaid compensable services made on
28 behalf of Medicaid eligible persons is subject to the
29 availability of moneys and any limitations or directions
30 provided for in the General Appropriations Act or chapter 216.
31 Further, nothing in this section shall be construed to prevent
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HB 2329, First Engrossed
1 or limit the agency from adjusting fees, reimbursement rates,
2 lengths of stay, number of visits, or number of services, or
3 making any other adjustments necessary to comply with the
4 availability of moneys and any limitations or directions
5 provided for in the General Appropriations Act, provided the
6 adjustment is consistent with legislative intent.
7 (1) Reimbursement to hospitals licensed under part I
8 of chapter 395 must be made prospectively or on the basis of
9 negotiation.
10 (a) Reimbursement for inpatient care is limited as
11 provided for in s. 409.905(5). Reimbursement for hospital
12 outpatient care is limited to $1,500 $1,000 per state fiscal
13 year per recipient, except for:
14 1. Such care provided to a Medicaid recipient under
15 age 21, in which case the only limitation is medical
16 necessity;
17 2. Renal dialysis services; and
18 3. Other exceptions made by the agency.
19 (2)
20 (b) Subject to any limitations or directions provided
21 for in the General Appropriations Act, the agency shall
22 establish and implement a Florida Title XIX Long-Term Care
23 Reimbursement Plan (Medicaid) for nursing home care in order
24 to provide care and services in conformance with the
25 applicable state and federal laws, rules, regulations, and
26 quality and safety standards and to ensure that individuals
27 eligible for medical assistance have reasonable geographic
28 access to such care. Under the plan, interim rate adjustments
29 shall not be granted to reflect increases in the cost of
30 general or professional liability insurance for nursing homes
31 unless the following criteria are met: have at least a 65
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HB 2329, First Engrossed
1 percent Medicaid utilization in the the most recent cost
2 report submitted to the agency, and the increase in general or
3 professional liability costs to the facility for the most
4 recent policy period affects the total Medicaid per diem by at
5 least 5 percent. This rate adjustment shall not result in the
6 per diem exceeding the class ceiling. This provision shall
7 apply only to fiscal year 2000-2001 and shall be implemented
8 to the extent existing appropriations are available. The
9 agency shall report to the Governor, the Speaker of the House
10 of Representatives, and the President of the Senate by
11 December 31, 2000 on the cost of liability insurance for
12 Florida nursing homes for fiscal years 1999 and 2000 and the
13 extent to which these costs are not being compensated by the
14 Medicaid program. Medicaid participating nursing homes shall
15 be required to report to the agency information necessary to
16 compile this report. Effective no earlier than the
17 rate-setting period beginning April 1, 1999, the agency shall
18 establish a case-mix reimbursement methodology for the rate of
19 payment for long-term care services for nursing home
20 residents. The agency shall compute a per diem rate for
21 Medicaid residents, adjusted for case mix, which is based on a
22 resident classification system that accounts for the relative
23 resource utilization by different types of residents and which
24 is based on level-of-care data and other appropriate data. The
25 case-mix methodology developed by the agency shall take into
26 account the medical, behavioral, and cognitive deficits of
27 residents. In developing the reimbursement methodology, the
28 agency shall evaluate and modify other aspects of the
29 reimbursement plan as necessary to improve the overall
30 effectiveness of the plan with respect to the costs of patient
31 care, operating costs, and property costs. In the event
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HB 2329, First Engrossed
1 adequate data are not available, the agency is authorized to
2 adjust the patient's care component or the per diem rate to
3 more adequately cover the cost of services provided in the
4 patient's care component. The agency shall work with the
5 Department of Elderly Affairs, the Florida Health Care
6 Association, and the Florida Association of Homes for the
7 Aging in developing the methodology. It is the intent of the
8 Legislature that the reimbursement plan achieve the goal of
9 providing access to health care for nursing home residents who
10 require large amounts of care while encouraging diversion
11 services as an alternative to nursing home care for residents
12 who can be served within the community. The agency shall base
13 the establishment of any maximum rate of payment, whether
14 overall or component, on the available moneys as provided for
15 in the General Appropriations Act. The agency may base the
16 maximum rate of payment on the results of scientifically valid
17 analysis and conclusions derived from objective statistical
18 data pertinent to the particular maximum rate of payment.
19 Section 18. Section 409.9119, Florida Statutes, is
20 created to read:
21 409.9119 Disproportionate share program for children's
22 hospitals.--In addition to the payments made under s. 409.911,
23 the Agency for Health Care Administration shall develop and
24 implement a system under which disproportionate share payments
25 are made to those hospitals that are licensed by the state as
26 a children's hospital. This system of payments must conform to
27 federal requirements and must distribute funds in each fiscal
28 year for which an appropriation is made by making quarterly
29 Medicaid payments. Notwithstanding s. 409.915, counties are
30 exempt from contributing toward the cost of this special
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HB 2329, First Engrossed
1 reimbursement for hospitals that serve a disproportionate
2 share of low-income patients.
3 (1) The agency shall use the following formula to
4 calculate the total amount earned for hospitals that
5 participate in the children's hospital disproportionate share
6 program:
7 TAE = DSR x BMPD x MD
8 Where:
9 TAE = total amount earned by a children's hospital.
10 DSR = disproportionate share rate.
11 BMPD = base Medicaid per diem.
12 MD = Medicaid days.
13 (2) The agency shall calculate the total additional
14 payment for hospitals that participate in the children's
15 hospital disproportionate share program as follows:
16
17 TAP = (TAE x TA)
18
19 STAE
20 Where:
21 TAP = total additional payment for a children's
22 hospital.
23 TAE = total amount earned by a children's hospital.
24 STAE = sum of total amount earned by each hospital that
25 participates in the children's hospital disproportionate share
26 program.
27 TA = total appropriation for the children's hospital
28 disproportionate share program.
29
30 (3) A hospital may not receive any payments under this
31 section until it achieves full compliance with the applicable
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HB 2329, First Engrossed
1 rules of the agency. A hospital that is not in compliance for
2 two or more consecutive quarters may not receive its share of
3 the funds. Any forfeited funds must be distributed to the
4 remaining participating children's hospitals that are in
5 compliance.
6 Section 19. Subsection (9) of section 409.912, Florida
7 Statutes, is amended 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 (9) The agency, after notifying the Legislature, may
22 apply for waivers of applicable federal laws and regulations
23 as necessary to implement more appropriate systems of health
24 care for Medicaid recipients and reduce the cost of the
25 Medicaid program to the state and federal governments and
26 shall implement such programs, after legislative approval,
27 within a reasonable period of time after federal approval.
28 These programs must be designed primarily to reduce the need
29 for inpatient care, custodial care and other long-term or
30 institutional care, and other high-cost services.
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HB 2329, First Engrossed
1 (a) Prior to seeking legislative approval of such a
2 waiver as authorized by this subsection, the agency shall
3 provide notice and an opportunity for public comment. Notice
4 shall be provided to all persons who have made requests of the
5 agency for advance notice and shall be published in the
6 Florida Administrative Weekly not less than 28 days prior to
7 the intended action.
8 (b) Notwithstanding s. 216.292, funds that are
9 appropriated to the Department of Elderly Affairs for the
10 Assisted Living for the Elderly Medicaid waiver and are not
11 expended shall be transferred to the agency to fund
12 Medicaid-reimbursed nursing home care.
13
14 Notwithstanding the provisions of chapter 287, the agency may,
15 at its discretion, renew a contract or contracts for fiscal
16 intermediary services one or more times for such periods as
17 the agency may decide; however, all such renewals may not
18 combine to exceed a total period longer than the term of the
19 original contract.
20 Section 20. Section 409.919, Florida Statutes, is
21 amended to read:
22 409.919 Rules.--The agency shall adopt any rules
23 necessary to comply with or administer ss. 409.901-409.920 and
24 all rules necessary to comply with federal requirements. In
25 addition, the Department of Children and Family Services shall
26 adopt and accept transfer of any rules necessary to carry out
27 its responsibilities for receiving and processing Medicaid
28 applications and determining Medicaid eligibility, and for
29 assuring compliance with and administering ss. 409.901-409.906
30 and any other provisions related to responsibility for the
31 determination of Medicaid eligibility.
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HB 2329, First Engrossed
1 Section 21. Notwithstanding the provisions of ss.
2 236.0812, 409.9071, and 409.908(21), Florida Statutes,
3 developmental research schools, as authorized under s.
4 228.053, Florida Statutes, shall be authorized to participate
5 in the Medicaid certified school match program subject to the
6 provisions of ss. 236.0812, 409.9071, and 409.908(21), Florida
7 Statutes.
8 Section 22. (1) The Agency for Health Care
9 Administration is directed to submit to the Health Care
10 Financing Administration a request for a waiver that will
11 allow the agency to undertake a pilot project that would
12 implement a coordinated system of care for adult ventilator
13 dependent patients. Under this pilot program, the agency shall
14 identify a network of skilled nursing facilities that have
15 respiratory departments geared towards intensive treatment and
16 rehabilitation of adult ventilator patients and will contract
17 with such a network for respiratory services under a
18 capitation arrangement. The pilot project must allow the
19 agency to evaluate a coordinated and focused system of care
20 for adult ventilator dependent patients to determine the
21 overall cost-effectiveness and improved outcomes for
22 participants.
23 (2) The agency shall submit the waiver by September 1,
24 2000. The agency shall forward a preliminary report of the
25 pilot project's findings to the Governor, the Speaker of the
26 House of Representatives, and the President of the Senate 6
27 months after project implementation. The agency shall submit
28 a final report of the pilot project's findings to the
29 Governor, the Speaker of the House of Representatives, and the
30 President of the Senate no later than February 15, 2002.
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HB 2329, First Engrossed
1 Section 23. Subsection (7) of section 430.703, Florida
2 Statutes, is renumbered as subsection (8), and a new
3 subsection (7) is added to said section to read:
4 430.703 Definitions.--As used in this act, the term:
5 (7) "Other qualified provider" means an entity
6 licensed under chapter 400 that meets all the financial and
7 quality assurance requirements for a provider service network
8 as specified in s. 409.912, and can demonstrate a long-term
9 care continuum.
10 Section 24. Subsection (1) of section 430.707, Florida
11 Statutes, is amended to read:
12 430.707 Contracts.--
13 (1) The department, in consultation with the agency,
14 shall select and contract with managed care organizations and
15 with other qualified providers to provide long-term care
16 within community diversion pilot project areas.
17 Section 25. Paragraph (b) of subsection (4) of section
18 409.912, Florida Statutes, is repealed.
19 Section 26. This act shall take effect July 1, 2000.
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