House Bill hb0029Ce1
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HB 29-C, First Engrossed
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 amending s. 409.906, F.S.; eliminating Medicaid
6 coverage for adult denture services; limiting
7 coverage for hearing and visual services to
8 children under age 21; authorizing the Agency
9 for Health Care Administration to use mail
10 order pharmacies for drugs prescribed for a
11 Medicaid recipient; amending s. 409.9065, F.S.;
12 revising eligibility for the pharmaceutical
13 expense assistance program; limiting program
14 enrollment levels and authorizing the agency to
15 develop a waiting list; amending s. 409.907,
16 F.S.; authorizing the agency to withhold
17 payments to a Medicaid provider that the agency
18 is investigating for fraud or abuse; providing
19 for inspections and submission of background
20 information as a condition of initial and
21 renewal applications for provider participation
22 in the Medicaid program; clarifying timeframe
23 for enrollment of providers; providing
24 additional considerations for denial of a
25 provider application; amending s. 409.908,
26 F.S.; revising pharmacy provider dispensing
27 fees for products on the preferred drug list
28 and those not so listed; amending ss. 409.912
29 and 409.9122, F.S.; eliminating requirement
30 that the agency provide enrollment choice
31 counseling to certain Medicaid recipients;
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HB 29-C, First Engrossed
1 amending s. 409.913, F.S.; specifying
2 additional sanctions which may be imposed by
3 the agency against a Medicaid provider;
4 removing a limitation on certain costs the
5 agency is entitled to recover for provider
6 violations; amending s. 409.915, F.S.;
7 increasing county Medicaid contributions for
8 certain inpatient hospitalization and nursing
9 home and intermediate facilities care; amending
10 ss. 400.071, 400.191, 400.23, 400.235,
11 409.8132, and 409.815, F.S.; removing
12 references to Medicaid enrollment choice
13 counseling and to nursing facility consumer
14 satisfaction surveys, to conform to the act;
15 correcting cross references; providing that the
16 act fulfills an important state interest;
17 repealing s. 400.0225, F.S., relating to
18 nursing facility consumer satisfaction surveys;
19 repealing s. 400.148, F.S., relating to the
20 Medicaid "Up or Out" Quality of Care Contract
21 Management Program; repealing ss. 464.0195,
22 464.0196, and 464.0197, F.S., relating to
23 establishment, operation, and funding of the
24 Florida Center for Nursing; providing effective
25 dates.
26
27 Be It Enacted by the Legislature of the State of Florida:
28
29 Section 1. Subsection (8) of section 409.903, Florida
30 Statutes, is amended to read:
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HB 29-C, First Engrossed
1 409.903 Mandatory payments for eligible persons.--The
2 agency shall make payments for medical assistance and related
3 services on behalf of the following persons who the
4 department, or the Social Security Administration by contract
5 with the Department of Children and Family Services,
6 determines to be eligible, subject to the income, assets, and
7 categorical eligibility tests set forth in federal and state
8 law. Payment on behalf of these Medicaid eligible persons is
9 subject to the availability of moneys and any limitations
10 established by the General Appropriations Act or chapter 216.
11 (8) A person who is age 65 or over or is determined by
12 the agency to be disabled, whose income is at or below 100
13 percent of the most current federal poverty level and whose
14 assets do not exceed limitations established by the agency.
15 However, the agency may only pay for premiums, coinsurance,
16 and deductibles, as required by federal law, unless additional
17 coverage is provided for any or all members of this group by
18 s. 409.904(1).
19 Section 2. Present subsections (1) and (2) of section
20 409.904, Florida Statutes, are amended to read:
21 409.904 Optional payments for eligible persons.--The
22 agency may make payments for medical assistance and related
23 services on behalf of the following persons who are determined
24 to be eligible subject to the income, assets, and categorical
25 eligibility tests set forth in federal and state law. Payment
26 on behalf of these Medicaid eligible persons is subject to the
27 availability of moneys and any limitations established by the
28 General Appropriations Act or chapter 216.
29 (1) A person who is age 65 or older or is determined
30 to be disabled, whose income is at or below 85 100 percent of
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HB 29-C, First Engrossed
1 federal poverty level, and whose assets do not exceed
2 established limitations.
3 (2) Pregnant women and children under age 1 who would
4 otherwise qualify for Medicaid under s. 409.903(5) and
5 children under age 18 who would otherwise qualify under
6 subsection (7) or s. 409.903(6) or (7) except for their level
7 of income and whose assets fall within the limits established
8 by the Department of Children and Family Services for the
9 medically needy. Coverage for the medically needy is not
10 available to presumptively eligible pregnant women. A family,
11 a pregnant woman, a child under age 18, a person age 65 or
12 over, or a blind or disabled person who would be eligible
13 under any group listed in s. 409.903(1), (2), or (3), except
14 that the income or assets of such family or person exceed
15 established limitations. For a family or person in this
16 group, medical expenses are deductible from income in
17 accordance with federal requirements in order to make a
18 determination of eligibility. A family or person in this
19 group, which group is known as the "medically needy," is
20 eligible to receive the same services as other Medicaid
21 recipients, with the exception of services in skilled nursing
22 facilities and intermediate care facilities for the
23 developmentally disabled.
24 Section 3. Present subsections (1), (12), (20), and
25 (23) of section 409.906, Florida Statutes, are amended to
26 read:
27 409.906 Optional Medicaid services.--Subject to
28 specific appropriations, the agency may make payments for
29 services which are optional to the state under Title XIX of
30 the Social Security Act and are furnished by Medicaid
31 providers to recipients who are determined to be eligible on
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HB 29-C, First Engrossed
1 the dates on which the services were provided. Any optional
2 service that is provided shall be provided only when medically
3 necessary and in accordance with state and federal law.
4 Optional services rendered by providers in mobile units to
5 Medicaid recipients may be restricted or prohibited by the
6 agency. Nothing in this section shall be construed to prevent
7 or limit the agency from adjusting fees, reimbursement rates,
8 lengths of stay, number of visits, or number of services, or
9 making any other adjustments necessary to comply with the
10 availability of moneys and any limitations or directions
11 provided for in the General Appropriations Act or chapter 216.
12 If necessary to safeguard the state's systems of providing
13 services to elderly and disabled persons and subject to the
14 notice and review provisions of s. 216.177, the Governor may
15 direct the Agency for Health Care Administration to amend the
16 Medicaid state plan to delete the optional Medicaid service
17 known as "Intermediate Care Facilities for the Developmentally
18 Disabled." Optional services may include:
19 (1) ADULT DENTURE SERVICES.--The agency may pay for
20 dentures, the procedures required to seat dentures, and the
21 repair and reline of dentures, provided by or under the
22 direction of a licensed dentist, for a recipient who is age 21
23 or older. However, Medicaid will not provide reimbursement for
24 dental services provided in a mobile dental unit, except for a
25 mobile dental unit:
26 (a) Owned by, operated by, or having a contractual
27 agreement with the Department of Health and complying with
28 Medicaid's county health department clinic services program
29 specifications as a county health department clinic services
30 provider.
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1 (b) Owned by, operated by, or having a contractual
2 arrangement with a federally qualified health center and
3 complying with Medicaid's federally qualified health center
4 specifications as a federally qualified health center
5 provider.
6 (c) Rendering dental services to Medicaid recipients,
7 21 years of age and older, at nursing facilities.
8 (d) Owned by, operated by, or having a contractual
9 agreement with a state-approved dental educational
10 institution.
11 (11)(12) CHILDREN'S HEARING SERVICES.--The agency may
12 pay for hearing and related services, including hearing
13 evaluations, hearing aid devices, dispensing of the hearing
14 aid, and related repairs, if provided to a recipient under age
15 21 by a licensed hearing aid specialist, otolaryngologist,
16 otologist, audiologist, or physician.
17 (19)(20) PRESCRIBED DRUG SERVICES.--The agency may pay
18 for medications that are prescribed for a recipient by a
19 physician or other licensed practitioner of the healing arts
20 authorized to prescribe medications and that are dispensed to
21 the recipient by a licensed pharmacist or physician in
22 accordance with applicable state and federal law. The agency
23 may use mail order pharmacy services for dispensing drugs.
24 (22)(23) CHILDREN'S VISUAL SERVICES.--The agency may
25 pay for visual examinations, eyeglasses, and eyeglass repairs
26 for a recipient under age 21, if they are prescribed by a
27 licensed physician specializing in diseases of the eye or by a
28 licensed optometrist.
29 Section 4. Subsections (2), (3), and (5) of section
30 409.9065, Florida Statutes, are amended to read:
31 409.9065 Pharmaceutical expense assistance.--
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HB 29-C, First Engrossed
1 (2) ELIGIBILITY.--Two groups of individuals are
2 eligible for the program:
3 (a) Individuals age 65 and older or disabled adults
4 age 21 and older with incomes between 85 and 90 percent of the
5 federal poverty level.
6 (b) Eligibility for the program is limited to those
7 Individuals who qualify for limited assistance under the
8 Florida Medicaid program as a result of being dually eligible
9 for both Medicare and Medicaid, but whose limited assistance
10 or Medicare coverage does not include any pharmacy benefit. To
11 the extent that funds are appropriated, specifically eligible
12 are low-income senior citizens who:
13 1.(a) Are Florida residents age 65 and over;
14 2.(b) Have an income between 90 and 120 percent of the
15 federal poverty level;
16 3.(c) Are eligible for both Medicare and Medicaid;
17 4.(d) Are not enrolled in a Medicare health
18 maintenance organization that provides a pharmacy benefit; and
19 5.(e) Request to be enrolled in the program.
20 (3) BENEFITS.--Medications covered under the
21 pharmaceutical expense assistance program are those covered
22 under the Medicaid program in s. 409.906(19)(20). Monthly
23 benefit payments shall be limited to $80 per program
24 participant. Participants are required to make a 10-percent
25 coinsurance payment for each prescription purchased through
26 this program.
27 (5) NONENTITLEMENT.--The pharmaceutical expense
28 assistance program established by this section is not an
29 entitlement. Enrollment levels are limited to those authorized
30 by the Legislature in appropriation. If there are insufficient
31 funds to serve all individuals eligible under subsection (2)
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HB 29-C, First Engrossed
1 and seeking coverage, the agency is authorized to develop a
2 waiting list based on application date to use for enrolling
3 individuals in unfilled enrollment slots.
4 Section 5. Effective upon becoming a law, paragraph
5 (a) of subsection (5) and subsections (7) and (9) of section
6 409.907, Florida Statutes, are amended to read:
7 409.907 Medicaid provider agreements.--The agency may
8 make payments for medical assistance and related services
9 rendered to Medicaid recipients only to an individual or
10 entity who has a provider agreement in effect with the agency,
11 who is performing services or supplying goods in accordance
12 with federal, state, and local law, and who agrees that no
13 person shall, on the grounds of handicap, race, color, or
14 national origin, or for any other reason, be subjected to
15 discrimination under any program or activity for which the
16 provider receives payment from the agency.
17 (5) The agency:
18 (a) Is required to make timely payment at the
19 established rate for services or goods furnished to a
20 recipient by the provider upon receipt of a properly completed
21 claim form. The claim form shall require certification that
22 the services or goods have been completely furnished to the
23 recipient and that, with the exception of those services or
24 goods specified by the agency, the amount billed does not
25 exceed the provider's usual and customary charge for the same
26 services or goods. The agency may withhold payment to a
27 provider for any pending claim if the provider is under an
28 active fraud or abuse investigation by the agency until the
29 conclusion of the investigation by the agency. When exercising
30 the provisions of this paragraph, the agency shall complete
31 its investigation in a timely manner.
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HB 29-C, First Engrossed
1 (7) The agency may require, as a condition of
2 participating in the Medicaid program and before entering into
3 the provider agreement, that the provider submit information,
4 in an initial and any required renewal applications,
5 concerning the professional, business, and personal background
6 of the provider and permit an onsite inspection of the
7 provider's service location by agency staff or other personnel
8 designated by the agency to perform this function. Before
9 entering into the provider agreement, or as a condition of
10 continuing participation in the Medicaid program, the agency
11 may also require that Medicaid providers reimbursed on a
12 fee-for-services basis or fee schedule basis which is not
13 cost-based, post a surety bond not to exceed $50,000 or the
14 total amount billed by the provider to the program during the
15 current or most recent calendar year, whichever is greater.
16 For new providers, the amount of the surety bond shall be
17 determined by the agency based on the provider's estimate of
18 its first year's billing. If the provider's billing during the
19 first year exceeds the bond amount, the agency may require the
20 provider to acquire an additional bond equal to the actual
21 billing level of the provider. A provider's bond shall not
22 exceed $50,000 if a physician or group of physicians licensed
23 under chapter 458, chapter 459, or chapter 460 has a 50
24 percent or greater ownership interest in the provider or if
25 the provider is an assisted living facility licensed under
26 part III of chapter 400. The bonds permitted by this section
27 are in addition to the bonds referenced in s. 400.179(4)(d).
28 If the provider is a corporation, partnership, association, or
29 other entity, the agency may require the provider to submit
30 information concerning the background of that entity and of
31 any principal of the entity, including any partner or
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1 shareholder having an ownership interest in the entity equal
2 to 5 percent or greater, and any treating provider who
3 participates in or intends to participate in Medicaid through
4 the entity. The information must include:
5 (a) Proof of holding a valid license or operating
6 certificate, as applicable, if required by the state or local
7 jurisdiction in which the provider is located or if required
8 by the Federal Government.
9 (b) Information concerning any prior violation, fine,
10 suspension, termination, or other administrative action taken
11 under the Medicaid laws, rules, or regulations of this state
12 or of any other state or the Federal Government; any prior
13 violation of the laws, rules, or regulations relating to the
14 Medicare program; any prior violation of the rules or
15 regulations of any other public or private insurer; and any
16 prior violation of the laws, rules, or regulations of any
17 regulatory body of this or any other state.
18 (c) Full and accurate disclosure of any financial or
19 ownership interest that the provider, or any principal,
20 partner, or major shareholder thereof, may hold in any other
21 Medicaid provider or health care related entity or any other
22 entity that is licensed by the state to provide health or
23 residential care and treatment to persons.
24 (d) If a group provider, identification of all members
25 of the group and attestation that all members of the group are
26 enrolled in or have applied to enroll in the Medicaid program.
27 (9) Upon receipt of a completed, signed, and dated
28 application, and completion of any necessary background
29 investigation and criminal history record check, the agency
30 must either:
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1 (a) Enroll the applicant as a Medicaid provider no
2 earlier than the effective date of the approval of the
3 provider application; or
4 (b) Deny the application if the agency finds that it
5 is in the best interest of the Medicaid program to do so. The
6 agency may consider the factors listed in subsection (10), as
7 well as any other factor that could affect the effective and
8 efficient administration of the program, including, but not
9 limited to, the current availability of medical care,
10 services, or supplies to recipients, taking into account
11 geographic location and reasonable travel time; the number of
12 providers of the same type already enrolled in the same
13 geographic area; and the credentials, experience, success, and
14 patient outcomes of the provider for the services for which it
15 is making application to provide in the Medicaid program.
16 Section 6. Paragraphs (g) and (t) of subsection (3)
17 and subsections (14) and (20) of section 409.908, Florida
18 Statutes, are amended to read:
19 409.908 Reimbursement of Medicaid providers.--Subject
20 to specific appropriations, the agency shall reimburse
21 Medicaid providers, in accordance with state and federal law,
22 according to methodologies set forth in the rules of the
23 agency and in policy manuals and handbooks incorporated by
24 reference therein. These methodologies may include fee
25 schedules, reimbursement methods based on cost reporting,
26 negotiated fees, competitive bidding pursuant to s. 287.057,
27 and other mechanisms the agency considers efficient and
28 effective for purchasing services or goods on behalf of
29 recipients. Payment for Medicaid compensable services made on
30 behalf of Medicaid eligible persons is subject to the
31 availability of moneys and any limitations or directions
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HB 29-C, First Engrossed
1 provided for in the General Appropriations Act or chapter 216.
2 Further, nothing in this section shall be construed to prevent
3 or limit the agency from adjusting fees, reimbursement rates,
4 lengths of stay, number of visits, or number of services, or
5 making any other adjustments necessary to comply with the
6 availability of moneys and any limitations or directions
7 provided for in the General Appropriations Act, provided the
8 adjustment is consistent with legislative intent.
9 (3) Subject to any limitations or directions provided
10 for in the General Appropriations Act, the following Medicaid
11 services and goods may be reimbursed on a fee-for-service
12 basis. For each allowable service or goods furnished in
13 accordance with Medicaid rules, policy manuals, handbooks, and
14 state and federal law, the payment shall be the amount billed
15 by the provider, the provider's usual and customary charge, or
16 the maximum allowable fee established by the agency, whichever
17 amount is less, with the exception of those services or goods
18 for which the agency makes payment using a methodology based
19 on capitation rates, average costs, or negotiated fees.
20 (g) Children's hearing services.
21 (t) Children's visual services.
22 (14) A provider of prescribed drugs shall be
23 reimbursed the least of the amount billed by the provider, the
24 provider's usual and customary charge, or the Medicaid maximum
25 allowable fee established by the agency, plus a dispensing
26 fee. The agency is directed to implement a variable dispensing
27 fee for payments for prescribed medicines while ensuring
28 continued access for Medicaid recipients. The variable
29 dispensing fee may be based upon, but not limited to, either
30 or both the volume of prescriptions dispensed by a specific
31 pharmacy provider, and the volume of prescriptions dispensed
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HB 29-C, First Engrossed
1 to an individual recipient, and dispensing of preferred drug
2 list products. The agency shall increase the pharmacy
3 dispensing fee authorized by statute and appropriation by
4 $0.50 for the dispensing of a Medicaid preferred drug list
5 product and reduce the pharmacy dispensing fee by $0.50 for
6 the dispensing of a Medicaid product that is not included on
7 the preferred drug list. The agency is authorized to limit
8 reimbursement for prescribed medicine in order to comply with
9 any limitations or directions provided for in the General
10 Appropriations Act, which may include implementing a
11 prospective or concurrent utilization review program.
12 (20) A renal dialysis facility that provides dialysis
13 services under s. 409.906(8)(9) must be reimbursed the lesser
14 of the amount billed by the provider, the provider's usual and
15 customary charge, or the maximum allowable fee established by
16 the agency, whichever amount is less.
17 Section 7. Subsection (26) of section 409.912, Florida
18 Statutes, is amended to read:
19 409.912 Cost-effective purchasing of health care.--The
20 agency shall purchase goods and services for Medicaid
21 recipients in the most cost-effective manner consistent with
22 the delivery of quality medical care. The agency shall
23 maximize the use of prepaid per capita and prepaid aggregate
24 fixed-sum basis services when appropriate and other
25 alternative service delivery and reimbursement methodologies,
26 including competitive bidding pursuant to s. 287.057, designed
27 to facilitate the cost-effective purchase of a case-managed
28 continuum of care. The agency shall also require providers to
29 minimize the exposure of recipients to the need for acute
30 inpatient, custodial, and other institutional care and the
31 inappropriate or unnecessary use of high-cost services. The
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HB 29-C, First Engrossed
1 agency may establish prior authorization requirements for
2 certain populations of Medicaid beneficiaries, certain drug
3 classes, or particular drugs to prevent fraud, abuse, overuse,
4 and possible dangerous drug interactions. The Pharmaceutical
5 and Therapeutics Committee shall make recommendations to the
6 agency on drugs for which prior authorization is required. The
7 agency shall inform the Pharmaceutical and Therapeutics
8 Committee of its decisions regarding drugs subject to prior
9 authorization.
10 (26) The agency shall perform choice counseling,
11 enrollments, and disenrollments for Medicaid recipients who
12 are eligible for MediPass or managed care plans.
13 Notwithstanding the prohibition contained in paragraph
14 (18)(f), managed care plans may perform preenrollments of
15 Medicaid recipients under the supervision of the agency or its
16 agents. For the purposes of this section, "preenrollment"
17 means the provision of marketing and educational materials to
18 a Medicaid recipient and assistance in completing the
19 application forms, but shall not include actual enrollment
20 into a managed care plan. An application for enrollment shall
21 not be deemed complete until the agency or its agent verifies
22 that the recipient made an informed, voluntary choice. The
23 agency, in cooperation with the Department of Children and
24 Family Services, may test new marketing initiatives to inform
25 Medicaid recipients about their managed care options at
26 selected sites. The agency shall report to the Legislature on
27 the effectiveness of such initiatives. The agency may
28 contract with a third party to perform managed care plan and
29 MediPass choice-counseling, enrollment, and disenrollment
30 services for Medicaid recipients and is authorized to adopt
31 rules to implement such services. The agency may adjust the
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1 capitation rate only to cover the costs of a third-party
2 choice-counseling, enrollment, and disenrollment contract, and
3 for agency supervision and management of the managed care plan
4 choice-counseling, enrollment, and disenrollment contract.
5 Section 8. Paragraph (e) of subsection (2) of section
6 409.9122, Florida Statutes, is amended to read:
7 409.9122 Mandatory Medicaid managed care enrollment;
8 programs and procedures.--
9 (2)
10 (e) Prior to requesting a Medicaid recipient who is
11 subject to mandatory managed care enrollment to make a choice
12 between a managed care plan or MediPass, the agency shall
13 contact and provide choice counseling to the recipient.
14 Medicaid recipients who are already enrolled in a managed care
15 plan or MediPass shall be offered the opportunity to change
16 managed care plans or MediPass providers on a staggered basis,
17 as defined by the agency. All Medicaid recipients shall have
18 90 days in which to make a choice of managed care plans or
19 MediPass providers. Those Medicaid recipients who do not make
20 a choice shall be assigned to a managed care plan or MediPass
21 in accordance with paragraph (f). To facilitate continuity of
22 care, for a Medicaid recipient who is also a recipient of
23 Supplemental Security Income (SSI), prior to assigning the SSI
24 recipient to a managed care plan or MediPass, the agency shall
25 determine whether the SSI recipient has an ongoing
26 relationship with a MediPass provider or managed care plan,
27 and if so, the agency shall assign the SSI recipient to that
28 MediPass provider or managed care plan. Those SSI recipients
29 who do not have such a provider relationship shall be assigned
30 to a managed care plan or MediPass provider in accordance with
31 paragraph (f).
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1 Section 9. Effective upon becoming a law, paragraphs
2 (f) and (g) are added to subsection (15) of section 409.913,
3 Florida Statutes, and paragraph (a) of subsection (22) of said
4 section is amended, to read:
5 409.913 Oversight of the integrity of the Medicaid
6 program.--The agency shall operate a program to oversee the
7 activities of Florida Medicaid recipients, and providers and
8 their representatives, to ensure that fraudulent and abusive
9 behavior and neglect of recipients occur to the minimum extent
10 possible, and to recover overpayments and impose sanctions as
11 appropriate.
12 (15) The agency may impose any of the following
13 sanctions on a provider or a person for any of the acts
14 described in subsection (14):
15 (f) Imposition of liens against the provider's assets,
16 including, but not limited to, financial assets and real
17 property, not to exceed the amount of the fine or recovery
18 sought.
19 (g) Other remedies as permitted by law to effect the
20 recovery of a fine or overpayment.
21 (22)(a) In an audit or investigation of a violation
22 committed by a provider which is conducted pursuant to this
23 section, the agency is entitled to recover all up to $15,000
24 in investigative, legal, and expert witness costs if the
25 agency's findings were not contested by the provider or, if
26 contested, the agency ultimately prevailed.
27 Section 10. Subsections (1) and (2) of section
28 409.915, Florida Statutes, are amended to read:
29 409.915 County contributions to Medicaid.--Although
30 the state is responsible for the full portion of the state
31 share of the matching funds required for the Medicaid program,
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1 in order to acquire a certain portion of these funds, the
2 state shall charge the counties for certain items of care and
3 service as provided in this section.
4 (1) Each county shall participate in the following
5 items of care and service:
6 (a) For both health maintenance members and
7 fee-for-service beneficiaries, payments for inpatient
8 hospitalization in excess of 9 10 days, but not in excess of
9 45 days, with the exception of pregnant women and children
10 whose income is in excess of the federal poverty level and who
11 do not participate in the Medicaid medically needy program.
12 (b) Payments for nursing home or intermediate
13 facilities care in excess of $170 per month, with the
14 exception of skilled nursing care for children under age 21.
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 $140 $55 per month
21 per person.
22 Section 11. Subsection (8) of section 400.071, Florida
23 Statutes, is amended to read:
24 400.071 Application for license.--
25 (8) As a condition of licensure, each facility must
26 agree to participate in a consumer satisfaction measurement
27 process as prescribed by the agency.
28 Section 12. Paragraphs (a) and (b) of subsection (2)
29 of section 400.191, Florida Statutes, are amended to read:
30 400.191 Availability, distribution, and posting of
31 reports and records.--
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1 (2) The agency shall provide additional information in
2 consumer-friendly printed and electronic formats to assist
3 consumers and their families in comparing and evaluating
4 nursing home facilities.
5 (a) The agency shall provide an Internet site which
6 shall include at least the following information either
7 directly or indirectly through a link to another established
8 site or sites of the agency's choosing:
9 1. A list by name and address of all nursing home
10 facilities in this state.
11 2. Whether such nursing home facilities are
12 proprietary or nonproprietary.
13 3. The current owner of the facility's license and the
14 year that that entity became the owner of the license.
15 4. The name of the owner or owners of each facility
16 and whether the facility is affiliated with a company or other
17 organization owning or managing more than one nursing facility
18 in this state.
19 5. The total number of beds in each facility.
20 6. The number of private and semiprivate rooms in each
21 facility.
22 7. The religious affiliation, if any, of each
23 facility.
24 8. The languages spoken by the administrator and staff
25 of each facility.
26 9. Whether or not each facility accepts Medicare or
27 Medicaid recipients or insurance, health maintenance
28 organization, Veterans Administration, CHAMPUS program, or
29 workers' compensation coverage.
30 10. Recreational and other programs available at each
31 facility.
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1 11. Special care units or programs offered at each
2 facility.
3 12. Whether the facility is a part of a retirement
4 community that offers other services pursuant to part III,
5 part IV, or part V.
6 13. The results of consumer and family satisfaction
7 surveys for each facility, as described in s. 400.0225. The
8 results may be converted to a score or scores, which may be
9 presented in either numeric or symbolic form for the intended
10 consumer audience.
11 13.14. Survey and deficiency information contained on
12 the Online Survey Certification and Reporting (OSCAR) system
13 of the federal Health Care Financing Administration, including
14 annual survey, revisit, and complaint survey information, for
15 each facility for the past 45 months. For noncertified
16 nursing homes, state survey and deficiency information,
17 including annual survey, revisit, and complaint survey
18 information for the past 45 months shall be provided.
19 14.15. A summary of the Online Survey Certification
20 and Reporting (OSCAR) data for each facility over the past 45
21 months. Such summary may include a score, rating, or
22 comparison ranking with respect to other facilities based on
23 the number of citations received by the facility of annual,
24 revisit, and complaint surveys; the severity and scope of the
25 citations; and the number of annual recertification surveys
26 the facility has had during the past 45 months. The score,
27 rating, or comparison ranking may be presented in either
28 numeric or symbolic form for the intended consumer audience.
29 (b) The agency shall provide the following information
30 in printed form:
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HB 29-C, First Engrossed
1 1. A list by name and address of all nursing home
2 facilities in this state.
3 2. Whether such nursing home facilities are
4 proprietary or nonproprietary.
5 3. The current owner or owners of the facility's
6 license and the year that entity became the owner of the
7 license.
8 4. The total number of beds, and of private and
9 semiprivate rooms, in each facility.
10 5. The religious affiliation, if any, of each
11 facility.
12 6. The name of the owner of each facility and whether
13 the facility is affiliated with a company or other
14 organization owning or managing more than one nursing facility
15 in this state.
16 7. The languages spoken by the administrator and staff
17 of each facility.
18 8. Whether or not each facility accepts Medicare or
19 Medicaid recipients or insurance, health maintenance
20 organization, Veterans Administration, CHAMPUS program, or
21 workers' compensation coverage.
22 9. Recreational programs, special care units, and
23 other programs available at each facility.
24 10. The results of consumer and family satisfaction
25 surveys for each facility, as described in s. 400.0225. The
26 results may be converted to a score or scores, which may be
27 presented in either numeric or symbolic form for the intended
28 consumer audience.
29 10.11. The Internet address for the site where more
30 detailed information can be seen.
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1 11.12. A statement advising consumers that each
2 facility will have its own policies and procedures related to
3 protecting resident property.
4 12.13. A summary of the Online Survey Certification
5 and Reporting (OSCAR) data for each facility over the past 45
6 months. Such summary may include a score, rating, or
7 comparison ranking with respect to other facilities based on
8 the number of citations received by the facility on annual,
9 revisit, and complaint surveys; the severity and scope of the
10 citations; the number of citations; and the number of annual
11 recertification surveys the facility has had during the past
12 45 months. The score, rating, or comparison ranking may be
13 presented in either numeric or symbolic form for the intended
14 consumer audience.
15 Section 13. Paragraph (h) of subsection (2) of section
16 400.23, Florida Statutes, is amended to read:
17 400.23 Rules; evaluation and deficiencies; licensure
18 status.--
19 (2) Pursuant to the intention of the Legislature, the
20 agency, in consultation with the Department of Health and the
21 Department of Elderly Affairs, shall adopt and enforce rules
22 to implement this part, which shall include reasonable and
23 fair criteria in relation to:
24 (h) The implementation of the consumer satisfaction
25 survey pursuant to s. 400.0225; The availability,
26 distribution, and posting of reports and records pursuant to
27 s. 400.191; and the Gold Seal Program pursuant to s. 400.235.
28 Section 14. Paragraph (c) of subsection (5) of section
29 400.235, Florida Statutes, is amended to read:
30 400.235 Nursing home quality and licensure status;
31 Gold Seal Program.--
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1 (5) Facilities must meet the following additional
2 criteria for recognition as a Gold Seal Program facility:
3 (c) Participate in a consistently in the required
4 consumer satisfaction process as prescribed by the agency, and
5 demonstrate that information is elicited from residents,
6 family members, and guardians about satisfaction with the
7 nursing facility, its environment, the services and care
8 provided, the staff's skills and interactions with residents,
9 attention to resident's needs, and the facility's efforts to
10 act on information gathered from the consumer satisfaction
11 measures.
12
13 A facility assigned a conditional licensure status may not
14 qualify for consideration for the Gold Seal Program until
15 after it has operated for 30 months with no class I or class
16 II deficiencies and has completed a regularly scheduled
17 relicensure survey.
18 Section 15. Subsection (7) of section 409.8132,
19 Florida Statutes, is amended to read:
20 409.8132 Medikids program component.--
21 (7) ENROLLMENT.--Enrollment in the Medikids program
22 component may only occur during periodic open enrollment
23 periods as specified by the agency. An applicant may apply for
24 enrollment in the Medikids program component and proceed
25 through the eligibility determination process at any time
26 throughout the year. However, enrollment in Medikids shall not
27 begin until the next open enrollment period; and a child may
28 not receive services under the Medikids program until the
29 child is enrolled in a managed care plan or MediPass. In
30 addition, once determined eligible, an applicant may receive
31 choice counseling and select a managed care plan or MediPass.
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1 The agency may initiate mandatory assignment for a Medikids
2 applicant who has not chosen a managed care plan or MediPass
3 provider after the applicant's voluntary choice period ends.
4 An applicant may select MediPass under the Medikids program
5 component only in counties that have fewer than two managed
6 care plans available to serve Medicaid recipients and only if
7 the federal Health Care Financing Administration determines
8 that MediPass constitutes "health insurance coverage" as
9 defined in Title XXI of the Social Security Act.
10 Section 16. Paragraph (q) of subsection (2) of section
11 409.815, Florida Statutes, is amended to read:
12 409.815 Health benefits coverage; limitations.--
13 (2) BENCHMARK BENEFITS.--In order for health benefits
14 coverage to qualify for premium assistance payments for an
15 eligible child under ss. 409.810-409.820, the health benefits
16 coverage, except for coverage under Medicaid and Medikids,
17 must include the following minimum benefits, as medically
18 necessary.
19 (q) Dental services.--Subject to a specific
20 appropriation for this benefit, covered services include those
21 dental services provided to children by the Florida Medicaid
22 program under s. 409.906(5)(6).
23 Section 17. Pursuant to s. 18, Art. VII of the State
24 Constitution, the Legislature finds that this act fulfills an
25 important state interest.
26 Section 18. Sections 400.0225, 400.148, 464.0195,
27 464.0196, and 464.0197, Florida Statutes, are repealed.
28 Section 19. Except as otherwise provided herein, this
29 act shall take effect January 1, 2002.
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