House Bill hb0029C
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Florida House of Representatives - 2001 HB 29-C
By Representative Murman
1 A bill to be entitled
2 An act relating to health care; amending ss.
3 409.903 and 409.904, F.S.; revising eligibility
4 categories for optional Medicaid services;
5 restricting certain nursing, intermediate care,
6 or state mental hospital services to the extent
7 that Medicaid contract beds are available;
8 amending s. 409.905, F.S.; restricting certain
9 nursing and rehabilitative services to the
10 extent that Medicaid beds are available;
11 amending s. 409.906, F.S.; eliminating Medicaid
12 coverage for adult denture services; limiting
13 coverage for hearing and visual services to
14 children under age 21; restricting certain
15 intermediate care nursing and rehabilitation
16 services to the extent that Medicaid contract
17 beds are available; authorizing the Agency for
18 Health Care Administration to use mail order
19 pharmacies for drugs prescribed for a Medicaid
20 recipient; amending s. 409.9065, F.S.; revising
21 eligibility for the pharmaceutical expense
22 assistance program; limiting program enrollment
23 levels and authorizing the agency to develop a
24 waiting list; amending s. 409.907, F.S.;
25 authorizing the agency to withhold payments to
26 a Medicaid provider that the agency is
27 investigating for fraud or abuse; providing for
28 inspections and submission of background
29 information as a condition of initial and
30 renewal applications for provider participation
31 in the Medicaid program; clarifying timeframe
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1 for enrollment of providers; providing
2 additional considerations for denial of a
3 provider application; amending s. 409.908,
4 F.S.; revising pharmacy provider dispensing
5 fees for products on the preferred drug list
6 and those not so listed; amending ss. 409.912
7 and 409.9122, F.S.; eliminating requirement
8 that the agency provide enrollment choice
9 counseling to certain Medicaid recipients;
10 amending s. 409.913, F.S.; specifying
11 additional sanctions which may be imposed by
12 the agency against a Medicaid provider;
13 removing a limitation on certain costs the
14 agency is entitled to recover for provider
15 violations; amending s. 409.915, F.S.;
16 increasing county Medicaid contributions for
17 certain inpatient hospitalization and nursing
18 home and intermediate facilities care; amending
19 ss. 400.071, 400.191, 400.23, 400.235,
20 409.8132, and 409.815, F.S.; removing
21 references to Medicaid enrollment choice
22 counseling and to nursing facility consumer
23 satisfaction surveys, to conform to the act;
24 correcting cross references; providing that the
25 act fulfills an important state interest;
26 repealing s. 400.0225, F.S., relating to
27 nursing facility consumer satisfaction surveys;
28 repealing s. 400.148, F.S., relating to the
29 Medicaid "Up or Out" Quality of Care Contract
30 Management Program; repealing ss. 464.0195,
31 464.0196, and 464.0197, F.S., relating to
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1 establishment, operation, and funding of the
2 Florida Center for Nursing; providing effective
3 dates.
4
5 Be It Enacted by the Legislature of the State of Florida:
6
7 Section 1. Subsection (8) of section 409.903, Florida
8 Statutes, is amended to read:
9 409.903 Mandatory payments for eligible persons.--The
10 agency shall make payments for medical assistance and related
11 services on behalf of the following persons who the
12 department, or the Social Security Administration by contract
13 with the Department of Children and Family Services,
14 determines to be eligible, subject to the income, assets, and
15 categorical eligibility tests set forth in federal and state
16 law. Payment on behalf of these Medicaid eligible persons is
17 subject to the availability of moneys and any limitations
18 established by the General Appropriations Act or chapter 216.
19 (8) A person who is age 65 or over or is determined by
20 the agency to be disabled, whose income is at or below 100
21 percent of the most current federal poverty level and whose
22 assets do not exceed limitations established by the agency.
23 However, the agency may only pay for premiums, coinsurance,
24 and deductibles, as required by federal law, unless additional
25 coverage is provided for any or all members of this group by
26 s. 409.904(1).
27 Section 2. Present subsections (1), (2), and (3) of
28 section 409.904, Florida Statutes, are amended to read:
29 409.904 Optional payments for eligible persons.--The
30 agency may make payments for medical assistance and related
31 services on behalf of the following persons who are determined
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1 to be eligible subject to the income, assets, and categorical
2 eligibility tests set forth in federal and state law. Payment
3 on behalf of these Medicaid eligible persons is subject to the
4 availability of moneys and any limitations established by the
5 General Appropriations Act or chapter 216.
6 (1) A person who is age 65 or older or is determined
7 to be disabled, whose income is at or below 100 percent of
8 federal poverty level, and whose assets do not exceed
9 established limitations.
10 (1)(2) Pregnant women and children under age 1 who
11 would otherwise qualify for Medicaid under s. 409.903(5) and
12 children under age 18 who would otherwise qualify under
13 subsection (7) or s. 409.903(6) or (7) except for their level
14 of income and whose assets fall within the limits established
15 by the Department of Children and Family Services for the
16 medically needy. Coverage for the medically needy is not
17 available to presumptively eligible pregnant women. A family,
18 a pregnant woman, a child under age 18, a person age 65 or
19 over, or a blind or disabled person who would be eligible
20 under any group listed in s. 409.903(1), (2), or (3), except
21 that the income or assets of such family or person exceed
22 established limitations. For a family or person in this group,
23 medical expenses are deductible from income in accordance with
24 federal requirements in order to make a determination of
25 eligibility. A family or person in this group, which group is
26 known as the "medically needy," is eligible to receive the
27 same services as other Medicaid recipients, with the exception
28 of services in skilled nursing facilities and intermediate
29 care facilities for the developmentally disabled.
30 (2)(3) To the extent Medicaid contract beds are
31 available, a person who is in need of the services of a
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1 licensed nursing facility, a licensed intermediate care
2 facility for the developmentally disabled, or a state mental
3 hospital, whose income does not exceed 300 percent of the SSI
4 income standard, and who meets the assets standards
5 established under federal and state law.
6 Section 3. Subsection (8) of section 409.905, Florida
7 Statutes, is amended to read:
8 409.905 Mandatory Medicaid services.--The agency may
9 make payments for the following services, which are required
10 of the state by Title XIX of the Social Security Act,
11 furnished by Medicaid providers to recipients who are
12 determined to be eligible on the dates on which the services
13 were provided. Any service under this section shall be
14 provided only when medically necessary and in accordance with
15 state and federal law. Mandatory services rendered by
16 providers in mobile units to Medicaid recipients may be
17 restricted by the agency. Nothing in this section shall be
18 construed to prevent or limit the agency from adjusting fees,
19 reimbursement rates, lengths of stay, number of visits, number
20 of services, or any other adjustments necessary to comply with
21 the availability of moneys and any limitations or directions
22 provided for in the General Appropriations Act or chapter 216.
23 (8) NURSING FACILITY SERVICES.--To the extent that
24 Medicaid contract beds are available, the agency shall pay for
25 24-hour-a-day nursing and rehabilitative services for a
26 recipient in a nursing facility licensed under part II of
27 chapter 400 or in a rural hospital, as defined in s. 395.602,
28 or in a Medicare certified skilled nursing facility operated
29 by a hospital, as defined by s. 395.002(11), that is licensed
30 under part I of chapter 395, and in accordance with provisions
31 set forth in s. 409.908(2)(a), which services are ordered by
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1 and provided under the direction of a licensed physician.
2 However, if a nursing facility has been destroyed or otherwise
3 made uninhabitable by natural disaster or other emergency and
4 another nursing facility is not available, the agency must pay
5 for similar services temporarily in a hospital licensed under
6 part I of chapter 395 provided federal funding is approved and
7 available.
8 Section 4. Present subsections (1), (12), (16), (20),
9 and (23) of section 409.906, Florida Statutes, are amended to
10 read:
11 409.906 Optional Medicaid services.--Subject to
12 specific appropriations, the agency may make payments for
13 services which are optional to the state under Title XIX of
14 the Social Security Act and are furnished by Medicaid
15 providers to recipients who are determined to be eligible on
16 the dates on which the services were provided. Any optional
17 service that is provided shall be provided only when medically
18 necessary and in accordance with state and federal law.
19 Optional services rendered by providers in mobile units to
20 Medicaid recipients may be restricted or prohibited by the
21 agency. Nothing in this section shall be construed to prevent
22 or limit the agency from adjusting fees, reimbursement rates,
23 lengths of stay, number of visits, or number of services, or
24 making any other adjustments necessary to comply with the
25 availability of moneys and any limitations or directions
26 provided for in the General Appropriations Act or chapter 216.
27 If necessary to safeguard the state's systems of providing
28 services to elderly and disabled persons and subject to the
29 notice and review provisions of s. 216.177, the Governor may
30 direct the Agency for Health Care Administration to amend the
31 Medicaid state plan to delete the optional Medicaid service
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1 known as "Intermediate Care Facilities for the Developmentally
2 Disabled." Optional services may include:
3 (1) ADULT DENTURE SERVICES.--The agency may pay for
4 dentures, the procedures required to seat dentures, and the
5 repair and reline of dentures, provided by or under the
6 direction of a licensed dentist, for a recipient who is age 21
7 or older. However, Medicaid will not provide reimbursement for
8 dental services provided in a mobile dental unit, except for a
9 mobile dental unit:
10 (a) Owned by, operated by, or having a contractual
11 agreement with the Department of Health and complying with
12 Medicaid's county health department clinic services program
13 specifications as a county health department clinic services
14 provider.
15 (b) Owned by, operated by, or having a contractual
16 arrangement with a federally qualified health center and
17 complying with Medicaid's federally qualified health center
18 specifications as a federally qualified health center
19 provider.
20 (c) Rendering dental services to Medicaid recipients,
21 21 years of age and older, at nursing facilities.
22 (d) Owned by, operated by, or having a contractual
23 agreement with a state-approved dental educational
24 institution.
25 (11)(12) CHILDREN'S HEARING SERVICES.--The agency may
26 pay for hearing and related services, including hearing
27 evaluations, hearing aid devices, dispensing of the hearing
28 aid, and related repairs, if provided to a recipient under age
29 21 by a licensed hearing aid specialist, otolaryngologist,
30 otologist, audiologist, or physician.
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1 (15)(16) INTERMEDIATE CARE SERVICES.--To the extent
2 that Medicaid contract beds are available, the agency may pay
3 for 24-hour-a-day intermediate care nursing and rehabilitation
4 services rendered to a recipient in a nursing facility
5 licensed under part II of chapter 400, if the services are
6 ordered by and provided under the direction of a physician.
7 (19)(20) PRESCRIBED DRUG SERVICES.--The agency may pay
8 for medications that are prescribed for a recipient by a
9 physician or other licensed practitioner of the healing arts
10 authorized to prescribe medications and that are dispensed to
11 the recipient by a licensed pharmacist or physician in
12 accordance with applicable state and federal law. The agency
13 may use mail order pharmacy services for dispensing drugs.
14 (22)(23) CHILDREN'S VISUAL SERVICES.--The agency may
15 pay for visual examinations, eyeglasses, and eyeglass repairs
16 for a recipient under age 21, if they are prescribed by a
17 licensed physician specializing in diseases of the eye or by a
18 licensed optometrist.
19 Section 5. Subsections (2), (3), and (5) of section
20 409.9065, Florida Statutes, are amended to read:
21 409.9065 Pharmaceutical expense assistance.--
22 (2) ELIGIBILITY.--Two groups of individuals are
23 eligible for the program:
24 (a) Individuals age 65 and older or disabled adults
25 age 21 and older with incomes above the supplemental security
26 income level but below 90 percent of the federal poverty
27 level.
28 (b) Eligibility for the program is limited to those
29 Individuals who qualify for limited assistance under the
30 Florida Medicaid program as a result of being dually eligible
31 for both Medicare and Medicaid, but whose limited assistance
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1 or Medicare coverage does not include any pharmacy benefit. To
2 the extent that funds are appropriated, specifically eligible
3 are low-income senior citizens who:
4 1.(a) Are Florida residents age 65 and over;
5 2.(b) Have an income between 90 and 120 percent of the
6 federal poverty level;
7 3.(c) Are eligible for both Medicare and Medicaid;
8 4.(d) Are not enrolled in a Medicare health
9 maintenance organization that provides a pharmacy benefit; and
10 5.(e) Request to be enrolled in the program.
11 (3) BENEFITS.--Medications covered under the
12 pharmaceutical expense assistance program are those covered
13 under the Medicaid program in s. 409.906(19)(20). Monthly
14 benefit payments shall be limited to $80 per program
15 participant. Participants are required to make a 10-percent
16 coinsurance payment for each prescription purchased through
17 this program.
18 (5) NONENTITLEMENT.--The pharmaceutical expense
19 assistance program established by this section is not an
20 entitlement. Enrollment levels are limited to those authorized
21 by the Legislature in appropriation. If there are insufficient
22 funds to serve all individuals eligible under subsection (2)
23 and seeking coverage, the agency is authorized to develop a
24 waiting list based on application date to use for enrolling
25 individuals in unfilled enrollment slots.
26 Section 6. Effective upon becoming a law, paragraph
27 (a) of subsection (5) and subsections (7) and (9) of section
28 409.907, Florida Statutes, are amended to read:
29 409.907 Medicaid provider agreements.--The agency may
30 make payments for medical assistance and related services
31 rendered to Medicaid recipients only to an individual or
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1 entity who has a provider agreement in effect with the agency,
2 who is performing services or supplying goods in accordance
3 with federal, state, and local law, and who agrees that no
4 person shall, on the grounds of handicap, race, color, or
5 national origin, or for any other reason, be subjected to
6 discrimination under any program or activity for which the
7 provider receives payment from the agency.
8 (5) The agency:
9 (a) Is required to make timely payment at the
10 established rate for services or goods furnished to a
11 recipient by the provider upon receipt of a properly completed
12 claim form. The claim form shall require certification that
13 the services or goods have been completely furnished to the
14 recipient and that, with the exception of those services or
15 goods specified by the agency, the amount billed does not
16 exceed the provider's usual and customary charge for the same
17 services or goods. The agency may withhold payment to a
18 provider for any pending claim if the provider is under an
19 active fraud or abuse investigation by the agency until the
20 conclusion of the investigation by the agency. When exercising
21 the provisions of this paragraph, the agency shall complete
22 its investigation in a timely manner.
23 (7) The agency may require, as a condition of
24 participating in the Medicaid program and before entering into
25 the provider agreement, that the provider submit information,
26 in an initial and any required renewal applications,
27 concerning the professional, business, and personal background
28 of the provider and permit an onsite inspection of the
29 provider's service location by agency staff or other personnel
30 designated by the agency to perform this function. Before
31 entering into the provider agreement, or as a condition of
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1 continuing participation in the Medicaid program, the agency
2 may also require that Medicaid providers reimbursed on a
3 fee-for-services basis or fee schedule basis which is not
4 cost-based, post a surety bond not to exceed $50,000 or the
5 total amount billed by the provider to the program during the
6 current or most recent calendar year, whichever is greater.
7 For new providers, the amount of the surety bond shall be
8 determined by the agency based on the provider's estimate of
9 its first year's billing. If the provider's billing during the
10 first year exceeds the bond amount, the agency may require the
11 provider to acquire an additional bond equal to the actual
12 billing level of the provider. A provider's bond shall not
13 exceed $50,000 if a physician or group of physicians licensed
14 under chapter 458, chapter 459, or chapter 460 has a 50
15 percent or greater ownership interest in the provider or if
16 the provider is an assisted living facility licensed under
17 part III of chapter 400. The bonds permitted by this section
18 are in addition to the bonds referenced in s. 400.179(4)(d).
19 If the provider is a corporation, partnership, association, or
20 other entity, the agency may require the provider to submit
21 information concerning the background of that entity and of
22 any principal of the entity, including any partner or
23 shareholder having an ownership interest in the entity equal
24 to 5 percent or greater, and any treating provider who
25 participates in or intends to participate in Medicaid through
26 the entity. The information must include:
27 (a) Proof of holding a valid license or operating
28 certificate, as applicable, if required by the state or local
29 jurisdiction in which the provider is located or if required
30 by the Federal Government.
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1 (b) Information concerning any prior violation, fine,
2 suspension, termination, or other administrative action taken
3 under the Medicaid laws, rules, or regulations of this state
4 or of any other state or the Federal Government; any prior
5 violation of the laws, rules, or regulations relating to the
6 Medicare program; any prior violation of the rules or
7 regulations of any other public or private insurer; and any
8 prior violation of the laws, rules, or regulations of any
9 regulatory body of this or any other state.
10 (c) Full and accurate disclosure of any financial or
11 ownership interest that the provider, or any principal,
12 partner, or major shareholder thereof, may hold in any other
13 Medicaid provider or health care related entity or any other
14 entity that is licensed by the state to provide health or
15 residential care and treatment to persons.
16 (d) If a group provider, identification of all members
17 of the group and attestation that all members of the group are
18 enrolled in or have applied to enroll in the Medicaid program.
19 (9) Upon receipt of a completed, signed, and dated
20 application, and completion of any necessary background
21 investigation and criminal history record check, the agency
22 must either:
23 (a) Enroll the applicant as a Medicaid provider no
24 earlier than the effective date of the approval of the
25 provider application; or
26 (b) Deny the application if the agency finds that it
27 is in the best interest of the Medicaid program to do so. The
28 agency may consider the factors listed in subsection (10), as
29 well as any other factor that could affect the effective and
30 efficient administration of the program, including, but not
31 limited to, the current availability of medical care,
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1 services, or supplies to recipients, taking into account
2 geographic location and reasonable travel time; the number of
3 providers of the same type already enrolled in the same
4 geographic area; and the credentials, experience, success, and
5 patient outcomes of the provider for the services for which it
6 is making application to provide in the Medicaid program.
7 Section 7. Paragraphs (g) and (t) of subsection (3)
8 and subsections (14) and (20) of section 409.908, Florida
9 Statutes, are amended to read:
10 409.908 Reimbursement of Medicaid providers.--Subject
11 to specific appropriations, the agency shall reimburse
12 Medicaid providers, in accordance with state and federal law,
13 according to methodologies set forth in the rules of the
14 agency and in policy manuals and handbooks incorporated by
15 reference therein. These methodologies may include fee
16 schedules, reimbursement methods based on cost reporting,
17 negotiated fees, competitive bidding pursuant to s. 287.057,
18 and other mechanisms the agency considers efficient and
19 effective for purchasing services or goods on behalf of
20 recipients. Payment for Medicaid compensable services made on
21 behalf of Medicaid eligible persons is subject to the
22 availability of moneys and any limitations or directions
23 provided for in the General Appropriations Act or chapter 216.
24 Further, nothing in this section shall be construed to prevent
25 or limit the agency from adjusting fees, reimbursement rates,
26 lengths of stay, number of visits, or number of services, or
27 making any other adjustments necessary to comply with the
28 availability of moneys and any limitations or directions
29 provided for in the General Appropriations Act, provided the
30 adjustment is consistent with legislative intent.
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1 (3) Subject to any limitations or directions provided
2 for in the General Appropriations Act, the following Medicaid
3 services and goods may be reimbursed on a fee-for-service
4 basis. For each allowable service or goods furnished in
5 accordance with Medicaid rules, policy manuals, handbooks, and
6 state and federal law, the payment shall be the amount billed
7 by the provider, the provider's usual and customary charge, or
8 the maximum allowable fee established by the agency, whichever
9 amount is less, with the exception of those services or goods
10 for which the agency makes payment using a methodology based
11 on capitation rates, average costs, or negotiated fees.
12 (g) Children's hearing services.
13 (t) Children's visual services.
14 (14) A provider of prescribed drugs shall be
15 reimbursed the least of the amount billed by the provider, the
16 provider's usual and customary charge, or the Medicaid maximum
17 allowable fee established by the agency, plus a dispensing
18 fee. The agency is directed to implement a variable dispensing
19 fee for payments for prescribed medicines while ensuring
20 continued access for Medicaid recipients. The variable
21 dispensing fee may be based upon, but not limited to, either
22 or both the volume of prescriptions dispensed by a specific
23 pharmacy provider, and the volume of prescriptions dispensed
24 to an individual recipient, and dispensing of preferred drug
25 list products. The agency shall increase the pharmacy
26 dispensing fee authorized by statute and appropriation by
27 $0.50 for the dispensing of a Medicaid preferred drug list
28 product and reduce the pharmacy dispensing fee by $0.50 for
29 the dispensing of a Medicaid product that is not included on
30 the preferred drug list. The agency is authorized to limit
31 reimbursement for prescribed medicine in order to comply with
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1 any limitations or directions provided for in the General
2 Appropriations Act, which may include implementing a
3 prospective or concurrent utilization review program.
4 (20) A renal dialysis facility that provides dialysis
5 services under s. 409.906(8)(9) must be reimbursed the lesser
6 of the amount billed by the provider, the provider's usual and
7 customary charge, or the maximum allowable fee established by
8 the agency, whichever amount is less.
9 Section 8. Subsection (26) of section 409.912, Florida
10 Statutes, is amended to read:
11 409.912 Cost-effective purchasing of health care.--The
12 agency shall purchase goods and services for Medicaid
13 recipients in the most cost-effective manner consistent with
14 the delivery of quality medical care. The agency shall
15 maximize the use of prepaid per capita and prepaid aggregate
16 fixed-sum basis services when appropriate and other
17 alternative service delivery and reimbursement methodologies,
18 including competitive bidding pursuant to s. 287.057, designed
19 to facilitate the cost-effective purchase of a case-managed
20 continuum of care. The agency shall also require providers to
21 minimize the exposure of recipients to the need for acute
22 inpatient, custodial, and other institutional care and the
23 inappropriate or unnecessary use of high-cost services. The
24 agency may establish prior authorization requirements for
25 certain populations of Medicaid beneficiaries, certain drug
26 classes, or particular drugs to prevent fraud, abuse, overuse,
27 and possible dangerous drug interactions. The Pharmaceutical
28 and Therapeutics Committee shall make recommendations to the
29 agency on drugs for which prior authorization is required. The
30 agency shall inform the Pharmaceutical and Therapeutics
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1 Committee of its decisions regarding drugs subject to prior
2 authorization.
3 (26) The agency shall perform choice counseling,
4 enrollments, and disenrollments for Medicaid recipients who
5 are eligible for MediPass or managed care plans.
6 Notwithstanding the prohibition contained in paragraph
7 (18)(f), managed care plans may perform preenrollments of
8 Medicaid recipients under the supervision of the agency or its
9 agents. For the purposes of this section, "preenrollment"
10 means the provision of marketing and educational materials to
11 a Medicaid recipient and assistance in completing the
12 application forms, but shall not include actual enrollment
13 into a managed care plan. An application for enrollment shall
14 not be deemed complete until the agency or its agent verifies
15 that the recipient made an informed, voluntary choice. The
16 agency, in cooperation with the Department of Children and
17 Family Services, may test new marketing initiatives to inform
18 Medicaid recipients about their managed care options at
19 selected sites. The agency shall report to the Legislature on
20 the effectiveness of such initiatives. The agency may
21 contract with a third party to perform managed care plan and
22 MediPass choice-counseling, enrollment, and disenrollment
23 services for Medicaid recipients and is authorized to adopt
24 rules to implement such services. The agency may adjust the
25 capitation rate only to cover the costs of a third-party
26 choice-counseling, enrollment, and disenrollment contract, and
27 for agency supervision and management of the managed care plan
28 choice-counseling, enrollment, and disenrollment contract.
29 Section 9. Paragraph (e) of subsection (2) of section
30 409.9122, Florida Statutes, is amended to read:
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1 409.9122 Mandatory Medicaid managed care enrollment;
2 programs and procedures.--
3 (2)
4 (e) Prior to requesting a Medicaid recipient who is
5 subject to mandatory managed care enrollment to make a choice
6 between a managed care plan or MediPass, the agency shall
7 contact and provide choice counseling to the recipient.
8 Medicaid recipients who are already enrolled in a managed care
9 plan or MediPass shall be offered the opportunity to change
10 managed care plans or MediPass providers on a staggered basis,
11 as defined by the agency. All Medicaid recipients shall have
12 90 days in which to make a choice of managed care plans or
13 MediPass providers. Those Medicaid recipients who do not make
14 a choice shall be assigned to a managed care plan or MediPass
15 in accordance with paragraph (f). To facilitate continuity of
16 care, for a Medicaid recipient who is also a recipient of
17 Supplemental Security Income (SSI), prior to assigning the SSI
18 recipient to a managed care plan or MediPass, the agency shall
19 determine whether the SSI recipient has an ongoing
20 relationship with a MediPass provider or managed care plan,
21 and if so, the agency shall assign the SSI recipient to that
22 MediPass provider or managed care plan. Those SSI recipients
23 who do not have such a provider relationship shall be assigned
24 to a managed care plan or MediPass provider in accordance with
25 paragraph (f).
26 Section 10. Effective upon becoming a law, paragraphs
27 (f) and (g) are added to subsection (15) of section 409.913,
28 Florida Statutes, and paragraph (a) of subsection (22) of said
29 section is amended, to read:
30 409.913 Oversight of the integrity of the Medicaid
31 program.--The agency shall operate a program to oversee the
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1 activities of Florida Medicaid recipients, and providers and
2 their representatives, to ensure that fraudulent and abusive
3 behavior and neglect of recipients occur to the minimum extent
4 possible, and to recover overpayments and impose sanctions as
5 appropriate.
6 (15) The agency may impose any of the following
7 sanctions on a provider or a person for any of the acts
8 described in subsection (14):
9 (f) Imposition of liens against the provider's assets,
10 including, but not limited to, financial assets and real
11 property, not to exceed the amount of the fine or recovery
12 sought.
13 (g) Other remedies as permitted by law to effect the
14 recovery of a fine or overpayment.
15 (22)(a) In an audit or investigation of a violation
16 committed by a provider which is conducted pursuant to this
17 section, the agency is entitled to recover all up to $15,000
18 in investigative, legal, and expert witness costs if the
19 agency's findings were not contested by the provider or, if
20 contested, the agency ultimately prevailed.
21 Section 11. Subsections (1) and (2) of section
22 409.915, Florida Statutes, are amended to read:
23 409.915 County contributions to Medicaid.--Although
24 the state is responsible for the full portion of the state
25 share of the matching funds required for the Medicaid program,
26 in order to acquire a certain portion of these funds, the
27 state shall charge the counties for certain items of care and
28 service as provided in this section.
29 (1) Each county shall participate in the following
30 items of care and service:
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1 (a) For both health maintenance members and
2 fee-for-service beneficiaries, payments for inpatient
3 hospitalization in excess of 9 10 days, but not in excess of
4 45 days, with the exception of pregnant women and children
5 whose income is in excess of the federal poverty level and who
6 do not participate in the Medicaid medically needy program.
7 (b) Payments for nursing home or intermediate
8 facilities care in excess of $170 per month, with the
9 exception of skilled nursing care for children under age 21.
10 (2) A county's participation must be 35 percent of the
11 total cost, or the applicable discounted cost paid by the
12 state for Medicaid recipients enrolled in health maintenance
13 organizations or prepaid health plans, of providing the items
14 listed in subsection (1), except that the payments for items
15 listed in paragraph (1)(b) may not exceed $140 $55 per month
16 per person.
17 Section 12. Subsection (8) of section 400.071, Florida
18 Statutes, is amended to read:
19 400.071 Application for license.--
20 (8) As a condition of licensure, each facility must
21 agree to participate in a consumer satisfaction measurement
22 process as prescribed by the agency.
23 Section 13. Paragraphs (a) and (b) of subsection (2)
24 of section 400.191, Florida Statutes, are amended to read:
25 400.191 Availability, distribution, and posting of
26 reports and records.--
27 (2) The agency shall provide additional information in
28 consumer-friendly printed and electronic formats to assist
29 consumers and their families in comparing and evaluating
30 nursing home facilities.
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1 (a) The agency shall provide an Internet site which
2 shall include at least the following information either
3 directly or indirectly through a link to another established
4 site or sites of the agency's choosing:
5 1. A list by name and address of all nursing home
6 facilities in this state.
7 2. Whether such nursing home facilities are
8 proprietary or nonproprietary.
9 3. The current owner of the facility's license and the
10 year that that entity became the owner of the license.
11 4. The name of the owner or owners of each facility
12 and whether the facility is affiliated with a company or other
13 organization owning or managing more than one nursing facility
14 in this state.
15 5. The total number of beds in each facility.
16 6. The number of private and semiprivate rooms in each
17 facility.
18 7. The religious affiliation, if any, of each
19 facility.
20 8. The languages spoken by the administrator and staff
21 of each facility.
22 9. Whether or not each facility accepts Medicare or
23 Medicaid recipients or insurance, health maintenance
24 organization, Veterans Administration, CHAMPUS program, or
25 workers' compensation coverage.
26 10. Recreational and other programs available at each
27 facility.
28 11. Special care units or programs offered at each
29 facility.
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1 12. Whether the facility is a part of a retirement
2 community that offers other services pursuant to part III,
3 part IV, or part V.
4 13. The results of consumer and family satisfaction
5 surveys for each facility, as described in s. 400.0225. The
6 results may be converted to a score or scores, which may be
7 presented in either numeric or symbolic form for the intended
8 consumer audience.
9 13.14. Survey and deficiency information contained on
10 the Online Survey Certification and Reporting (OSCAR) system
11 of the federal Health Care Financing Administration, including
12 annual survey, revisit, and complaint survey information, for
13 each facility for the past 45 months. For noncertified
14 nursing homes, state survey and deficiency information,
15 including annual survey, revisit, and complaint survey
16 information for the past 45 months shall be provided.
17 14.15. A summary of the Online Survey Certification
18 and Reporting (OSCAR) data for each facility over the past 45
19 months. Such summary may include a score, rating, or
20 comparison ranking with respect to other facilities based on
21 the number of citations received by the facility of annual,
22 revisit, and complaint surveys; the severity and scope of the
23 citations; and the number of annual recertification surveys
24 the facility has had during the past 45 months. The score,
25 rating, or comparison ranking may be presented in either
26 numeric or symbolic form for the intended consumer audience.
27 (b) The agency shall provide the following information
28 in printed form:
29 1. A list by name and address of all nursing home
30 facilities in this state.
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1 2. Whether such nursing home facilities are
2 proprietary or nonproprietary.
3 3. The current owner or owners of the facility's
4 license and the year that entity became the owner of the
5 license.
6 4. The total number of beds, and of private and
7 semiprivate rooms, in each facility.
8 5. The religious affiliation, if any, of each
9 facility.
10 6. The name of the owner of each facility and whether
11 the facility is affiliated with a company or other
12 organization owning or managing more than one nursing facility
13 in this state.
14 7. The languages spoken by the administrator and staff
15 of each facility.
16 8. Whether or not each facility accepts Medicare or
17 Medicaid recipients or insurance, health maintenance
18 organization, Veterans Administration, CHAMPUS program, or
19 workers' compensation coverage.
20 9. Recreational programs, special care units, and
21 other programs available at each facility.
22 10. The results of consumer and family satisfaction
23 surveys for each facility, as described in s. 400.0225. The
24 results may be converted to a score or scores, which may be
25 presented in either numeric or symbolic form for the intended
26 consumer audience.
27 10.11. The Internet address for the site where more
28 detailed information can be seen.
29 11.12. A statement advising consumers that each
30 facility will have its own policies and procedures related to
31 protecting resident property.
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1 12.13. 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 on annual,
6 revisit, and complaint surveys; the severity and scope of the
7 citations; the number of citations; and the number of annual
8 recertification surveys the facility has had during the past
9 45 months. The score, rating, or comparison ranking may be
10 presented in either numeric or symbolic form for the intended
11 consumer audience.
12 Section 14. Paragraph (h) of subsection (2) of section
13 400.23, Florida Statutes, is amended to read:
14 400.23 Rules; evaluation and deficiencies; licensure
15 status.--
16 (2) Pursuant to the intention of the Legislature, the
17 agency, in consultation with the Department of Health and the
18 Department of Elderly Affairs, shall adopt and enforce rules
19 to implement this part, which shall include reasonable and
20 fair criteria in relation to:
21 (h) The implementation of the consumer satisfaction
22 survey pursuant to s. 400.0225; The availability,
23 distribution, and posting of reports and records pursuant to
24 s. 400.191; and the Gold Seal Program pursuant to s. 400.235.
25 Section 15. Paragraph (c) of subsection (5) of section
26 400.235, Florida Statutes, is amended to read:
27 400.235 Nursing home quality and licensure status;
28 Gold Seal Program.--
29 (5) Facilities must meet the following additional
30 criteria for recognition as a Gold Seal Program facility:
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1 (c) Participate in a consistently in the required
2 consumer satisfaction process as prescribed by the agency, and
3 demonstrate that information is elicited from residents,
4 family members, and guardians about satisfaction with the
5 nursing facility, its environment, the services and care
6 provided, the staff's skills and interactions with residents,
7 attention to resident's needs, and the facility's efforts to
8 act on information gathered from the consumer satisfaction
9 measures.
10
11 A facility assigned a conditional licensure status may not
12 qualify for consideration for the Gold Seal Program until
13 after it has operated for 30 months with no class I or class
14 II deficiencies and has completed a regularly scheduled
15 relicensure survey.
16 Section 16. Subsection (7) of section 409.8132,
17 Florida Statutes, is amended to read:
18 409.8132 Medikids program component.--
19 (7) ENROLLMENT.--Enrollment in the Medikids program
20 component may only occur during periodic open enrollment
21 periods as specified by the agency. An applicant may apply for
22 enrollment in the Medikids program component and proceed
23 through the eligibility determination process at any time
24 throughout the year. However, enrollment in Medikids shall not
25 begin until the next open enrollment period; and a child may
26 not receive services under the Medikids program until the
27 child is enrolled in a managed care plan or MediPass. In
28 addition, once determined eligible, an applicant may receive
29 choice counseling and select a managed care plan or MediPass.
30 The agency may initiate mandatory assignment for a Medikids
31 applicant who has not chosen a managed care plan or MediPass
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1 provider after the applicant's voluntary choice period ends.
2 An applicant may select MediPass under the Medikids program
3 component only in counties that have fewer than two managed
4 care plans available to serve Medicaid recipients and only if
5 the federal Health Care Financing Administration determines
6 that MediPass constitutes "health insurance coverage" as
7 defined in Title XXI of the Social Security Act.
8 Section 17. Paragraph (q) of subsection (2) of section
9 409.815, Florida Statutes, is amended to read:
10 409.815 Health benefits coverage; limitations.--
11 (2) BENCHMARK BENEFITS.--In order for health benefits
12 coverage to qualify for premium assistance payments for an
13 eligible child under ss. 409.810-409.820, the health benefits
14 coverage, except for coverage under Medicaid and Medikids,
15 must include the following minimum benefits, as medically
16 necessary.
17 (q) Dental services.--Subject to a specific
18 appropriation for this benefit, covered services include those
19 dental services provided to children by the Florida Medicaid
20 program under s. 409.906(5)(6).
21 Section 18. Pursuant to s. 18, Art. VII of the State
22 Constitution, the Legislature finds that this act fulfills an
23 important state interest.
24 Section 19. Sections 400.0225, 400.148, 464.0195,
25 464.0196, and 464.0197, Florida Statutes, are repealed.
26 Section 20. Except as otherwise provided herein, this
27 act shall take effect January 1, 2002.
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2 HOUSE SUMMARY
3
Revises eligibility categories for optional Medicaid
4 services. Restricts certain nursing and rehabilitative
services, intermediate care, and state mental hospital
5 services to the extent that Medicaid contract beds are
available. Eliminates Medicaid coverage for adult denture
6 services. Limits hearing and visual services to children
under age 21. Authorizes the Agency for Health Care
7 Administration to use mail order pharmacies for drugs
prescribed for a Medicaid recipient. Revises eligibility
8 for the pharmaceutical expense assistance program. Limits
program enrollment levels and authorizes the agency to
9 develop a waiting list. Authorizes the agency to withhold
payments to a Medicaid provider that the agency is
10 investigating for fraud or abuse. Provides for inspection
and submission of background information as a condition
11 of initial and renewal applications for provider
participation in the Medicaid program. Clarifies the
12 timeframe for enrollment of providers. Provides
additional considerations for denial of a provider
13 application. Revises pharmacy provider dispensing fees
for products on the preferred drug list and those not on
14 the list. Eliminates provisions requiring the agency to
provide enrollment choice counseling to certain Medicaid
15 recipients. Specifies additional sanctions that the
agency may impose against Medicaid providers. Eliminates
16 the $15,000 ceiling on investigative, legal, and expert
witness costs the agency is entitled to recover for
17 provider violations. Increases county Medicaid
contributions for certain inpatient hospitalization and
18 nursing home and intermediate facilities care. Eliminates
provisions relating to nursing facility consumer
19 satisfaction surveys. Abolishes the Medicaid "Up or Out"
Quality of Care Contract Management Program. Abolishes
20 the Florida Center for Nursing. Provides that the act
fulfills an important state interest.
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