House Bill 2339c1
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Florida House of Representatives - 2000 CS/HB 2339
By the Committee on General Appropriations and
Representatives Feeney, Waters, Peaden, Fasano, Maygarden,
Farkas, Minton, Sorensen, Casey, Putnam and Argenio
1 A bill to be entitled
2 An act relating to comprehensive health care;
3 providing a short title; amending s. 400.471,
4 F.S.; deleting the certificate-of-need
5 requirement for licensure of Medicare-certified
6 home health agencies; amending s. 408.032,
7 F.S.; adding definitions of "exemption" and
8 "mental health services"; deleting the
9 definitions of "home health agency,"
10 "institutional health service," "intermediate
11 care facility," "multifacility project," and
12 "respite care"; revising the definition of
13 "health services"; amending s. 408.033, F.S.;
14 deleting references to the state health plan;
15 amending s. 408.034, F.S.; deleting a reference
16 to licensing of home health agencies by the
17 Agency for Health Care Administration; amending
18 s. 408.035, F.S.; deleting obsolete
19 certificate-of-need review criteria and
20 revising other criteria; amending s. 408.036,
21 F.S.; revising provisions relating to projects
22 subject to review; deleting references to
23 Medicare-certified home health agencies;
24 deleting the review of certain acquisitions;
25 specifying the types of bed increases subject
26 to review; deleting cost overruns from review;
27 deleting review of combinations or division of
28 nursing home certificates of need; providing
29 for expedited review of certain conversions of
30 licensed hospital beds; deleting the
31 requirement for an exemption for initiation or
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1 expansion of obstetric services, provision of
2 respite care services, establishment of a
3 Medicare-certified home health agency, or
4 provision of a health service exclusively on an
5 outpatient basis; providing exemptions for
6 combinations or divisions of nursing home
7 certificates of need and additions of certain
8 hospital beds and nursing home beds within
9 specified limitations; providing exemptions for
10 the addition of temporary acute care beds in
11 certain hospitals and for the establishment of
12 certain types of specialty hospitals through
13 transfer of beds and services from certain
14 existing hospitals; requiring a fee for each
15 request for exemption; amending s. 408.037,
16 F.S.; deleting reference to the state health
17 plan; amending ss. 408.038, 408.039, 408.044,
18 and 408.045, F.S.; replacing "department" with
19 "agency"; clarifying the opportunity to
20 challenge an intended award of a certificate of
21 need; amending s. 408.040, F.S.; deleting an
22 obsolete reference; revising the format of
23 conditions related to Medicaid; creating a
24 certificate-of-need workgroup within the Agency
25 for Health Care Administration; providing for
26 expenses; providing membership, duties, and
27 meetings; requiring reports; providing for
28 termination; amending s. 651.118, F.S.;
29 excluding a specified number of beds from a
30 time limit imposed on extension of
31 authorization for continuing care residential
2
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1 community providers to use sheltered beds for
2 nonresidents; requiring a facility to report
3 such use after the expiration of the extension;
4 amending s. 395.701, F.S.; reducing the annual
5 assessment on hospitals to fund public medical
6 assistance; providing for contingent effect;
7 amending s. 395.7015, F.S.; reducing the annual
8 assessment on certain health care entities;
9 amending s. 408.904, F.S.; increasing certain
10 benefits for hospital outpatient services;
11 amending s. 409.912, F.S.; providing for a
12 contract with reimbursement of an entity in
13 Pasco or Pinellas County that provides in-home
14 physician services to Medicaid recipients with
15 degenerative neurological diseases; providing
16 for future repeal; providing appropriations;
17 providing for effect of amendments to ss.
18 395.701 and 395.7015, F.S., contingent on a
19 federal waiver; providing for the transfer of
20 certain unexpended Medicaid funds from the
21 Department of Elderly Affairs to the Agency for
22 Health Care Administration; amending ss.
23 641.31, 641.315, and 641.3155, F.S.;
24 prohibiting a health maintenance organization
25 from restricting a provider's ability to
26 provide inpatient hospital services to a
27 subscriber; requiring payment for medically
28 necessary inpatient hospital services;
29 providing applicability; amending s. 641.51,
30 F.S.; relating to quality assurance program
31 requirements for certain managed care
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1 organizations; allowing the rendering of
2 adverse determinations by physicians licensed
3 in any state; requiring the submission of facts
4 and documentation pertaining to rendered
5 adverse determinations; providing timeframe for
6 organizations to submit facts and documentation
7 to providers and subscribers in writing;
8 requiring an authorized representative to sign
9 the notification; creating s. 381.7351, F.S.;
10 creating the "Reducing Racial and Ethnic Health
11 Disparities: Closing the Gap Act"; creating s.
12 381.7352, F.S.; providing legislative findings
13 and intent; creating s. 381.7353, F.S.;
14 providing for the creation of the Reducing
15 Racial and Ethnic Health Disparities: Closing
16 the Gap grant program, to be administered by
17 the Department of Health; providing department
18 duties and responsibilities; authorizing
19 appointment of an advisory committee; creating
20 s. 381.7354, F.S.; providing eligibility for
21 grant awards; creating s. 381.7355, F.S.;
22 providing project requirements, an application
23 process, and review criteria; creating s.
24 381.7356, F.S.; providing for Closing the Gap
25 grant awards; providing for local matching
26 funds; providing factors for determination of
27 the amount of grant awards; providing for award
28 of grants to begin by a specified date, subject
29 to specific appropriation; providing for annual
30 renewal of grants; creating the Florida
31 Commission on Excellence in Health Care;
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1 providing legislative findings and intent;
2 providing definitions; providing duties and
3 responsibilities; providing for membership,
4 organization, meetings, procedures, and staff;
5 providing for reimbursement of travel and
6 related expenses of certain members; providing
7 certain evidentiary prohibitions; requiring a
8 report to the Governor, the President of the
9 Senate, and the Speaker of the House of
10 Representatives; providing for termination of
11 the commission; amending s. 408.7056, F.S.;
12 providing additional definitions for the
13 Statewide Provider and Subscriber Assistance
14 Program; amending s. 627.654, F.S.; providing
15 for insuring small employers under policies
16 issued to small employer health alliances;
17 providing requirements for participation;
18 providing limitations; providing for insuring
19 spouses and dependent children; allowing a
20 single master policy to include alternative
21 health plans; amending s. 627.6571, F.S.;
22 including small employer health alliances
23 within policy nonrenewal or discontinuance,
24 coverage modification, and application
25 provisions; amending s. 627.6699, F.S.;
26 revising restrictions relating to premium rates
27 to authorize small employer carriers to modify
28 rates under certain circumstances and to
29 authorize carriers to issue group health
30 insurance policies to small employer health
31 alliances under certain circumstances;
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1 requiring carriers issuing a policy to an
2 alliance to allow appointed agents to sell such
3 a policy; amending ss. 240.2995, 240.2996,
4 240.512, 381.0406, 395.3035, and 627.4301,
5 F.S.; conforming cross references; defining the
6 term "managed care"; creating s. 641.185, F.S.;
7 providing health maintenance organization
8 subscriber protections; specifying the
9 principles to serve as standards for the
10 Department of Insurance and the Agency for
11 Health Care Administration exercising their
12 duties and responsibilities; requiring that a
13 health maintenance organization observe certain
14 standards in providing health care for
15 subscribers; providing for subscribers to
16 receive quality care from a broad panel of
17 providers, referrals, preventive care,
18 emergency screening services, and second
19 opinions; providing for assurance of
20 independent accreditation by a national review
21 organization and financial security of the
22 organization; providing for continuity of
23 health care; providing for timely, concise
24 information regarding reimbursement to
25 providers and services; providing for
26 flexibility to transfer to another health
27 maintenance organization within the state;
28 providing for eligibility without
29 discrimination based on health status;
30 providing requirements for health maintenance
31 organizations that issue group health contracts
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1 relating to preexisting conditions, contract
2 renewability, cancellation, extension,
3 termination, and conversion; providing for
4 timely, urgent grievances and appeals within
5 the organization; providing for timely and
6 urgent review of grievances and appeals by an
7 independent state external review agency;
8 providing for notice of rate changes; providing
9 for information regarding contract provisions,
10 services, medical conditions, providers, and
11 service delivery; providing that no civil cause
12 of action is created; amending s. 641.511,
13 F.S.; requiring posting of certain consumer
14 assistance notices; providing requirements;
15 amending s. 627.6699, F.S.; revising a
16 definition; requiring small employer carriers
17 to begin to offer and issue all small employer
18 benefit plans on a specified date; deleting a
19 requirement that basic and standard small
20 employer health benefit plans be issued;
21 providing additional requirements for
22 determining premium rates for benefit plans;
23 providing for application to plans provided by
24 certain small employer carriers under certain
25 circumstances; amending s. 409.212, F.S.;
26 providing for periodic increase in the optional
27 state supplementation rate; amending s.
28 409.901, F.S.; amending definitions of terms
29 used in ss. 409.910-409.920, F.S.; amending s.
30 409.902, F.S.; providing that the Department of
31 Children and Family Services is responsible for
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1 Medicaid eligibility determinations; amending
2 s. 409.903, F.S.; providing responsibility for
3 determinations of eligibility for payments for
4 medical assistance and related services;
5 amending s. 409.905, F.S.; increasing the
6 maximum amount that may be paid under Medicaid
7 for hospital outpatient services; amending s.
8 409.906, F.S.; allowing the Department of
9 Children and Family Services to transfer funds
10 to the Agency for Health Care Administration to
11 cover state match requirements as specified;
12 amending s. 409.907, F.S.; specifying bonding
13 requirements for providers; specifying grounds
14 on which provider applications may be denied;
15 amending s. 409.908, F.S.; increasing the
16 maximum amount of reimbursement allowable to
17 Medicaid providers for hospital inpatient care;
18 creating s. 409.9119, F.S.; creating a
19 disproportionate share program for children's
20 hospitals; providing formulas governing
21 payments made to hospitals under the program;
22 providing for withholding payments from a
23 hospital that is not complying with agency
24 rules; amending s. 409.919, F.S.; providing for
25 the adoption and the transfer of certain rules
26 relating to the determination of Medicaid
27 eligibility; authorizing developmental research
28 schools to participate in Medicaid certified
29 school match program; providing for the Agency
30 for Health Care Administration to seek a
31 federal waiver allowing the agency to undertake
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1 a pilot project that involves contracting with
2 skilled nursing facilities for the provision of
3 rehabilitation services to adult ventilator
4 dependent patients; providing for evaluation of
5 the pilot program; repealing s. 400.464(3),
6 F.S., relating to home health agency licenses
7 provided to certificate-of-need exempt
8 entities; repealing ss. 408.70(3), 408.701,
9 408.702, 408.703, 408.704, 408.7041, 408.7042,
10 408.7045, 408.7055, and 408.706, F.S., relating
11 to community health purchasing alliances;
12 repealing s. 409.912(4)(b), F.S., relating to
13 the authorization of the agency to contract
14 with certain prepaid health care services
15 providers; providing appropriations; reducing
16 certain allocation of positions and funds;
17 providing effective dates.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. This act may be cited as the "Patient
22 Protection Act of 2000."
23 Section 2. Subsections (2) and (11) of section
24 400.471, Florida Statutes, are amended to read:
25 400.471 Application for license; fee; provisional
26 license; temporary permit.--
27 (2) The applicant must file with the application
28 satisfactory proof that the home health agency is in
29 compliance with this part and applicable rules, including:
30
31
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1 (a) A listing of services to be provided, either
2 directly by the applicant or through contractual arrangements
3 with existing providers;
4 (b) The number and discipline of professional staff to
5 be employed; and
6 (c) Proof of financial ability to operate.
7
8 If the applicant has applied for a certificate of need under
9 ss. 408.0331-408.045 within the preceding 12 months, the
10 applicant may submit the proof required during the
11 certificate-of-need process along with an attestation that
12 there has been no substantial change in the facts and
13 circumstances underlying the original submission.
14 (11) The agency may not issue a license designated as
15 certified to a home health agency that fails to receive a
16 certificate of need under ss. 408.031-408.045 or that fails to
17 satisfy the requirements of a Medicare certification survey
18 from the agency.
19 Section 3. Section 408.032, Florida Statutes, is
20 amended to read:
21 408.032 Definitions.--As used in ss. 408.031-408.045,
22 the term:
23 (1) "Agency" means the Agency for Health Care
24 Administration.
25 (2) "Capital expenditure" means an expenditure,
26 including an expenditure for a construction project undertaken
27 by a health care facility as its own contractor, which, under
28 generally accepted accounting principles, is not properly
29 chargeable as an expense of operation and maintenance, which
30 is made to change the bed capacity of the facility, or
31 substantially change the services or service area of the
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1 health care facility, health service provider, or hospice, and
2 which includes the cost of the studies, surveys, designs,
3 plans, working drawings, specifications, initial financing
4 costs, and other activities essential to acquisition,
5 improvement, expansion, or replacement of the plant and
6 equipment.
7 (3) "Certificate of need" means a written statement
8 issued by the agency evidencing community need for a new,
9 converted, expanded, or otherwise significantly modified
10 health care facility, health service, or hospice.
11 (4) "Commenced construction" means initiation of and
12 continuous activities beyond site preparation associated with
13 erecting or modifying a health care facility, including
14 procurement of a building permit applying the use of
15 agency-approved construction documents, proof of an executed
16 owner/contractor agreement or an irrevocable or binding forced
17 account, and actual undertaking of foundation forming with
18 steel installation and concrete placing.
19 (5) "District" means a health service planning
20 district composed of the following counties:
21 District 1.--Escambia, Santa Rosa, Okaloosa, and Walton
22 Counties.
23 District 2.--Holmes, Washington, Bay, Jackson,
24 Franklin, Gulf, Gadsden, Liberty, Calhoun, Leon, Wakulla,
25 Jefferson, Madison, and Taylor Counties.
26 District 3.--Hamilton, Suwannee, Lafayette, Dixie,
27 Columbia, Gilchrist, Levy, Union, Bradford, Putnam, Alachua,
28 Marion, Citrus, Hernando, Sumter, and Lake Counties.
29 District 4.--Baker, Nassau, Duval, Clay, St. Johns,
30 Flagler, and Volusia Counties.
31 District 5.--Pasco and Pinellas Counties.
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1 District 6.--Hillsborough, Manatee, Polk, Hardee, and
2 Highlands Counties.
3 District 7.--Seminole, Orange, Osceola, and Brevard
4 Counties.
5 District 8.--Sarasota, DeSoto, Charlotte, Lee, Glades,
6 Hendry, and Collier Counties.
7 District 9.--Indian River, Okeechobee, St. Lucie,
8 Martin, and Palm Beach Counties.
9 District 10.--Broward County.
10 District 11.--Dade and Monroe Counties.
11 (6) "Exemption" means the process by which a proposal
12 that would otherwise require a certificate of need may proceed
13 without a certificate of need.
14 (7)(6) "Expedited review" means the process by which
15 certain types of applications are not subject to the review
16 cycle requirements contained in s. 408.039(1), and the letter
17 of intent requirements contained in s. 408.039(2).
18 (8)(7) "Health care facility" means a hospital,
19 long-term care hospital, skilled nursing facility, hospice,
20 intermediate care facility, or intermediate care facility for
21 the developmentally disabled. A facility relying solely on
22 spiritual means through prayer for healing is not included as
23 a health care facility.
24 (9)(8) "Health services" means diagnostic, curative,
25 or rehabilitative services and includes alcohol treatment,
26 drug abuse treatment, and mental health services. Obstetric
27 services are not health services for purposes of ss.
28 408.031-408.045.
29 (9) "Home health agency" means an organization, as
30 defined in s. 400.462(4), that is certified or seeks
31 certification as a Medicare home health service provider.
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1 (10) "Hospice" or "hospice program" means a hospice as
2 defined in part VI of chapter 400.
3 (11) "Hospital" means a health care facility licensed
4 under chapter 395.
5 (12) "Institutional health service" means a health
6 service which is provided by or through a health care facility
7 and which entails an annual operating cost of $500,000 or
8 more. The agency shall, by rule, adjust the annual operating
9 cost threshold annually using an appropriate inflation index.
10 (13) "Intermediate care facility" means an institution
11 which provides, on a regular basis, health-related care and
12 services to individuals who do not require the degree of care
13 and treatment which a hospital or skilled nursing facility is
14 designed to provide, but who, because of their mental or
15 physical condition, require health-related care and services
16 above the level of room and board.
17 (12)(14) "Intermediate care facility for the
18 developmentally disabled" means a residential facility
19 licensed under chapter 393 and certified by the Federal
20 Government pursuant to the Social Security Act as a provider
21 of Medicaid services to persons who are mentally retarded or
22 who have a related condition.
23 (13)(15) "Long-term care hospital" means a hospital
24 licensed under chapter 395 which meets the requirements of 42
25 C.F.R. s. 412.23(e) and seeks exclusion from the Medicare
26 prospective payment system for inpatient hospital services.
27 (14) "Mental health services" means inpatient services
28 provided in a hospital licensed under chapter 395 and listed
29 on the hospital license as psychiatric beds for adults;
30 psychiatric beds for children and adolescents; intensive
31 residential treatment beds for children and adolescents;
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1 substance abuse beds for adults; or substance abuse beds for
2 children and adolescents.
3 (16) "Multifacility project" means an integrated
4 residential and health care facility consisting of independent
5 living units, assisted living facility units, and nursing home
6 beds certificated on or after January 1, 1987, where:
7 (a) The aggregate total number of independent living
8 units and assisted living facility units exceeds the number of
9 nursing home beds.
10 (b) The developer of the project has expended the sum
11 of $500,000 or more on the certificated and noncertificated
12 elements of the project combined, exclusive of land costs, by
13 the conclusion of the 18th month of the life of the
14 certificate of need.
15 (c) The total aggregate cost of construction of the
16 certificated element of the project, when combined with other,
17 noncertificated elements, is $10 million or more.
18 (d) All elements of the project are contiguous or
19 immediately adjacent to each other and construction of all
20 elements will be continuous.
21 (15)(17) "Nursing home geographically underserved
22 area" means:
23 (a) A county in which there is no existing or approved
24 nursing home;
25 (b) An area with a radius of at least 20 miles in
26 which there is no existing or approved nursing home; or
27 (c) An area with a radius of at least 20 miles in
28 which all existing nursing homes have maintained at least a 95
29 percent occupancy rate for the most recent 6 months or a 90
30 percent occupancy rate for the most recent 12 months.
31
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1 (18) "Respite care" means short-term care in a
2 licensed health care facility which is personal or custodial
3 and is provided for chronic illness, physical infirmity, or
4 advanced age for the purpose of temporarily relieving family
5 members of the burden of providing care and attendance.
6 (16)(19) "Skilled nursing facility" means an
7 institution, or a distinct part of an institution, which is
8 primarily engaged in providing, to inpatients, skilled nursing
9 care and related services for patients who require medical or
10 nursing care, or rehabilitation services for the
11 rehabilitation of injured, disabled, or sick persons.
12 (17)(20) "Tertiary health service" means a health
13 service which, due to its high level of intensity, complexity,
14 specialized or limited applicability, and cost, should be
15 limited to, and concentrated in, a limited number of hospitals
16 to ensure the quality, availability, and cost-effectiveness of
17 such service. Examples of such service include, but are not
18 limited to, organ transplantation, specialty burn units,
19 neonatal intensive care units, comprehensive rehabilitation,
20 and medical or surgical services which are experimental or
21 developmental in nature to the extent that the provision of
22 such services is not yet contemplated within the commonly
23 accepted course of diagnosis or treatment for the condition
24 addressed by a given service. The agency shall establish by
25 rule a list of all tertiary health services.
26 (18)(21) "Regional area" means any of those regional
27 health planning areas established by the agency to which local
28 and district health planning funds are directed to local
29 health councils through the General Appropriations Act.
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31
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1 Section 4. Paragraph (b) of subsection (1) and
2 paragraph (a) of subsection (3) of section 408.033, Florida
3 Statutes, are amended to read:
4 408.033 Local and state health planning.--
5 (1) LOCAL HEALTH COUNCILS.--
6 (b) Each local health council may:
7 1. Develop a district or regional area health plan
8 that permits is consistent with the objectives and strategies
9 in the state health plan, but that shall permit each local
10 health council to develop strategies and set priorities for
11 implementation based on its unique local health needs. The
12 district or regional area health plan must contain preferences
13 for the development of health services and facilities, which
14 may be considered by the agency in its review of
15 certificate-of-need applications. The district health plan
16 shall be submitted to the agency and updated periodically. The
17 district health plans shall use a uniform format and be
18 submitted to the agency according to a schedule developed by
19 the agency in conjunction with the local health councils. The
20 schedule must provide for coordination between the development
21 of the state health plan and the district health plans and for
22 the development of district health plans by major sections
23 over a multiyear period. The elements of a district plan
24 which are necessary to the review of certificate-of-need
25 applications for proposed projects within the district may be
26 adopted by the agency as a part of its rules.
27 2. Advise the agency on health care issues and
28 resource allocations.
29 3. Promote public awareness of community health needs,
30 emphasizing health promotion and cost-effective health service
31 selection.
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1 4. Collect data and conduct analyses and studies
2 related to health care needs of the district, including the
3 needs of medically indigent persons, and assist the agency and
4 other state agencies in carrying out data collection
5 activities that relate to the functions in this subsection.
6 5. Monitor the onsite construction progress, if any,
7 of certificate-of-need approved projects and report council
8 findings to the agency on forms provided by the agency.
9 6. Advise and assist any regional planning councils
10 within each district that have elected to address health
11 issues in their strategic regional policy plans with the
12 development of the health element of the plans to address the
13 health goals and policies in the State Comprehensive Plan.
14 7. Advise and assist local governments within each
15 district on the development of an optional health plan element
16 of the comprehensive plan provided in chapter 163, to assure
17 compatibility with the health goals and policies in the State
18 Comprehensive Plan and district health plan. To facilitate
19 the implementation of this section, the local health council
20 shall annually provide the local governments in its service
21 area, upon request, with:
22 a. A copy and appropriate updates of the district
23 health plan;
24 b. A report of hospital and nursing home utilization
25 statistics for facilities within the local government
26 jurisdiction; and
27 c. Applicable agency rules and calculated need
28 methodologies for health facilities and services regulated
29 under s. 408.034 for the district served by the local health
30 council.
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1 8. Monitor and evaluate the adequacy, appropriateness,
2 and effectiveness, within the district, of local, state,
3 federal, and private funds distributed to meet the needs of
4 the medically indigent and other underserved population
5 groups.
6 9. In conjunction with the Agency for Health Care
7 Administration, plan for services at the local level for
8 persons infected with the human immunodeficiency virus.
9 10. Provide technical assistance to encourage and
10 support activities by providers, purchasers, consumers, and
11 local, regional, and state agencies in meeting the health care
12 goals, objectives, and policies adopted by the local health
13 council.
14 11. Provide the agency with data required by rule for
15 the review of certificate-of-need applications and the
16 projection of need for health services and facilities in the
17 district.
18 (3) DUTIES AND RESPONSIBILITIES OF THE AGENCY.--
19 (a) The agency, in conjunction with the local health
20 councils, is responsible for the coordinated planning of all
21 health care services in the state and for the preparation of
22 the state health plan.
23 Section 5. Subsection (2) of section 408.034, Florida
24 Statutes, is amended to read:
25 408.034 Duties and responsibilities of agency;
26 rules.--
27 (2) In the exercise of its authority to issue licenses
28 to health care facilities and health service providers, as
29 provided under chapters 393, 395, and parts II, IV, and VI of
30 chapter 400, the agency may not issue a license to any health
31 care facility, health service provider, hospice, or part of a
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1 health care facility which fails to receive a certificate of
2 need or an exemption for the licensed facility or service.
3 Section 6. Section 408.035, Florida Statutes, is
4 amended to read:
5 408.035 Review criteria.--
6 (1) The agency shall determine the reviewability of
7 applications and shall review applications for
8 certificate-of-need determinations for health care facilities
9 and health services in context with the following criteria:
10 (1)(a) The need for the health care facilities and
11 health services being proposed in relation to the applicable
12 district health plan, except in emergency circumstances that
13 pose a threat to the public health.
14 (2)(b) The availability, quality of care, efficiency,
15 appropriateness, accessibility, and extent of utilization of,
16 and adequacy of like and existing health care facilities and
17 health services in the service district of the applicant.
18 (3)(c) The ability of the applicant to provide quality
19 of care and the applicant's record of providing quality of
20 care.
21 (d) The availability and adequacy of other health care
22 facilities and health services in the service district of the
23 applicant, such as outpatient care and ambulatory or home care
24 services, which may serve as alternatives for the health care
25 facilities and health services to be provided by the
26 applicant.
27 (e) Probable economies and improvements in service
28 which may be derived from operation of joint, cooperative, or
29 shared health care resources.
30 (4)(f) The need in the service district of the
31 applicant for special health care equipment and services that
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1 are not reasonably and economically accessible in adjoining
2 areas.
3 (5)(g) The needs of need for research and educational
4 facilities, including, but not limited to, facilities with
5 institutional training programs and community training
6 programs for health care practitioners and for doctors of
7 osteopathic medicine and medicine at the student, internship,
8 and residency training levels.
9 (6)(h) The availability of resources, including health
10 personnel, management personnel, and funds for capital and
11 operating expenditures, for project accomplishment and
12 operation.; the effects the project will have on clinical
13 needs of health professional training programs in the service
14 district; the extent to which the services will be accessible
15 to schools for health professions in the service district for
16 training purposes if such services are available in a limited
17 number of facilities; the availability of alternative uses of
18 such resources for the provision of other health services; and
19 (7) The extent to which the proposed services will
20 enhance access to health care for be accessible to all
21 residents of the service district.
22 (8)(i) The immediate and long-term financial
23 feasibility of the proposal.
24 (j) The special needs and circumstances of health
25 maintenance organizations.
26 (k) The needs and circumstances of those entities that
27 provide a substantial portion of their services or resources,
28 or both, to individuals not residing in the service district
29 in which the entities are located or in adjacent service
30 districts. Such entities may include medical and other health
31 professions, schools, multidisciplinary clinics, and specialty
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1 services such as open-heart surgery, radiation therapy, and
2 renal transplantation.
3 (9)(l) The extent to which the proposal will foster
4 competition that promotes quality and cost-effectiveness. The
5 probable impact of the proposed project on the costs of
6 providing health services proposed by the applicant, upon
7 consideration of factors including, but not limited to, the
8 effects of competition on the supply of health services being
9 proposed and the improvements or innovations in the financing
10 and delivery of health services which foster competition and
11 service to promote quality assurance and cost-effectiveness.
12 (10)(m) The costs and methods of the proposed
13 construction, including the costs and methods of energy
14 provision and the availability of alternative, less costly, or
15 more effective methods of construction.
16 (11)(n) The applicant's past and proposed provision of
17 health care services to Medicaid patients and the medically
18 indigent.
19 (o) The applicant's past and proposed provision of
20 services that promote a continuum of care in a multilevel
21 health care system, which may include, but are not limited to,
22 acute care, skilled nursing care, home health care, and
23 assisted living facilities.
24 (12)(p) The applicant's designation as a Gold Seal
25 Program nursing facility pursuant to s. 400.235, when the
26 applicant is requesting additional nursing home beds at that
27 facility.
28 (2) In cases of capital expenditure proposals for the
29 provision of new health services to inpatients, the agency
30 shall also reference each of the following in its findings of
31 fact:
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1 (a) That less costly, more efficient, or more
2 appropriate alternatives to such inpatient services are not
3 available and the development of such alternatives has been
4 studied and found not practicable.
5 (b) That existing inpatient facilities providing
6 inpatient services similar to those proposed are being used in
7 an appropriate and efficient manner.
8 (c) In the case of new construction or replacement
9 construction, that alternatives to the construction, for
10 example, modernization or sharing arrangements, have been
11 considered and have been implemented to the maximum extent
12 practicable.
13 (d) That patients will experience serious problems in
14 obtaining inpatient care of the type proposed, in the absence
15 of the proposed new service.
16 (e) In the case of a proposal for the addition of beds
17 for the provision of skilled nursing or intermediate care
18 services, that the addition will be consistent with the plans
19 of other agencies of the state responsible for the provision
20 and financing of long-term care, including home health
21 services.
22 Section 7. Section 408.036, Florida Statutes, is
23 amended to read:
24 408.036 Projects subject to review.--
25 (1) APPLICABILITY.--Unless exempt under subsection
26 (3), all health-care-related projects, as described in
27 paragraphs (a)-(h)(k), are subject to review and must file an
28 application for a certificate of need with the agency. The
29 agency is exclusively responsible for determining whether a
30 health-care-related project is subject to review under ss.
31 408.031-408.045.
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1 (a) The addition of beds by new construction or
2 alteration.
3 (b) The new construction or establishment of
4 additional health care facilities, including a replacement
5 health care facility when the proposed project site is not
6 located on the same site as the existing health care facility.
7 (c) The conversion from one type of health care
8 facility to another, including the conversion from one level
9 of care to another, in a skilled or intermediate nursing
10 facility, if the conversion effects a change in the level of
11 care of 10 beds or 10 percent of total bed capacity of the
12 skilled or intermediate nursing facility within a 2-year
13 period. If the nursing facility is certified for both skilled
14 and intermediate nursing care, the provisions of this
15 paragraph do not apply.
16 (d) An Any increase in the total licensed bed capacity
17 of a health care facility.
18 (e) Subject to the provisions of paragraph (3)(i), The
19 establishment of a Medicare-certified home health agency, the
20 establishment of a hospice or hospice inpatient facility, or
21 the direct provision of such services by a health care
22 facility or health maintenance organization for those other
23 than the subscribers of the health maintenance organization;
24 except that this paragraph does not apply to the establishment
25 of a Medicare-certified home health agency by a facility
26 described in paragraph (3)(h).
27 (f) An acquisition by or on behalf of a health care
28 facility or health maintenance organization, by any means,
29 which acquisition would have required review if the
30 acquisition had been by purchase.
31
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1 (f)(g) The establishment of inpatient institutional
2 health services by a health care facility, or a substantial
3 change in such services.
4 (h) The acquisition by any means of an existing health
5 care facility by any person, unless the person provides the
6 agency with at least 30 days' written notice of the proposed
7 acquisition, which notice is to include the services to be
8 offered and the bed capacity of the facility, and unless the
9 agency does not determine, within 30 days after receipt of
10 such notice, that the services to be provided and the bed
11 capacity of the facility will be changed.
12 (i) An increase in the cost of a project for which a
13 certificate of need has been issued when the increase in cost
14 exceeds 20 percent of the originally approved cost of the
15 project, except that a cost overrun review is not necessary
16 when the cost overrun is less than $20,000.
17 (g)(j) An increase in the number of beds for acute
18 care, specialty burn units, neonatal intensive care units,
19 comprehensive rehabilitation, mental health services, or
20 hospital-based distinct part skilled nursing units, or at a
21 long-term care hospital psychiatric or rehabilitation beds.
22 (h)(k) The establishment of tertiary health services.
23 (2) PROJECTS SUBJECT TO EXPEDITED REVIEW.--Unless
24 exempt pursuant to subsection (3), projects subject to an
25 expedited review shall include, but not be limited to:
26 (a) Cost overruns, as defined in paragraph (1)(i).
27 (a)(b) Research, education, and training programs.
28 (b)(c) Shared services contracts or projects.
29 (c)(d) A transfer of a certificate of need.
30 (d)(e) A 50-percent increase in nursing home beds for
31 a facility incorporated and operating in this state for at
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1 least 60 years on or before July 1, 1988, which has a licensed
2 nursing home facility located on a campus providing a variety
3 of residential settings and supportive services. The
4 increased nursing home beds shall be for the exclusive use of
5 the campus residents. Any application on behalf of an
6 applicant meeting this requirement shall be subject to the
7 base fee of $5,000 provided in s. 408.038.
8 (f) Combination within one nursing home facility of
9 the beds or services authorized by two or more certificates of
10 need issued in the same planning subdistrict.
11 (g) Division into two or more nursing home facilities
12 of beds or services authorized by one certificate of need
13 issued in the same planning subdistrict. Such division shall
14 not be approved if it would adversely affect the original
15 certificate's approved cost.
16 (e)(h) Replacement of a health care facility when the
17 proposed project site is located in the same district and
18 within a 1-mile radius of the replaced health care facility.
19 (f) The conversion of mental health services beds
20 licensed under chapter 395 or hospital-based distinct part
21 skilled nursing unit beds to general acute care beds; the
22 conversion of mental health services beds between or among the
23 licensed bed categories defined as beds for mental health
24 services; or the conversion of general acute care beds to beds
25 for mental health services.
26 1. Conversion under this paragraph shall not establish
27 a new licensed bed category at the hospital but shall apply
28 only to categories of beds licensed at that hospital.
29 2. Beds converted under this paragraph must be
30 licensed and operational for at least 12 months before the
31
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1 hospital may apply for additional conversion affecting beds of
2 the same type.
3
4 The agency shall develop rules to implement the provisions for
5 expedited review, including time schedule, application content
6 which may be reduced from the full requirements of s.
7 408.037(1), and application processing.
8 (3) EXEMPTIONS.--Upon request, the following projects
9 are subject to supported by such documentation as the agency
10 requires, the agency shall grant an exemption from the
11 provisions of subsection (1):
12 (a) For the initiation or expansion of obstetric
13 services.
14 (a)(b) For replacement of any expenditure to replace
15 or renovate any part of a licensed health care facility on the
16 same site, provided that the number of licensed beds in each
17 licensed bed category will not increase and, in the case of a
18 replacement facility, the project site is the same as the
19 facility being replaced.
20 (c) For providing respite care services. An individual
21 may be admitted to a respite care program in a hospital
22 without regard to inpatient requirements relating to admitting
23 order and attendance of a member of a medical staff.
24 (b)(d) For hospice services or home health services
25 provided by a rural hospital, as defined in s. 395.602, or for
26 swing beds in such rural hospital in a number that does not
27 exceed one-half of its licensed beds.
28 (c)(e) For the conversion of licensed acute care
29 hospital beds to Medicare and Medicaid certified skilled
30 nursing beds in a rural hospital as defined in s. 395.602, so
31 long as the conversion of the beds does not involve the
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1 construction of new facilities. The total number of skilled
2 nursing beds, including swing beds, may not exceed one-half of
3 the total number of licensed beds in the rural hospital as of
4 July 1, 1993. Certified skilled nursing beds designated under
5 this paragraph, excluding swing beds, shall be included in the
6 community nursing home bed inventory. A rural hospital which
7 subsequently decertifies any acute care beds exempted under
8 this paragraph shall notify the agency of the decertification,
9 and the agency shall adjust the community nursing home bed
10 inventory accordingly.
11 (d)(f) For the addition of nursing home beds at a
12 skilled nursing facility that is part of a retirement
13 community that provides a variety of residential settings and
14 supportive services and that has been incorporated and
15 operated in this state for at least 65 years on or before July
16 1, 1994. All nursing home beds must not be available to the
17 public but must be for the exclusive use of the community
18 residents.
19 (e)(g) For an increase in the bed capacity of a
20 nursing facility licensed for at least 50 beds as of January
21 1, 1994, under part II of chapter 400 which is not part of a
22 continuing care facility if, after the increase, the total
23 licensed bed capacity of that facility is not more than 60
24 beds and if the facility has been continuously licensed since
25 1950 and has received a superior rating on each of its two
26 most recent licensure surveys.
27 (h) For the establishment of a Medicare-certified home
28 health agency by a facility certified under chapter 651; a
29 retirement community, as defined in s. 400.404(2)(g); or a
30 residential facility that serves only retired military
31 personnel, their dependents, and the surviving dependents of
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1 deceased military personnel. Medicare-reimbursed home health
2 services provided through such agency shall be offered
3 exclusively to residents of the facility or retirement
4 community or to residents of facilities or retirement
5 communities owned, operated, or managed by the same corporate
6 entity. Each visit made to deliver Medicare-reimbursable home
7 health services to a home health patient who, at the time of
8 service, is not a resident of the facility or retirement
9 community shall be a deceptive and unfair trade practice and
10 constitutes a violation of ss. 501.201-501.213.
11 (i) For the establishment of a Medicare-certified home
12 health agency. This paragraph shall take effect 90 days after
13 the adjournment sine die of the next regular session of the
14 Legislature occurring after the legislative session in which
15 the Legislature receives a report from the Director of Health
16 Care Administration certifying that the federal Health Care
17 Financing Administration has implemented a per-episode
18 prospective pay system for Medicare-certified home health
19 agencies.
20 (f)(j) For an inmate health care facility built by or
21 for the exclusive use of the Department of Corrections as
22 provided in chapter 945. This exemption expires when such
23 facility is converted to other uses.
24 (k) For an expenditure by or on behalf of a health
25 care facility to provide a health service exclusively on an
26 outpatient basis.
27 (g)(l) For the termination of an inpatient a health
28 care service, upon 30 days' written notice to the agency.
29 (h)(m) For the delicensure of beds, upon 30 days'
30 written notice to the agency. A request for exemption An
31 application submitted under this paragraph must identify the
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1 number, the category of beds classification, and the name of
2 the facility in which the beds to be delicensed are located.
3 (i)(n) For the provision of adult inpatient diagnostic
4 cardiac catheterization services in a hospital.
5 1. In addition to any other documentation otherwise
6 required by the agency, a request for an exemption submitted
7 under this paragraph must comply with the following criteria:
8 a. The applicant must certify it will not provide
9 therapeutic cardiac catheterization pursuant to the grant of
10 the exemption.
11 b. The applicant must certify it will meet and
12 continuously maintain the minimum licensure requirements
13 adopted by the agency governing such programs pursuant to
14 subparagraph 2.
15 c. The applicant must certify it will provide a
16 minimum of 2 percent of its services to charity and Medicaid
17 patients.
18 2. The agency shall adopt licensure requirements by
19 rule which govern the operation of adult inpatient diagnostic
20 cardiac catheterization programs established pursuant to the
21 exemption provided in this paragraph. The rules shall ensure
22 that such programs:
23 a. Perform only adult inpatient diagnostic cardiac
24 catheterization services authorized by the exemption and will
25 not provide therapeutic cardiac catheterization or any other
26 services not authorized by the exemption.
27 b. Maintain sufficient appropriate equipment and
28 health personnel to ensure quality and safety.
29 c. Maintain appropriate times of operation and
30 protocols to ensure availability and appropriate referrals in
31 the event of emergencies.
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1 d. Maintain appropriate program volumes to ensure
2 quality and safety.
3 e. Provide a minimum of 2 percent of its services to
4 charity and Medicaid patients each year.
5 3.a. The exemption provided by this paragraph shall
6 not apply unless the agency determines that the program is in
7 compliance with the requirements of subparagraph 1. and that
8 the program will, after beginning operation, continuously
9 comply with the rules adopted pursuant to subparagraph 2. The
10 agency shall monitor such programs to ensure compliance with
11 the requirements of subparagraph 2.
12 b.(I) The exemption for a program shall expire
13 immediately when the program fails to comply with the rules
14 adopted pursuant to sub-subparagraphs 2.a., b., and c.
15 (II) Beginning 18 months after a program first begins
16 treating patients, the exemption for a program shall expire
17 when the program fails to comply with the rules adopted
18 pursuant to sub-subparagraphs 2.d. and e.
19 (III) If the exemption for a program expires pursuant
20 to sub-sub-subparagraph (I) or sub-sub-subparagraph (II), the
21 agency shall not grant an exemption pursuant to this paragraph
22 for an adult inpatient diagnostic cardiac catheterization
23 program located at the same hospital until 2 years following
24 the date of the determination by the agency that the program
25 failed to comply with the rules adopted pursuant to
26 subparagraph 2.
27 4. The agency shall not grant any exemption under this
28 paragraph until the adoption of the rules required under this
29 paragraph, or until March 1, 1998, whichever comes first.
30 However, if final rules have not been adopted by March 1,
31 1998, the proposed rules governing the exemptions shall be
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1 used by the agency to grant exemptions under the provisions of
2 this paragraph until final rules become effective.
3 (j)(o) For any expenditure to provide mobile surgical
4 facilities and related health care services provided under
5 contract with the Department of Corrections or a private
6 correctional facility operating pursuant to chapter 957.
7 (k)(p) For state veterans' nursing homes operated by
8 or on behalf of the Florida Department of Veterans' Affairs in
9 accordance with part II of chapter 296 for which at least 50
10 percent of the construction cost is federally funded and for
11 which the Federal Government pays a per diem rate not to
12 exceed one-half of the cost of the veterans' care in such
13 state nursing homes. These beds shall not be included in the
14 nursing home bed inventory.
15 (l) For combination within one nursing home facility
16 of the beds or services authorized by two or more certificates
17 of need issued in the same planning subdistrict. An exemption
18 granted under this paragraph shall extend the validity period
19 of the certificates of need to be consolidated by the length
20 of the period beginning upon submission of the exemption
21 request and ending with issuance of the exemption. The
22 longest validity period among the certificates shall be
23 applicable to each of the combined certificates.
24 (m) For division into two or more nursing home
25 facilities of beds or services authorized by one certificate
26 of need issued in the same planning subdistrict. An exemption
27 granted under this paragraph shall extend the validity period
28 of the certificate of need to be divided by the length of the
29 period beginning upon submission of the exemption request and
30 ending with issuance of the exemption.
31
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1 (n) For the addition of hospital beds licensed under
2 chapter 395 for acute care, mental health services, or a
3 hospital-based distinct part skilled nursing unit in a number
4 that may not exceed 10 total beds or 10 percent of the
5 licensed capacity of the bed category being expanded,
6 whichever is greater. Beds for specialty burn units, neonatal
7 intensive care units, or comprehensive rehabilitation, or at a
8 long-term care hospital, may not be increased under this
9 paragraph.
10 1. In addition to any other documentation otherwise
11 required by the agency, a request for exemption submitted
12 under this paragraph must:
13 a. Certify that the prior 12-month average occupancy
14 rate for the category of licensed beds being expanded at the
15 facility meets or exceeds 80 percent or, for a hospital-based
16 distinct part skilled nursing unit, the prior 12-month average
17 occupancy rate meets or exceeds 96 percent.
18 b. Certify that any beds of the same type authorized
19 for the facility under this paragraph before the date of the
20 current request for an exemption have been licensed and
21 operational for at least 12 months.
22 2. The timeframes and monitoring process specified in
23 s. 408.040(2)(a)-(c) apply to any exemption issued under this
24 paragraph.
25 3. The agency shall count beds authorized under this
26 paragraph as approved beds in the published inventory of
27 hospital beds until the beds are licensed.
28 (o) For the addition of acute care beds, as authorized
29 by rule consistent with s. 395.003(4), in a number that may
30 not exceed 10 total beds or 10 percent of licensed bed
31 capacity, whichever is greater, for temporary beds in a
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1 hospital which has experienced high seasonal occupancy within
2 the prior 12-month period or in a hospital that must respond
3 to emergency circumstances.
4 (p) For the addition of nursing home beds licensed
5 under chapter 400 in a number not exceeding 10 total beds or
6 10 percent of the number of beds licensed in the facility
7 being expanded, whichever is greater.
8 1. In addition to any other documentation required by
9 the agency, a request for exemption submitted under this
10 paragraph must:
11 a. Certify that the facility has not had any class I
12 or class II deficiencies within the 30 months preceding the
13 request for addition.
14 b. Certify that the prior 12-month average occupancy
15 rate for the nursing home beds at the facility meets or
16 exceeds 96 percent.
17 c. Certify that any beds authorized for the facility
18 under this paragraph before the date of the current request
19 for an exemption have been licensed and operational for at
20 least 12 months.
21 2. The timeframes and monitoring process specified in
22 s. 408.040(2)(a)-(c) apply to any exemption issued under this
23 paragraph.
24 3. The agency shall count beds authorized under this
25 paragraph as approved beds in the published inventory of
26 nursing home beds until the beds are licensed.
27 (q) For establishment of a specialty hospital offering
28 a range of medical service restricted to a defined age or
29 gender group of the population or a restricted range of
30 services appropriate to the diagnosis, care, and treatment of
31 patients with specific categories of medical illnesses or
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1 disorders, through the transfer of beds and services from an
2 existing hospital in the same county.
3 (4) A request for exemption under this subsection (3)
4 may be made at any time and is not subject to the batching
5 requirements of this section. The request shall be supported
6 by such documentation as the agency requires by rule. The
7 agency shall assess a fee of $250 for each request for
8 exemption submitted under subsection (3).
9 Section 8. Paragraph (a) of subsection (1) of section
10 408.037, Florida Statutes, is amended to read:
11 408.037 Application content.--
12 (1) An application for a certificate of need must
13 contain:
14 (a) A detailed description of the proposed project and
15 statement of its purpose and need in relation to the district
16 local health plan and the state health plan.
17 Section 9. Section 408.038, Florida Statutes, is
18 amended to read:
19 408.038 Fees.--The agency department shall assess fees
20 on certificate-of-need applications. Such fees shall be for
21 the purpose of funding the functions of the local health
22 councils and the activities of the agency department and shall
23 be allocated as provided in s. 408.033. The fee shall be
24 determined as follows:
25 (1) A minimum base fee of $5,000.
26 (2) In addition to the base fee of $5,000, 0.015 of
27 each dollar of proposed expenditure, except that a fee may not
28 exceed $22,000.
29 Section 10. Subsections (3) and (4), paragraph (c) of
30 subsection (5), and paragraphs (a) and (b) of subsection (6)
31 of section 408.039, Florida Statutes, are amended to read:
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1 408.039 Review process.--The review process for
2 certificates of need shall be as follows:
3 (3) APPLICATION PROCESSING.--
4 (a) An applicant shall file an application with the
5 agency department, and shall furnish a copy of the application
6 to the local health council and the agency department. Within
7 15 days after the applicable application filing deadline
8 established by agency department rule, the staff of the agency
9 department shall determine if the application is complete. If
10 the application is incomplete, the staff shall request
11 specific information from the applicant necessary for the
12 application to be complete; however, the staff may make only
13 one such request. If the requested information is not filed
14 with the agency department within 21 days of the receipt of
15 the staff's request, the application shall be deemed
16 incomplete and deemed withdrawn from consideration.
17 (b) Upon the request of any applicant or substantially
18 affected person within 14 days after notice that an
19 application has been filed, a public hearing may be held at
20 the agency's department's discretion if the agency department
21 determines that a proposed project involves issues of great
22 local public interest. The public hearing shall allow
23 applicants and other interested parties reasonable time to
24 present their positions and to present rebuttal information. A
25 recorded verbatim record of the hearing shall be maintained.
26 The public hearing shall be held at the local level within 21
27 days after the application is deemed complete.
28 (4) STAFF RECOMMENDATIONS.--
29 (a) The agency's department's review of and final
30 agency action on applications shall be in accordance with the
31 district health plan, and statutory criteria, and the
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1 implementing administrative rules. In the application review
2 process, the agency department shall give a preference, as
3 defined by rule of the agency department, to an applicant
4 which proposes to develop a nursing home in a nursing home
5 geographically underserved area.
6 (b) Within 60 days after all the applications in a
7 review cycle are determined to be complete, the agency
8 department shall issue its State Agency Action Report and
9 Notice of Intent to grant a certificate of need for the
10 project in its entirety, to grant a certificate of need for
11 identifiable portions of the project, or to deny a certificate
12 of need. The State Agency Action Report shall set forth in
13 writing its findings of fact and determinations upon which its
14 decision is based. If a finding of fact or determination by
15 the agency department is counter to the district health plan
16 of the local health council, the agency department shall
17 provide in writing its reason for its findings, item by item,
18 to the local health council. If the agency department intends
19 to grant a certificate of need, the State Agency Action Report
20 or the Notice of Intent shall also include any conditions
21 which the agency department intends to attach to the
22 certificate of need. The agency department shall designate by
23 rule a senior staff person, other than the person who issues
24 the final order, to issue State Agency Action Reports and
25 Notices of Intent.
26 (c) The agency department shall publish its proposed
27 decision set forth in the Notice of Intent in the Florida
28 Administrative Weekly within 14 days after the Notice of
29 Intent is issued.
30 (d) If no administrative hearing is requested pursuant
31 to subsection (5), the State Agency Action Report and the
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1 Notice of Intent shall become the final order of the agency
2 department. The agency department shall provide a copy of the
3 final order to the appropriate local health council.
4 (5) ADMINISTRATIVE HEARINGS.--
5 (c) In administrative proceedings challenging the
6 issuance or denial of a certificate of need, only applicants
7 considered by the agency in the same batching cycle are
8 entitled to a comparative hearing on their applications.
9 Existing health care facilities may initiate or intervene in
10 an administrative hearing upon a showing that an established
11 program will be substantially affected by the issuance of any
12 certificate of need, whether reviewed under s. 408.036(1) or
13 (2), to a competing proposed facility or program within the
14 same district.
15 (6) JUDICIAL REVIEW.--
16 (a) A party to an administrative hearing for an
17 application for a certificate of need has the right, within
18 not more than 30 days after the date of the final order, to
19 seek judicial review in the District Court of Appeal pursuant
20 to s. 120.68. The agency department shall be a party in any
21 such proceeding.
22 (b) In such judicial review, the court shall affirm
23 the final order of the agency department, unless the decision
24 is arbitrary, capricious, or not in compliance with ss.
25 408.031-408.045.
26 Section 11. Subsections (1) and (2) of section
27 408.040, Florida Statutes, are amended to read:
28 408.040 Conditions and monitoring.--
29 (1)(a) The agency may issue a certificate of need
30 predicated upon statements of intent expressed by an applicant
31 in the application for a certificate of need. Any conditions
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1 imposed on a certificate of need based on such statements of
2 intent shall be stated on the face of the certificate of need.
3 1. Any certificate of need issued for construction of
4 a new hospital or for the addition of beds to an existing
5 hospital shall include a statement of the number of beds
6 approved by category of service, including rehabilitation or
7 psychiatric service, for which the agency has adopted by rule
8 a specialty-bed-need methodology. All beds that are approved,
9 but are not covered by any specialty-bed-need methodology,
10 shall be designated as general.
11 (b)2. The agency may consider, in addition to the
12 other criteria specified in s. 408.035, a statement of intent
13 by the applicant that a specified to designate a percentage of
14 the annual patient days at beds of the facility will be
15 utilized for use by patients eligible for care under Title XIX
16 of the Social Security Act. Any certificate of need issued to
17 a nursing home in reliance upon an applicant's statements that
18 to provide a specified percentage number of annual patient
19 days will be utilized beds for use by residents eligible for
20 care under Title XIX of the Social Security Act must include a
21 statement that such certification is a condition of issuance
22 of the certificate of need. The certificate-of-need program
23 shall notify the Medicaid program office and the Department of
24 Elderly Affairs when it imposes conditions as authorized in
25 this paragraph subparagraph in an area in which a community
26 diversion pilot project is implemented.
27 (c)(b) A certificateholder may apply to the agency for
28 a modification of conditions imposed under paragraph (a) or
29 paragraph (b). If the holder of a certificate of need
30 demonstrates good cause why the certificate should be
31 modified, the agency shall reissue the certificate of need
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1 with such modifications as may be appropriate. The agency
2 shall by rule define the factors constituting good cause for
3 modification.
4 (d)(c) If the holder of a certificate of need fails to
5 comply with a condition upon which the issuance of the
6 certificate was predicated, the agency may assess an
7 administrative fine against the certificateholder in an amount
8 not to exceed $1,000 per failure per day. In assessing the
9 penalty, the agency shall take into account as mitigation the
10 relative lack of severity of a particular failure. Proceeds
11 of such penalties shall be deposited in the Public Medical
12 Assistance Trust Fund.
13 (2)(a) Unless the applicant has commenced
14 construction, if the project provides for construction, unless
15 the applicant has incurred an enforceable capital expenditure
16 commitment for a project, if the project does not provide for
17 construction, or unless subject to paragraph (b), a
18 certificate of need shall terminate 18 months after the date
19 of issuance, except in the case of a multifacility project, as
20 defined in s. 408.032, where the certificate of need shall
21 terminate 2 years after the date of issuance. The agency shall
22 monitor the progress of the holder of the certificate of need
23 in meeting the timetable for project development specified in
24 the application with the assistance of the local health
25 council as specified in s. 408.033(1)(b)5., and may revoke the
26 certificate of need, if the holder of the certificate is not
27 meeting such timetable and is not making a good faith effort,
28 as defined by rule, to meet it.
29 (b) A certificate of need issued to an applicant
30 holding a provisional certificate of authority under chapter
31 651 shall terminate 1 year after the applicant receives a
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1 valid certificate of authority from the Department of
2 Insurance.
3 (c) The certificate-of-need validity period for a
4 project shall be extended by the agency, to the extent that
5 the applicant demonstrates to the satisfaction of the agency
6 that good faith commencement of the project is being delayed
7 by litigation or by governmental action or inaction with
8 respect to regulations or permitting precluding commencement
9 of the project.
10 (d) If an application is filed to consolidate two or
11 more certificates as authorized by s. 408.036(2)(f) or to
12 divide a certificate of need into two or more facilities as
13 authorized by s. 408.036(2)(g), the validity period of the
14 certificate or certificates of need to be consolidated or
15 divided shall be extended for the period beginning upon
16 submission of the application and ending when final agency
17 action and any appeal from such action has been concluded.
18 However, no such suspension shall be effected if the
19 application is withdrawn by the applicant.
20 Section 12. Section 408.044, Florida Statutes, is
21 amended to read:
22 408.044 Injunction.--Notwithstanding the existence or
23 pursuit of any other remedy, the agency department may
24 maintain an action in the name of the state for injunction or
25 other process against any person to restrain or prevent the
26 pursuit of a project subject to review under ss.
27 408.031-408.045, in the absence of a valid certificate of
28 need.
29 Section 13. Section 408.045, Florida Statutes, is
30 amended to read:
31
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1 408.045 Certificate of need; competitive sealed
2 proposals.--
3 (1) The application, review, and issuance procedures
4 for a certificate of need for an intermediate care facility
5 for the developmentally disabled may be made by the agency
6 department by competitive sealed proposals.
7 (2) The agency department shall make a decision
8 regarding the issuance of the certificate of need in
9 accordance with the provisions of s. 287.057(15), rules
10 adopted by the agency department relating to intermediate care
11 facilities for the developmentally disabled, and the criteria
12 in s. 408.035, as further defined by rule.
13 (3) Notification of the decision shall be issued to
14 all applicants not later than 28 calendar days after the date
15 responses to a request for proposal are due.
16 (4) The procedures provided for under this section are
17 exempt from the batching cycle requirements and the public
18 hearing requirement of s. 408.039.
19 (5) The agency department may use the competitive
20 sealed proposal procedure for determining a certificate of
21 need for other types of health care facilities and services if
22 the agency department identifies an unmet health care need and
23 when funding in whole or in part for such health care
24 facilities or services is authorized by the Legislature.
25 Section 14. (1)(a) There is created a
26 certificate-of-need workgroup staffed by the Agency for Health
27 Care Administration.
28 (b) Workgroup participants shall be responsible for
29 only the expenses that they generate individually through
30 workgroup participation. The agency shall be responsible for
31
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1 expenses incidental to the production of any required data or
2 reports.
3 (2) The workgroup shall consist of 30 members, 10
4 appointed by the Governor, 10 appointed by the President of
5 the Senate, and 10 appointed by the Speaker of the House of
6 Representatives. The workgroup chair shall be selected by
7 majority vote of a quorum present. Sixteen members shall
8 constitute a quorum. The membership shall include, but not be
9 limited to, representatives from health care provider
10 organizations, health care facilities, individual health care
11 practitioners, local health councils, and consumer
12 organizations, and persons with health care market expertise
13 as private-sector consultants.
14 (3) Appointment to the workgroup shall be as follows:
15 (a) The Governor shall appoint one representative each
16 from the hospital industry, the nursing home industry, the
17 hospice industry, the local health councils, and a consumer
18 organization; three health care market consultants, one of
19 whom is a recognized expert on hospital markets, one of whom
20 is a recognized expert on nursing home or long-term care
21 markets, and one of whom is a recognized expert on hospice
22 markets; one representative from the Medicaid program; and one
23 representative from a health care facility that provides a
24 tertiary service.
25 (b) The President of the Senate shall appoint a
26 representative of a for-profit hospital, a representative of a
27 not-for-profit hospital, a representative of a public
28 hospital, two representatives of the nursing home industry,
29 two representatives of the hospice industry, a representative
30 of a consumer organization, a representative from the
31 Department of Elderly Affairs involved with the implementation
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1 of a long-term care community diversion program, and a health
2 care market consultant with expertise in health care
3 economics.
4 (c) The Speaker of the House of Representatives shall
5 appoint a representative from the Florida Hospital
6 Association, a representative of the Association of Community
7 Hospitals and Health Systems of Florida, a representative of
8 the Florida League of Health Systems, a representative of the
9 Florida Health Care Association, a representative of the
10 Florida Association of Homes for the Aging, three
11 representatives of Florida Hospices and Palliative Care, one
12 representative of local health councils, and one
13 representative of a consumer organization.
14 (4) The workgroup shall study issues pertaining to the
15 certificate-of-need program, including the impact of trends in
16 health care delivery and financing. The workgroup shall study
17 issues relating to implementation of the certificate-of-need
18 program.
19 (5) The workgroup shall meet at least annually, at the
20 request of the chair. The workgroup shall submit an interim
21 report by December 31, 2001, and a final report by December
22 31, 2002. The workgroup is abolished effective July 1, 2003.
23 Section 15. Subsection (7) of section 651.118, Florida
24 Statutes, is amended to read:
25 651.118 Agency for Health Care Administration;
26 certificates of need; sheltered beds; community beds.--
27 (7) Notwithstanding the provisions of subsection (2),
28 at the discretion of the continuing care provider, sheltered
29 nursing home beds may be used for persons who are not
30 residents of the facility and who are not parties to a
31 continuing care contract for a period of up to 5 years after
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1 the date of issuance of the initial nursing home license. A
2 provider whose 5-year period has expired or is expiring may
3 request the Agency for Health Care Administration for an
4 extension, not to exceed 30 percent of the total sheltered
5 nursing home beds, if the utilization by residents of the
6 facility in the sheltered beds will not generate sufficient
7 income to cover facility expenses, as evidenced by one of the
8 following:
9 (a) The facility has a net loss for the most recent
10 fiscal year as determined under generally accepted accounting
11 principles, excluding the effects of extraordinary or unusual
12 items, as demonstrated in the most recently audited financial
13 statement; or
14 (b) The facility would have had a pro forma loss for
15 the most recent fiscal year, excluding the effects of
16 extraordinary or unusual items, if revenues were reduced by
17 the amount of revenues from persons in sheltered beds who were
18 not residents, as reported on by a certified public
19 accountant.
20
21 The agency shall be authorized to grant an extension to the
22 provider based on the evidence required in this subsection.
23 The agency may request a facility to use up to 25 percent of
24 the patient days generated by new admissions of nonresidents
25 during the extension period to serve Medicaid recipients for
26 those beds authorized for extended use if there is a
27 demonstrated need in the respective service area and if funds
28 are available. A provider who obtains an extension is
29 prohibited from applying for additional sheltered beds under
30 the provision of subsection (2), unless additional residential
31 units are built or the provider can demonstrate need by
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1 facility residents to the Agency for Health Care
2 Administration. The 5-year limit does not apply to up to five
3 sheltered beds designated for inpatient hospice care as part
4 of a contractual arrangement with a hospice licensed under
5 part VI of chapter 400. A facility that uses such beds after
6 the 5-year period shall report such use to the Agency for
7 Health Care Administration. For purposes of this subsection,
8 "resident" means a person who, upon admission to the facility,
9 initially resides in a part of the facility not licensed under
10 part II of chapter 400.
11 Section 16. Subsection (2) of section 395.701, Florida
12 Statutes, is amended to read:
13 395.701 Annual assessments on net operating revenues
14 for inpatient services to fund public medical assistance;
15 administrative fines for failure to pay assessments when due;
16 exemption.--
17 (2)(a) There is imposed upon each hospital an
18 assessment in an amount equal to 1.5 percent of the annual net
19 operating revenue for inpatient services for each hospital,
20 such revenue to be determined by the agency, based on the
21 actual experience of the hospital as reported to the agency.
22 Within 6 months after the end of each hospital fiscal year,
23 the agency shall certify the amount of the assessment for each
24 hospital. The assessment shall be payable to and collected by
25 the agency in equal quarterly amounts, on or before the first
26 day of each calendar quarter, beginning with the first full
27 calendar quarter that occurs after the agency certifies the
28 amount of the assessment for each hospital. All moneys
29 collected pursuant to this subsection shall be deposited into
30 the Public Medical Assistance Trust Fund.
31
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1 (b) There is imposed upon each hospital an assessment
2 in an amount equal to 1 percent of the annual net operating
3 revenue for outpatient services for each hospital, such
4 revenue to be determined by the agency, based on the actual
5 experience of the hospital as reported to the agency. Within 6
6 months after the end of each hospital fiscal year, the agency
7 shall certify the amount of the assessment for each hospital.
8 The assessment shall be payable to and collected by the agency
9 in equal quarterly amounts, on or before the first day of each
10 calendar quarter, beginning with the first full calendar
11 quarter that occurs after the agency certifies the amount of
12 the assessment for each hospital. All moneys collected
13 pursuant to this subsection shall be deposited into the Public
14 Medical Assistance Trust Fund.
15 Section 17. Paragraph (a) of subsection (2) of section
16 395.7015, Florida Statutes, is amended to read:
17 395.7015 Annual assessment on health care entities.--
18 (2) There is imposed an annual assessment against
19 certain health care entities as described in this section:
20 (a) The assessment shall be equal to 1 1.5 percent of
21 the annual net operating revenues of health care entities. The
22 assessment shall be payable to and collected by the agency.
23 Assessments shall be based on annual net operating revenues
24 for the entity's most recently completed fiscal year as
25 provided in subsection (3).
26 Section 18. Paragraph (c) of subsection (2) of section
27 408.904, Florida Statutes, is amended to read:
28 408.904 Benefits.--
29 (2) Covered health services include:
30 (c) Hospital outpatient services. Those services
31 provided to a member in the outpatient portion of a hospital
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1 licensed under part I of chapter 395, up to a limit of $1,500
2 $1,000 per calendar year per member, that are preventive,
3 diagnostic, therapeutic, or palliative.
4 Section 19. Paragraph (e) is added to subsection (3)
5 of section 409.912, Florida Statutes, and subsection (9) of
6 said section is amended to read:
7 409.912 Cost-effective purchasing of health care.--The
8 agency shall purchase goods and services for Medicaid
9 recipients in the most cost-effective manner consistent with
10 the delivery of quality medical care. The agency shall
11 maximize the use of prepaid per capita and prepaid aggregate
12 fixed-sum basis services when appropriate and other
13 alternative service delivery and reimbursement methodologies,
14 including competitive bidding pursuant to s. 287.057, designed
15 to facilitate the cost-effective purchase of a case-managed
16 continuum of care. The agency shall also require providers to
17 minimize the exposure of recipients to the need for acute
18 inpatient, custodial, and other institutional care and the
19 inappropriate or unnecessary use of high-cost services.
20 (3) The agency may contract with:
21 (e) An entity in Pasco County or Pinellas County that
22 provides in-home physician services to Medicaid recipients
23 with degenerative neurological diseases in order to test the
24 cost-effectiveness of enhanced home-based medical care. The
25 entity providing the services shall be reimbursed on a
26 fee-for-service basis at a rate not less than comparable
27 Medicare reimbursement rates. The agency may apply for waivers
28 of federal regulations necessary to implement such program.
29 This paragraph shall be repealed on July 1, 2002.
30 (9) The agency, after notifying the Legislature, may
31 apply for waivers of applicable federal laws and regulations
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1 as necessary to implement more appropriate systems of health
2 care for Medicaid recipients and reduce the cost of the
3 Medicaid program to the state and federal governments and
4 shall implement such programs, after legislative approval,
5 within a reasonable period of time after federal approval.
6 These programs must be designed primarily to reduce the need
7 for inpatient care, custodial care and other long-term or
8 institutional care, and other high-cost services.
9 (a) Prior to seeking legislative approval of such a
10 waiver as authorized by this subsection, the agency shall
11 provide notice and an opportunity for public comment. Notice
12 shall be provided to all persons who have made requests of the
13 agency for advance notice and shall be published in the
14 Florida Administrative Weekly not less than 28 days prior to
15 the intended action.
16 (b) Notwithstanding s. 216.292, funds that are
17 appropriated to the Department of Elderly Affairs for the
18 Assisted Living for the Elderly Medicaid waiver and are not
19 expended shall be transferred to the agency to fund
20 Medicaid-reimbursed nursing home care.
21 Section 20. The Legislature shall appropriate each
22 fiscal year from either the General Revenue Fund or the Agency
23 for Health Care Administration Tobacco Settlement Trust Fund
24 an amount sufficient to replace the funds lost due to
25 reduction by this act of the assessment on other health care
26 entities under s. 395.7015, Florida Statutes, and the
27 reduction by this act in the assessment on hospitals under s.
28 395.701, Florida Statutes, and to maintain federal approval of
29 the reduced amount of funds deposited into the Public Medical
30 Assistance Trust Fund under s. 395.701, Florida Statutes, as
31 state match for the state's Medicaid program.
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1 Section 21. There is hereby appropriated the sum of
2 $28.3 million from the General Revenue Fund to the Agency for
3 Health Care Administration to implement the provisions of this
4 act relating to the Public Medical Assistance Trust Fund,
5 provided, however, that no portion of this appropriation shall
6 be effective that duplicates a similar appropriation for the
7 same purpose contained in other legislation from the 2000
8 Legislative Session that becomes law.
9 Section 22. The amendments to ss. 395.701 and
10 395.7015, Florida Statutes, by this act shall take effect only
11 upon the Agency for Health Care Administration receiving
12 written confirmation from the federal Health Care Financing
13 Administration that the changes contained in such amendments
14 will not adversely affect the use of the remaining assessments
15 as state match for the state's Medicaid program.
16 Section 23. Effective July 1, 2000, and applicable to
17 provider contracts entered into or renewed on or after that
18 date, subsection (39) is added to section 641.31, Florida
19 Statutes, to read:
20 641.31 Health maintenance contracts.--
21 (39) A health maintenance organization contract may
22 not prohibit or restrict a subscriber from receiving inpatient
23 services in a contracted hospital from a contracted primary
24 care or admitting physician if such services are determined by
25 the organization to be medically necessary and covered
26 services under the organization's contract with the contract
27 holder.
28 Section 24. Effective July 1, 2000, and applicable to
29 provider contracts entered into or renewed on or after that
30 date, subsection (11) is added to section 641.315, Florida
31 Statutes, to read:
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1 641.315 Provider contracts.--
2 (11) A contract between a health maintenance
3 organization and a contracted primary care or admitting
4 physician may not contain any provision that prohibits such
5 physician from providing inpatient services in a contracted
6 hospital to a subscriber if such services are determined by
7 the organization to be medically necessary and covered
8 services under the organization's contract with the contract
9 holder.
10 Section 25. Effective July 1, 2000, and applicable to
11 provider contracts entered into or renewed on or after that
12 date, subsection (5) is added to section 641.3155, Florida
13 Statutes, to read:
14 641.3155 Provider contracts; payment of claims.--
15 (5) A health maintenance organization shall pay a
16 contracted primary care or admitting physician, pursuant to
17 such physician's contract, for providing inpatient services in
18 a contracted hospital to a subscriber, if such services are
19 determined by the organization to be medically necessary and
20 covered services under the organization's contract with the
21 contract holder.
22 Section 26. Subsections (4) through (10) of section
23 641.51, Florida Statutes, are renumbered as subsections (5)
24 through (11), respectively, and a new subsection (4) is added
25 to said section to read:
26 641.51 Quality assurance program; second medical
27 opinion requirement.--
28 (4) The organization shall ensure that only a
29 physician licensed under chapter 458 or chapter 459, or an
30 allopathic or osteopathic physician with an active,
31 unencumbered license in another state with similar licensing
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1 requirements may render an adverse determination regarding a
2 service provided by a physician licensed in this state. The
3 organization shall submit to the treating provider and the
4 subscriber written notification regarding the organization's
5 adverse determination within 2 working days after the
6 subscriber or provider is notified of the adverse
7 determination. The written notification must include the
8 utilization review criteria or benefits provisions used in the
9 adverse determination, identify the physician who rendered the
10 adverse determination, and be signed by an authorized
11 representative of the organization or the physician who
12 rendered the adverse determination. The organization must
13 include with the notification of an adverse determination
14 information concerning the appeal process for adverse
15 determinations.
16 Section 27. Section 381.7351, Florida Statutes, is
17 created to read:
18 381.7351 Short title.--Sections 381.7351-381.7356 may
19 be cited as the "Reducing Racial and Ethnic Health
20 Disparities: Closing the Gap Act."
21 Section 28. Section 381.7352, Florida Statutes, is
22 created to read:
23 381.7352 Legislative findings and intent.--
24 (1) The Legislature finds that despite state
25 investments in health care programs, certain racial and ethnic
26 populations in Florida continue to have significantly poorer
27 health outcomes when compared to non-Hispanic whites. The
28 Legislature finds that local solutions to health care problems
29 can have a dramatic and positive effect on the health status
30 of these populations. Local governments and communities are
31 best equipped to identify the health education, health
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1 promotion, and disease prevention needs of the racial and
2 ethnic populations in their communities, mobilize the
3 community to address health outcome disparities, enlist and
4 organize local public and private resources, and faith-based
5 organizations to address these disparities, and evaluate the
6 effectiveness of interventions.
7 (2) It is therefore the intent of the Legislature to
8 provide funds within Florida counties and Front Porch Florida
9 Communities, in the form of Reducing Racial and Ethnic Health
10 Disparities: Closing the Gap grants, to stimulate the
11 development of community-based and neighborhood-based projects
12 which will improve the health outcomes of racial and ethnic
13 populations. Further, it is the intent of the Legislature
14 that these programs foster the development of coordinated,
15 collaborative, and broad-based participation by public and
16 private entities, and faith-based organizations. Finally, it
17 is the intent of the Legislature that the grant program
18 function as a partnership between state and local governments,
19 faith-based organizations, and private-sector health care
20 providers, including managed care, voluntary health care
21 resources, social service providers, and nontraditional
22 partners.
23 Section 29. Section 381.7353, Florida Statutes, is
24 created to read:
25 381.7353 Reducing Racial and Ethnic Health
26 Disparities: Closing the Gap grant program; administration;
27 department duties.--
28 (1) The Reducing Racial and Ethnic Health Disparities:
29 Closing the Gap grant program shall be administered by the
30 Department of Health.
31 (2) The department shall:
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1 (a) Publicize the availability of funds and establish
2 an application process for submitting a grant proposal.
3 (b) Provide technical assistance and training,
4 including a statewide meeting promoting best practice
5 programs, as requested, to grant recipients.
6 (c) Develop uniform data reporting requirements for
7 the purpose of evaluating the performance of the grant
8 recipients and demonstrating improved health outcomes.
9 (d) Develop a monitoring process to evaluate progress
10 toward meeting grant objectives.
11 (e) Coordinate with existing community-based programs,
12 such as chronic disease community intervention programs,
13 cancer prevention and control programs, diabetes control
14 programs, the Healthy Start program, the Florida KidCare
15 Program, the HIV/AIDS program, immunization programs, and
16 other related programs at the state and local levels, to avoid
17 duplication of effort and promote consistency.
18 (3) Pursuant to s. 20.43(6), the secretary may appoint
19 an ad hoc advisory committee to: examine areas where public
20 awareness, public education, research, and coordination
21 regarding racial and ethnic health outcome disparities are
22 lacking; consider access and transportation issues which
23 contribute to health status disparities; and make
24 recommendations for closing gaps in health outcomes and
25 increasing the public's awareness and understanding of health
26 disparities that exist between racial and ethnic populations.
27 Section 30. Section 381.7354, Florida Statutes, is
28 created to read:
29 381.7354 Eligibility.--
30 (1) Any person, entity, or organization within a
31 county may apply for a Closing the Gap grant and may serve as
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1 the lead agency to administer and coordinate project
2 activities within the county and develop community
3 partnerships necessary to implement the grant.
4 (2) Persons, entities, or organizations within
5 adjoining counties with populations of less than 100,000,
6 based on the annual estimates produced by the Population
7 Program of the University of Florida Bureau of Economic and
8 Business Research, may jointly submit a multicounty Closing
9 the Gap grant proposal. However, the proposal must clearly
10 identify a single lead agency with respect to program
11 accountability and administration.
12 (3) In addition to the grants awarded under
13 subsections (1) and (2), up to 20 percent of the funding for
14 the Reducing Racial and Ethnic Health Disparities: Closing the
15 Gap grant program shall be dedicated to projects that address
16 improving racial and ethnic health status within specific
17 Front Porch Florida Communities, as designated pursuant to s.
18 14.2015(9)(b).
19 (4) Nothing in ss. 381.7351-381.7356 shall prevent a
20 person, entity, or organization within a county or group of
21 counties from separately contracting for the provision of
22 racial and ethnic health promotion, health awareness, and
23 disease prevention services.
24 Section 31. Section 381.7355, Florida Statutes, is
25 created to read:
26 381.7355 Project requirements; review criteria.--
27 (1) Closing the Gap grant proposals shall be submitted
28 to the Department of Health for review.
29 (2) A proposal must include each of the following
30 elements:
31
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1 (a) The purpose and objectives of the proposal,
2 including identification of the particular racial or ethnic
3 disparity the project will address. The proposal must address
4 one or more of the following priority areas:
5 1. Decreasing racial and ethnic disparities in
6 maternal and infant mortality rates.
7 2. Decreasing racial and ethnic disparities in
8 morbidity and mortality rates relating to cancer.
9 3. Decreasing racial and ethnic disparities in
10 morbidity and mortality rates relating to HIV/AIDS.
11 4. Decreasing racial and ethnic disparities in
12 morbidity and mortality rates relating to cardiovascular
13 disease.
14 5. Decreasing racial and ethnic disparities in
15 morbidity and mortality rates relating to diabetes.
16 6. Increasing adult and child immunization rates in
17 certain racial and ethnic populations.
18 (b) Identification and relevance of the target
19 population.
20 (c) Methods for obtaining baseline health status data
21 and assessment of community health needs.
22 (d) Mechanisms for mobilizing community resources and
23 gaining local commitment.
24 (e) Development and implementation of health promotion
25 and disease prevention interventions.
26 (f) Mechanisms and strategies for evaluating the
27 project's objectives, procedures, and outcomes.
28 (g) A proposed work plan, including a timeline for
29 implementing the project.
30 (h) Likelihood that project activities will occur and
31 continue in the absence of funding.
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1 (3) Priority shall be given to proposals that:
2 (a) Represent areas with the greatest documented
3 racial and ethnic health status disparities.
4 (b) Exceed the minimum local contribution requirements
5 specified in s. 381.7356.
6 (c) Demonstrate broad-based local support and
7 commitment from entities representing racial and ethnic
8 populations, including non-Hispanic whites. Indicators of
9 support and commitment may include agreements to participate
10 in the program, letters of endorsement, letters of commitment,
11 interagency agreements, or other forms of support.
12 (d) Demonstrate a high degree of participation by the
13 health care community in clinical preventive service
14 activities and community-based health promotion and disease
15 prevention interventions.
16 (e) Have been submitted from counties with a high
17 proportion of residents living in poverty and with poor health
18 status indicators.
19 (f) Demonstrate a coordinated community approach to
20 addressing racial and ethnic health issues within existing
21 publicly financed health care programs.
22 (g) Incorporate intervention mechanisms which have a
23 high probability of improving the targeted population's health
24 status.
25 (h) Demonstrate a commitment to quality management in
26 all aspects of project administration and implementation.
27 Section 32. Section 381.7356, Florida Statutes, is
28 created to read:
29 381.7356 Local matching funds; grant awards.--
30 (1) One or more Closing the Gap grants may be awarded
31 in a county, or in a group of adjoining counties from which a
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1 multicounty application is submitted. Front Porch Florida
2 Communities grants may also be awarded in a county or group of
3 adjoining counties that are also receiving a grant award.
4 (2) Closing the Gap grants shall be awarded on a
5 matching basis. One dollar in local matching funds must be
6 provided for each $3 grant payment made by the state, except
7 that:
8 (a) In counties with populations greater than 50,000,
9 up to 50 percent of the local match may be in kind in the form
10 of free services or human resources. Fifty percent of the
11 local match must be in the form of cash.
12 (b) In counties with populations of 50,000 or less,
13 the required local matching funds may be provided entirely
14 through in-kind contributions.
15 (c) Grant awards to Front Porch Florida Communities
16 shall not be required to have a matching requirement.
17 (3) The amount of the grant award shall be based on
18 the county or neighborhood's population, or on the combined
19 population in a group of adjoining counties from which a
20 multicounty application is submitted, and on other factors, as
21 determined by the department.
22 (4) Dissemination of grant awards shall begin no later
23 than January 1, 2001.
24 (5) A Closing the Gap grant shall be funded for 1 year
25 and may be renewed annually upon application to and approval
26 by the department, subject to the achievement of quality
27 standards, objectives, and outcomes and to the availability of
28 funds.
29 (6) Implementation of the Reducing Racial and Ethnic
30 Health Disparities: Closing the Gap grant program shall be
31
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1 subject to a specific appropriation provided in the General
2 Appropriations Act.
3 Section 33. Florida Commission on Excellence in Health
4 Care.--
5 (1) LEGISLATIVE FINDINGS AND INTENT.--The Legislature
6 finds that the health care delivery industry is one of the
7 largest and most complex industries in Florida. The
8 Legislature finds that the current system of regulating health
9 care practitioners and health care providers is one of blame
10 and punishment and does not encourage voluntary admission of
11 errors and immediate corrective action on a large scale. The
12 Legislature finds that previous attempts to identify and
13 address areas which impact the quality of care provided by the
14 health care industry have suffered from a lack of coordination
15 among the industry's stakeholders and regulators. The
16 Legislature finds that additional focus on strengthening
17 health care delivery systems by eliminating avoidable mistakes
18 in the diagnosis and treatment of Floridians holds tremendous
19 promise to increase the quality of health care services
20 available to Floridians, thereby reducing the costs associated
21 with medical mistakes and malpractice and in turn increasing
22 access to health care in the state. To achieve this enhanced
23 focus, it is the intent of the Legislature to create the
24 Florida Commission on Excellence in Health Care to facilitate
25 the development of a comprehensive statewide strategy for
26 improving health care delivery systems through meaningful
27 reporting standards, data collection and review, and quality
28 measurement.
29 (2) DEFINITIONS.--As used in this act, the term:
30 (a) "Agency" means the Agency for Health Care
31 Administration.
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1 (b) "Commission" means the Florida Commission on
2 Excellence in Health Care.
3 (c) "Department" means the Department of Health.
4 (d) "Error," with respect to health care, means an
5 unintended act, by omission or commission.
6 (e) "Health care practitioner" means any person
7 licensed under chapter 457; chapter 458; chapter 459; chapter
8 460; chapter 461; chapter 462; chapter 463; chapter 464;
9 chapter 465; chapter 466; chapter 467; part I, part II, part
10 III, part V, part X, part XIII, or part XIV of chapter 468;
11 chapter 478; chapter 480; part III or part IV of chapter 483;
12 chapter 484; chapter 486; chapter 490; or chapter 491, Florida
13 Statutes.
14 (f) "Health care provider" means any health care
15 facility or other health care organization licensed or
16 certified to provide approved medical and allied health
17 services in this state.
18 (3) COMMISSION; DUTIES AND RESPONSIBILITIES.--There is
19 hereby created the Florida Commission on Excellence in Health
20 Care. The commission shall:
21 (a) Identify existing data sources that evaluate
22 quality of care in Florida and collect, analyze, and evaluate
23 this data.
24 (b) Establish guidelines for data sharing and
25 coordination.
26 (c) Identify core sets of quality measures for
27 standardized reporting by appropriate components of the health
28 care continuum.
29 (d) Recommend a framework for quality measurement and
30 outcome reporting.
31
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1 (e) Develop quality measures that enhance and improve
2 the ability to evaluate and improve care.
3 (f) Make recommendations regarding research and
4 development needed to advance quality measurement and
5 reporting.
6 (g) Evaluate regulatory issues relating to the
7 pharmacy profession and recommend changes necessary to
8 optimize patient safety.
9 (h) Facilitate open discussion of a process to ensure
10 that comparative information on health care quality is valid,
11 reliable, comprehensive, understandable, and widely available
12 in the public domain.
13 (i) Sponsor public hearings to share information and
14 expertise, identify "best practices," and recommend methods to
15 promote their acceptance.
16 (j) Evaluate current regulatory programs to determine
17 what changes, if any, need to be made to facilitate patient
18 safety.
19 (k) Review public and private health care purchasing
20 systems to determine if there are sufficient mandates and
21 incentives to facilitate continuous improvement in patient
22 safety.
23 (l) Analyze how effective existing regulatory systems
24 are in ensuring continuous competence and knowledge of
25 effective safety practices.
26 (m) Develop a framework for organizations that
27 license, accredit, or credential health care practitioners and
28 health care providers to more quickly and effectively identify
29 unsafe providers and practitioners and to take action
30 necessary to remove the unsafe provider or practitioner from
31
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1 practice or operation until such time as the practitioner or
2 provider has proven safe to practice or operate.
3 (n) Recommend procedures for development of a
4 curriculum on patient safety and methods of incorporating such
5 curriculum into training, licensure, and certification
6 requirements.
7 (o) Develop a framework for regulatory bodies to
8 disseminate information on patient safety to health care
9 practitioners, health care providers, and consumers through
10 conferences, journal articles and editorials, newsletters,
11 publications, and Internet websites.
12 (p) Recommend procedures to incorporate recognized
13 patient safety considerations into practice guidelines and
14 into standards related to the introduction and diffusion of
15 new technologies, therapies, and drugs.
16 (q) Recommend a framework for development of
17 community-based collaborative initiatives for error reporting
18 and analysis and implementation of patient safety
19 improvements.
20 (r) Evaluate the role of advertising in promoting or
21 adversely affecting patient safety.
22 (s) Evaluate and make recommendations regarding the
23 need for licensure of additional persons who participate in
24 the delivery of health care to Floridians, including, but not
25 limited to, surgical technologists and pharmacy technicians.
26 (t) Evaluate the benefits and problems of the current
27 disciplinary systems and make recommendations regarding
28 alternatives and improvements.
29 (4) MEMBERSHIP, ORGANIZATION, MEETINGS, PROCEDURES,
30 STAFF.--
31 (a) The commission shall consist of:
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1 1. The Secretary of Health and the Executive Director
2 of the Agency for Health Care Administration.
3 2. One representative each from the following agencies
4 or organizations: the Board of Medicine, the Board of
5 Osteopathic Medicine, the Board of Pharmacy, the Board of
6 Nursing, the Board of Dentistry, the Florida Dental
7 Association, the Florida Medical Association, the Florida
8 Osteopathic Medical Association, the Florida Academy of
9 Physician Assistants, the Florida Chiropractic Society, the
10 Florida Chiropractic Association, the Florida Podiatric
11 Medical Association, the Florida Society of Ambulatory
12 Surgical Centers, the Florida Statutory Teaching Hospital
13 Council, Inc., the Florida Statutory Rural Hospital Council,
14 the Florida Nurses Association, the Florida Organization of
15 Nursing Executives, the Florida Pharmacy Association, the
16 Florida Society of Health System Pharmacists, Inc., the
17 Florida Hospital Association, the Association of Community
18 Hospitals and Health Systems of Florida, Inc., the Florida
19 League of Health Care Systems, the Florida Health Care Risk
20 Management Advisory Council, the Florida Health Care
21 Association, and the Florida Association of Homes for the
22 Aging;
23 3. One licensed clinical laboratory director,
24 appointed by the Secretary of Health;
25 4. Two health lawyers, appointed by the Secretary of
26 Health, one of whom shall be a member of The Florida Bar
27 Health Law Section who defends physicians and one of whom
28 shall be a member of the Florida Academy of Trial Lawyers;
29 5. One representative of the medical malpractice
30 professional liability insurance industry, appointed by the
31 Secretary of Health;
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1 6. One representative of a Florida medical school
2 appointed by the Secretary of Health;
3 7. Two representatives of the health insurance
4 industry, appointed by the Executive Director of the Agency
5 for Health Care Administration, one of whom shall represent
6 indemnity plans and one of whom shall represent managed care;
7 8. Five consumer advocates, consisting of one from the
8 Association for Responsible Medicine, two appointed by the
9 Governor, one appointed by the President of the Senate, and
10 one appointed by the Speaker of the House of Representatives;
11 and
12 9. Two legislators, one appointed by the President of
13 the Senate and one appointed by the Speaker of the House of
14 Representatives.
15
16 Commission membership shall reflect the geographic and
17 demographic diversity of the state.
18 (b) The Secretary of Health and the Executive Director
19 of the Agency for Health Care Administration shall jointly
20 chair the commission. Subcommittees shall be formed by the
21 joint chairs, as needed, to make recommendations to the full
22 commission on the subjects assigned. However, all votes on
23 work products of the commission shall be at the full
24 commission level, and all recommendations to the Governor, the
25 President of the Senate, and the Speaker of the House of
26 Representatives must pass by a two-thirds vote of the full
27 commission. Sponsoring agencies and organizations may
28 designate an alternative member who may attend and vote on
29 behalf of the sponsoring agency or organization in the event
30 the appointed member is unable to attend a meeting of the
31 commission or any subcommittee. The commission shall be
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1 staffed by employees of the Department of Health and the
2 Agency for Health Care Administration. Sponsoring agencies or
3 organizations must fund the travel and related expenses of
4 their appointed members on the commission. Travel and related
5 expenses for the consumer members of the commission shall be
6 reimbursed by the state pursuant to s. 112.061, Florida
7 Statutes. The commission shall hold its first meeting no later
8 than July 15, 2000.
9 (5) EVIDENTIARY PROHIBITIONS.--
10 (a) The findings, recommendations, evaluations,
11 opinions, investigations, proceedings, records, reports,
12 minutes, testimony, correspondence, work product, and actions
13 of the commission shall be available to the public, but may
14 not be introduced into evidence at any civil, criminal,
15 special, or administrative proceeding against a health care
16 practitioner or health care provider arising out of the
17 matters which are the subject of the findings of the
18 commission. Moreover, no member of the commission shall be
19 examined in any civil, criminal, special, or administrative
20 proceeding against a health care practitioner or health care
21 provider as to any evidence or other matters produced or
22 presented during the proceedings of this commission or as to
23 any findings, recommendations, evaluations, opinions,
24 investigations, proceedings, records, reports, minutes,
25 testimony, correspondence, work product, or other actions of
26 the commission or any members thereof. However, nothing in
27 this section shall be construed to mean that information,
28 documents, or records otherwise available and obtained from
29 original sources are immune from discovery or use in any
30 civil, criminal, special, or administrative proceeding merely
31 because they were presented during proceedings of the
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1 commission. Nor shall any person who testifies before the
2 commission or who is a member of the commission be prevented
3 from testifying as to matters within his or her knowledge in a
4 subsequent civil, criminal, special, or administrative
5 proceeding merely because such person testified in front of
6 the commission.
7 (b) The findings, recommendations, evaluations,
8 opinions, investigations, proceedings, records, reports,
9 minutes, testimony, correspondence, work product, and actions
10 of the commission shall be used as a guide and resource and
11 shall not be construed as establishing or advocating the
12 standard of care for health care practitioners or health care
13 providers unless subsequently enacted into law or adopted in
14 rule. Nor shall any findings, recommendations, evaluations,
15 opinions, investigations, proceedings, records, reports,
16 minutes, testimony, correspondence, work product, or actions
17 of the commission be admissible as evidence in any way,
18 directly or indirectly, by introduction of documents or as a
19 basis of an expert opinion as to the standard of care
20 applicable to health care practitioners or health care
21 providers in any civil, criminal, special, or administrative
22 proceeding unless subsequently enacted into law or adopted in
23 rule.
24 (c) No person who testifies before the commission or
25 who is a member of the commission may specifically identify
26 any patient, health care practitioner, or health care provider
27 by name. Moreover, the findings, recommendations, evaluations,
28 opinions, investigations, proceedings, records, reports,
29 minutes, testimony, correspondence, work product, and actions
30 of the commission may not specifically identify any patient,
31 health care practitioner, or health care provider by name.
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1 (6) REPORT; TERMINATION.--The commission shall provide
2 a report of its findings and recommendations to the Governor,
3 the President of the Senate, and the Speaker of the House of
4 Representatives no later than February 1, 2001. After
5 submission of the report, the commission shall continue to
6 exist for the purpose of assisting the Department of Health,
7 the Agency for Health Care Administration, and the regulatory
8 boards in their drafting of proposed legislation and rules to
9 implement its recommendations and for the purpose of providing
10 information to the health care industry on its
11 recommendations. The commission shall be terminated June 1,
12 2001.
13 Section 34. Effective October 1, 2000, subsection (1)
14 of section 408.7056, Florida Statutes, is amended to read:
15 408.7056 Statewide Provider and Subscriber Assistance
16 Program.--
17 (1) As used in this section, the term:
18 (a) "Agency" means the Agency for Health Care
19 Administration.
20 (b) "Department" means the Department of Insurance.
21 (c) "Grievance procedure" means an established set of
22 rules that specify a process for appeal of an organizational
23 decision.
24 (d) "Health care provider" or "provider" means a
25 state-licensed or state-authorized facility, a facility
26 principally supported by a local government or by funds from a
27 charitable organization that holds a current exemption from
28 federal income tax under s. 501(c)(3) of the Internal Revenue
29 Code, a licensed practitioner, a county health department
30 established under part I of chapter 154, a prescribed
31 pediatric extended care center defined in s. 400.902, a
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1 federally supported primary care program such as a migrant
2 health center or a community health center authorized under s.
3 329 or s. 330 of the United States Public Health Services Act
4 that delivers health care services to individuals, or a
5 community facility that receives funds from the state under
6 the Community Alcohol, Drug Abuse, and Mental Health Services
7 Act and provides mental health services to individuals.
8 (e)(a) "Managed care entity" means a health
9 maintenance organization or a prepaid health clinic certified
10 under chapter 641, a prepaid health plan authorized under s.
11 409.912, or an exclusive provider organization certified under
12 s. 627.6472.
13 (f)(b) "Panel" means a statewide provider and
14 subscriber assistance panel selected as provided in subsection
15 (11).
16 Section 35. Effective October 1, 2000, section
17 627.654, Florida Statutes, is amended to read:
18 627.654 Labor union, and association, and small
19 employer health alliance groups.--
20 (1)(a) A group of individuals may be insured under a
21 policy issued to an association, including a labor union,
22 which association has a constitution and bylaws and not less
23 than 25 individual members and which has been organized and
24 has been maintained in good faith for a period of 1 year for
25 purposes other than that of obtaining insurance, or to the
26 trustees of a fund established by such an association, which
27 association or trustees shall be deemed the policyholder,
28 insuring at least 15 individual members of the association for
29 the benefit of persons other than the officers of the
30 association, the association or trustees.
31
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1 (b) A small employer, as defined in s. 627.6699 and
2 including the employer's eligible employees and the spouses
3 and dependents of such employees, may be insured under a
4 policy issued to a small employer health alliance by a carrier
5 as defined in s. 627.6699. A small employer health alliance
6 must be organized as a not-for-profit corporation under
7 chapter 617. Notwithstanding any other law, if a small
8 employer member of an alliance loses eligibility to purchase
9 health care through the alliance solely because the business
10 of the small employer member expands to more than 50 and fewer
11 than 75 eligible employees, the small employer member may, at
12 its next renewal date, purchase coverage through the alliance
13 for not more than 1 additional year. A small employer health
14 alliance shall establish conditions of participation in the
15 alliance by a small employer, including, but not limited to:
16 1. Assurance that the small employer is not formed for
17 the purpose of securing health benefit coverage.
18 2. Assurance that the employees of a small employer
19 have not been added for the purpose of securing health benefit
20 coverage.
21 (2) No such policy of insurance as defined in
22 subsection (1) may be issued to any such association or
23 alliance, unless all individual members of such association,
24 or all small employer members of an alliance, or all of any
25 class or classes thereof, are declared eligible and acceptable
26 to the insurer at the time of issuance of the policy.
27 (3) Any such policy issued under paragraph (1)(a) may
28 insure the spouse or dependent children with or without the
29 member being insured.
30 (4) A single master policy issued to an association,
31 labor union, or small employer health alliance may include
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1 more than one health plan from the same insurer or affiliated
2 insurer group as alternatives for an employer, employee, or
3 member to select.
4 Section 36. Effective October 1, 2000, paragraph (f)
5 of subsection (2), paragraph (b) of subsection (4), and
6 subsection (6) of section 627.6571, Florida Statutes, are
7 amended to read:
8 627.6571 Guaranteed renewability of coverage.--
9 (2) An insurer may nonrenew or discontinue a group
10 health insurance policy based only on one or more of the
11 following conditions:
12 (f) In the case of health insurance coverage that is
13 made available only through one or more bona fide associations
14 as defined in subsection (5) or through one or more small
15 employer health alliances as described in s. 627.654(1)(b),
16 the membership of an employer in the association or in the
17 small employer health alliance, on the basis of which the
18 coverage is provided, ceases, but only if such coverage is
19 terminated under this paragraph uniformly without regard to
20 any health-status-related factor that relates to any covered
21 individuals.
22 (4) At the time of coverage renewal, an insurer may
23 modify the health insurance coverage for a product offered:
24 (b) In the small-group market if, for coverage that is
25 available in such market other than only through one or more
26 bona fide associations as defined in subsection (5) or through
27 one or more small employer health alliances as described in s.
28 627.654(1)(b), such modification is consistent with s.
29 627.6699 and effective on a uniform basis among group health
30 plans with that product.
31
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1 (6) In applying this section in the case of health
2 insurance coverage that is made available by an insurer in the
3 small-group market or large-group market to employers only
4 through one or more associations or through one or more small
5 employer health alliances as described in s. 627.654(1)(b), a
6 reference to "policyholder" is deemed, with respect to
7 coverage provided to an employer member of the association, to
8 include a reference to such employer.
9 Section 37. Effective October 1, 2000, paragraph (h)
10 of subsection (5), paragraph (b) of subsection (6), and
11 paragraph (a) of subsection (12) of section 627.6699, Florida
12 Statutes, are amended to read:
13 627.6699 Employee Health Care Access Act.--
14 (5) AVAILABILITY OF COVERAGE.--
15 (h) All health benefit plans issued under this section
16 must comply with the following conditions:
17 1. For employers who have fewer than two employees, a
18 late enrollee may be excluded from coverage for no longer than
19 24 months if he or she was not covered by creditable coverage
20 continually to a date not more than 63 days before the
21 effective date of his or her new coverage.
22 2. Any requirement used by a small employer carrier in
23 determining whether to provide coverage to a small employer
24 group, including requirements for minimum participation of
25 eligible employees and minimum employer contributions, must be
26 applied uniformly among all small employer groups having the
27 same number of eligible employees applying for coverage or
28 receiving coverage from the small employer carrier, except
29 that a small employer carrier that participates in,
30 administers, or issues health benefits pursuant to s. 381.0406
31 which do not include a preexisting condition exclusion may
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1 require as a condition of offering such benefits that the
2 employer has had no health insurance coverage for its
3 employees for a period of at least 6 months. A small employer
4 carrier may vary application of minimum participation
5 requirements and minimum employer contribution requirements
6 only by the size of the small employer group.
7 3. In applying minimum participation requirements with
8 respect to a small employer, a small employer carrier shall
9 not consider as an eligible employee employees or dependents
10 who have qualifying existing coverage in an employer-based
11 group insurance plan or an ERISA qualified self-insurance plan
12 in determining whether the applicable percentage of
13 participation is met. However, a small employer carrier may
14 count eligible employees and dependents who have coverage
15 under another health plan that is sponsored by that employer
16 except if such plan is offered pursuant to s. 408.706.
17 4. A small employer carrier shall not increase any
18 requirement for minimum employee participation or any
19 requirement for minimum employer contribution applicable to a
20 small employer at any time after the small employer has been
21 accepted for coverage, unless the employer size has changed,
22 in which case the small employer carrier may apply the
23 requirements that are applicable to the new group size.
24 5. If a small employer carrier offers coverage to a
25 small employer, it must offer coverage to all the small
26 employer's eligible employees and their dependents. A small
27 employer carrier may not offer coverage limited to certain
28 persons in a group or to part of a group, except with respect
29 to late enrollees.
30 6. A small employer carrier may not modify any health
31 benefit plan issued to a small employer with respect to a
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1 small employer or any eligible employee or dependent through
2 riders, endorsements, or otherwise to restrict or exclude
3 coverage for certain diseases or medical conditions otherwise
4 covered by the health benefit plan.
5 7. An initial enrollment period of at least 30 days
6 must be provided. An annual 30-day open enrollment period
7 must be offered to each small employer's eligible employees
8 and their dependents. A small employer carrier must provide
9 special enrollment periods as required by s. 627.65615.
10 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
11 (b) For all small employer health benefit plans that
12 are subject to this section and are issued by small employer
13 carriers on or after January 1, 1994, premium rates for health
14 benefit plans subject to this section are subject to the
15 following:
16 1. Small employer carriers must use a modified
17 community rating methodology in which the premium for each
18 small employer must be determined solely on the basis of the
19 eligible employee's and eligible dependent's gender, age,
20 family composition, tobacco use, or geographic area as
21 determined under paragraph (5)(j).
22 2. Rating factors related to age, gender, family
23 composition, tobacco use, or geographic location may be
24 developed by each carrier to reflect the carrier's experience.
25 The factors used by carriers are subject to department review
26 and approval.
27 3. Small employer carriers may not modify the rate for
28 a small employer for 12 months from the initial issue date or
29 renewal date, unless the composition of the group changes or
30 benefits are changed. However, a small employer carrier may
31 modify the rate one time prior to 12 months after the initial
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1 issue date for a small employer who enrolls under a previously
2 issued group policy that has a common anniversary date for all
3 employers covered under the policy if:
4 a. The carrier discloses to the employer in a clear
5 and conspicuous manner the date of the first renewal and the
6 fact that the premium may increase on or after that date.
7 b. The insurer demonstrates to the department that
8 efficiencies in administration are achieved and reflected in
9 the rates charged to small employers covered under the policy.
10 4. A carrier may issue a group health insurance policy
11 to a small employer health alliance or other group association
12 with rates that reflect a premium credit for expense savings
13 attributable to administrative activities being performed by
14 the alliance or group association if such expense savings are
15 specifically documented in the insurer's rate filing and are
16 approved by the department. Any such credit may not be based
17 on different morbidity assumptions or on any other factor
18 related to the health status or claims experience of any
19 person covered under the policy. Nothing in this subparagraph
20 exempts an alliance or group association from licensure for
21 any activities that require licensure under the Insurance
22 Code. A carrier issuing a group health insurance policy to a
23 small employer health alliance or other group association
24 shall allow any properly licensed and appointed agent of that
25 carrier to market and sell the small employer health alliance
26 or other group association policy. Such agent shall be paid
27 the usual and customary commission paid to any agent selling
28 the policy. Carriers participating in the alliance program, in
29 accordance with ss. 408.70-408.706, may apply a different
30 community rate to business written in that program.
31
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1 (12) STANDARD, BASIC, AND LIMITED HEALTH BENEFIT
2 PLANS.--
3 (a)1. By May 15, 1993, the commissioner shall appoint
4 a health benefit plan committee composed of four
5 representatives of carriers which shall include at least two
6 representatives of HMOs, at least one of which is a staff
7 model HMO, two representatives of agents, four representatives
8 of small employers, and one employee of a small employer. The
9 carrier members shall be selected from a list of individuals
10 recommended by the board. The commissioner may require the
11 board to submit additional recommendations of individuals for
12 appointment. As alliances are established under s. 408.702,
13 each alliance shall also appoint an additional member to the
14 committee.
15 2. The committee shall develop changes to the form and
16 level of coverages for the standard health benefit plan and
17 the basic health benefit plan, and shall submit the forms, and
18 levels of coverages to the department by September 30, 1993.
19 The department must approve such forms and levels of coverages
20 by November 30, 1993, and may return the submissions to the
21 committee for modification on a schedule that allows the
22 department to grant final approval by November 30, 1993.
23 3. The plans shall comply with all of the requirements
24 of this subsection.
25 4. The plans must be filed with and approved by the
26 department prior to issuance or delivery by any small employer
27 carrier.
28 5. After approval of the revised health benefit plans,
29 if the department determines that modifications to a plan
30 might be appropriate, the commissioner shall appoint a new
31 health benefit plan committee in the manner provided in
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1 subparagraph 1. to submit recommended modifications to the
2 department for approval.
3 Section 38. Effective October 1, 2000, subsection (1)
4 of section 240.2995, Florida Statutes, is amended to read:
5 240.2995 University health services support
6 organizations.--
7 (1) Each state university is authorized to establish
8 university health services support organizations which shall
9 have the ability to enter into, for the benefit of the
10 university academic health sciences center, arrangements with
11 other entities as providers for accountable health
12 partnerships, as defined in s. 408.701, and providers in other
13 integrated health care systems or similar entities. To the
14 extent required by law or rule, university health services
15 support organizations shall become licensed as insurance
16 companies, pursuant to chapter 624, or be certified as health
17 maintenance organizations, pursuant to chapter 641.
18 University health services support organizations shall have
19 sole responsibility for the acts, debts, liabilities, and
20 obligations of the organization. In no case shall the state
21 or university have any responsibility for such acts, debts,
22 liabilities, and obligations incurred or assumed by university
23 health services support organizations.
24 Section 39. Effective October 1, 2000, paragraph (a)
25 of subsection (2) of section 240.2996, Florida Statutes, is
26 amended to read:
27 240.2996 University health services support
28 organization; confidentiality of information.--
29 (2) The following university health services support
30 organization's records and information are confidential and
31
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1 exempt from the provisions of s. 119.07(1) and s. 24(a), Art.
2 I of the State Constitution:
3 (a) Contracts for managed care arrangements, as
4 managed care is defined in s. 408.701, under which the
5 university health services support organization provides
6 health care services, including preferred provider
7 organization contracts, health maintenance organization
8 contracts, alliance network arrangements, and exclusive
9 provider organization contracts, and any documents directly
10 relating to the negotiation, performance, and implementation
11 of any such contracts for managed care arrangements or
12 alliance network arrangements. As used in this paragraph, the
13 term "managed care" means systems or techniques generally used
14 by third-party payors or their agents to affect access to and
15 control payment for health care services. Managed-care
16 techniques most often include one or more of the following:
17 prior, concurrent, and retrospective review of the medical
18 necessity and appropriateness of services or site of services;
19 contracts with selected health care providers; financial
20 incentives or disincentives related to the use of specific
21 providers, services, or service sites; controlled access to
22 and coordination of services by a case manager; and payor
23 efforts to identify treatment alternatives and modify benefit
24 restrictions for high-cost patient care.
25
26 The exemptions in this subsection are subject to the Open
27 Government Sunset Review Act of 1995 in accordance with s.
28 119.15 and shall stand repealed on October 2, 2001, unless
29 reviewed and saved from repeal through reenactment by the
30 Legislature.
31
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1 Section 40. Effective October 1, 2000, paragraph (b)
2 of subsection (8) of section 240.512, Florida Statutes, is
3 amended to read:
4 240.512 H. Lee Moffitt Cancer Center and Research
5 Institute.--There is established the H. Lee Moffitt Cancer
6 Center and Research Institute at the University of South
7 Florida.
8 (8)
9 (b) Proprietary confidential business information is
10 confidential and exempt from the provisions of s. 119.07(1)
11 and s. 24(a), Art. I of the State Constitution. However, the
12 Auditor General and Board of Regents, pursuant to their
13 oversight and auditing functions, must be given access to all
14 proprietary confidential business information upon request and
15 without subpoena and must maintain the confidentiality of
16 information so received. As used in this paragraph, the term
17 "proprietary confidential business information" means
18 information, regardless of its form or characteristics, which
19 is owned or controlled by the not-for-profit corporation or
20 its subsidiaries; is intended to be and is treated by the
21 not-for-profit corporation or its subsidiaries as private and
22 the disclosure of which would harm the business operations of
23 the not-for-profit corporation or its subsidiaries; has not
24 been intentionally disclosed by the corporation or its
25 subsidiaries unless pursuant to law, an order of a court or
26 administrative body, a legislative proceeding pursuant to s.
27 5, Art. III of the State Constitution, or a private agreement
28 that provides that the information may be released to the
29 public; and which is information concerning:
30 1. Internal auditing controls and reports of internal
31 auditors;
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1 2. Matters reasonably encompassed in privileged
2 attorney-client communications;
3 3. Contracts for managed-care arrangements, as managed
4 care is defined in s. 408.701, including preferred provider
5 organization contracts, health maintenance organization
6 contracts, and exclusive provider organization contracts, and
7 any documents directly relating to the negotiation,
8 performance, and implementation of any such contracts for
9 managed-care arrangements;
10 4. Bids or other contractual data, banking records,
11 and credit agreements the disclosure of which would impair the
12 efforts of the not-for-profit corporation or its subsidiaries
13 to contract for goods or services on favorable terms;
14 5. Information relating to private contractual data,
15 the disclosure of which would impair the competitive interest
16 of the provider of the information;
17 6. Corporate officer and employee personnel
18 information;
19 7. Information relating to the proceedings and records
20 of credentialing panels and committees and of the governing
21 board of the not-for-profit corporation or its subsidiaries
22 relating to credentialing;
23 8. Minutes of meetings of the governing board of the
24 not-for-profit corporation and its subsidiaries, except
25 minutes of meetings open to the public pursuant to subsection
26 (9);
27 9. Information that reveals plans for marketing
28 services that the corporation or its subsidiaries reasonably
29 expect to be provided by competitors;
30 10. Trade secrets as defined in s. 688.002, including
31 reimbursement methodologies or rates; or
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1 11. The identity of donors or prospective donors of
2 property who wish to remain anonymous or any information
3 identifying such donors or prospective donors. The anonymity
4 of these donors or prospective donors must be maintained in
5 the auditor's report.
6
7 As used in this paragraph, the term "managed care" means
8 systems or techniques generally used by third-party payors or
9 their agents to affect access to and control payment for
10 health care services. Managed-care techniques most often
11 include one or more of the following: prior, concurrent, and
12 retrospective review of the medical necessity and
13 appropriateness of services or site of services; contracts
14 with selected health care providers; financial incentives or
15 disincentives related to the use of specific providers,
16 services, or service sites; controlled access to and
17 coordination of services by a case manager; and payor efforts
18 to identify treatment alternatives and modify benefit
19 restrictions for high-cost patient care.
20 Section 41. Effective October 1, 2000, subsection (14)
21 of section 381.0406, Florida Statutes, is amended to read:
22 381.0406 Rural health networks.--
23 (14) NETWORK FINANCING.--Networks may use all sources
24 of public and private funds to support network activities.
25 Nothing in this section prohibits networks from becoming
26 managed care providers, or accountable health partnerships,
27 provided they meet the requirements for an accountable health
28 partnership as specified in s. 408.706.
29 Section 42. Effective October 1, 2000, paragraph (a)
30 of subsection (2) of section 395.3035, Florida Statutes, is
31 amended to read:
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1 395.3035 Confidentiality of hospital records and
2 meetings.--
3 (2) The following records and information of any
4 hospital that is subject to chapter 119 and s. 24(a), Art. I
5 of the State Constitution are confidential and exempt from the
6 provisions of s. 119.07(1) and s. 24(a), Art. I of the State
7 Constitution:
8 (a) Contracts for managed care arrangements, as
9 managed care is defined in s. 408.701, under which the public
10 hospital provides health care services, including preferred
11 provider organization contracts, health maintenance
12 organization contracts, exclusive provider organization
13 contracts, and alliance network arrangements, and any
14 documents directly relating to the negotiation, performance,
15 and implementation of any such contracts for managed care or
16 alliance network arrangements. As used in this paragraph, the
17 term "managed care" means systems or techniques generally used
18 by third-party payors or their agents to affect access to and
19 control payment for health care services. Managed-care
20 techniques most often include one or more of the following:
21 prior, concurrent, and retrospective review of the medical
22 necessity and appropriateness of services or site of services;
23 contracts with selected health care providers; financial
24 incentives or disincentives related to the use of specific
25 providers, services, or service sites; controlled access to
26 and coordination of services by a case manager; and payor
27 efforts to identify treatment alternatives and modify benefit
28 restrictions for high-cost patient care.
29 Section 43. Effective October 1, 2000, paragraph (b)
30 of subsection (1) of section 627.4301, Florida Statutes, is
31 amended to read:
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1 627.4301 Genetic information for insurance purposes.--
2 (1) DEFINITIONS.--As used in this section, the term:
3 (b) "Health insurer" means an authorized insurer
4 offering health insurance as defined in s. 624.603, a
5 self-insured plan as defined in s. 624.031, a
6 multiple-employer welfare arrangement as defined in s.
7 624.437, a prepaid limited health service organization as
8 defined in s. 636.003, a health maintenance organization as
9 defined in s. 641.19, a prepaid health clinic as defined in s.
10 641.402, a fraternal benefit society as defined in s. 632.601,
11 an accountable health partnership as defined in s. 408.701, or
12 any health care arrangement whereby risk is assumed.
13 Section 44. Section 641.185, Florida Statutes, is
14 created to read:
15 641.185 Health maintenance organization subscriber
16 protections.--
17 (1) With respect to the provisions of this part and
18 part III, the principles expressed in the following statements
19 shall serve as standards to be followed by the Department of
20 Insurance and the Agency for Health Care Administration in
21 exercising their powers and duties, in exercising
22 administrative discretion, in administrative interpretations
23 of the law, in enforcing its provisions, and in adopting
24 rules:
25 (a) A health maintenance organization shall ensure
26 that the health care services provided to its subscribers
27 shall be rendered under reasonable standards of quality of
28 care which are at a minimum consistent with the prevailing
29 standards of medical practice in the community pursuant to ss.
30 641.495(1) and 641.51.
31
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1 (b) A health maintenance organization subscriber
2 should receive quality health care from a broad panel of
3 providers, including referrals, preventive care pursuant to s.
4 641.402(1), emergency screening and services pursuant to ss.
5 641.31(12) and 641.513, and second opinions pursuant to s.
6 641.51.
7 (c) A health maintenance organization subscriber
8 should receive assurance that the health maintenance
9 organization has been independently accredited by a national
10 review organization pursuant to s. 641.512, and is financially
11 secure as determined by the state pursuant to ss. 641.221,
12 641.225, and 641.228.
13 (d) A health maintenance organization subscriber
14 should receive continuity of health care, even after the
15 provider is no longer with the health maintenance organization
16 pursuant to s. 641.51(7).
17 (e) A health maintenance organization subscriber
18 should receive timely, concise information regarding the
19 health maintenance organization's reimbursement to providers
20 and services pursuant to ss. 641.31 and 641.31015.
21 (f) A health maintenance organization subscriber
22 should receive the flexibility to transfer to another Florida
23 health maintenance organization, regardless of health status,
24 pursuant to ss. 641.3104, 641.3107, 641.3111, 641.3921,
25 641.3922, and 641.228.
26 (g) A health maintenance organization subscriber
27 should be eligible for coverage without discrimination against
28 individual participants and beneficiaries of group plans based
29 on health status pursuant to s. 641.31073.
30 (h) A health maintenance organization that issues a
31 group health contract must: provide coverage for preexisting
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1 conditions pursuant to s. 641.31071; guarantee renewability of
2 coverage pursuant to s. 641.31074; provide notice of
3 cancellation pursuant to s. 641.3108; provide extension of
4 benefits pursuant to s. 641.3111; provide for conversion on
5 termination of eligibility pursuant to s. 641.3921; and
6 provide for conversion contracts and conditions pursuant to s.
7 641.3922.
8 (i) A health maintenance organization subscriber
9 should receive timely, and, if necessary, urgent grievances
10 and appeals within the health maintenance organization
11 pursuant to ss. 641.228, 641.31(5), 641.47, and 641.511.
12 (j) A health maintenance organization should receive
13 timely and, if necessary, urgent review by an independent
14 state external review organization for unresolved grievances
15 and appeals pursuant to s. 408.7056.
16 (k) A health maintenance organization subscriber shall
17 be given written notice at least 30 days in advance of a rate
18 change pursuant to s. 641.31(3)(b). In the case of a group
19 member, there may be a contractual agreement with the health
20 maintenance organization to have the employer provide the
21 required notice to the individual members of the group
22 pursuant to s. 641.31(3)(b).
23 (l) A health maintenance organization subscriber shall
24 be given a copy of the applicable health maintenance contract,
25 certificate, or member handbook specifying: all the
26 provisions, disclosure, and limitations required pursuant to
27 s. 641.31(1) and (4); the covered services, including those
28 services, medical conditions, and provider types specified in
29 ss. 641.31, 641.31094, 641.31095, 641.31096, 641.51(10), and
30 641.513; and where and in what manner services may be obtained
31 pursuant to s. 641.31(4).
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1 (2) This section shall not be construed as creating a
2 civil cause of action by any subscriber or provider against
3 any health maintenance organization.
4 Section 45. Subsection (11) of section 641.511,
5 Florida Statutes, is renumbered as subsection (12) and a new
6 subsection (11) is added to said section to read:
7 641.511 Subscriber grievance reporting and resolution
8 requirements.--
9 (11) Each organization, as part of its contract with
10 any provider, must require the provider to post a consumer
11 assistance notice prominently displayed in the reception area
12 of the provider and clearly noticeable by all patients. The
13 consumer assistance notice must state the addresses and
14 toll-free telephone numbers of the Agency for Health Care
15 Administration, the Statewide Provider and Subscriber
16 Assistance Program, and the Department of Insurance. The
17 consumer assistance notice must also clearly state that the
18 address and toll-free telephone number of the organization's
19 grievance department shall be provided upon request. The
20 agency is authorized to promulgate rules to implement this
21 section.
22 Section 46. Paragraph (n) of subsection (3), paragraph
23 (c) of subsection (5), and paragraphs (b) and (d) of
24 subsection (6) of section 627.6699, Florida Statutes, are
25 amended to read:
26 627.6699 Employee Health Care Access Act.--
27 (3) DEFINITIONS.--As used in this section, the term:
28 (n) "Modified community rating" means a method used to
29 develop carrier premiums which spreads financial risk across a
30 large population, and allows the use of separate rating
31 factors adjustments for age, gender, family composition,
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1 tobacco usage, and geographic area as determined under
2 paragraph (5)(j); and allows adjustments for claims
3 experience, health status, or duration of coverage as provided
4 in subparagraph (6)(b)5.; and administrative and acquisition
5 expenses as provided in subparagraph (6)(b)6.
6 (5) AVAILABILITY OF COVERAGE.--
7 (c) Every small employer carrier must, as a condition
8 of transacting business in this state:
9 1. Beginning July 1, 2000 January 1, 1994, offer and
10 issue all small employer health benefit plans on a
11 guaranteed-issue basis to every eligible small employer, with
12 two 3 to 50 eligible employees, that elects to be covered
13 under such plan, agrees to make the required premium payments,
14 and satisfies the other provisions of the plan. A rider for
15 additional or increased benefits may be medically underwritten
16 and may only be added to the standard health benefit plan.
17 The increased rate charged for the additional or increased
18 benefit must be rated in accordance with this section.
19 2. Beginning August 1, 2000 April 15, 1994, offer and
20 issue basic and standard small employer health benefit plans
21 on a guaranteed-issue basis, during an open enrollment period
22 of August 1 through August 31 of each year, to every eligible
23 small employer, with less than one or two eligible employees,
24 which is not formed primarily for purposes of buying health
25 insurance and which elects to be covered under such plan,
26 agrees to make the required premium payments, and satisfies
27 the other provisions of the plan. Coverage provided pursuant
28 to this subparagraph shall begin on October 1 of the same year
29 as the date of enrollment, unless the small employer carrier
30 and the small employer agree to a different date. A rider for
31 additional or increased benefits may be medically underwritten
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1 and may only be added to the standard health benefit plan.
2 The increased rate charged for the additional or increased
3 benefit must be rated in accordance with this section. For
4 purposes of this subparagraph, a person, his or her spouse,
5 and his or her dependent children shall constitute a single
6 eligible employee if such person and spouse are employed by
7 the same small employer and either one has a normal work week
8 of less than 25 hours.
9
10 3. Offer to eligible small employers the standard and basic
11 health benefit plans. This paragraph subparagraph does not
12 limit a carrier's ability to offer other health benefit plans
13 to small employers if the standard and basic health benefit
14 plans are offered and rejected.
15 (6) RESTRICTIONS RELATING TO PREMIUM RATES.--
16 (b) For all small employer health benefit plans that
17 are subject to this section and are issued by small employer
18 carriers on or after January 1, 1994, premium rates for health
19 benefit plans subject to this section are subject to the
20 following:
21 1. Small employer carriers must use a modified
22 community rating methodology in which the premium for each
23 small employer must be determined solely on the basis of the
24 eligible employee's and eligible dependent's gender, age,
25 family composition, tobacco use, or geographic area as
26 determined under paragraph (5)(j) and may be adjusted as
27 permitted by subparagraphs 5. and 6.
28 2. Rating factors related to age, gender, family
29 composition, tobacco use, or geographic location may be
30 developed by each carrier to reflect the carrier's experience.
31
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1 The factors used by carriers are subject to department review
2 and approval.
3 3. Small employer carriers may not modify the rate for
4 a small employer for 12 months from the initial issue date or
5 renewal date, unless the composition of the group changes or
6 benefits are changed.
7 4. Carriers participating in the alliance program, in
8 accordance with ss. 408.70-408.706, may apply a different
9 community rate to business written in that program.
10 5. Any adjustments in rates for claims experience,
11 health status, or duration of coverage may not be charged to
12 individual employees or dependents. For a small employer's
13 policy, such adjustments may not result in a rate for the
14 small employer which deviates more than 15 percent from the
15 carrier's approved rate. Any such adjustment must be applied
16 uniformly to the rates charged for all employees and
17 dependents of the small employer. A small employer carrier may
18 make an adjustment to a small employer's renewal premium, not
19 to exceed 10 percent annually, due to the claims experience,
20 health status, or duration of coverage of the employees or
21 dependents of the small employer. Semiannually, small group
22 carriers shall report information on forms adopted by rule by
23 the department, to enable the department to monitor the
24 relationship of aggregate adjusted premiums actually charged
25 policyholders by each carrier to the premiums that would have
26 been charged by application of the carrier's approved modified
27 community rates. If the aggregate resulting from the
28 application of such adjustment exceeds the premium that would
29 have been charged by application of the approved modified
30 community rate by 5 percent for the current reporting period,
31 the carrier shall limit the application of such adjustments to
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1 only minus adjustments beginning not more than 60 days after
2 the report is sent to the department. For any subsequent
3 reporting period, if the total aggregate adjusted premium
4 actually charged does not exceed the premium that would have
5 been charged by application of the approved modified community
6 rate by 5 percent, the carrier may apply both plus and minus
7 adjustments.
8 6. A small employer carrier may provide a credit to a
9 small employer's premium based on administrative and
10 acquisition expense differences resulting from the size of the
11 group. Group size administrative and acquisition expense
12 factors may be developed by each carrier to reflect the
13 carrier's experience and are subject to department review and
14 approval.
15 7. A small employer carrier rating methodology may
16 include separate rating categories for one dependent child,
17 for two dependent children, and for three or more dependent
18 children for family coverage of employees having a spouse and
19 dependent children or employees having dependent children
20 only. A small employer carrier may have fewer, but not
21 greater, numbers of categories for dependent children than
22 those specified in this subparagraph.
23 8. Small employer carriers may not use a composite
24 rating methodology to rate a small employer with fewer than 10
25 employees. For the purposes of this subparagraph a "composite
26 rating methodology" means a rating methodology that averages
27 the impact of the rating factors for age and gender in the
28 premiums charged to all of the employees of a small employer.
29 (d) Notwithstanding s. 627.401(2), this section and
30 ss. 627.410 and 627.411 apply to any health benefit plan
31 provided by a small employer carrier that is an insurer, and
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1 this section and s. 641.31 apply to any health benefit
2 provided by a small employer carrier that is a health
3 maintenance organization, that provides coverage to one or
4 more employees of a small employer regardless of where the
5 policy, certificate, or contract is issued or delivered, if
6 the health benefit plan covers employees or their covered
7 dependents who are residents of this state.
8 Section 47. Subsection (6) of section 409.212, Florida
9 Statutes, is renumbered as subsection (7), and new subsection
10 (6) is added to said section to read:
11 409.212 Optional supplementation.--
12 (6) The optional state supplementation rate shall be
13 increased by the cost-of-living adjustment to the federal
14 benefits rate provided the average state optional
15 supplementation contribution does not increase as a result.
16 Section 48. Subsections (3), (15), and (18) of section
17 409.901, Florida Statutes, are amended to read:
18 409.901 Definitions.--As used in ss. 409.901-409.920,
19 except as otherwise specifically provided, the term:
20 (3) "Applicant" means an individual whose written
21 application for medical assistance provided by Medicaid under
22 ss. 409.903-409.906 has been submitted to the Department of
23 Children and Family Services agency, or to the Social Security
24 Administration if the application is for Supplemental Security
25 Income, but has not received final action. This term includes
26 an individual, who need not be alive at the time of
27 application, whose application is submitted through a
28 representative or a person acting for the individual.
29 (15) "Medicaid program" means the program authorized
30 under Title XIX of the federal Social Security Act which
31 provides for payments for medical items or services, or both,
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1 on behalf of any person who is determined by the Department of
2 Children and Family Services, or, for Supplemental Security
3 Income, by the Social Security Administration, to be eligible
4 on the date of service for Medicaid assistance.
5 (18) "Medicaid recipient" or "recipient" means an
6 individual whom the Department of Children and Family
7 Services, or, for Supplemental Security Income, by the Social
8 Security Administration, determines is eligible, pursuant to
9 federal and state law, to receive medical assistance and
10 related services for which the agency may make payments under
11 the Medicaid program. For the purposes of determining
12 third-party liability, the term includes an individual
13 formerly determined to be eligible for Medicaid, an individual
14 who has received medical assistance under the Medicaid
15 program, or an individual on whose behalf Medicaid has become
16 obligated.
17 Section 49. Section 409.902, Florida Statutes, is
18 amended to read:
19 409.902 Designated single state agency; payment
20 requirements; program title.--The Agency for Health Care
21 Administration is designated as the single state agency
22 authorized to make payments for medical assistance and related
23 services under Title XIX of the Social Security Act. These
24 payments shall be made, subject to any limitations or
25 directions provided for in the General Appropriations Act,
26 only for services included in the program, shall be made only
27 on behalf of eligible individuals, and shall be made only to
28 qualified providers in accordance with federal requirements
29 for Title XIX of the Social Security Act and the provisions of
30 state law. This program of medical assistance is designated
31 the "Medicaid program." The Department of Children and Family
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1 Services is responsible for Medicaid eligibility
2 determinations, including, but not limited to, policy, rules,
3 and the agreement with the Social Security Administration for
4 Medicaid eligibility determinations for Supplemental Security
5 Income recipients, as well as the actual determination of
6 eligibility.
7 Section 50. Section 409.903, Florida Statutes, is
8 amended to read:
9 409.903 Mandatory payments for eligible persons.--The
10 agency shall make payments for medical assistance and related
11 services on behalf of the following persons who the
12 department, or the Social Security Administration by contract
13 with the Department of Children and Family Services, agency
14 determines to be eligible, subject to the income, assets, and
15 categorical eligibility tests set forth in federal and state
16 law. Payment on behalf of these Medicaid eligible persons is
17 subject to the availability of moneys and any limitations
18 established by the General Appropriations Act or chapter 216.
19 (1) Low-income families with children are eligible for
20 Medicaid provided they meet the following requirements:
21 (a) The family includes a dependent child who is
22 living with a caretaker relative.
23 (b) The family's income does not exceed the gross
24 income test limit.
25 (c) The family's countable income and resources do not
26 exceed the applicable Aid to Families with Dependent Children
27 (AFDC) income and resource standards under the AFDC state plan
28 in effect in July 1996, except as amended in the Medicaid
29 state plan to conform as closely as possible to the
30 requirements of the WAGES Program as created in s. 414.015, to
31 the extent permitted by federal law.
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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
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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 to be disabled, whose income is at or below 100
11 percent of the most current federal poverty level and whose
12 assets do not exceed limitations established by the agency.
13 However, the agency may only pay for premiums, coinsurance,
14 and deductibles, as required by federal law, unless additional
15 coverage is provided for any or all members of this group by
16 s. 409.904(1).
17 Section 51. Subsection (6) of section 409.905, Florida
18 Statutes, is amended to read:
19 409.905 Mandatory Medicaid services.--The agency may
20 make payments for the following services, which are required
21 of the state by Title XIX of the Social Security Act,
22 furnished by Medicaid providers to recipients who are
23 determined to be eligible on the dates on which the services
24 were provided. Any service under this section shall be
25 provided only when medically necessary and in accordance with
26 state and federal law. Nothing in this section shall be
27 construed to prevent or limit the agency from adjusting fees,
28 reimbursement rates, lengths of stay, number of visits, number
29 of services, or any other adjustments necessary to comply with
30 the availability of moneys and any limitations or directions
31 provided for in the General Appropriations Act or chapter 216.
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1 (6) HOSPITAL OUTPATIENT SERVICES.--The agency shall
2 pay for preventive, diagnostic, therapeutic, or palliative
3 care and other services provided to a recipient in the
4 outpatient portion of a hospital licensed under part I of
5 chapter 395, and provided under the direction of a licensed
6 physician or licensed dentist, except that payment for such
7 care and services is limited to $1,500 $1,000 per state fiscal
8 year per recipient, unless an exception has been made by the
9 agency, and with the exception of a Medicaid recipient under
10 age 21, in which case the only limitation is medical
11 necessity.
12 Section 52. Subsection (5) of section 409.906, Florida
13 Statutes, is amended to read:
14 409.906 Optional Medicaid services.--Subject to
15 specific appropriations, the agency may make payments for
16 services which are optional to the state under Title XIX of
17 the Social Security Act and are furnished by Medicaid
18 providers to recipients who are determined to be eligible on
19 the dates on which the services were provided. Any optional
20 service that is provided shall be provided only when medically
21 necessary and in accordance with state and federal law.
22 Nothing in this section shall be construed to prevent or limit
23 the agency from adjusting fees, reimbursement rates, lengths
24 of stay, number of visits, or number of services, or making
25 any other adjustments necessary to comply with the
26 availability of moneys and any limitations or directions
27 provided for in the General Appropriations Act or chapter 216.
28 If necessary to safeguard the state's systems of providing
29 services to elderly and disabled persons and subject to the
30 notice and review provisions of s. 216.177, the Governor may
31 direct the Agency for Health Care Administration to amend the
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1 Medicaid state plan to delete the optional Medicaid service
2 known as "Intermediate Care Facilities for the Developmentally
3 Disabled." Optional services may include:
4 (5) CASE MANAGEMENT SERVICES.--The agency may pay for
5 primary care case management services rendered to a recipient
6 pursuant to a federally approved waiver, and targeted case
7 management services for specific groups of targeted
8 recipients, for which funding has been provided and which are
9 rendered pursuant to federal guidelines. The agency is
10 authorized to limit reimbursement for targeted case management
11 services in order to comply with any limitations or directions
12 provided for in the General Appropriations Act.
13 Notwithstanding s. 216.292, the Department of Children and
14 Family Services may transfer general funds to the Agency for
15 Health Care Administration to fund state match requirements
16 exceeding the amount specified in the General Appropriations
17 Act for targeted case management services.
18 Section 53. Subsection (7), (9), and (10) of section
19 409.907, Florida Statutes, are amended to read:
20 409.907 Medicaid provider agreements.--The agency may
21 make payments for medical assistance and related services
22 rendered to Medicaid recipients only to an individual or
23 entity who has a provider agreement in effect with the agency,
24 who is performing services or supplying goods in accordance
25 with federal, state, and local law, and who agrees that no
26 person shall, on the grounds of handicap, race, color, or
27 national origin, or for any other reason, be subjected to
28 discrimination under any program or activity for which the
29 provider receives payment from the agency.
30 (7) The agency may require, as a condition of
31 participating in the Medicaid program and before entering into
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1 the provider agreement, that the provider submit information
2 concerning the professional, business, and personal background
3 of the provider and permit an onsite inspection of the
4 provider's service location by agency staff or other personnel
5 designated by the agency to perform assist in this function.
6 Before entering into the provider agreement, or as a condition
7 of continuing in the Medicaid program, the agency and may also
8 require that Medicaid providers reimbursed on a
9 fee-for-services basis or fee schedule basis which is not
10 cost-based, post a surety bond from the provider not to exceed
11 $50,000 or the total amount billed by the provider to the
12 program during the currant or most recent calendar year,
13 whichever is greater. For new providers, the amount of the
14 surety bond shall be determined by the agency based on the
15 provider's estimate of its first year's billing. If the
16 provider's billing during the first year exceeds the bond
17 amount, the agency may require the provider to acquire an
18 additional bond equal to the actual billing level of the
19 provider. A provider's bond shall not exceed $50,000 if a
20 physician or group of physicians licensed under chapter 458,
21 chapter 459, or chapter 460 has a 50 percent or greater
22 ownership interest in the provider or if the provider is an
23 assisted living facility licensed under part III of chapter
24 400. The bonds permitted by this section are in addition to
25 the bonds referenced in s. 400.179(4)(d). If the provider is a
26 corporation, partnership, association, or other entity, the
27 agency may require the provider to submit information
28 concerning the background of that entity and of any principal
29 of the entity, including any partner or shareholder having an
30 ownership interest in the entity equal to 5 percent or
31 greater, and any treating provider who participates in or
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1 intends to participate in Medicaid through the entity. The
2 information must include:
3 (a) Proof of holding a valid license or operating
4 certificate, as applicable, if required by the state or local
5 jurisdiction in which the provider is located or if required
6 by the Federal Government.
7 (b) Information concerning any prior violation, fine,
8 suspension, termination, or other administrative action taken
9 under the Medicaid laws, rules, or regulations of this state
10 or of any other state or the Federal Government; any prior
11 violation of the laws, rules, or regulations relating to the
12 Medicare program; any prior violation of the rules or
13 regulations of any other public or private insurer; and any
14 prior violation of the laws, rules, or regulations of any
15 regulatory body of this or any other state.
16 (c) Full and accurate disclosure of any financial or
17 ownership interest that the provider, or any principal,
18 partner, or major shareholder thereof, may hold in any other
19 Medicaid provider or health care related entity or any other
20 entity that is licensed by the state to provide health or
21 residential care and treatment to persons.
22 (d) If a group provider, identification of all members
23 of the group and attestation that all members of the group are
24 enrolled in or have applied to enroll in the Medicaid program.
25 (9) Upon receipt of a completed, signed, and dated
26 application, and completion of any necessary background
27 investigation and criminal history record check, the agency
28 must either:
29 (a) Enroll the applicant as a Medicaid provider; or
30 (b) Deny the application if the agency finds that,
31 based on the grounds listed in subsection (10), it is in the
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1 best interest of the Medicaid program to do so, specifying the
2 reasons for denial. The agency may consider the factors listed
3 in subsection (10), as well as any other factor that could
4 affect the effective and efficient administration of the
5 program, including, but not limited to, the current
6 availability of medical care, services, or supplies to
7 recipients, taking into account geographic location and
8 reasonable travel time.
9 (10) The agency may consider whether deny enrollment
10 in the Medicaid program to a provider if the provider, or any
11 officer, director, agent, managing employee, or affiliated
12 person, or any partner or shareholder having an ownership
13 interest equal to 5 percent or greater in the provider if the
14 provider is a corporation, partnership, or other business
15 entity, has:
16 (a) Made a false representation or omission of any
17 material fact in making the application, including the
18 submission of an application that conceals the controlling or
19 ownership interest of any officer, director, agent, managing
20 employee, affiliated person, or partner or shareholder who may
21 not be eligible to participate;
22 (b) Been or is currently excluded, suspended,
23 terminated from, or has involuntarily withdrawn from
24 participation in, Florida's Medicaid program or any other
25 state's Medicaid program, or from participation in any other
26 governmental or private health care or health insurance
27 program;
28 (c) Been convicted of a criminal offense relating to
29 the delivery of any goods or services under Medicaid or
30 Medicare or any other public or private health care or health
31 insurance program including the performance of management or
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1 administrative services relating to the delivery of goods or
2 services under any such program;
3 (d) Been convicted under federal or state law of a
4 criminal offense related to the neglect or abuse of a patient
5 in connection with the delivery of any health care goods or
6 services;
7 (e) Been convicted under federal or state law of a
8 criminal offense relating to the unlawful manufacture,
9 distribution, prescription, or dispensing of a controlled
10 substance;
11 (f) Been convicted of any criminal offense relating to
12 fraud, theft, embezzlement, breach of fiduciary
13 responsibility, or other financial misconduct;
14 (g) Been convicted under federal or state law of a
15 crime punishable by imprisonment of a year or more which
16 involves moral turpitude;
17 (h) Been convicted in connection with the interference
18 or obstruction of any investigation into any criminal offense
19 listed in this subsection;
20 (i) Been found to have violated federal or state laws,
21 rules, or regulations governing Florida's Medicaid program or
22 any other state's Medicaid program, the Medicare program, or
23 any other publicly funded federal or state health care or
24 health insurance program, and been sanctioned accordingly;
25 (j) Been previously found by a licensing, certifying,
26 or professional standards board or agency to have violated the
27 standards or conditions relating to licensure or certification
28 or the quality of services provided; or
29 (k) Failed to pay any fine or overpayment properly
30 assessed under the Medicaid program in which no appeal is
31 pending or after resolution of the proceeding by stipulation
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1 or agreement, unless the agency has issued a specific letter
2 of forgiveness or has approved a repayment schedule to which
3 the provider agrees to adhere.
4 Section 54. Paragraph (a) of subsection (1) of section
5 409.908, Florida Statutes, is amended to read:
6 409.908 Reimbursement of Medicaid providers.--Subject
7 to specific appropriations, the agency shall reimburse
8 Medicaid providers, in accordance with state and federal law,
9 according to methodologies set forth in the rules of the
10 agency and in policy manuals and handbooks incorporated by
11 reference therein. These methodologies may include fee
12 schedules, reimbursement methods based on cost reporting,
13 negotiated fees, competitive bidding pursuant to s. 287.057,
14 and other mechanisms the agency considers efficient and
15 effective for purchasing services or goods on behalf of
16 recipients. Payment for Medicaid compensable services made on
17 behalf of Medicaid eligible persons is subject to the
18 availability of moneys and any limitations or directions
19 provided for in the General Appropriations Act or chapter 216.
20 Further, nothing in this section shall be construed to prevent
21 or limit the agency from adjusting fees, reimbursement rates,
22 lengths of stay, number of visits, or number of services, or
23 making any other adjustments necessary to comply with the
24 availability of moneys and any limitations or directions
25 provided for in the General Appropriations Act, provided the
26 adjustment is consistent with legislative intent.
27 (1) Reimbursement to hospitals licensed under part I
28 of chapter 395 must be made prospectively or on the basis of
29 negotiation.
30 (a) Reimbursement for inpatient care is limited as
31 provided for in s. 409.905(5). Reimbursement for hospital
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1 outpatient care is limited to $1,500 $1,000 per state fiscal
2 year per recipient, except for:
3 1. Such care provided to a Medicaid recipient under
4 age 21, in which case the only limitation is medical
5 necessity;
6 2. Renal dialysis services; and
7 3. Other exceptions made by the agency.
8 Section 55. Section 409.9119, Florida Statutes, is
9 created to read:
10 409.9119 Disproportionate share program for children's
11 hospitals.--In addition to the payments made under s. 409.911,
12 the Agency for Health Care Administration shall develop and
13 implement a system under which disproportionate share payments
14 are made to those hospitals that are licensed by the state as
15 a children's hospital. This system of payments must conform to
16 federal requirements and must distribute funds in each fiscal
17 year for which an appropriation is made by making quarterly
18 Medicaid payments. Notwithstanding s. 409.915, counties are
19 exempt from contributing toward the cost of this special
20 reimbursement for hospitals that serve a disproportionate
21 share of low-income patients.
22 (1) The agency shall use the following formula to
23 calculate the total amount earned for hospitals that
24 participate in the children's hospital disproportionate share
25 program:
26 TAE = DSR x BMPD x MD
27 Where:
28 TAE = total amount earned by a children's hospital.
29 DSR = disproportionate share rate.
30 BMPD = base Medicaid per diem.
31 MD = Medicaid days.
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1 (2) The agency shall calculate the total additional
2 payment for hospitals that participate in the children's
3 hospital disproportionate share program as follows:
4
5 TAP = (TAE x TA)
6
7 STAE
8 Where:
9 TAP = total additional payment for a children's
10 hospital.
11 TAE = total amount earned by a children's hospital.
12 STAE = sum of total amount earned by each hospital that
13 participates in the children's hospital disproportionate share
14 program.
15 TA = total appropriation for the children's hospital
16 disproportionate share program.
17
18 (3) A hospital may not receive any payments under this
19 section until it achieves full compliance with the applicable
20 rules of the agency. A hospital that is not in compliance for
21 two or more consecutive quarters may not receive its share of
22 the funds. Any forfeited funds must be distributed to the
23 remaining participating children's hospitals that are in
24 compliance.
25 Section 56. Section 409.919, Florida Statutes, is
26 amended to read:
27 409.919 Rules.--The agency shall adopt any rules
28 necessary to comply with or administer ss. 409.901-409.920 and
29 all rules necessary to comply with federal requirements. In
30 addition, the Department of Children and Family Services shall
31 adopt and accept transfer of any rules necessary to carry out
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1 its responsibilities for receiving and processing Medicaid
2 applications and determining Medicaid eligibility, and for
3 assuring compliance with and administering ss. 409.901-409.906
4 and any other provisions related to responsibility for the
5 determination of Medicaid eligibility.
6 Section 57. Notwithstanding the provisions of ss.
7 236.0812, 409.9071, and 409.908(21), Florida Statutes,
8 developmental research schools, as authorized under s.
9 228.053, Florida Statutes, shall be authorized to participate
10 in the Medicaid certified school match program subject to the
11 provisions of ss. 236.0812, 409.9071, and 409.908(21), Florida
12 Statutes.
13 Section 58. (1) The Agency for Health Care
14 Administration is directed to submit to the Health Care
15 Financing Administration a request for a waiver that will
16 allow the agency to undertake a pilot project that would
17 implement a coordinated system of care for adult ventilator
18 dependent patients. Under this pilot program, the agency shall
19 identify a network of skilled nursing facilities that have
20 respiratory departments geared towards intensive treatment and
21 rehabilitation of adult ventilator patients and will contract
22 with such a network for respiratory services under a
23 capitation arrangement. The pilot project must allow the
24 agency to evaluate a coordinated and focused system of care
25 for adult ventilator dependent patients to determine the
26 overall cost-effectiveness and improved outcomes for
27 participants.
28 (2) The agency shall submit the waiver by September 1,
29 2000. The agency shall forward a preliminary report of the
30 pilot project's findings to the Governor, the Speaker of the
31 House of Representatives, and the President of the Senate 6
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1 months after project implementation. The agency shall submit
2 a final report of the pilot project's findings to the
3 Governor, the Speaker of the House of Representatives, and the
4 President of the Senate no later than February 15, 2002.
5 Section 59. Subsection (3) of section 400.464 and
6 paragraph (b) of subsection (4) of section 409.912, Florida
7 Statutes, are repealed.
8 Section 60. Effective October 1, 2000, subsection (3)
9 of section 408.70 and sections 408.701, 408.702, 408.703,
10 408.704, 408.7041, 408.7042, 408.7045, 408.7055, and 408.706,
11 Florida Statutes, are repealed.
12 Section 61. The sum of $91,000 in nonrecurring general
13 revenue is hereby appropriated from the General Revenue Fund
14 to the Department of Health to cover costs of the Florida
15 Commission on Excellence in Health Care relating to the travel
16 and related expenses of staff, consumer members, and members
17 appointed by the department or agency; the hiring of
18 consultants, if necessary; and the reproduction and
19 dissemination of documents; however, no portion of this
20 appropriation shall be effective that duplicates a similar
21 appropriation for the same purpose contained in other
22 legislation from the 2000 legislative session that becomes
23 law.
24 Section 62. The sum of $200,000 is appropriated from
25 the Insurance Commissioner's Regulatory Trust Fund to the
26 Office of Legislative Services for the purpose of implementing
27 the legislative intent expressed in s. 624.215(1), Florida
28 Statutes, for a systematic review of current mandated health
29 coverages. The review must be conducted by certified actuaries
30 and other appropriate professionals and shall consist of an
31 assessment of the impact, including, but not limited to, the
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1 costs and benefits, of current mandated health coverages using
2 the guidelines provided in s. 624.215(2), Florida Statutes.
3 This assessment shall establish the aggregate cost of mandated
4 health coverages.
5 Section 63. The General Appropriations Act for Fiscal
6 Year 2000-2001 shall be reduced by four full-time-equivalent
7 positions and $260,719 from the Health Care Trust Fund in the
8 Agency for Health Care Administration for purposes of
9 implementing the provisions of this act; however, the
10 reductions shall not be effective if duplicative of similar
11 reductions for the same purpose contained in other legislation
12 from the 2000 legislative session that becomes law.
13 Section 64. Except as otherwise provided herein, this
14 act shall take effect July 1, 2000.
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