Senate Bill sb0026Bc1
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Florida Senate - 2001 CS for SB 26-B
By the Committee on Appropriations; and Senator Silver
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1 A bill to be entitled
2 An act relating to the Agency for Health Care
3 Administration; amending s. 409.903, F.S.;
4 revising standards for eligibility for certain
5 mandatory medical assistance; repealing s.
6 409.904(11), F.S., which provides eligibility
7 of specified persons for certain optional
8 medical assistance; amending s. 409.904, F.S.;
9 revising standards for eligibility for certain
10 optional medical assistance; amending s.
11 409.906, F.S.; revising eligibility for certain
12 Medicaid services and methods of delivering
13 services; amending s. 409.9065, F.S.;
14 prescribing additional eligibility standards
15 with respect to pharmaceutical expense
16 assistance; amending s. 409.907, F.S.;
17 authorizing withholding of Medicaid payments in
18 certain circumstances; prescribing additional
19 requirements with respect to providers'
20 submission of information; prescribing
21 additional duties for the agency with respect
22 to provider applications; amending s. 409.9116,
23 F.S.; revising the disproportionate share
24 programs for rural hospitals; eliminating
25 financial assistance program for certain rural
26 hospitals; amending s. 409.912, F.S.; revising
27 the reimbursement rate to pharmacies for
28 Medicaid prescribed drugs; amending s. 409.913,
29 F.S.; prescribing additional sanctions that may
30 be imposed upon a Medicaid provider;
31 eliminating a limit on costs that may be
1
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1 recovered against a provider; amending s.
2 409.915, F.S.; revising the limit on a county's
3 payment for certain Medicaid costs; providing
4 that the act fulfills an important state
5 interest; amending s. 409.908, F.S.; revising
6 pharmacy dispensing fees for Medicaid drugs;
7 repealing s. 400.0225, F.S., relating to
8 consumer-satisfaction surveys; amending s.
9 400.191, F.S.; eliminating a provision relating
10 to consumer-satisfaction and
11 family-satisfaction surveys; amending s.
12 400.235, F.S.; eliminating a provision relating
13 to participation in the consumer-satisfaction
14 process; repealing s. 400.148, F.S., relating
15 to the Medicaid "Up-or-Out" Quality of Care
16 Contract Management Program; amending s.
17 400.071, F.S.; eliminating a provision relating
18 to participation in a
19 consumer-satisfaction-measurement process;
20 amending s. 409.815, F.S.; conforming a
21 cross-reference; providing effective dates.
22
23 Be It Enacted by the Legislature of the State of Florida:
24
25 Section 1. Effective July 1, 2002, subsection (5) of
26 section 409.903, Florida Statutes, is amended to read:
27 409.903 Mandatory payments for eligible persons.--The
28 agency shall make payments for medical assistance and related
29 services on behalf of the following persons who the
30 department, or the Social Security Administration by contract
31 with the Department of Children and Family Services,
2
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1 determines to be eligible, subject to the income, assets, and
2 categorical eligibility tests set forth in federal and state
3 law. Payment on behalf of these Medicaid eligible persons is
4 subject to the availability of moneys and any limitations
5 established by the General Appropriations Act or chapter 216.
6 (5) A pregnant woman for the duration of her pregnancy
7 and for the postpartum period as defined in federal law and
8 rule, or a child under age 1, if she either is living in a
9 family that has an income which is at or below 150 percent of
10 the most current federal poverty level, or a child under age
11 1, if the child is living in a family or, effective January 1,
12 1992, that has an income which is at or below 185 percent of
13 the most current federal poverty level. Such a person is not
14 subject to an assets test. Further, a pregnant woman who
15 applies for eligibility for the Medicaid program through a
16 qualified Medicaid provider must be offered the opportunity,
17 subject to federal rules, to be made presumptively eligible
18 for the Medicaid program.
19 Section 2. Subsection (11) of section 409.904, Florida
20 Statutes, is repealed.
21 Section 3. Effective July 1, 2002, subsections (2) and
22 (5) of section 409.904, Florida Statutes, are amended to read:
23 409.904 Optional payments for eligible persons.--The
24 agency may make payments for medical assistance and related
25 services on behalf of the following persons who are determined
26 to be eligible subject to the income, assets, and categorical
27 eligibility tests set forth in federal and state law. Payment
28 on behalf of these Medicaid eligible persons is subject to the
29 availability of moneys and any limitations established by the
30 General Appropriations Act or chapter 216.
31
3
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1 (2)(a) A pregnant woman who would otherwise qualify
2 for Medicaid under s. 409.903(5) except for her level of
3 income and whose assets fall within the limits established by
4 the Department of Children and Family Services for the
5 medically needy. A pregnant woman who applies for medically
6 needy eligibility may not be made presumptively eligible.
7 (b) A child under age 21 who would otherwise qualify
8 for Medicaid or the Florida Kidcare program except for the
9 family's level of income and whose assets fall within the
10 limits established by the Department of Children and Family
11 Services for the medically needy. A family, a pregnant woman,
12 a child under age 18, a person age 65 or over, or a blind or
13 disabled person who would be eligible under any group listed
14 in s. 409.903(1), (2), or (3), except that the income or
15 assets of such family or person exceed established
16 limitations.
17
18 For a family or person in this group, medical expenses are
19 deductible from income in accordance with federal requirements
20 in order to make a determination of eligibility. A family or
21 person in this group, which group is known as the "medically
22 needy," is eligible to receive the same services as other
23 Medicaid recipients, with the exception of services in skilled
24 nursing facilities and intermediate care facilities for the
25 developmentally disabled.
26 (5) Subject to specific federal authorization, a
27 postpartum woman living in a family that has an income that is
28 at or below 150 185 percent of the most current federal
29 poverty level is eligible for family planning services as
30 specified in s. 409.905(3) for a period of up to 24 months
31
4
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1 following a pregnancy for which Medicaid paid for
2 pregnancy-related services.
3 Section 4. Effective July 1, 2002, subsections (1),
4 (12), and (23) of section 409.906, Florida Statutes, are
5 amended to read:
6 409.906 Optional Medicaid services.--Subject to
7 specific appropriations, the agency may make payments for
8 services which are optional to the state under Title XIX of
9 the Social Security Act and are furnished by Medicaid
10 providers to recipients who are determined to be eligible on
11 the dates on which the services were provided. Any optional
12 service that is provided shall be provided only when medically
13 necessary and in accordance with state and federal law.
14 Optional services rendered by providers in mobile units to
15 Medicaid recipients may be restricted or prohibited by the
16 agency. Nothing in this section shall be construed to prevent
17 or limit the agency from adjusting fees, reimbursement rates,
18 lengths of stay, number of visits, or number of services, or
19 making any other adjustments necessary to comply with the
20 availability of moneys and any limitations or directions
21 provided for in the General Appropriations Act or chapter 216.
22 If necessary to safeguard the state's systems of providing
23 services to elderly and disabled persons and subject to the
24 notice and review provisions of s. 216.177, the Governor may
25 direct the Agency for Health Care Administration to amend the
26 Medicaid state plan to delete the optional Medicaid service
27 known as "Intermediate Care Facilities for the Developmentally
28 Disabled." Optional services may include:
29 (1) ADULT DENTURE SERVICES.--The agency may pay for
30 dentures, the procedures required to seat dentures, and the
31 repair and reline of dentures, provided by or under the
5
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1 direction of a licensed dentist, for a recipient who is age 21
2 or older. However, Medicaid will not provide reimbursement for
3 dental services provided in a mobile dental unit, except for a
4 mobile dental unit:
5 (a) Owned by, operated by, or having a contractual
6 agreement with the Department of Health and complying with
7 Medicaid's county health department clinic services program
8 specifications as a county health department clinic services
9 provider.
10 (b) Owned by, operated by, or having a contractual
11 arrangement with a federally qualified health center and
12 complying with Medicaid's federally qualified health center
13 specifications as a federally qualified health center
14 provider.
15 (c) Rendering dental services to Medicaid recipients,
16 21 years of age and older, at nursing facilities.
17 (d) Owned by, operated by, or having a contractual
18 agreement with a state-approved dental educational
19 institution.
20 (e) This subsection is repealed July 1, 2002.
21 (12) CHILDREN'S HEARING SERVICES.--The agency may pay
22 for hearing and related services, including hearing
23 evaluations, hearing aid devices, dispensing of the hearing
24 aid, and related repairs, if provided to a recipient under age
25 21 by a licensed hearing aid specialist, otolaryngologist,
26 otologist, audiologist, or physician.
27 (23) CHILDREN'S VISUAL SERVICES.--The agency may pay
28 for visual examinations, eyeglasses, and eyeglass repairs for
29 a recipient under age 21, if they are prescribed by a licensed
30 physician specializing in diseases of the eye or by a licensed
31 optometrist.
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1 Section 5. Subsection (20) of section 409.906, Florida
2 Statutes, is amended to read:
3 409.906 Optional Medicaid services.--Subject to
4 specific appropriations, the agency may make payments for
5 services which are optional to the state under Title XIX of
6 the Social Security Act and are furnished by Medicaid
7 providers to recipients who are determined to be eligible on
8 the dates on which the services were provided. Any optional
9 service that is provided shall be provided only when medically
10 necessary and in accordance with state and federal law.
11 Optional services rendered by providers in mobile units to
12 Medicaid recipients may be restricted or prohibited by the
13 agency. Nothing in this section shall be construed to prevent
14 or limit the agency from adjusting fees, reimbursement rates,
15 lengths of stay, number of visits, or number of services, or
16 making any other adjustments necessary to comply with the
17 availability of moneys and any limitations or directions
18 provided for in the General Appropriations Act or chapter 216.
19 If necessary to safeguard the state's systems of providing
20 services to elderly and disabled persons and subject to the
21 notice and review provisions of s. 216.177, the Governor may
22 direct the Agency for Health Care Administration to amend the
23 Medicaid state plan to delete the optional Medicaid service
24 known as "Intermediate Care Facilities for the Developmentally
25 Disabled." Optional services may include:
26 (20) PRESCRIBED DRUG SERVICES.--The agency may pay for
27 medications that are prescribed for a recipient by a physician
28 or other licensed practitioner of the healing arts authorized
29 to prescribe medications and that are dispensed to the
30 recipient by a licensed pharmacist or physician in accordance
31 with applicable state and federal law. The agency may use
7
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1 mail-order pharmacy services for dispensing drugs. For adults
2 eligible through the medically needy program, pharmacies must
3 dispense a generic drug for a product prescribed for a
4 beneficiary if a generic product exists for the product
5 prescribed.
6 Section 6. Subsections (3) and (5) of section
7 409.9065, Florida Statutes, are amended to read:
8 409.9065 Pharmaceutical expense assistance.--
9 (3) BENEFITS.--Medications covered under the
10 pharmaceutical expense assistance program are those covered
11 under the Medicaid program in s. 409.906(19) s. 409.906(20).
12 Monthly benefit payments shall be limited to $80 per program
13 participant. Participants are required to make a 10-percent
14 coinsurance payment for each prescription purchased through
15 this program.
16 (5) NONENTITLEMENT.--The pharmaceutical expense
17 assistance program established by this section is not an
18 entitlement. Enrollment levels are limited to those authorized
19 by the Legislature in the annual General Appropriations Act.
20 If funds are insufficient to serve all individuals eligible
21 under subsection (2) and seeking coverage, the agency may
22 develop a waiting list based on application dates to use in
23 enrolling individuals in unfilled enrollment slots.
24 Section 7. Effective upon this act becoming a law,
25 paragraph (a) of subsection (5) and subsections (7) and (9) of
26 section 409.907, Florida Statutes, are amended to read:
27 409.907 Medicaid provider agreements.--The agency may
28 make payments for medical assistance and related services
29 rendered to Medicaid recipients only to an individual or
30 entity who has a provider agreement in effect with the agency,
31 who is performing services or supplying goods in accordance
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1 with federal, state, and local law, and who agrees that no
2 person shall, on the grounds of handicap, race, color, or
3 national origin, or for any other reason, be subjected to
4 discrimination under any program or activity for which the
5 provider receives payment from the agency.
6 (5) The agency:
7 (a) Is required to make timely payment at the
8 established rate for services or goods furnished to a
9 recipient by the provider upon receipt of a properly completed
10 claim form. The claim form shall require certification that
11 the services or goods have been completely furnished to the
12 recipient and that, with the exception of those services or
13 goods specified by the agency, the amount billed does not
14 exceed the provider's usual and customary charge for the same
15 services or goods. When a provider is under an active fraud or
16 abuse investigation by the agency, the agency may withhold
17 payment to that provider for any pending claim until the
18 conclusion of the investigation. When exercising the
19 provisions of this paragraph, the agency must timely complete
20 its investigation.
21 (7) The agency may require, as a condition of
22 participating in the Medicaid program and before entering into
23 the provider agreement, that the provider submit information,
24 in an initial and any required renewal applications,
25 concerning the professional, business, and personal background
26 of the provider and permit an onsite inspection of the
27 provider's service location by agency staff or other personnel
28 designated by the agency to perform this function. Before
29 entering into the provider agreement, or as a condition of
30 continuing participation in the Medicaid program, the agency
31 may also require that Medicaid providers reimbursed on a
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1 fee-for-services basis or fee schedule basis which is not
2 cost-based, post a surety bond not to exceed $50,000 or the
3 total amount billed by the provider to the program during the
4 current or most recent calendar year, whichever is greater.
5 For new providers, the amount of the surety bond shall be
6 determined by the agency based on the provider's estimate of
7 its first year's billing. If the provider's billing during the
8 first year exceeds the bond amount, the agency may require the
9 provider to acquire an additional bond equal to the actual
10 billing level of the provider. A provider's bond shall not
11 exceed $50,000 if a physician or group of physicians licensed
12 under chapter 458, chapter 459, or chapter 460 has a 50
13 percent or greater ownership interest in the provider or if
14 the provider is an assisted living facility licensed under
15 part III of chapter 400. The bonds permitted by this section
16 are in addition to the bonds referenced in s. 400.179(4)(d).
17 If the provider is a corporation, partnership, association, or
18 other entity, the agency may require the provider to submit
19 information concerning the background of that entity and of
20 any principal of the entity, including any partner or
21 shareholder having an ownership interest in the entity equal
22 to 5 percent or greater, and any treating provider who
23 participates in or intends to participate in Medicaid through
24 the entity. The information must include:
25 (a) Proof of holding a valid license or operating
26 certificate, as applicable, if required by the state or local
27 jurisdiction in which the provider is located or if required
28 by the Federal Government.
29 (b) Information concerning any prior violation, fine,
30 suspension, termination, or other administrative action taken
31 under the Medicaid laws, rules, or regulations of this state
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1 or of any other state or the Federal Government; any prior
2 violation of the laws, rules, or regulations relating to the
3 Medicare program; any prior violation of the rules or
4 regulations of any other public or private insurer; and any
5 prior violation of the laws, rules, or regulations of any
6 regulatory body of this or any other state.
7 (c) Full and accurate disclosure of any financial or
8 ownership interest that the provider, or any principal,
9 partner, or major shareholder thereof, may hold in any other
10 Medicaid provider or health care related entity or any other
11 entity that is licensed by the state to provide health or
12 residential care and treatment to persons.
13 (d) If a group provider, identification of all members
14 of the group and attestation that all members of the group are
15 enrolled in or have applied to enroll in the Medicaid program.
16 (9) Upon receipt of a completed, signed, and dated
17 application, and completion of any necessary background
18 investigation and criminal history record check, the agency
19 must either:
20 (a) Enroll the applicant as a Medicaid provider no
21 earlier than the effective date of the approval of the
22 provider application; or
23 (b) Deny the application if the agency finds that it
24 is in the best interest of the Medicaid program to do so. The
25 agency may consider the factors listed in subsection (10), as
26 well as any other factor that could affect the effective and
27 efficient administration of the program, including, but not
28 limited to, the current availability of medical care,
29 services, or supplies to recipients, taking into account
30 geographic location and reasonable travel time; the number of
31 providers of the same type already enrolled in the same
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1 geographic area; and the credentials, experience, success, and
2 patient outcomes of the provider for the services that it is
3 making application to provide in the Medicaid program.
4 Section 8. Section 409.9116, Florida Statutes, is
5 amended to read:
6 409.9116 Disproportionate share share/financial
7 assistance program for rural hospitals.--In addition to the
8 payments made under s. 409.911, the Agency for Health Care
9 Administration shall administer a federally matched
10 disproportionate share program and a state-funded financial
11 assistance program for statutory rural hospitals. The agency
12 shall make disproportionate share payments to statutory rural
13 hospitals that qualify for such payments and financial
14 assistance payments to statutory rural hospitals that do not
15 qualify for disproportionate share payments. The
16 disproportionate share program payments shall be limited by
17 and conform with federal requirements. Funds shall be
18 distributed quarterly in each fiscal year for which an
19 appropriation is made. Notwithstanding the provisions of s.
20 409.915, counties are exempt from contributing toward the cost
21 of this special reimbursement for hospitals serving a
22 disproportionate share of low-income patients.
23 (1) The following formula shall be used by the agency
24 to calculate the total amount earned for hospitals that
25 participate in the rural hospital disproportionate share
26 program or the financial assistance program:
27
28 TAERH = (CCD + MDD)/TPD
29
30 Where:
31
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1 CCD = total charity care-other, plus charity
2 care-Hill-Burton, minus 50 percent of unrestricted tax revenue
3 from local governments, and restricted funds for indigent
4 care, divided by gross revenue per adjusted patient day;
5 however, if CCD is less than zero, then zero shall be used for
6 CCD.
7 MDD = Medicaid inpatient days plus Medicaid HMO
8 inpatient days.
9 TPD = total inpatient days.
10 TAERH = total amount earned by each rural hospital.
11
12 In computing the total amount earned by each rural hospital,
13 the agency must use the most recent actual data reported in
14 accordance with s. 408.061(4)(a).
15 (2) The agency shall use the following formula for
16 distribution of funds for the disproportionate share
17 share/financial assistance program for rural hospitals.
18 (a) The agency shall first determine a preliminary
19 payment amount for each rural hospital by allocating all
20 available state funds using the following formula:
21
22 PDAER = (TAERH x TARH)/STAERH
23
24 Where:
25 PDAER = preliminary distribution amount for each rural
26 hospital.
27 TAERH = total amount earned by each rural hospital.
28 TARH = total amount appropriated or distributed under
29 this section.
30 STAERH = sum of total amount earned by each rural
31 hospital.
13
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1 (b) Federal matching funds for the disproportionate
2 share program shall then be calculated for those hospitals
3 that qualify for disproportionate share in paragraph (a).
4 (c) Any state funds not spent due to an individual
5 hospital's disproportionate-share limit will be redistributed
6 proportionately to those hospitals with an available
7 disproportionate-share limit to maximize available federal
8 funds.
9 (c) The state-funds-only payment amount shall then be
10 calculated for each hospital using the formula:
11
12 SFOER = Maximum value of (1) SFOL - PDAER or (2) 0
13
14 Where:
15 SFOER = state-funds-only payment amount for each rural
16 hospital.
17 SFOL = state-funds-only payment level, which is set at
18 4 percent of TARH.
19
20 In calculating the SFOER, PDAER includes federal matching
21 funds from paragraph (b).
22 (d) The adjusted total amount allocated to the rural
23 disproportionate share program shall then be calculated using
24 the following formula:
25
26 ATARH = (TARH - SSFOER)
27
28 Where:
29 ATARH = adjusted total amount appropriated or
30 distributed under this section.
31
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1 SSFOER = sum of the state-funds-only payment amount
2 calculated under paragraph (c) for all rural hospitals.
3 (e) The distribution of the adjusted total amount of
4 rural disproportionate share hospital funds shall then be
5 calculated using the following formula:
6
7 DAERH = [(TAERH x ATARH)/STAERH]
8
9 Where:
10 DAERH = distribution amount for each rural hospital.
11 (d)(f) Federal matching funds for the disproportionate
12 share program shall then be calculated for those hospitals
13 that qualify for disproportionate share in paragraph (a) (e).
14 (g) State-funds-only payment amounts calculated under
15 paragraph (c) and corresponding federal matching funds are
16 then added to the results of paragraph (f) to determine the
17 total distribution amount for each rural hospital.
18 (3) The Agency for Health Care Administration may
19 recommend to the Legislature a formula to be used in
20 subsequent fiscal years to distribute funds appropriated for
21 this section that includes charity care, uncompensated care to
22 medically indigent patients, and Medicaid inpatient days.
23 (4) In the event that federal matching funds for the
24 rural hospital disproportionate share program are not
25 available, state matching funds appropriated for the program
26 may be utilized for the Rural Hospital Financial Assistance
27 Program and shall be allocated to rural hospitals based on the
28 formulas in subsections (1) and (2).
29 (5) In order to receive payments under this section, a
30 hospital must be a rural hospital as defined in s. 395.602 and
31 must meet the following additional requirements:
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1 (a) Agree to conform to all agency requirements to
2 ensure high quality in the provision of services, including
3 criteria adopted by agency rule concerning staffing ratios,
4 medical records, standards of care, equipment, space, and such
5 other standards and criteria as the agency deems appropriate
6 as specified by rule.
7 (b) Agree to accept all patients, regardless of
8 ability to pay, on a functional space-available basis.
9 (c) Agree to provide backup and referral services to
10 the county public health departments and other low-income
11 providers within the hospital's service area, including the
12 development of written agreements between these organizations
13 and the hospital.
14 (d) For any hospital owned by a county government
15 which is leased to a management company, agree to submit on a
16 quarterly basis a report to the agency, in a format specified
17 by the agency, which provides a specific accounting of how all
18 funds dispersed under this act are spent.
19 (6) For the 2000-2001 fiscal year only, the Agency for
20 Health Care Administration shall use the following formula for
21 distribution of the funds in Specific Appropriation 212 of the
22 2000-2001 General Appropriations Act for the disproportionate
23 share/financial assistance program for rural hospitals.
24 (a) The agency shall first determine a preliminary
25 payment amount for each rural hospital by allocating all
26 available state funds using the following formula:
27
28 PDAER = (TAERH x TARH)/STAERH
29
30 Where:
31
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1 PDAER = preliminary distribution amount for each rural
2 hospital.
3 TAERH = total amount earned by each rural hospital.
4 TARH = total amount appropriated or distributed under
5 this section.
6 STAERH = sum of total amount earned by each rural
7 hospital.
8 (b) Federal matching funds for the disproportionate
9 share program shall then be calculated for those hospitals
10 that qualify for disproportionate share in paragraph (a).
11 (c) The state-funds-only payment amount is then
12 calculated for each hospital using the formula:
13
14 SFOER = Maximum value of (1) SFOL - PDAER or (2) 0
15
16 Where:
17 SFOER = state-funds-only payment amount for each rural
18 hospital.
19 SFOL = state-funds-only payment level, which is set at
20 4 percent of TARH.
21 (d) The adjusted total amount allocated to the rural
22 disproportionate share program shall then be calculated using
23 the following formula:
24
25 ATARH = (TARH - SSFOER)
26
27 Where:
28 ATARH = adjusted total amount appropriated or
29 distributed under this section.
30 SSFOER = sum of the state-funds-only payment amount
31 calculated under paragraph (c) for all rural hospitals.
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1 (e) The determination of the amount of rural
2 disproportionate share hospital funds is calculated by the
3 following formula:
4
5 TDAERH = [(TAERH x ATARH)/STAERH]
6
7 Where:
8 TDAERH = total distribution amount for each rural
9 hospital.
10 (f) Federal matching funds for the disproportionate
11 share program shall then be calculated for those hospitals
12 that qualify for disproportionate share in paragraph (e).
13 (g) State-funds-only payment amounts calculated under
14 paragraph (c) are then added to the results of paragraph (f)
15 to determine the total distribution amount for each rural
16 hospital.
17 (h) This subsection is repealed on July 1, 2001.
18 (6)(7) This section applies only to hospitals that
19 were defined as statutory rural hospitals, or their
20 successor-in-interest hospital, prior to July 1, 1998. Any
21 additional hospital that is defined as a statutory rural
22 hospital, or its successor-in-interest hospital, on or after
23 July 1, 1998, is not eligible for programs under this section
24 unless additional funds are appropriated each fiscal year
25 specifically to the rural hospital disproportionate share
26 programs and financial assistance programs in an amount
27 necessary to prevent any hospital, or its
28 successor-in-interest hospital, eligible for the programs
29 prior to July 1, 1998, from incurring a reduction in payments
30 because of the eligibility of an additional hospital to
31 participate in the programs. A hospital, or its
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1 successor-in-interest hospital, which received funds pursuant
2 to this section before July 1, 1998, and which qualifies under
3 s. 395.602(2)(e), shall be included in the programs under this
4 section and is not required to seek additional appropriations
5 under this subsection.
6 Section 9. Paragraph (a) of subsection (37) of section
7 409.912, Florida Statutes, is amended to read:
8 409.912 Cost-effective purchasing of health care.--The
9 agency shall purchase goods and services for Medicaid
10 recipients in the most cost-effective manner consistent with
11 the delivery of quality medical care. The agency shall
12 maximize the use of prepaid per capita and prepaid aggregate
13 fixed-sum basis services when appropriate and other
14 alternative service delivery and reimbursement methodologies,
15 including competitive bidding pursuant to s. 287.057, designed
16 to facilitate the cost-effective purchase of a case-managed
17 continuum of care. The agency shall also require providers to
18 minimize the exposure of recipients to the need for acute
19 inpatient, custodial, and other institutional care and the
20 inappropriate or unnecessary use of high-cost services. The
21 agency may establish prior authorization requirements for
22 certain populations of Medicaid beneficiaries, certain drug
23 classes, or particular drugs to prevent fraud, abuse, overuse,
24 and possible dangerous drug interactions. The Pharmaceutical
25 and Therapeutics Committee shall make recommendations to the
26 agency on drugs for which prior authorization is required. The
27 agency shall inform the Pharmaceutical and Therapeutics
28 Committee of its decisions regarding drugs subject to prior
29 authorization.
30
31
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1 (37)(a) The agency shall implement a Medicaid
2 prescribed-drug spending-control program that includes the
3 following components:
4 1. Medicaid prescribed-drug coverage for brand-name
5 drugs for adult Medicaid recipients is limited to the
6 dispensing of four brand-name drugs per month per recipient.
7 Children are exempt from this restriction. Antiretroviral
8 agents are excluded from this limitation. No requirements for
9 prior authorization or other restrictions on medications used
10 to treat mental illnesses such as schizophrenia, severe
11 depression, or bipolar disorder may be imposed on Medicaid
12 recipients. Medications that will be available without
13 restriction for persons with mental illnesses include atypical
14 antipsychotic medications, conventional antipsychotic
15 medications, selective serotonin reuptake inhibitors, and
16 other medications used for the treatment of serious mental
17 illnesses. The agency shall also limit the amount of a
18 prescribed drug dispensed to no more than a 34-day supply. The
19 agency shall continue to provide unlimited generic drugs,
20 contraceptive drugs and items, and diabetic supplies. Although
21 a drug may be included on the preferred drug formulary, it
22 would not be exempt from the four-brand limit. The agency may
23 authorize exceptions to the brand-name-drug restriction based
24 upon the treatment needs of the patients, only when such
25 exceptions are based on prior consultation provided by the
26 agency or an agency contractor, but the agency must establish
27 procedures to ensure that:
28 a. There will be a response to a request for prior
29 consultation by telephone or other telecommunication device
30 within 24 hours after receipt of a request for prior
31 consultation;
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1 b. A 72-hour supply of the drug prescribed will be
2 provided in an emergency or when the agency does not provide a
3 response within 24 hours as required by sub-subparagraph a.;
4 and
5 c. Except for the exception for nursing home residents
6 and other institutionalized adults and except for drugs on the
7 restricted formulary for which prior authorization may be
8 sought by an institutional or community pharmacy, prior
9 authorization for an exception to the brand-name-drug
10 restriction is sought by the prescriber and not by the
11 pharmacy. When prior authorization is granted for a patient in
12 an institutional setting beyond the brand-name-drug
13 restriction, such approval is authorized for 12 months and
14 monthly prior authorization is not required for that patient.
15 2. Reimbursement to pharmacies for Medicaid prescribed
16 drugs shall be set at the average wholesale price less 15
17 13.25 percent.
18 3. The agency shall develop and implement a process
19 for managing the drug therapies of Medicaid recipients who are
20 using significant numbers of prescribed drugs each month. The
21 management process may include, but is not limited to,
22 comprehensive, physician-directed medical-record reviews,
23 claims analyses, and case evaluations to determine the medical
24 necessity and appropriateness of a patient's treatment plan
25 and drug therapies. The agency may contract with a private
26 organization to provide drug-program-management services. The
27 Medicaid drug benefit management program shall include
28 initiatives to manage drug therapies for HIV/AIDS patients,
29 patients using 20 or more unique prescriptions in a 180-day
30 period, and the top 1,000 patients in annual spending.
31
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1 4. The agency may limit the size of its pharmacy
2 network based on need, competitive bidding, price
3 negotiations, credentialing, or similar criteria. The agency
4 shall give special consideration to rural areas in determining
5 the size and location of pharmacies included in the Medicaid
6 pharmacy network. A pharmacy credentialing process may include
7 criteria such as a pharmacy's full-service status, location,
8 size, patient educational programs, patient consultation,
9 disease-management services, and other characteristics. The
10 agency may impose a moratorium on Medicaid pharmacy enrollment
11 when it is determined that it has a sufficient number of
12 Medicaid-participating providers.
13 5. The agency shall develop and implement a program
14 that requires Medicaid practitioners who prescribe drugs to
15 use a counterfeit-proof prescription pad for Medicaid
16 prescriptions. The agency shall require the use of
17 standardized counterfeit-proof prescription pads by
18 Medicaid-participating prescribers or prescribers who write
19 prescriptions for Medicaid recipients. The agency may
20 implement the program in targeted geographic areas or
21 statewide.
22 6. The agency may enter into arrangements that require
23 manufacturers of generic drugs prescribed to Medicaid
24 recipients to provide rebates of at least 15.1 percent of the
25 average manufacturer price for the manufacturer's generic
26 products. These arrangements shall require that if a
27 generic-drug manufacturer pays federal rebates for
28 Medicaid-reimbursed drugs at a level below 15.1 percent, the
29 manufacturer must provide a supplemental rebate to the state
30 in an amount necessary to achieve a 15.1-percent rebate level.
31
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1 7. The agency may establish a preferred drug formulary
2 in accordance with 42 U.S.C. s. 1396r-8, and, pursuant to the
3 establishment of such formulary, it is authorized to negotiate
4 supplemental rebates from manufacturers that are in addition
5 to those required by Title XIX of the Social Security Act and
6 at no less than 10 percent of the average manufacturer price
7 as defined in 42 U.S.C. s. 1936 on the last day of a quarter
8 unless the federal or supplemental rebate, or both, equals or
9 exceeds 25 percent. There is no upper limit on the
10 supplemental rebates the agency may negotiate. The agency may
11 determine that specific products, brand-name or generic, are
12 competitive at lower rebate percentages. Agreement to pay the
13 minimum supplemental rebate percentage will guarantee a
14 manufacturer that the Medicaid Pharmaceutical and Therapeutics
15 Committee will consider a product for inclusion on the
16 preferred drug formulary. However, a pharmaceutical
17 manufacturer is not guaranteed placement on the formulary by
18 simply paying the minimum supplemental rebate. Agency
19 decisions will be made on the clinical efficacy of a drug and
20 recommendations of the Medicaid Pharmaceutical and
21 Therapeutics Committee, as well as the price of competing
22 products minus federal and state rebates. The agency is
23 authorized to contract with an outside agency or contractor to
24 conduct negotiations for supplemental rebates. For the
25 purposes of this section, the term "supplemental rebates" may
26 include, at the agency's discretion, cash rebates and other
27 program benefits that offset a Medicaid expenditure. Such
28 other program benefits may include, but are not limited to,
29 disease management programs, drug product donation programs,
30 drug utilization control programs, prescriber and beneficiary
31 counseling and education, fraud and abuse initiatives, and
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1 other services or administrative investments with guaranteed
2 savings to the Medicaid program in the same year the rebate
3 reduction is included in the General Appropriations Act. The
4 agency is authorized to seek any federal waivers to implement
5 this initiative.
6 8. The agency shall establish an advisory committee
7 for the purposes of studying the feasibility of using a
8 restricted drug formulary for nursing home residents and other
9 institutionalized adults. The committee shall be comprised of
10 seven members appointed by the Secretary of Health Care
11 Administration. The committee members shall include two
12 physicians licensed under chapter 458 or chapter 459; three
13 pharmacists licensed under chapter 465 and appointed from a
14 list of recommendations provided by the Florida Long-Term Care
15 Pharmacy Alliance; and two pharmacists licensed under chapter
16 465.
17 Section 10. Effective upon this act becoming a law,
18 subsection (15) and paragraph (a) of subsection (22) of
19 section 409.913, Florida Statutes, are amended to read:
20 409.913 Oversight of the integrity of the Medicaid
21 program.--The agency shall operate a program to oversee the
22 activities of Florida Medicaid recipients, and providers and
23 their representatives, to ensure that fraudulent and abusive
24 behavior and neglect of recipients occur to the minimum extent
25 possible, and to recover overpayments and impose sanctions as
26 appropriate.
27 (15) The agency may impose any of the following
28 sanctions on a provider or a person for any of the acts
29 described in subsection (14):
30 (a) Suspension for a specific period of time of not
31 more than 1 year.
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1 (b) Termination for a specific period of time of from
2 more than 1 year to 20 years.
3 (c) Imposition of a fine of up to $5,000 for each
4 violation. Each day that an ongoing violation continues, such
5 as refusing to furnish Medicaid-related records or refusing
6 access to records, is considered, for the purposes of this
7 section, to be a separate violation. Each instance of
8 improper billing of a Medicaid recipient; each instance of
9 including an unallowable cost on a hospital or nursing home
10 Medicaid cost report after the provider or authorized
11 representative has been advised in an audit exit conference or
12 previous audit report of the cost unallowability; each
13 instance of furnishing a Medicaid recipient goods or
14 professional services that are inappropriate or of inferior
15 quality as determined by competent peer judgment; each
16 instance of knowingly submitting a materially false or
17 erroneous Medicaid provider enrollment application, request
18 for prior authorization for Medicaid services, drug exception
19 request, or cost report; each instance of inappropriate
20 prescribing of drugs for a Medicaid recipient as determined by
21 competent peer judgment; and each false or erroneous Medicaid
22 claim leading to an overpayment to a provider is considered,
23 for the purposes of this section, to be a separate violation.
24 (d) Immediate suspension, if the agency has received
25 information of patient abuse or neglect or of any act
26 prohibited by s. 409.920. Upon suspension, the agency must
27 issue an immediate final order under s. 120.569(2)(n).
28 (e) A fine, not to exceed $10,000, for a violation of
29 paragraph (14)(i).
30 (f) Imposition of liens against provider assets,
31 including, but not limited to, financial assets and real
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1 property, not to exceed the amount of the fine or recovery
2 sought.
3 (g) Other remedies as permitted by law to effect the
4 recovery of a fine or overpayment.
5 (22)(a) In an audit or investigation of a violation
6 committed by a provider which is conducted pursuant to this
7 section, the agency is entitled to recover all up to $15,000
8 in investigative, legal, and expert witness costs if the
9 agency's findings were not contested by the provider or, if
10 contested, the agency ultimately prevailed.
11 Section 11. Effective April 1, 2002, subsection (2) of
12 section 409.915, Florida Statutes, is amended to read:
13 409.915 County contributions to Medicaid.--Although
14 the state is responsible for the full portion of the state
15 share of the matching funds required for the Medicaid program,
16 in order to acquire a certain portion of these funds, the
17 state shall charge the counties for certain items of care and
18 service as provided in this section.
19 (2) A county's participation must be 35 percent of the
20 total cost, or the applicable discounted cost paid by the
21 state for Medicaid recipients enrolled in health maintenance
22 organizations or prepaid health plans, of providing the items
23 listed in subsection (1), except that the payments for items
24 listed in paragraph (1)(b) may not exceed $90 $55 per month
25 per person.
26 Section 12. The Legislature determines and declares
27 that this act fulfills an important state interest.
28 Section 13. Subsection (14) of section 409.908,
29 Florida Statutes, is amended to read:
30 409.908 Reimbursement of Medicaid providers.--Subject
31 to specific appropriations, the agency shall reimburse
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1 Medicaid providers, in accordance with state and federal law,
2 according to methodologies set forth in the rules of the
3 agency and in policy manuals and handbooks incorporated by
4 reference therein. These methodologies may include fee
5 schedules, reimbursement methods based on cost reporting,
6 negotiated fees, competitive bidding pursuant to s. 287.057,
7 and other mechanisms the agency considers efficient and
8 effective for purchasing services or goods on behalf of
9 recipients. Payment for Medicaid compensable services made on
10 behalf of Medicaid eligible persons is subject to the
11 availability of moneys and any limitations or directions
12 provided for in the General Appropriations Act or chapter 216.
13 Further, nothing in this section shall be construed to prevent
14 or limit the agency from adjusting fees, reimbursement rates,
15 lengths of stay, number of visits, or number of services, or
16 making any other adjustments necessary to comply with the
17 availability of moneys and any limitations or directions
18 provided for in the General Appropriations Act, provided the
19 adjustment is consistent with legislative intent.
20 (14) A provider of prescribed drugs shall be
21 reimbursed the least of the amount billed by the provider, the
22 provider's usual and customary charge, or the Medicaid maximum
23 allowable fee established by the agency, plus a dispensing
24 fee. The agency is directed to implement a variable dispensing
25 fee for payments for prescribed medicines while ensuring
26 continued access for Medicaid recipients. The variable
27 dispensing fee may be based upon, but not limited to, either
28 or both the volume of prescriptions dispensed by a specific
29 pharmacy provider, and the volume of prescriptions dispensed
30 to an individual recipient, and dispensing of
31 preferred-drug-list products. The agency shall increase the
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1 pharmacy dispensing fee authorized by statute and in the
2 annual General Appropriations Act by $0.50 for the dispensing
3 of a Medicaid preferred-drug-list product and reduce the
4 pharmacy dispensing fee by $0.50 for the dispensing of a
5 Medicaid product that is not included on the preferred-drug
6 list. The agency is authorized to limit reimbursement for
7 prescribed medicine in order to comply with any limitations or
8 directions provided for in the General Appropriations Act,
9 which may include implementing a prospective or concurrent
10 utilization review program.
11 Section 14. Section 400.0225, Florida Statutes, is
12 repealed.
13 Section 15. Paragraph (a) of subsection (2) of section
14 400.191, Florida Statutes, is amended to read:
15 400.191 Availability, distribution, and posting of
16 reports and records.--
17 (2) The agency shall provide additional information in
18 consumer-friendly printed and electronic formats to assist
19 consumers and their families in comparing and evaluating
20 nursing home facilities.
21 (a) The agency shall provide an Internet site which
22 shall include at least the following information either
23 directly or indirectly through a link to another established
24 site or sites of the agency's choosing:
25 1. A list by name and address of all nursing home
26 facilities in this state.
27 2. Whether such nursing home facilities are
28 proprietary or nonproprietary.
29 3. The current owner of the facility's license and the
30 year that that entity became the owner of the license.
31
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1 4. The name of the owner or owners of each facility
2 and whether the facility is affiliated with a company or other
3 organization owning or managing more than one nursing facility
4 in this state.
5 5. The total number of beds in each facility.
6 6. The number of private and semiprivate rooms in each
7 facility.
8 7. The religious affiliation, if any, of each
9 facility.
10 8. The languages spoken by the administrator and staff
11 of each facility.
12 9. Whether or not each facility accepts Medicare or
13 Medicaid recipients or insurance, health maintenance
14 organization, Veterans Administration, CHAMPUS program, or
15 workers' compensation coverage.
16 10. Recreational and other programs available at each
17 facility.
18 11. Special care units or programs offered at each
19 facility.
20 12. Whether the facility is a part of a retirement
21 community that offers other services pursuant to part III,
22 part IV, or part V.
23 13. The results of consumer and family satisfaction
24 surveys for each facility, as described in s. 400.0225. The
25 results may be converted to a score or scores, which may be
26 presented in either numeric or symbolic form for the intended
27 consumer audience.
28 13.14. Survey and deficiency information contained on
29 the Online Survey Certification and Reporting (OSCAR) system
30 of the federal Health Care Financing Administration, including
31 annual survey, revisit, and complaint survey information, for
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1 each facility for the past 45 months. For noncertified
2 nursing homes, state survey and deficiency information,
3 including annual survey, revisit, and complaint survey
4 information for the past 45 months shall be provided.
5 14.15. A summary of the Online Survey Certification
6 and Reporting (OSCAR) data for each facility over the past 45
7 months. Such summary may include a score, rating, or
8 comparison ranking with respect to other facilities based on
9 the number of citations received by the facility of annual,
10 revisit, and complaint surveys; the severity and scope of the
11 citations; and the number of annual recertification surveys
12 the facility has had during the past 45 months. The score,
13 rating, or comparison ranking may be presented in either
14 numeric or symbolic form for the intended consumer audience.
15 Section 16. Paragraph (c) of subsection (5) of section
16 400.235, Florida Statutes, is amended to read:
17 400.235 Nursing home quality and licensure status;
18 Gold Seal Program.--
19 (5) Facilities must meet the following additional
20 criteria for recognition as a Gold Seal Program facility:
21 (c) Participate consistently in a the required
22 consumer satisfaction process as prescribed by the agency, and
23 demonstrate that information is elicited from residents,
24 family members, and guardians about satisfaction with the
25 nursing facility, its environment, the services and care
26 provided, the staff's skills and interactions with residents,
27 attention to resident's needs, and the facility's efforts to
28 act on information gathered from the consumer satisfaction
29 measures.
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31
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1 A facility assigned a conditional licensure status may not
2 qualify for consideration for the Gold Seal Program until
3 after it has operated for 30 months with no class I or class
4 II deficiencies and has completed a regularly scheduled
5 relicensure survey.
6 Section 17. Section 400.148, Florida Statutes, is
7 repealed.
8 Section 18. Section 400.071, Florida Statutes, is
9 amended to read:
10 400.071 Application for license.--
11 (1) An application for a license as required by s.
12 400.062 shall be made to the agency on forms furnished by it
13 and shall be accompanied by the appropriate license fee.
14 (2) The application shall be under oath and shall
15 contain the following:
16 (a) The name, address, and social security number of
17 the applicant if an individual; if the applicant is a firm,
18 partnership, or association, its name, address, and employer
19 identification number (EIN), and the name and address of any
20 controlling interest; and the name by which the facility is to
21 be known.
22 (b) The name of any person whose name is required on
23 the application under the provisions of paragraph (a) and who
24 owns at least a 10-percent interest in any professional
25 service, firm, association, partnership, or corporation
26 providing goods, leases, or services to the facility for which
27 the application is made, and the name and address of the
28 professional service, firm, association, partnership, or
29 corporation in which such interest is held.
30
31
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1 (c) The location of the facility for which a license
2 is sought and an indication, as in the original application,
3 that such location conforms to the local zoning ordinances.
4 (d) The name of the person or persons under whose
5 management or supervision the facility will be conducted and
6 the name of the administrator.
7 (e) A signed affidavit disclosing any financial or
8 ownership interest that a person or entity described in
9 paragraph (a) or paragraph (d) has held in the last 5 years in
10 any entity licensed by this state or any other state to
11 provide health or residential care which has closed
12 voluntarily or involuntarily; has filed for bankruptcy; has
13 had a receiver appointed; has had a license denied, suspended,
14 or revoked; or has had an injunction issued against it which
15 was initiated by a regulatory agency. The affidavit must
16 disclose the reason any such entity was closed, whether
17 voluntarily or involuntarily.
18 (f) The total number of beds and the total number of
19 Medicare and Medicaid certified beds.
20 (g) Information relating to the number, experience,
21 and training of the employees of the facility and of the moral
22 character of the applicant and employees which the agency
23 requires by rule, including the name and address of any
24 nursing home with which the applicant or employees have been
25 affiliated through ownership or employment within 5 years of
26 the date of the application for a license and the record of
27 any criminal convictions involving the applicant and any
28 criminal convictions involving an employee if known by the
29 applicant after inquiring of the employee. The applicant must
30 demonstrate that sufficient numbers of qualified staff, by
31 training or experience, will be employed to properly care for
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1 the type and number of residents who will reside in the
2 facility.
3 (h) Copies of any civil verdict or judgment involving
4 the applicant rendered within the 10 years preceding the
5 application, relating to medical negligence, violation of
6 residents' rights, or wrongful death. As a condition of
7 licensure, the licensee agrees to provide to the agency copies
8 of any new verdict or judgment involving the applicant,
9 relating to such matters, within 30 days after filing with the
10 clerk of the court. The information required in this
11 paragraph shall be maintained in the facility's licensure file
12 and in an agency database which is available as a public
13 record.
14 (3) The applicant shall submit evidence which
15 establishes the good moral character of the applicant,
16 manager, supervisor, and administrator. No applicant, if the
17 applicant is an individual; no member of a board of directors
18 or officer of an applicant, if the applicant is a firm,
19 partnership, association, or corporation; and no licensed
20 nursing home administrator shall have been convicted, or found
21 guilty, regardless of adjudication, of a crime in any
22 jurisdiction which affects or may potentially affect residents
23 in the facility.
24 (4) Each applicant for licensure must comply with the
25 following requirements:
26 (a) Upon receipt of a completed, signed, and dated
27 application, the agency shall require background screening of
28 the applicant, in accordance with the level 2 standards for
29 screening set forth in chapter 435. As used in this
30 subsection, the term "applicant" means the facility
31 administrator, or similarly titled individual who is
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1 responsible for the day-to-day operation of the licensed
2 facility, and the facility financial officer, or similarly
3 titled individual who is responsible for the financial
4 operation of the licensed facility.
5 (b) The agency may require background screening for a
6 member of the board of directors of the licensee or an officer
7 or an individual owning 5 percent or more of the licensee if
8 the agency has probable cause to believe that such individual
9 has been convicted of an offense prohibited under the level 2
10 standards for screening set forth in chapter 435.
11 (c) Proof of compliance with the level 2 background
12 screening requirements of chapter 435 which has been submitted
13 within the previous 5 years in compliance with any other
14 health care or assisted living licensure requirements of this
15 state is acceptable in fulfillment of paragraph (a). Proof of
16 compliance with background screening which has been submitted
17 within the previous 5 years to fulfill the requirements of the
18 Department of Insurance pursuant to chapter 651 as part of an
19 application for a certificate of authority to operate a
20 continuing care retirement community is acceptable in
21 fulfillment of the Department of Law Enforcement and Federal
22 Bureau of Investigation background check.
23 (d) A provisional license may be granted to an
24 applicant when each individual required by this section to
25 undergo background screening has met the standards for the
26 Department of Law Enforcement background check, but the agency
27 has not yet received background screening results from the
28 Federal Bureau of Investigation, or a request for a
29 disqualification exemption has been submitted to the agency as
30 set forth in chapter 435, but a response has not yet been
31 issued. A license may be granted to the applicant upon the
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1 agency's receipt of a report of the results of the Federal
2 Bureau of Investigation background screening for each
3 individual required by this section to undergo background
4 screening which confirms that all standards have been met, or
5 upon the granting of a disqualification exemption by the
6 agency as set forth in chapter 435. Any other person who is
7 required to undergo level 2 background screening may serve in
8 his or her capacity pending the agency's receipt of the report
9 from the Federal Bureau of Investigation; however, the person
10 may not continue to serve if the report indicates any
11 violation of background screening standards and a
12 disqualification exemption has not been requested of and
13 granted by the agency as set forth in chapter 435.
14 (e) Each applicant must submit to the agency, with its
15 application, a description and explanation of any exclusions,
16 permanent suspensions, or terminations of the applicant from
17 the Medicare or Medicaid programs. Proof of compliance with
18 disclosure of ownership and control interest requirements of
19 the Medicaid or Medicare programs shall be accepted in lieu of
20 this submission.
21 (f) Each applicant must submit to the agency a
22 description and explanation of any conviction of an offense
23 prohibited under the level 2 standards of chapter 435 by a
24 member of the board of directors of the applicant, its
25 officers, or any individual owning 5 percent or more of the
26 applicant. This requirement shall not apply to a director of a
27 not-for-profit corporation or organization if the director
28 serves solely in a voluntary capacity for the corporation or
29 organization, does not regularly take part in the day-to-day
30 operational decisions of the corporation or organization,
31 receives no remuneration for his or her services on the
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1 corporation or organization's board of directors, and has no
2 financial interest and has no family members with a financial
3 interest in the corporation or organization, provided that the
4 director and the not-for-profit corporation or organization
5 include in the application a statement affirming that the
6 director's relationship to the corporation satisfies the
7 requirements of this paragraph.
8 (g) An application for license renewal must contain
9 the information required under paragraphs (e) and (f).
10 (5) The applicant shall furnish satisfactory proof of
11 financial ability to operate and conduct the nursing home in
12 accordance with the requirements of this part and all rules
13 adopted under this part, and the agency shall establish
14 standards for this purpose, including information reported
15 under paragraph (2)(e). The agency also shall establish
16 documentation requirements, to be completed by each applicant,
17 that show anticipated facility revenues and expenditures, the
18 basis for financing the anticipated cash-flow requirements of
19 the facility, and an applicant's access to contingency
20 financing.
21 (6) If the applicant offers continuing care agreements
22 as defined in chapter 651, proof shall be furnished that such
23 applicant has obtained a certificate of authority as required
24 for operation under that chapter.
25 (7) As a condition of licensure, each licensee, except
26 one offering continuing care agreements as defined in chapter
27 651, must agree to accept recipients of Title XIX of the
28 Social Security Act on a temporary, emergency basis. The
29 persons whom the agency may require such licensees to accept
30 are those recipients of Title XIX of the Social Security Act
31 who are residing in a facility in which existing conditions
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1 constitute an immediate danger to the health, safety, or
2 security of the residents of the facility.
3 (8) As a condition of licensure, each facility must
4 agree to participate in a consumer satisfaction measurement
5 process as prescribed by the agency.
6 (8)(9) The agency may not issue a license to a nursing
7 home that fails to receive a certificate of need under the
8 provisions of ss. 408.031-408.045. It is the intent of the
9 Legislature that, in reviewing a certificate-of-need
10 application to add beds to an existing nursing home facility,
11 preference be given to the application of a licensee who has
12 been awarded a Gold Seal as provided for in s. 400.235, if the
13 applicant otherwise meets the review criteria specified in s.
14 408.035.
15 (9)(10) The agency may develop an abbreviated survey
16 for licensure renewal applicable to a licensee that has
17 continuously operated as a nursing facility since 1991 or
18 earlier, has operated under the same management for at least
19 the preceding 30 months, and has had during the preceding 30
20 months no class I or class II deficiencies.
21 (10)(11) The agency may issue an inactive license to a
22 nursing home that will be temporarily unable to provide
23 services but that is reasonably expected to resume services.
24 Such designation may be made for a period not to exceed 12
25 months but may be renewed by the agency for up to 6 additional
26 months. Any request by a licensee that a nursing home become
27 inactive must be submitted to the agency and approved by the
28 agency prior to initiating any suspension of service or
29 notifying residents. Upon agency approval, the nursing home
30 shall notify residents of any necessary discharge or transfer
31 as provided in s. 400.0255.
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1 (11)(12) As a condition of licensure, each facility
2 must establish and submit with its application a plan for
3 quality assurance and for conducting risk management.
4 Section 19. Paragraph (q) of subsection (2) of section
5 409.815, Florida Statutes, is amended to read:
6 409.815 Health benefits coverage; limitations.--
7 (2) BENCHMARK BENEFITS.--In order for health benefits
8 coverage to qualify for premium assistance payments for an
9 eligible child under ss. 409.810-409.820, the health benefits
10 coverage, except for coverage under Medicaid and Medikids,
11 must include the following minimum benefits, as medically
12 necessary.
13 (q) Dental services.--Subject to a specific
14 appropriation for this benefit, covered services include those
15 dental services provided to children by the Florida Medicaid
16 program under s. 409.906(5) s. 409.906(6).
17 Section 20. Except as otherwise specifically provided
18 in this act, this act shall take effect January 1, 2002.
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Florida Senate - 2001 CS for SB 26-B
309-524-02
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 26-B
3
4 Removes language that delayed the minimum staffing for nursing
homes.
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Clarifies continued Medicaid coverage of children under age 1
6 with family incomes at or below 185 percent of the federal
poverty level.
7
Clarifies continuation of children's Medically Needy coverage.
8
Revises the effective date for elimination of Adult Dental,
9 Visual, and Hearing Services from January 1, 2002 to July 1,
2002.
10
Revises the effective date from April 1, 2002 to January 1,
11 2002 for implementation of mail-order pharmacy services.
12 Provides an effective date of April 1, 2002 for implementation
of the increase in county contributions for nursing home and
13 intermediate care facilities.
14 Adds language that "declares that this act fulfills an
important state interest" as a result of the increase in
15 county contributions.
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