Senate Bill sb0026Be1
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
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
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
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; amending s. 400.071, F.S.; eliminating
15 a provision relating to participation in a
16 consumer-satisfaction-measurement process;
17 amending s. 409.815, F.S.; conforming a
18 cross-reference; providing effective dates.
19
20 Be It Enacted by the Legislature of the State of Florida:
21
22 Section 1. Effective July 1, 2002, subsection (5) of
23 section 409.903, Florida Statutes, is amended to read:
24 409.903 Mandatory payments for eligible persons.--The
25 agency shall make payments for medical assistance and related
26 services on behalf of the following persons who the
27 department, or the Social Security Administration by contract
28 with the Department of Children and Family Services,
29 determines to be eligible, subject to the income, assets, and
30 categorical eligibility tests set forth in federal and state
31 law. Payment on behalf of these Medicaid eligible persons is
2
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 subject to the availability of moneys and any limitations
2 established by the General Appropriations Act or chapter 216.
3 (5) A pregnant woman for the duration of her pregnancy
4 and for the postpartum period as defined in federal law and
5 rule, or a child under age 1, if she either is living in a
6 family that has an income which is at or below 150 percent of
7 the most current federal poverty level, or a child under age
8 1, if the child is living in a family or, effective January 1,
9 1992, that has an income which is at or below 185 percent of
10 the most current federal poverty level. Such a person is not
11 subject to an assets test. Further, a pregnant woman who
12 applies for eligibility for the Medicaid program through a
13 qualified Medicaid provider must be offered the opportunity,
14 subject to federal rules, to be made presumptively eligible
15 for the Medicaid program.
16 Section 2. Subsection (11) of section 409.904, Florida
17 Statutes, is repealed.
18 Section 3. Effective July 1, 2002, subsections (2) and
19 (5) of section 409.904, Florida Statutes, are amended to read:
20 409.904 Optional payments for eligible persons.--The
21 agency may make payments for medical assistance and related
22 services on behalf of the following persons who are determined
23 to be eligible subject to the income, assets, and categorical
24 eligibility tests set forth in federal and state law. Payment
25 on behalf of these Medicaid eligible persons is subject to the
26 availability of moneys and any limitations established by the
27 General Appropriations Act or chapter 216.
28 (2)(a) A pregnant woman who would otherwise qualify
29 for Medicaid under s. 409.903(5) except for her level of
30 income and whose assets fall within the limits established by
31 the Department of Children and Family Services for the
3
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 medically needy. A pregnant woman who applies for medically
2 needy eligibility may not be made presumptively eligible.
3 (b) A child under age 21 who would otherwise qualify
4 for Medicaid or the Florida Kidcare program except for the
5 family's level of income and whose assets fall within the
6 limits established by the Department of Children and Family
7 Services for the medically needy. A family, a pregnant woman,
8 a child under age 18, a person age 65 or over, or a blind or
9 disabled person who would be eligible under any group listed
10 in s. 409.903(1), (2), or (3), except that the income or
11 assets of such family or person exceed established
12 limitations.
13
14 For a family or person in this group, medical expenses are
15 deductible from income in accordance with federal requirements
16 in order to make a determination of eligibility. A family or
17 person in this group, which group is known as the "medically
18 needy," is eligible to receive the same services as other
19 Medicaid recipients, with the exception of services in skilled
20 nursing facilities and intermediate care facilities for the
21 developmentally disabled.
22 (5) Subject to specific federal authorization, a
23 postpartum woman living in a family that has an income that is
24 at or below 150 185 percent of the most current federal
25 poverty level is eligible for family planning services as
26 specified in s. 409.905(3) for a period of up to 24 months
27 following a pregnancy for which Medicaid paid for
28 pregnancy-related services.
29 Section 4. Effective July 1, 2002, subsections (1),
30 (12), and (23) of section 409.906, Florida Statutes, are
31 amended to read:
4
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 409.906 Optional Medicaid services.--Subject to
2 specific appropriations, the agency may make payments for
3 services which are optional to the state under Title XIX of
4 the Social Security Act and are furnished by Medicaid
5 providers to recipients who are determined to be eligible on
6 the dates on which the services were provided. Any optional
7 service that is provided shall be provided only when medically
8 necessary and in accordance with state and federal law.
9 Optional services rendered by providers in mobile units to
10 Medicaid recipients may be restricted or prohibited by the
11 agency. Nothing in this section shall be construed to prevent
12 or limit the agency from adjusting fees, reimbursement rates,
13 lengths of stay, number of visits, or number of services, or
14 making any other adjustments necessary to comply with the
15 availability of moneys and any limitations or directions
16 provided for in the General Appropriations Act or chapter 216.
17 If necessary to safeguard the state's systems of providing
18 services to elderly and disabled persons and subject to the
19 notice and review provisions of s. 216.177, the Governor may
20 direct the Agency for Health Care Administration to amend the
21 Medicaid state plan to delete the optional Medicaid service
22 known as "Intermediate Care Facilities for the Developmentally
23 Disabled." Optional services may include:
24 (1) ADULT DENTURE SERVICES.--The agency may pay for
25 dentures, the procedures required to seat dentures, and the
26 repair and reline of dentures, provided by or under the
27 direction of a licensed dentist, for a recipient who is age 21
28 or older. However, Medicaid will not provide reimbursement for
29 dental services provided in a mobile dental unit, except for a
30 mobile dental unit:
31
5
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 (a) Owned by, operated by, or having a contractual
2 agreement with the Department of Health and complying with
3 Medicaid's county health department clinic services program
4 specifications as a county health department clinic services
5 provider.
6 (b) Owned by, operated by, or having a contractual
7 arrangement with a federally qualified health center and
8 complying with Medicaid's federally qualified health center
9 specifications as a federally qualified health center
10 provider.
11 (c) Rendering dental services to Medicaid recipients,
12 21 years of age and older, at nursing facilities.
13 (d) Owned by, operated by, or having a contractual
14 agreement with a state-approved dental educational
15 institution.
16 (e) This subsection is repealed July 1, 2002.
17 (12) CHILDREN'S HEARING SERVICES.--The agency may pay
18 for hearing and related services, including hearing
19 evaluations, hearing aid devices, dispensing of the hearing
20 aid, and related repairs, if provided to a recipient under age
21 21 by a licensed hearing aid specialist, otolaryngologist,
22 otologist, audiologist, or physician.
23 (23) CHILDREN'S VISUAL SERVICES.--The agency may pay
24 for visual examinations, eyeglasses, and eyeglass repairs for
25 a recipient under age 21, if they are prescribed by a licensed
26 physician specializing in diseases of the eye or by a licensed
27 optometrist.
28 Section 5. Subsection (20) of section 409.906, Florida
29 Statutes, is amended to read:
30 409.906 Optional Medicaid services.--Subject to
31 specific appropriations, the agency may make payments for
6
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 services which are optional to the state under Title XIX of
2 the Social Security Act and are furnished by Medicaid
3 providers to recipients who are determined to be eligible on
4 the dates on which the services were provided. Any optional
5 service that is provided shall be provided only when medically
6 necessary and in accordance with state and federal law.
7 Optional services rendered by providers in mobile units to
8 Medicaid recipients may be restricted or prohibited by the
9 agency. Nothing in this section shall be construed to prevent
10 or limit the agency from adjusting fees, reimbursement rates,
11 lengths of stay, number of visits, or number of services, or
12 making any other adjustments necessary to comply with the
13 availability of moneys and any limitations or directions
14 provided for in the General Appropriations Act or chapter 216.
15 If necessary to safeguard the state's systems of providing
16 services to elderly and disabled persons and subject to the
17 notice and review provisions of s. 216.177, the Governor may
18 direct the Agency for Health Care Administration to amend the
19 Medicaid state plan to delete the optional Medicaid service
20 known as "Intermediate Care Facilities for the Developmentally
21 Disabled." Optional services may include:
22 (20) PRESCRIBED DRUG SERVICES.--The agency may pay for
23 medications that are prescribed for a recipient by a physician
24 or other licensed practitioner of the healing arts authorized
25 to prescribe medications and that are dispensed to the
26 recipient by a licensed pharmacist or physician in accordance
27 with applicable state and federal law. The agency may use
28 mail-order pharmacy services for dispensing drugs. For adults
29 eligible through the medically needy program, pharmacies must
30 dispense a generic drug for a product prescribed for a
31
7
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 beneficiary if a generic product exists for the product
2 prescribed.
3 Section 6. Subsections (3) and (5) of section
4 409.9065, Florida Statutes, are amended to read:
5 409.9065 Pharmaceutical expense assistance.--
6 (3) BENEFITS.--Medications covered under the
7 pharmaceutical expense assistance program are those covered
8 under the Medicaid program in s. 409.906(19) s. 409.906(20).
9 Monthly benefit payments shall be limited to $80 per program
10 participant. Participants are required to make a 10-percent
11 coinsurance payment for each prescription purchased through
12 this program.
13 (5) NONENTITLEMENT.--The pharmaceutical expense
14 assistance program established by this section is not an
15 entitlement. Enrollment levels are limited to those authorized
16 by the Legislature in the annual General Appropriations Act.
17 If funds are insufficient to serve all individuals eligible
18 under subsection (2) and seeking coverage, the agency may
19 develop a waiting list based on application dates to use in
20 enrolling individuals in unfilled enrollment slots.
21 Section 7. Effective upon this act becoming a law,
22 paragraph (a) of subsection (5) and subsections (7) and (9) of
23 section 409.907, Florida Statutes, are amended to read:
24 409.907 Medicaid provider agreements.--The agency may
25 make payments for medical assistance and related services
26 rendered to Medicaid recipients only to an individual or
27 entity who has a provider agreement in effect with the agency,
28 who is performing services or supplying goods in accordance
29 with federal, state, and local law, and who agrees that no
30 person shall, on the grounds of handicap, race, color, or
31 national origin, or for any other reason, be subjected to
8
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 discrimination under any program or activity for which the
2 provider receives payment from the agency.
3 (5) The agency:
4 (a) Is required to make timely payment at the
5 established rate for services or goods furnished to a
6 recipient by the provider upon receipt of a properly completed
7 claim form. The claim form shall require certification that
8 the services or goods have been completely furnished to the
9 recipient and that, with the exception of those services or
10 goods specified by the agency, the amount billed does not
11 exceed the provider's usual and customary charge for the same
12 services or goods. When a provider is under an active fraud or
13 abuse investigation by the agency, the agency may withhold
14 payment to that provider for any pending claim until the
15 conclusion of the investigation. When exercising the
16 provisions of this paragraph, the agency must timely complete
17 its investigation.
18 (7) The agency may require, as a condition of
19 participating in the Medicaid program and before entering into
20 the provider agreement, that the provider submit information,
21 in an initial and any required renewal applications,
22 concerning the professional, business, and personal background
23 of the provider and permit an onsite inspection of the
24 provider's service location by agency staff or other personnel
25 designated by the agency to perform this function. Before
26 entering into the provider agreement, or as a condition of
27 continuing participation in the Medicaid program, the agency
28 may also require that Medicaid providers reimbursed on a
29 fee-for-services basis or fee schedule basis which is not
30 cost-based, post a surety bond not to exceed $50,000 or the
31 total amount billed by the provider to the program during the
9
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 current or most recent calendar year, whichever is greater.
2 For new providers, the amount of the surety bond shall be
3 determined by the agency based on the provider's estimate of
4 its first year's billing. If the provider's billing during the
5 first year exceeds the bond amount, the agency may require the
6 provider to acquire an additional bond equal to the actual
7 billing level of the provider. A provider's bond shall not
8 exceed $50,000 if a physician or group of physicians licensed
9 under chapter 458, chapter 459, or chapter 460 has a 50
10 percent or greater ownership interest in the provider or if
11 the provider is an assisted living facility licensed under
12 part III of chapter 400. The bonds permitted by this section
13 are in addition to the bonds referenced in s. 400.179(4)(d).
14 If the provider is a corporation, partnership, association, or
15 other entity, the agency may require the provider to submit
16 information concerning the background of that entity and of
17 any principal of the entity, including any partner or
18 shareholder having an ownership interest in the entity equal
19 to 5 percent or greater, and any treating provider who
20 participates in or intends to participate in Medicaid through
21 the entity. The information must include:
22 (a) Proof of holding a valid license or operating
23 certificate, as applicable, if required by the state or local
24 jurisdiction in which the provider is located or if required
25 by the Federal Government.
26 (b) Information concerning any prior violation, fine,
27 suspension, termination, or other administrative action taken
28 under the Medicaid laws, rules, or regulations of this state
29 or of any other state or the Federal Government; any prior
30 violation of the laws, rules, or regulations relating to the
31 Medicare program; any prior violation of the rules or
10
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 regulations of any other public or private insurer; and any
2 prior violation of the laws, rules, or regulations of any
3 regulatory body of this or any other state.
4 (c) Full and accurate disclosure of any financial or
5 ownership interest that the provider, or any principal,
6 partner, or major shareholder thereof, may hold in any other
7 Medicaid provider or health care related entity or any other
8 entity that is licensed by the state to provide health or
9 residential care and treatment to persons.
10 (d) If a group provider, identification of all members
11 of the group and attestation that all members of the group are
12 enrolled in or have applied to enroll in the Medicaid program.
13 (9) Upon receipt of a completed, signed, and dated
14 application, and completion of any necessary background
15 investigation and criminal history record check, the agency
16 must either:
17 (a) Enroll the applicant as a Medicaid provider no
18 earlier than the effective date of the approval of the
19 provider application; or
20 (b) Deny the application if the agency finds that it
21 is in the best interest of the Medicaid program to do so. The
22 agency may consider the factors listed in subsection (10), as
23 well as any other factor that could affect the effective and
24 efficient administration of the program, including, but not
25 limited to, the current availability of medical care,
26 services, or supplies to recipients, taking into account
27 geographic location and reasonable travel time; the number of
28 providers of the same type already enrolled in the same
29 geographic area; and the credentials, experience, success, and
30 patient outcomes of the provider for the services that it is
31 making application to provide in the Medicaid program.
11
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 Section 8. Section 409.9116, Florida Statutes, is
2 amended to read:
3 409.9116 Disproportionate share share/financial
4 assistance program for rural hospitals.--In addition to the
5 payments made under s. 409.911, the Agency for Health Care
6 Administration shall administer a federally matched
7 disproportionate share program and a state-funded financial
8 assistance program for statutory rural hospitals. The agency
9 shall make disproportionate share payments to statutory rural
10 hospitals that qualify for such payments and financial
11 assistance payments to statutory rural hospitals that do not
12 qualify for disproportionate share payments. The
13 disproportionate share program payments shall be limited by
14 and conform with federal requirements. Funds shall be
15 distributed quarterly in each fiscal year for which an
16 appropriation is made. Notwithstanding the provisions of s.
17 409.915, counties are exempt from contributing toward the cost
18 of this special reimbursement for hospitals serving a
19 disproportionate share of low-income patients.
20 (1) The following formula shall be used by the agency
21 to calculate the total amount earned for hospitals that
22 participate in the rural hospital disproportionate share
23 program or the financial assistance program:
24
25 TAERH = (CCD + MDD)/TPD
26
27 Where:
28 CCD = total charity care-other, plus charity
29 care-Hill-Burton, minus 50 percent of unrestricted tax revenue
30 from local governments, and restricted funds for indigent
31 care, divided by gross revenue per adjusted patient day;
12
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 however, if CCD is less than zero, then zero shall be used for
2 CCD.
3 MDD = Medicaid inpatient days plus Medicaid HMO
4 inpatient days.
5 TPD = total inpatient days.
6 TAERH = total amount earned by each rural hospital.
7
8 In computing the total amount earned by each rural hospital,
9 the agency must use the most recent actual data reported in
10 accordance with s. 408.061(4)(a).
11 (2) The agency shall use the following formula for
12 distribution of funds for the disproportionate share
13 share/financial assistance program for rural hospitals.
14 (a) The agency shall first determine a preliminary
15 payment amount for each rural hospital by allocating all
16 available state funds using the following formula:
17
18 PDAER = (TAERH x TARH)/STAERH
19
20 Where:
21 PDAER = preliminary distribution amount for each rural
22 hospital.
23 TAERH = total amount earned by each rural hospital.
24 TARH = total amount appropriated or distributed under
25 this section.
26 STAERH = sum of total amount earned by each rural
27 hospital.
28 (b) Federal matching funds for the disproportionate
29 share program shall then be calculated for those hospitals
30 that qualify for disproportionate share in paragraph (a).
31
13
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 (c) Any state funds not spent due to an individual
2 hospital's disproportionate-share limit will be redistributed
3 proportionately to those hospitals with an available
4 disproportionate-share limit to maximize available federal
5 funds.
6 (c) The state-funds-only payment amount shall then be
7 calculated for each hospital using the formula:
8
9 SFOER = Maximum value of (1) SFOL - PDAER or (2) 0
10
11 Where:
12 SFOER = state-funds-only payment amount for each rural
13 hospital.
14 SFOL = state-funds-only payment level, which is set at
15 4 percent of TARH.
16
17 In calculating the SFOER, PDAER includes federal matching
18 funds from paragraph (b).
19 (d) The adjusted total amount allocated to the rural
20 disproportionate share program shall then be calculated using
21 the following formula:
22
23 ATARH = (TARH - SSFOER)
24
25 Where:
26 ATARH = adjusted total amount appropriated or
27 distributed under this section.
28 SSFOER = sum of the state-funds-only payment amount
29 calculated under paragraph (c) for all rural hospitals.
30
31
14
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 (e) The distribution of the adjusted total amount of
2 rural disproportionate share hospital funds shall then be
3 calculated using the following formula:
4
5 DAERH = [(TAERH x ATARH)/STAERH]
6
7 Where:
8 DAERH = distribution amount for each rural hospital.
9 (d)(f) Federal matching funds for the disproportionate
10 share program shall then be calculated for those hospitals
11 that qualify for disproportionate share in paragraph (a) (e).
12 (g) State-funds-only payment amounts calculated under
13 paragraph (c) and corresponding federal matching funds are
14 then added to the results of paragraph (f) to determine the
15 total distribution amount for each rural hospital.
16 (3) The Agency for Health Care Administration may
17 recommend to the Legislature a formula to be used in
18 subsequent fiscal years to distribute funds appropriated for
19 this section that includes charity care, uncompensated care to
20 medically indigent patients, and Medicaid inpatient days.
21 (4) In the event that federal matching funds for the
22 rural hospital disproportionate share program are not
23 available, state matching funds appropriated for the program
24 may be utilized for the Rural Hospital Financial Assistance
25 Program and shall be allocated to rural hospitals based on the
26 formulas in subsections (1) and (2).
27 (5) In order to receive payments under this section, a
28 hospital must be a rural hospital as defined in s. 395.602 and
29 must meet the following additional requirements:
30 (a) Agree to conform to all agency requirements to
31 ensure high quality in the provision of services, including
15
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 criteria adopted by agency rule concerning staffing ratios,
2 medical records, standards of care, equipment, space, and such
3 other standards and criteria as the agency deems appropriate
4 as specified by rule.
5 (b) Agree to accept all patients, regardless of
6 ability to pay, on a functional space-available basis.
7 (c) Agree to provide backup and referral services to
8 the county public health departments and other low-income
9 providers within the hospital's service area, including the
10 development of written agreements between these organizations
11 and the hospital.
12 (d) For any hospital owned by a county government
13 which is leased to a management company, agree to submit on a
14 quarterly basis a report to the agency, in a format specified
15 by the agency, which provides a specific accounting of how all
16 funds dispersed under this act are spent.
17 (6) For the 2000-2001 fiscal year only, the Agency for
18 Health Care Administration shall use the following formula for
19 distribution of the funds in Specific Appropriation 212 of the
20 2000-2001 General Appropriations Act for the disproportionate
21 share/financial assistance program for rural hospitals.
22 (a) The agency shall first determine a preliminary
23 payment amount for each rural hospital by allocating all
24 available state funds using the following formula:
25
26 PDAER = (TAERH x TARH)/STAERH
27
28 Where:
29 PDAER = preliminary distribution amount for each rural
30 hospital.
31 TAERH = total amount earned by each rural hospital.
16
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 TARH = total amount appropriated or distributed under
2 this section.
3 STAERH = sum of total amount earned by each rural
4 hospital.
5 (b) Federal matching funds for the disproportionate
6 share program shall then be calculated for those hospitals
7 that qualify for disproportionate share in paragraph (a).
8 (c) The state-funds-only payment amount is then
9 calculated for each hospital using the formula:
10
11 SFOER = Maximum value of (1) SFOL - PDAER or (2) 0
12
13 Where:
14 SFOER = state-funds-only payment amount for each rural
15 hospital.
16 SFOL = state-funds-only payment level, which is set at
17 4 percent of TARH.
18 (d) The adjusted total amount allocated to the rural
19 disproportionate share program shall then be calculated using
20 the following formula:
21
22 ATARH = (TARH - SSFOER)
23
24 Where:
25 ATARH = adjusted total amount appropriated or
26 distributed under this section.
27 SSFOER = sum of the state-funds-only payment amount
28 calculated under paragraph (c) for all rural hospitals.
29 (e) The determination of the amount of rural
30 disproportionate share hospital funds is calculated by the
31 following formula:
17
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1
2 TDAERH = [(TAERH x ATARH)/STAERH]
3
4 Where:
5 TDAERH = total distribution amount for each rural
6 hospital.
7 (f) Federal matching funds for the disproportionate
8 share program shall then be calculated for those hospitals
9 that qualify for disproportionate share in paragraph (e).
10 (g) State-funds-only payment amounts calculated under
11 paragraph (c) are then added to the results of paragraph (f)
12 to determine the total distribution amount for each rural
13 hospital.
14 (h) This subsection is repealed on July 1, 2001.
15 (6)(7) This section applies only to hospitals that
16 were defined as statutory rural hospitals, or their
17 successor-in-interest hospital, prior to July 1, 1998. Any
18 additional hospital that is defined as a statutory rural
19 hospital, or its successor-in-interest hospital, on or after
20 July 1, 1998, is not eligible for programs under this section
21 unless additional funds are appropriated each fiscal year
22 specifically to the rural hospital disproportionate share
23 programs and financial assistance programs in an amount
24 necessary to prevent any hospital, or its
25 successor-in-interest hospital, eligible for the programs
26 prior to July 1, 1998, from incurring a reduction in payments
27 because of the eligibility of an additional hospital to
28 participate in the programs. A hospital, or its
29 successor-in-interest hospital, which received funds pursuant
30 to this section before July 1, 1998, and which qualifies under
31 s. 395.602(2)(e), shall be included in the programs under this
18
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 section and is not required to seek additional appropriations
2 under this subsection.
3 Section 9. Paragraph (a) of subsection (37) of section
4 409.912, Florida Statutes, is amended to read:
5 409.912 Cost-effective purchasing of health care.--The
6 agency shall purchase goods and services for Medicaid
7 recipients in the most cost-effective manner consistent with
8 the delivery of quality medical care. The agency shall
9 maximize the use of prepaid per capita and prepaid aggregate
10 fixed-sum basis services when appropriate and other
11 alternative service delivery and reimbursement methodologies,
12 including competitive bidding pursuant to s. 287.057, designed
13 to facilitate the cost-effective purchase of a case-managed
14 continuum of care. The agency shall also require providers to
15 minimize the exposure of recipients to the need for acute
16 inpatient, custodial, and other institutional care and the
17 inappropriate or unnecessary use of high-cost services. The
18 agency may establish prior authorization requirements for
19 certain populations of Medicaid beneficiaries, certain drug
20 classes, or particular drugs to prevent fraud, abuse, overuse,
21 and possible dangerous drug interactions. The Pharmaceutical
22 and Therapeutics Committee shall make recommendations to the
23 agency on drugs for which prior authorization is required. The
24 agency shall inform the Pharmaceutical and Therapeutics
25 Committee of its decisions regarding drugs subject to prior
26 authorization.
27 (37)(a) The agency shall implement a Medicaid
28 prescribed-drug spending-control program that includes the
29 following components:
30 1. Medicaid prescribed-drug coverage for brand-name
31 drugs for adult Medicaid recipients is limited to the
19
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 dispensing of four brand-name drugs per month per recipient.
2 Children are exempt from this restriction. Antiretroviral
3 agents are excluded from this limitation. No requirements for
4 prior authorization or other restrictions on medications used
5 to treat mental illnesses such as schizophrenia, severe
6 depression, or bipolar disorder may be imposed on Medicaid
7 recipients. Medications that will be available without
8 restriction for persons with mental illnesses include atypical
9 antipsychotic medications, conventional antipsychotic
10 medications, selective serotonin reuptake inhibitors, and
11 other medications used for the treatment of serious mental
12 illnesses. The agency shall also limit the amount of a
13 prescribed drug dispensed to no more than a 34-day supply. The
14 agency shall continue to provide unlimited generic drugs,
15 contraceptive drugs and items, and diabetic supplies. Although
16 a drug may be included on the preferred drug formulary, it
17 would not be exempt from the four-brand limit. The agency may
18 authorize exceptions to the brand-name-drug restriction based
19 upon the treatment needs of the patients, only when such
20 exceptions are based on prior consultation provided by the
21 agency or an agency contractor, but the agency must establish
22 procedures to ensure that:
23 a. There will be a response to a request for prior
24 consultation by telephone or other telecommunication device
25 within 24 hours after receipt of a request for prior
26 consultation;
27 b. A 72-hour supply of the drug prescribed will be
28 provided in an emergency or when the agency does not provide a
29 response within 24 hours as required by sub-subparagraph a.;
30 and
31
20
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 c. Except for the exception for nursing home residents
2 and other institutionalized adults and except for drugs on the
3 restricted formulary for which prior authorization may be
4 sought by an institutional or community pharmacy, prior
5 authorization for an exception to the brand-name-drug
6 restriction is sought by the prescriber and not by the
7 pharmacy. When prior authorization is granted for a patient in
8 an institutional setting beyond the brand-name-drug
9 restriction, such approval is authorized for 12 months and
10 monthly prior authorization is not required for that patient.
11 2. Reimbursement to pharmacies for Medicaid prescribed
12 drugs shall be set at the average wholesale price less 15
13 13.25 percent.
14 3. The agency shall develop and implement a process
15 for managing the drug therapies of Medicaid recipients who are
16 using significant numbers of prescribed drugs each month. The
17 management process may include, but is not limited to,
18 comprehensive, physician-directed medical-record reviews,
19 claims analyses, and case evaluations to determine the medical
20 necessity and appropriateness of a patient's treatment plan
21 and drug therapies. The agency may contract with a private
22 organization to provide drug-program-management services. The
23 Medicaid drug benefit management program shall include
24 initiatives to manage drug therapies for HIV/AIDS patients,
25 patients using 20 or more unique prescriptions in a 180-day
26 period, and the top 1,000 patients in annual spending.
27 4. The agency may limit the size of its pharmacy
28 network based on need, competitive bidding, price
29 negotiations, credentialing, or similar criteria. The agency
30 shall give special consideration to rural areas in determining
31 the size and location of pharmacies included in the Medicaid
21
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 pharmacy network. A pharmacy credentialing process may include
2 criteria such as a pharmacy's full-service status, location,
3 size, patient educational programs, patient consultation,
4 disease-management services, and other characteristics. The
5 agency may impose a moratorium on Medicaid pharmacy enrollment
6 when it is determined that it has a sufficient number of
7 Medicaid-participating providers.
8 5. The agency shall develop and implement a program
9 that requires Medicaid practitioners who prescribe drugs to
10 use a counterfeit-proof prescription pad for Medicaid
11 prescriptions. The agency shall require the use of
12 standardized counterfeit-proof prescription pads by
13 Medicaid-participating prescribers or prescribers who write
14 prescriptions for Medicaid recipients. The agency may
15 implement the program in targeted geographic areas or
16 statewide.
17 6. The agency may enter into arrangements that require
18 manufacturers of generic drugs prescribed to Medicaid
19 recipients to provide rebates of at least 15.1 percent of the
20 average manufacturer price for the manufacturer's generic
21 products. These arrangements shall require that if a
22 generic-drug manufacturer pays federal rebates for
23 Medicaid-reimbursed drugs at a level below 15.1 percent, the
24 manufacturer must provide a supplemental rebate to the state
25 in an amount necessary to achieve a 15.1-percent rebate level.
26 7. The agency may establish a preferred drug formulary
27 in accordance with 42 U.S.C. s. 1396r-8, and, pursuant to the
28 establishment of such formulary, it is authorized to negotiate
29 supplemental rebates from manufacturers that are in addition
30 to those required by Title XIX of the Social Security Act and
31 at no less than 10 percent of the average manufacturer price
22
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 as defined in 42 U.S.C. s. 1936 on the last day of a quarter
2 unless the federal or supplemental rebate, or both, equals or
3 exceeds 25 percent. There is no upper limit on the
4 supplemental rebates the agency may negotiate. The agency may
5 determine that specific products, brand-name or generic, are
6 competitive at lower rebate percentages. Agreement to pay the
7 minimum supplemental rebate percentage will guarantee a
8 manufacturer that the Medicaid Pharmaceutical and Therapeutics
9 Committee will consider a product for inclusion on the
10 preferred drug formulary. However, a pharmaceutical
11 manufacturer is not guaranteed placement on the formulary by
12 simply paying the minimum supplemental rebate. Agency
13 decisions will be made on the clinical efficacy of a drug and
14 recommendations of the Medicaid Pharmaceutical and
15 Therapeutics Committee, as well as the price of competing
16 products minus federal and state rebates. The agency is
17 authorized to contract with an outside agency or contractor to
18 conduct negotiations for supplemental rebates. For the
19 purposes of this section, the term "supplemental rebates" may
20 include, at the agency's discretion, cash rebates and other
21 program benefits that offset a Medicaid expenditure. Such
22 other program benefits may include, but are not limited to,
23 disease management programs, drug product donation programs,
24 drug utilization control programs, prescriber and beneficiary
25 counseling and education, fraud and abuse initiatives, and
26 other services or administrative investments with guaranteed
27 savings to the Medicaid program in the same year the rebate
28 reduction is included in the General Appropriations Act. The
29 agency is authorized to seek any federal waivers to implement
30 this initiative.
31
23
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 8. The agency shall establish an advisory committee
2 for the purposes of studying the feasibility of using a
3 restricted drug formulary for nursing home residents and other
4 institutionalized adults. The committee shall be comprised of
5 seven members appointed by the Secretary of Health Care
6 Administration. The committee members shall include two
7 physicians licensed under chapter 458 or chapter 459; three
8 pharmacists licensed under chapter 465 and appointed from a
9 list of recommendations provided by the Florida Long-Term Care
10 Pharmacy Alliance; and two pharmacists licensed under chapter
11 465.
12 Section 10. Effective upon this act becoming a law,
13 subsection (15) and paragraph (a) of subsection (22) of
14 section 409.913, Florida Statutes, are amended to read:
15 409.913 Oversight of the integrity of the Medicaid
16 program.--The agency shall operate a program to oversee the
17 activities of Florida Medicaid recipients, and providers and
18 their representatives, to ensure that fraudulent and abusive
19 behavior and neglect of recipients occur to the minimum extent
20 possible, and to recover overpayments and impose sanctions as
21 appropriate.
22 (15) The agency may impose any of the following
23 sanctions on a provider or a person for any of the acts
24 described in subsection (14):
25 (a) Suspension for a specific period of time of not
26 more than 1 year.
27 (b) Termination for a specific period of time of from
28 more than 1 year to 20 years.
29 (c) Imposition of a fine of up to $5,000 for each
30 violation. Each day that an ongoing violation continues, such
31 as refusing to furnish Medicaid-related records or refusing
24
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 access to records, is considered, for the purposes of this
2 section, to be a separate violation. Each instance of
3 improper billing of a Medicaid recipient; each instance of
4 including an unallowable cost on a hospital or nursing home
5 Medicaid cost report after the provider or authorized
6 representative has been advised in an audit exit conference or
7 previous audit report of the cost unallowability; each
8 instance of furnishing a Medicaid recipient goods or
9 professional services that are inappropriate or of inferior
10 quality as determined by competent peer judgment; each
11 instance of knowingly submitting a materially false or
12 erroneous Medicaid provider enrollment application, request
13 for prior authorization for Medicaid services, drug exception
14 request, or cost report; each instance of inappropriate
15 prescribing of drugs for a Medicaid recipient as determined by
16 competent peer judgment; and each false or erroneous Medicaid
17 claim leading to an overpayment to a provider is considered,
18 for the purposes of this section, to be a separate violation.
19 (d) Immediate suspension, if the agency has received
20 information of patient abuse or neglect or of any act
21 prohibited by s. 409.920. Upon suspension, the agency must
22 issue an immediate final order under s. 120.569(2)(n).
23 (e) A fine, not to exceed $10,000, for a violation of
24 paragraph (14)(i).
25 (f) Imposition of liens against provider assets,
26 including, but not limited to, financial assets and real
27 property, not to exceed the amount of fines or recoveries
28 sought, upon entry of an order by a court determining that
29 such moneys are due or recoverable.
30 (g) Other remedies as permitted by law to effect the
31 recovery of a fine or overpayment.
25
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 (22)(a) In an audit or investigation of a violation
2 committed by a provider which is conducted pursuant to this
3 section, the agency is entitled to recover all up to $15,000
4 in investigative, legal, and expert witness costs if the
5 agency's findings were not contested by the provider or, if
6 contested, the agency ultimately prevailed.
7 Section 11. Effective April 1, 2002, subsection (2) of
8 section 409.915, Florida Statutes, is amended to read:
9 409.915 County contributions to Medicaid.--Although
10 the state is responsible for the full portion of the state
11 share of the matching funds required for the Medicaid program,
12 in order to acquire a certain portion of these funds, the
13 state shall charge the counties for certain items of care and
14 service as provided in this section.
15 (2) A county's participation must be 35 percent of the
16 total cost, or the applicable discounted cost paid by the
17 state for Medicaid recipients enrolled in health maintenance
18 organizations or prepaid health plans, of providing the items
19 listed in subsection (1), except that the payments for items
20 listed in paragraph (1)(b) may not exceed $90 $55 per month
21 per person.
22 Section 12. The Legislature determines and declares
23 that this act fulfills an important state interest.
24 Section 13. Subsection (14) of section 409.908,
25 Florida Statutes, is amended to read:
26 409.908 Reimbursement of Medicaid providers.--Subject
27 to specific appropriations, the agency shall reimburse
28 Medicaid providers, in accordance with state and federal law,
29 according to methodologies set forth in the rules of the
30 agency and in policy manuals and handbooks incorporated by
31 reference therein. These methodologies may include fee
26
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 schedules, reimbursement methods based on cost reporting,
2 negotiated fees, competitive bidding pursuant to s. 287.057,
3 and other mechanisms the agency considers efficient and
4 effective for purchasing services or goods on behalf of
5 recipients. Payment for Medicaid compensable services made on
6 behalf of Medicaid eligible persons is subject to the
7 availability of moneys and any limitations or directions
8 provided for in the General Appropriations Act or chapter 216.
9 Further, nothing in this section shall be construed to prevent
10 or limit the agency from adjusting fees, reimbursement rates,
11 lengths of stay, number of visits, or number of services, or
12 making any other adjustments necessary to comply with the
13 availability of moneys and any limitations or directions
14 provided for in the General Appropriations Act, provided the
15 adjustment is consistent with legislative intent.
16 (14) A provider of prescribed drugs shall be
17 reimbursed the least of the amount billed by the provider, the
18 provider's usual and customary charge, or the Medicaid maximum
19 allowable fee established by the agency, plus a dispensing
20 fee. The agency is directed to implement a variable dispensing
21 fee for payments for prescribed medicines while ensuring
22 continued access for Medicaid recipients. The variable
23 dispensing fee may be based upon, but not limited to, either
24 or both the volume of prescriptions dispensed by a specific
25 pharmacy provider, and the volume of prescriptions dispensed
26 to an individual recipient, and dispensing of
27 preferred-drug-list products. The agency shall increase the
28 pharmacy dispensing fee authorized by statute and in the
29 annual General Appropriations Act by $0.50 for the dispensing
30 of a Medicaid preferred-drug-list product and reduce the
31 pharmacy dispensing fee by $0.50 for the dispensing of a
27
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 Medicaid product that is not included on the preferred-drug
2 list. The agency is authorized to limit reimbursement for
3 prescribed medicine in order to comply with any limitations or
4 directions provided for in the General Appropriations Act,
5 which may include implementing a prospective or concurrent
6 utilization review program.
7 Section 14. Section 400.0225, Florida Statutes, is
8 repealed.
9 Section 15. Paragraph (a) of subsection (2) of section
10 400.191, Florida Statutes, is amended to read:
11 400.191 Availability, distribution, and posting of
12 reports and records.--
13 (2) The agency shall provide additional information in
14 consumer-friendly printed and electronic formats to assist
15 consumers and their families in comparing and evaluating
16 nursing home facilities.
17 (a) The agency shall provide an Internet site which
18 shall include at least the following information either
19 directly or indirectly through a link to another established
20 site or sites of the agency's choosing:
21 1. A list by name and address of all nursing home
22 facilities in this state.
23 2. Whether such nursing home facilities are
24 proprietary or nonproprietary.
25 3. The current owner of the facility's license and the
26 year that that entity became the owner of the license.
27 4. The name of the owner or owners of each facility
28 and whether the facility is affiliated with a company or other
29 organization owning or managing more than one nursing facility
30 in this state.
31 5. The total number of beds in each facility.
28
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 6. The number of private and semiprivate rooms in each
2 facility.
3 7. The religious affiliation, if any, of each
4 facility.
5 8. The languages spoken by the administrator and staff
6 of each facility.
7 9. Whether or not each facility accepts Medicare or
8 Medicaid recipients or insurance, health maintenance
9 organization, Veterans Administration, CHAMPUS program, or
10 workers' compensation coverage.
11 10. Recreational and other programs available at each
12 facility.
13 11. Special care units or programs offered at each
14 facility.
15 12. Whether the facility is a part of a retirement
16 community that offers other services pursuant to part III,
17 part IV, or part V.
18 13. The results of consumer and family satisfaction
19 surveys for each facility, as described in s. 400.0225. The
20 results may be converted to a score or scores, which may be
21 presented in either numeric or symbolic form for the intended
22 consumer audience.
23 13.14. Survey and deficiency information contained on
24 the Online Survey Certification and Reporting (OSCAR) system
25 of the federal Health Care Financing Administration, including
26 annual survey, revisit, and complaint survey information, for
27 each facility for the past 45 months. For noncertified
28 nursing homes, state survey and deficiency information,
29 including annual survey, revisit, and complaint survey
30 information for the past 45 months shall be provided.
31
29
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 14.15. A summary of the Online Survey Certification
2 and Reporting (OSCAR) data for each facility over the past 45
3 months. Such summary may include a score, rating, or
4 comparison ranking with respect to other facilities based on
5 the number of citations received by the facility of annual,
6 revisit, and complaint surveys; the severity and scope of the
7 citations; and the number of annual recertification surveys
8 the facility has had during the past 45 months. The score,
9 rating, or comparison ranking may be presented in either
10 numeric or symbolic form for the intended consumer audience.
11 Section 16. Paragraph (c) of subsection (5) of section
12 400.235, Florida Statutes, is amended to read:
13 400.235 Nursing home quality and licensure status;
14 Gold Seal Program.--
15 (5) Facilities must meet the following additional
16 criteria for recognition as a Gold Seal Program facility:
17 (c) Participate consistently in a the required
18 consumer satisfaction process as prescribed by the agency, and
19 demonstrate that information is elicited from residents,
20 family members, and guardians about satisfaction with the
21 nursing facility, its environment, the services and care
22 provided, the staff's skills and interactions with residents,
23 attention to resident's needs, and the facility's efforts to
24 act on information gathered from the consumer satisfaction
25 measures.
26
27 A facility assigned a conditional licensure status may not
28 qualify for consideration for the Gold Seal Program until
29 after it has operated for 30 months with no class I or class
30 II deficiencies and has completed a regularly scheduled
31 relicensure survey.
30
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 Section 17. Section 400.071, Florida Statutes, is
2 amended to read:
3 400.071 Application for license.--
4 (1) An application for a license as required by s.
5 400.062 shall be made to the agency on forms furnished by it
6 and shall be accompanied by the appropriate license fee.
7 (2) The application shall be under oath and shall
8 contain the following:
9 (a) The name, address, and social security number of
10 the applicant if an individual; if the applicant is a firm,
11 partnership, or association, its name, address, and employer
12 identification number (EIN), and the name and address of any
13 controlling interest; and the name by which the facility is to
14 be known.
15 (b) The name of any person whose name is required on
16 the application under the provisions of paragraph (a) and who
17 owns at least a 10-percent interest in any professional
18 service, firm, association, partnership, or corporation
19 providing goods, leases, or services to the facility for which
20 the application is made, and the name and address of the
21 professional service, firm, association, partnership, or
22 corporation in which such interest is held.
23 (c) The location of the facility for which a license
24 is sought and an indication, as in the original application,
25 that such location conforms to the local zoning ordinances.
26 (d) The name of the person or persons under whose
27 management or supervision the facility will be conducted and
28 the name of the administrator.
29 (e) A signed affidavit disclosing any financial or
30 ownership interest that a person or entity described in
31 paragraph (a) or paragraph (d) has held in the last 5 years in
31
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 any entity licensed by this state or any other state to
2 provide health or residential care which has closed
3 voluntarily or involuntarily; has filed for bankruptcy; has
4 had a receiver appointed; has had a license denied, suspended,
5 or revoked; or has had an injunction issued against it which
6 was initiated by a regulatory agency. The affidavit must
7 disclose the reason any such entity was closed, whether
8 voluntarily or involuntarily.
9 (f) The total number of beds and the total number of
10 Medicare and Medicaid certified beds.
11 (g) Information relating to the number, experience,
12 and training of the employees of the facility and of the moral
13 character of the applicant and employees which the agency
14 requires by rule, including the name and address of any
15 nursing home with which the applicant or employees have been
16 affiliated through ownership or employment within 5 years of
17 the date of the application for a license and the record of
18 any criminal convictions involving the applicant and any
19 criminal convictions involving an employee if known by the
20 applicant after inquiring of the employee. The applicant must
21 demonstrate that sufficient numbers of qualified staff, by
22 training or experience, will be employed to properly care for
23 the type and number of residents who will reside in the
24 facility.
25 (h) Copies of any civil verdict or judgment involving
26 the applicant rendered within the 10 years preceding the
27 application, relating to medical negligence, violation of
28 residents' rights, or wrongful death. As a condition of
29 licensure, the licensee agrees to provide to the agency copies
30 of any new verdict or judgment involving the applicant,
31 relating to such matters, within 30 days after filing with the
32
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 clerk of the court. The information required in this
2 paragraph shall be maintained in the facility's licensure file
3 and in an agency database which is available as a public
4 record.
5 (3) The applicant shall submit evidence which
6 establishes the good moral character of the applicant,
7 manager, supervisor, and administrator. No applicant, if the
8 applicant is an individual; no member of a board of directors
9 or officer of an applicant, if the applicant is a firm,
10 partnership, association, or corporation; and no licensed
11 nursing home administrator shall have been convicted, or found
12 guilty, regardless of adjudication, of a crime in any
13 jurisdiction which affects or may potentially affect residents
14 in the facility.
15 (4) Each applicant for licensure must comply with the
16 following requirements:
17 (a) Upon receipt of a completed, signed, and dated
18 application, the agency shall require background screening of
19 the applicant, in accordance with the level 2 standards for
20 screening set forth in chapter 435. As used in this
21 subsection, the term "applicant" means the facility
22 administrator, or similarly titled individual who is
23 responsible for the day-to-day operation of the licensed
24 facility, and the facility financial officer, or similarly
25 titled individual who is responsible for the financial
26 operation of the licensed facility.
27 (b) The agency may require background screening for a
28 member of the board of directors of the licensee or an officer
29 or an individual owning 5 percent or more of the licensee if
30 the agency has probable cause to believe that such individual
31
33
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 has been convicted of an offense prohibited under the level 2
2 standards for screening set forth in chapter 435.
3 (c) Proof of compliance with the level 2 background
4 screening requirements of chapter 435 which has been submitted
5 within the previous 5 years in compliance with any other
6 health care or assisted living licensure requirements of this
7 state is acceptable in fulfillment of paragraph (a). Proof of
8 compliance with background screening which has been submitted
9 within the previous 5 years to fulfill the requirements of the
10 Department of Insurance pursuant to chapter 651 as part of an
11 application for a certificate of authority to operate a
12 continuing care retirement community is acceptable in
13 fulfillment of the Department of Law Enforcement and Federal
14 Bureau of Investigation background check.
15 (d) A provisional license may be granted to an
16 applicant when each individual required by this section to
17 undergo background screening has met the standards for the
18 Department of Law Enforcement background check, but the agency
19 has not yet received background screening results from the
20 Federal Bureau of Investigation, or a request for a
21 disqualification exemption has been submitted to the agency as
22 set forth in chapter 435, but a response has not yet been
23 issued. A license may be granted to the applicant upon the
24 agency's receipt of a report of the results of the Federal
25 Bureau of Investigation background screening for each
26 individual required by this section to undergo background
27 screening which confirms that all standards have been met, or
28 upon the granting of a disqualification exemption by the
29 agency as set forth in chapter 435. Any other person who is
30 required to undergo level 2 background screening may serve in
31 his or her capacity pending the agency's receipt of the report
34
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 from the Federal Bureau of Investigation; however, the person
2 may not continue to serve if the report indicates any
3 violation of background screening standards and a
4 disqualification exemption has not been requested of and
5 granted by the agency as set forth in chapter 435.
6 (e) Each applicant must submit to the agency, with its
7 application, a description and explanation of any exclusions,
8 permanent suspensions, or terminations of the applicant from
9 the Medicare or Medicaid programs. Proof of compliance with
10 disclosure of ownership and control interest requirements of
11 the Medicaid or Medicare programs shall be accepted in lieu of
12 this submission.
13 (f) Each applicant must submit to the agency a
14 description and explanation of any conviction of an offense
15 prohibited under the level 2 standards of chapter 435 by a
16 member of the board of directors of the applicant, its
17 officers, or any individual owning 5 percent or more of the
18 applicant. This requirement shall not apply to a director of a
19 not-for-profit corporation or organization if the director
20 serves solely in a voluntary capacity for the corporation or
21 organization, does not regularly take part in the day-to-day
22 operational decisions of the corporation or organization,
23 receives no remuneration for his or her services on the
24 corporation or organization's board of directors, and has no
25 financial interest and has no family members with a financial
26 interest in the corporation or organization, provided that the
27 director and the not-for-profit corporation or organization
28 include in the application a statement affirming that the
29 director's relationship to the corporation satisfies the
30 requirements of this paragraph.
31
35
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 (g) An application for license renewal must contain
2 the information required under paragraphs (e) and (f).
3 (5) The applicant shall furnish satisfactory proof of
4 financial ability to operate and conduct the nursing home in
5 accordance with the requirements of this part and all rules
6 adopted under this part, and the agency shall establish
7 standards for this purpose, including information reported
8 under paragraph (2)(e). The agency also shall establish
9 documentation requirements, to be completed by each applicant,
10 that show anticipated facility revenues and expenditures, the
11 basis for financing the anticipated cash-flow requirements of
12 the facility, and an applicant's access to contingency
13 financing.
14 (6) If the applicant offers continuing care agreements
15 as defined in chapter 651, proof shall be furnished that such
16 applicant has obtained a certificate of authority as required
17 for operation under that chapter.
18 (7) As a condition of licensure, each licensee, except
19 one offering continuing care agreements as defined in chapter
20 651, must agree to accept recipients of Title XIX of the
21 Social Security Act on a temporary, emergency basis. The
22 persons whom the agency may require such licensees to accept
23 are those recipients of Title XIX of the Social Security Act
24 who are residing in a facility in which existing conditions
25 constitute an immediate danger to the health, safety, or
26 security of the residents of the facility.
27 (8) As a condition of licensure, each facility must
28 agree to participate in a consumer satisfaction measurement
29 process as prescribed by the agency.
30 (8)(9) The agency may not issue a license to a nursing
31 home that fails to receive a certificate of need under the
36
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 provisions of ss. 408.031-408.045. It is the intent of the
2 Legislature that, in reviewing a certificate-of-need
3 application to add beds to an existing nursing home facility,
4 preference be given to the application of a licensee who has
5 been awarded a Gold Seal as provided for in s. 400.235, if the
6 applicant otherwise meets the review criteria specified in s.
7 408.035.
8 (9)(10) The agency may develop an abbreviated survey
9 for licensure renewal applicable to a licensee that has
10 continuously operated as a nursing facility since 1991 or
11 earlier, has operated under the same management for at least
12 the preceding 30 months, and has had during the preceding 30
13 months no class I or class II deficiencies.
14 (10)(11) The agency may issue an inactive license to a
15 nursing home that will be temporarily unable to provide
16 services but that is reasonably expected to resume services.
17 Such designation may be made for a period not to exceed 12
18 months but may be renewed by the agency for up to 6 additional
19 months. Any request by a licensee that a nursing home become
20 inactive must be submitted to the agency and approved by the
21 agency prior to initiating any suspension of service or
22 notifying residents. Upon agency approval, the nursing home
23 shall notify residents of any necessary discharge or transfer
24 as provided in s. 400.0255.
25 (11)(12) As a condition of licensure, each facility
26 must establish and submit with its application a plan for
27 quality assurance and for conducting risk management.
28 Section 18. Paragraph (q) of subsection (2) of section
29 409.815, Florida Statutes, is amended to read:
30 409.815 Health benefits coverage; limitations.--
31
37
CODING: Words stricken are deletions; words underlined are additions.
CS for SB 26-B First Engrossed
1 (2) BENCHMARK BENEFITS.--In order for health benefits
2 coverage to qualify for premium assistance payments for an
3 eligible child under ss. 409.810-409.820, the health benefits
4 coverage, except for coverage under Medicaid and Medikids,
5 must include the following minimum benefits, as medically
6 necessary.
7 (q) Dental services.--Subject to a specific
8 appropriation for this benefit, covered services include those
9 dental services provided to children by the Florida Medicaid
10 program under s. 409.906(5) s. 409.906(6).
11 Section 19. Except as otherwise specifically provided
12 in this act, this act shall take effect January 1, 2002.
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
38
CODING: Words stricken are deletions; words underlined are additions.