Senate Bill sb0042C
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Florida Senate - 2001 SB 42-C
By Senator Silver
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1 A bill to be entitled
2 An act relating to the Agency for Health Care
3 Administration; repealing s. 409.904(11), F.S.,
4 which provides eligibility of specified persons
5 for certain optional medical assistance;
6 amending s. 409.904, F.S.; revising standards
7 for eligibility for certain optional medical
8 assistance; amending s. 409.906, F.S.; revising
9 guidelines for payment for certain services;
10 revising eligibility for certain Medicaid
11 services and methods of delivering services;
12 amending s. 409.9065, F.S.; revising, and
13 prescribing additional, eligibility standards
14 with respect to pharmaceutical expense
15 assistance; amending s. 409.907, F.S.;
16 authorizing withholding of Medicaid payments in
17 certain circumstances; prescribing additional
18 requirements with respect to providers'
19 submission of information; prescribing
20 additional duties for the agency with respect
21 to provider applications; amending s. 409.912,
22 F.S.; revising the reimbursement rate to
23 pharmacies for Medicaid prescribed drugs;
24 providing for expanded home delivery of
25 pharmacy products; amending s. 409.9122, F.S.;
26 repealing provisions relating to choice
27 counseling for recipients; defining the term
28 "managed care plans"; 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
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1 recovered against a provider; requiring
2 disclosure of certain information relating to
3 rendering of services by a provider; providing
4 for withholding payments in cases of Medicaid
5 abuse and in cases subject to administrative
6 proceedings; prescribing agency procedures in
7 cases of overpayment; providing venue for
8 Medicaid overpayment cases; repealing s.
9 414.41(4), F.S., relating to agency procedures
10 in cases of overpayment; amending s. 409.915,
11 F.S.; revising the limit on a county's payment
12 for certain Medicaid costs; providing that the
13 act fulfills an important state interest;
14 amending s. 409.908, F.S.; revising pharmacy
15 dispensing fees for Medicaid drugs; repealing
16 s. 400.0225, F.S., relating to
17 consumer-satisfaction surveys; amending s.
18 400.179, F.S.; declaring liability for
19 overpayment when a nursing facility is sold;
20 amending s. 400.191, F.S.; eliminating a
21 provision relating to consumer-satisfaction and
22 family-satisfaction surveys; amending s.
23 400.235, F.S.; eliminating a provision relating
24 to participation in the consumer-satisfaction
25 process; amending s. 400.071, F.S.; eliminating
26 a provision relating to participation in a
27 consumer-satisfaction-measurement process;
28 amending s. 409.815, F.S.; conforming a
29 cross-reference; providing effective dates.
30
31 Be It Enacted by the Legislature of the State of Florida:
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1 Section 1. Effective July 1, 2002, subsection (11) of
2 section 409.904, Florida Statutes, is repealed.
3 Section 2. Effective July 1, 2002, subsections (1) and
4 (2) of section 409.904, Florida Statutes, are amended to read:
5 409.904 Optional payments for eligible persons.--The
6 agency may make payments for medical assistance and related
7 services on behalf of the following persons who are determined
8 to be eligible subject to the income, assets, and categorical
9 eligibility tests set forth in federal and state law. Payment
10 on behalf of these Medicaid eligible persons is subject to the
11 availability of moneys and any limitations established by the
12 General Appropriations Act or chapter 216.
13 (1) A person who is age 65 or older or is determined
14 to be disabled, whose income is at or below 89 100 percent of
15 federal poverty level, and whose assets do not exceed
16 established limitations.
17 (2)(a) A pregnant woman who would otherwise qualify
18 for Medicaid under s. 409.903(5) except for her level of
19 income and whose assets fall within the limits established by
20 the Department of Children and Family Services for the
21 medically needy. A pregnant woman who applies for medically
22 needy eligibility may not be made presumptively eligible.
23 (b) A child under age 21 who would otherwise qualify
24 for Medicaid or the Florida Kidcare program except for the
25 family's level of income and whose assets fall within the
26 limits established by the Department of Children and Family
27 Services for the medically needy. A family, a pregnant woman,
28 a child under age 18, a person age 65 or over, or a blind or
29 disabled person who would be eligible under any group listed
30 in s. 409.903(1), (2), or (3), except that the income or
31
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1 assets of such family or person exceed established
2 limitations.
3
4 For a family or person in this group, medical expenses are
5 deductible from income in accordance with federal requirements
6 in order to make a determination of eligibility. A family or
7 person in this group, which group is known as the "medically
8 needy," is eligible to receive the same services as other
9 Medicaid recipients, with the exception of services in skilled
10 nursing facilities and intermediate care facilities for the
11 developmentally disabled.
12 Section 3. Effective July 1, 2002, subsections (1),
13 (12), and (23) of section 409.906, Florida Statutes, are
14 amended to read:
15 409.906 Optional Medicaid services.--Subject to
16 specific appropriations, the agency may make payments for
17 services which are optional to the state under Title XIX of
18 the Social Security Act and are furnished by Medicaid
19 providers to recipients who are determined to be eligible on
20 the dates on which the services were provided. Any optional
21 service that is provided shall be provided only when medically
22 necessary and in accordance with state and federal law.
23 Optional services rendered by providers in mobile units to
24 Medicaid recipients may be restricted or prohibited by the
25 agency. Nothing in this section shall be construed to prevent
26 or limit the agency from adjusting fees, reimbursement rates,
27 lengths of stay, number of visits, or number of services, or
28 making any other adjustments necessary to comply with the
29 availability of moneys and any limitations or directions
30 provided for in the General Appropriations Act or chapter 216.
31 If necessary to safeguard the state's systems of providing
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1 services to elderly and disabled persons and subject to the
2 notice and review provisions of s. 216.177, the Governor may
3 direct the Agency for Health Care Administration to amend the
4 Medicaid state plan to delete the optional Medicaid service
5 known as "Intermediate Care Facilities for the Developmentally
6 Disabled." Optional services may include:
7 (1) ADULT DENTURE SERVICES.--The agency may pay for
8 dentures, the procedures required to seat dentures, and the
9 repair and reline of dentures, provided by or under the
10 direction of a licensed dentist, for a recipient who is age 21
11 or older. However, Medicaid will not provide reimbursement for
12 dental services provided in a mobile dental unit, except for a
13 mobile dental unit:
14 (a) Owned by, operated by, or having a contractual
15 agreement with the Department of Health and complying with
16 Medicaid's county health department clinic services program
17 specifications as a county health department clinic services
18 provider.
19 (b) Owned by, operated by, or having a contractual
20 arrangement with a federally qualified health center and
21 complying with Medicaid's federally qualified health center
22 specifications as a federally qualified health center
23 provider.
24 (c) Rendering dental services to Medicaid recipients,
25 21 years of age and older, at nursing facilities.
26 (d) Owned by, operated by, or having a contractual
27 agreement with a state-approved dental educational
28 institution.
29 (e) This subsection is repealed July 1, 2002.
30 (12) CHILDREN'S HEARING SERVICES.--The agency may pay
31 for hearing and related services, including hearing
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1 evaluations, hearing aid devices, dispensing of the hearing
2 aid, and related repairs, if provided to a recipient under age
3 21 by a licensed hearing aid specialist, otolaryngologist,
4 otologist, audiologist, or physician.
5 (23) CHILDREN'S VISUAL SERVICES.--The agency may pay
6 for visual examinations, eyeglasses, and eyeglass repairs for
7 a recipient under age 21, if they are prescribed by a licensed
8 physician specializing in diseases of the eye or by a licensed
9 optometrist.
10 Section 4. Subsections (13) and (20) of section
11 409.906, Florida Statutes, are amended to read:
12 409.906 Optional Medicaid services.--Subject to
13 specific appropriations, the agency may make payments for
14 services which are optional to the state under Title XIX of
15 the Social Security Act and are furnished by Medicaid
16 providers to recipients who are determined to be eligible on
17 the dates on which the services were provided. Any optional
18 service that is provided shall be provided only when medically
19 necessary and in accordance with state and federal law.
20 Optional services rendered by providers in mobile units to
21 Medicaid recipients may be restricted or prohibited by the
22 agency. Nothing in this section shall be construed to prevent
23 or limit the agency from adjusting fees, reimbursement rates,
24 lengths of stay, number of visits, or number of services, or
25 making any other adjustments necessary to comply with the
26 availability of moneys and any limitations or directions
27 provided for in the General Appropriations Act or chapter 216.
28 If necessary to safeguard the state's systems of providing
29 services to elderly and disabled persons and subject to the
30 notice and review provisions of s. 216.177, the Governor may
31 direct the Agency for Health Care Administration to amend the
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1 Medicaid state plan to delete the optional Medicaid service
2 known as "Intermediate Care Facilities for the Developmentally
3 Disabled." Optional services may include:
4 (13) HOME AND COMMUNITY-BASED SERVICES.--The agency
5 may pay for home-based or community-based services that are
6 rendered to a recipient in accordance with a federally
7 approved waiver program. The agency may limit or eliminate
8 coverage for certain Project AIDS Care Waiver services,
9 preauthorize high-cost or highly utilized services, or make
10 any other adjustments necessary to comply with any limitations
11 or directions provided for in the General Appropriations Act.
12 (20) PRESCRIBED DRUG SERVICES.--The agency may pay for
13 medications that are prescribed for a recipient by a physician
14 or other licensed practitioner of the healing arts authorized
15 to prescribe medications and that are dispensed to the
16 recipient by a licensed pharmacist or physician in accordance
17 with applicable state and federal law. The agency may use
18 mail-order pharmacy services for dispensing drugs. For adults
19 eligible through the medically needy program, pharmacies must
20 dispense a generic drug for a product prescribed for a
21 beneficiary if a generic product exists for the product
22 prescribed.
23 Section 5. Subsections (2), (3), and (5) of section
24 409.9065, Florida Statutes, are amended to read:
25 409.9065 Pharmaceutical expense assistance.--
26 (2) ELIGIBILITY.--Eligibility for the program is
27 limited to those individuals who qualify for limited
28 assistance under the Florida Medicaid program as a result of
29 being dually eligible for both Medicare and Medicaid, but
30 whose limited assistance or Medicare coverage does not include
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1 any pharmacy benefit. Specifically eligible are low-income
2 senior citizens who:
3 (a) Are Florida residents age 65 and over;
4 (b) Have an income between 89 90 and 120 percent of
5 the federal poverty level;
6 (c) Are eligible for both Medicare and Medicaid;
7 (d) Are not enrolled in a Medicare health maintenance
8 organization that provides a pharmacy benefit; and
9 (e) Request to be enrolled in the program.
10 (3) BENEFITS.--Medications covered under the
11 pharmaceutical expense assistance program are those covered
12 under the Medicaid program in s. 409.906(19) s. 409.906(20).
13 Monthly benefit payments shall be limited to $80 per program
14 participant. Participants are required to make a 10-percent
15 coinsurance payment for each prescription purchased through
16 this program.
17 (5) NONENTITLEMENT.--The pharmaceutical expense
18 assistance program established by this section is not an
19 entitlement. Enrollment levels are limited to those authorized
20 by the Legislature in the annual General Appropriations Act.
21 If funds are insufficient to serve all individuals eligible
22 under subsection (2) and seeking coverage, the agency may
23 develop a waiting list based on application dates to use in
24 enrolling individuals in unfilled enrollment slots.
25 Section 6. Effective upon this act becoming a law,
26 subsections (7) and (9) of section 409.907, Florida Statutes,
27 are amended to read:
28 409.907 Medicaid provider agreements.--The agency may
29 make payments for medical assistance and related services
30 rendered to Medicaid recipients only to an individual or
31 entity who has a provider agreement in effect with the agency,
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1 who is performing services or supplying goods in accordance
2 with federal, state, and local law, and who agrees that no
3 person shall, on the grounds of handicap, race, color, or
4 national origin, or for any other reason, be subjected to
5 discrimination under any program or activity for which the
6 provider receives payment from the agency.
7 (7) The agency may require, as a condition of
8 participating in the Medicaid program and before entering into
9 the provider agreement, that the provider submit information,
10 in an initial and any required renewal applications,
11 concerning the professional, business, and personal background
12 of the provider and permit an onsite inspection of the
13 provider's service location by agency staff or other personnel
14 designated by the agency to perform this function. As a
15 continuing condition of participation in the Medicaid program,
16 a provider shall immediately notify the agency of any current
17 or pending bankruptcy filing. Before entering into the
18 provider agreement, or as a condition of continuing
19 participation in the Medicaid program, the agency may also
20 require that Medicaid providers reimbursed on a
21 fee-for-services basis or fee schedule basis which is not
22 cost-based, post a surety bond not to exceed $50,000 or the
23 total amount billed by the provider to the program during the
24 current or most recent calendar year, whichever is greater.
25 For new providers, the amount of the surety bond shall be
26 determined by the agency based on the provider's estimate of
27 its first year's billing. If the provider's billing during the
28 first year exceeds the bond amount, the agency may require the
29 provider to acquire an additional bond equal to the actual
30 billing level of the provider. A provider's bond shall not
31 exceed $50,000 if a physician or group of physicians licensed
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1 under chapter 458, chapter 459, or chapter 460 has a 50
2 percent or greater ownership interest in the provider or if
3 the provider is an assisted living facility licensed under
4 part III of chapter 400. The bonds permitted by this section
5 are in addition to the bonds referenced in s. 400.179(4)(d).
6 If the provider is a corporation, partnership, association, or
7 other entity, the agency may require the provider to submit
8 information concerning the background of that entity and of
9 any principal of the entity, including any partner or
10 shareholder having an ownership interest in the entity equal
11 to 5 percent or greater, and any treating provider who
12 participates in or intends to participate in Medicaid through
13 the entity. The information must include:
14 (a) Proof of holding a valid license or operating
15 certificate, as applicable, if required by the state or local
16 jurisdiction in which the provider is located or if required
17 by the Federal Government.
18 (b) Information concerning any prior violation, fine,
19 suspension, termination, or other administrative action taken
20 under the Medicaid laws, rules, or regulations of this state
21 or of any other state or the Federal Government; any prior
22 violation of the laws, rules, or regulations relating to the
23 Medicare program; any prior violation of the rules or
24 regulations of any other public or private insurer; and any
25 prior violation of the laws, rules, or regulations of any
26 regulatory body of this or any other state.
27 (c) Full and accurate disclosure of any financial or
28 ownership interest that the provider, or any principal,
29 partner, or major shareholder thereof, may hold in any other
30 Medicaid provider or health care related entity or any other
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1 entity that is licensed by the state to provide health or
2 residential care and treatment to persons.
3 (d) If a group provider, identification of all members
4 of the group and attestation that all members of the group are
5 enrolled in or have applied to enroll in the Medicaid program.
6 (9) Upon receipt of a completed, signed, and dated
7 application, and completion of any necessary background
8 investigation and criminal history record check, the agency
9 must either:
10 (a) Enroll the applicant as a Medicaid provider no
11 earlier than the effective date of the approval of the
12 provider application; or
13 (b) Deny the application if the agency finds that it
14 is in the best interest of the Medicaid program to do so. The
15 agency may consider the factors listed in subsection (10), as
16 well as any other factor that could affect the effective and
17 efficient administration of the program, including, but not
18 limited to, the current availability of medical care,
19 services, or supplies to recipients, taking into account
20 geographic location and reasonable travel time; the number of
21 providers of the same type already enrolled in the same
22 geographic area; and the credentials, experience, success, and
23 patient outcomes of the provider for the services that it is
24 making application to provide in the Medicaid program.
25 Section 7. Paragraph (a) of subsection (37) of section
26 409.912, Florida Statutes, is amended to read:
27 409.912 Cost-effective purchasing of health care.--The
28 agency shall purchase goods and services for Medicaid
29 recipients in the most cost-effective manner consistent with
30 the delivery of quality medical care. The agency shall
31 maximize the use of prepaid per capita and prepaid aggregate
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1 fixed-sum basis services when appropriate and other
2 alternative service delivery and reimbursement methodologies,
3 including competitive bidding pursuant to s. 287.057, designed
4 to facilitate the cost-effective purchase of a case-managed
5 continuum of care. The agency shall also require providers to
6 minimize the exposure of recipients to the need for acute
7 inpatient, custodial, and other institutional care and the
8 inappropriate or unnecessary use of high-cost services. The
9 agency may establish prior authorization requirements for
10 certain populations of Medicaid beneficiaries, certain drug
11 classes, or particular drugs to prevent fraud, abuse, overuse,
12 and possible dangerous drug interactions. The Pharmaceutical
13 and Therapeutics Committee shall make recommendations to the
14 agency on drugs for which prior authorization is required. The
15 agency shall inform the Pharmaceutical and Therapeutics
16 Committee of its decisions regarding drugs subject to prior
17 authorization.
18 (37)(a) The agency shall implement a Medicaid
19 prescribed-drug spending-control program that includes the
20 following components:
21 1. Medicaid prescribed-drug coverage for brand-name
22 drugs for adult Medicaid recipients is limited to the
23 dispensing of four brand-name drugs per month per recipient.
24 Children are exempt from this restriction. Antiretroviral
25 agents are excluded from this limitation. No requirements for
26 prior authorization or other restrictions on medications used
27 to treat mental illnesses such as schizophrenia, severe
28 depression, or bipolar disorder may be imposed on Medicaid
29 recipients. Medications that will be available without
30 restriction for persons with mental illnesses include atypical
31 antipsychotic medications, conventional antipsychotic
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1 medications, selective serotonin reuptake inhibitors, and
2 other medications used for the treatment of serious mental
3 illnesses. The agency shall also limit the amount of a
4 prescribed drug dispensed to no more than a 34-day supply. The
5 agency shall continue to provide unlimited generic drugs,
6 contraceptive drugs and items, and diabetic supplies. Although
7 a drug may be included on the preferred drug formulary, it
8 would not be exempt from the four-brand limit. The agency may
9 authorize exceptions to the brand-name-drug restriction based
10 upon the treatment needs of the patients, only when such
11 exceptions are based on prior consultation provided by the
12 agency or an agency contractor, but the agency must establish
13 procedures to ensure that:
14 a. There will be a response to a request for prior
15 consultation by telephone or other telecommunication device
16 within 24 hours after receipt of a request for prior
17 consultation;
18 b. A 72-hour supply of the drug prescribed will be
19 provided in an emergency or when the agency does not provide a
20 response within 24 hours as required by sub-subparagraph a.;
21 and
22 c. Except for the exception for nursing home residents
23 and other institutionalized adults and except for drugs on the
24 restricted formulary for which prior authorization may be
25 sought by an institutional or community pharmacy, prior
26 authorization for an exception to the brand-name-drug
27 restriction is sought by the prescriber and not by the
28 pharmacy. When prior authorization is granted for a patient in
29 an institutional setting beyond the brand-name-drug
30 restriction, such approval is authorized for 12 months and
31 monthly prior authorization is not required for that patient.
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1 2. Reimbursement to pharmacies for Medicaid prescribed
2 drugs shall be set at the average wholesale price less 13.75
3 13.25 percent.
4 3. The agency shall develop and implement a process
5 for managing the drug therapies of Medicaid recipients who are
6 using significant numbers of prescribed drugs each month. The
7 management process may include, but is not limited to,
8 comprehensive, physician-directed medical-record reviews,
9 claims analyses, and case evaluations to determine the medical
10 necessity and appropriateness of a patient's treatment plan
11 and drug therapies. The agency may contract with a private
12 organization to provide drug-program-management services. The
13 Medicaid drug benefit management program shall include
14 initiatives to manage drug therapies for HIV/AIDS patients,
15 patients using 20 or more unique prescriptions in a 180-day
16 period, and the top 1,000 patients in annual spending.
17 4. The agency may limit the size of its pharmacy
18 network based on need, competitive bidding, price
19 negotiations, credentialing, or similar criteria. The agency
20 shall give special consideration to rural areas in determining
21 the size and location of pharmacies included in the Medicaid
22 pharmacy network. A pharmacy credentialing process may include
23 criteria such as a pharmacy's full-service status, location,
24 size, patient educational programs, patient consultation,
25 disease-management services, and other characteristics. The
26 agency may impose a moratorium on Medicaid pharmacy enrollment
27 when it is determined that it has a sufficient number of
28 Medicaid-participating providers.
29 5. The agency shall develop and implement a program
30 that requires Medicaid practitioners who prescribe drugs to
31 use a counterfeit-proof prescription pad for Medicaid
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1 prescriptions. The agency shall require the use of
2 standardized counterfeit-proof prescription pads by
3 Medicaid-participating prescribers or prescribers who write
4 prescriptions for Medicaid recipients. The agency may
5 implement the program in targeted geographic areas or
6 statewide.
7 6. The agency may enter into arrangements that require
8 manufacturers of generic drugs prescribed to Medicaid
9 recipients to provide rebates of at least 15.1 percent of the
10 average manufacturer price for the manufacturer's generic
11 products. These arrangements shall require that if a
12 generic-drug manufacturer pays federal rebates for
13 Medicaid-reimbursed drugs at a level below 15.1 percent, the
14 manufacturer must provide a supplemental rebate to the state
15 in an amount necessary to achieve a 15.1-percent rebate level.
16 7. The agency may establish a preferred drug formulary
17 in accordance with 42 U.S.C. s. 1396r-8, and, pursuant to the
18 establishment of such formulary, it is authorized to negotiate
19 supplemental rebates from manufacturers that are in addition
20 to those required by Title XIX of the Social Security Act and
21 at no less than 10 percent of the average manufacturer price
22 as defined in 42 U.S.C. s. 1936 on the last day of a quarter
23 unless the federal or supplemental rebate, or both, equals or
24 exceeds 25 percent. There is no upper limit on the
25 supplemental rebates the agency may negotiate. The agency may
26 determine that specific products, brand-name or generic, are
27 competitive at lower rebate percentages. Agreement to pay the
28 minimum supplemental rebate percentage will guarantee a
29 manufacturer that the Medicaid Pharmaceutical and Therapeutics
30 Committee will consider a product for inclusion on the
31 preferred drug formulary. However, a pharmaceutical
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1 manufacturer is not guaranteed placement on the formulary by
2 simply paying the minimum supplemental rebate. Agency
3 decisions will be made on the clinical efficacy of a drug and
4 recommendations of the Medicaid Pharmaceutical and
5 Therapeutics Committee, as well as the price of competing
6 products minus federal and state rebates. The agency is
7 authorized to contract with an outside agency or contractor to
8 conduct negotiations for supplemental rebates. For the
9 purposes of this section, the term "supplemental rebates" may
10 include, at the agency's discretion, cash rebates and other
11 program benefits that offset a Medicaid expenditure. Such
12 other program benefits may include, but are not limited to,
13 disease management programs, drug product donation programs,
14 drug utilization control programs, prescriber and beneficiary
15 counseling and education, fraud and abuse initiatives, and
16 other services or administrative investments with guaranteed
17 savings to the Medicaid program in the same year the rebate
18 reduction is included in the General Appropriations Act. The
19 agency is authorized to seek any federal waivers to implement
20 this initiative.
21 8. The agency shall establish an advisory committee
22 for the purposes of studying the feasibility of using a
23 restricted drug formulary for nursing home residents and other
24 institutionalized adults. The committee shall be comprised of
25 seven members appointed by the Secretary of Health Care
26 Administration. The committee members shall include two
27 physicians licensed under chapter 458 or chapter 459; three
28 pharmacists licensed under chapter 465 and appointed from a
29 list of recommendations provided by the Florida Long-Term Care
30 Pharmacy Alliance; and two pharmacists licensed under chapter
31 465.
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1 9. The Agency for Health Care Administration shall
2 expand home delivery of pharmacy products. To assist Medicaid
3 patients in securing their prescriptions and reduce program
4 costs, the agency shall expand its current mail-order-pharmacy
5 diabetes-supply program to include all generic and brand-name
6 drugs used by Medicaid patients with diabetes. Medicaid
7 recipients in the current program may obtain nondiabetes drugs
8 on a voluntary basis. To further reduce program costs and
9 expand access to home delivery of pharmacy products for
10 diabetic recipients, the agency shall offer home delivery of
11 pharmacy products to Medicaid recipients with diabetes. This
12 mail-order feature for drugs will be voluntary on the part of
13 a Medicaid recipient with diabetes. The agency will allow all
14 qualified and enrolled pharmacies to provide this mail-order
15 program to Medicaid-eligible diabetic recipients who are not
16 eligible for the current mail-order diabetes-supply program,
17 provided such pharmacies accept the same reimbursement rates
18 as its current mail-order diabetes-supply program and offer
19 equivalent levels of patient education and support services.
20 The agency may seek and implement any federal waivers
21 necessary to implement this subparagraph.
22 Section 8. Paragraphs (e) and (f) of subsection (2) of
23 section 409.9122, Florida Statutes, are amended to read:
24 409.9122 Mandatory Medicaid managed care enrollment;
25 programs and procedures.--
26 (2)
27 (e) Prior to requesting a Medicaid recipient who is
28 subject to mandatory managed care enrollment to make a choice
29 between a managed care plan or MediPass, the agency shall
30 contact and provide choice counseling to the recipient.
31 Medicaid recipients who are already enrolled in a managed care
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1 plan or MediPass shall be offered the opportunity to change
2 managed care plans or MediPass providers on a staggered basis,
3 as defined by the agency. All Medicaid recipients shall have
4 90 days in which to make a choice of managed care plans or
5 MediPass providers. Those Medicaid recipients who do not make
6 a choice shall be assigned to a managed care plan or MediPass
7 in accordance with paragraph (f). To facilitate continuity of
8 care, for a Medicaid recipient who is also a recipient of
9 Supplemental Security Income (SSI), prior to assigning the SSI
10 recipient to a managed care plan or MediPass, the agency shall
11 determine whether the SSI recipient has an ongoing
12 relationship with a MediPass provider or managed care plan,
13 and if so, the agency shall assign the SSI recipient to that
14 MediPass provider or managed care plan. Those SSI recipients
15 who do not have such a provider relationship shall be assigned
16 to a managed care plan or MediPass provider in accordance with
17 paragraph (f).
18 (f) When a Medicaid recipient does not choose a
19 managed care plan or MediPass provider, the agency shall
20 assign the Medicaid recipient to a managed care plan or
21 MediPass provider. Medicaid recipients who are subject to
22 mandatory assignment but who fail to make a choice shall be
23 assigned to managed care plans or provider service networks
24 until an equal enrollment of 50 percent in MediPass and
25 provider service networks and 50 percent in managed care plans
26 is achieved. Once equal enrollment is achieved, the
27 assignments shall be divided in order to maintain an equal
28 enrollment in MediPass and managed care plans. Thereafter,
29 assignment of Medicaid recipients who fail to make a choice
30 shall be based proportionally on the preferences of recipients
31 who have made a choice in the previous period. Such
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1 proportions shall be revised at least quarterly to reflect an
2 update of the preferences of Medicaid recipients. The agency
3 shall also disproportionately assign Medicaid-eligible
4 children in families who are required to but have failed to
5 make a choice of managed care plan or MediPass for their child
6 and who are to be assigned to the MediPass program to
7 children's networks as described in s. 409.912(3)(g) and where
8 available. The disproportionate assignment of children to
9 children's networks shall be made until the agency has
10 determined that the children's networks have sufficient
11 numbers to be economically operated. For purposes of this
12 paragraph, when referring to assignment, the term "managed
13 care plans" includes exclusive provider organizations,
14 provider service networks, minority physician networks, and
15 pediatric emergency department diversion programs authorized
16 by this chapter or the General Appropriations Act. When making
17 assignments, the agency shall take into account the following
18 criteria:
19 1. A managed care plan has sufficient network capacity
20 to meet the need of members.
21 2. The managed care plan or MediPass has previously
22 enrolled the recipient as a member, or one of the managed care
23 plan's primary care providers or MediPass providers has
24 previously provided health care to the recipient.
25 3. The agency has knowledge that the member has
26 previously expressed a preference for a particular managed
27 care plan or MediPass provider as indicated by Medicaid
28 fee-for-service claims data, but has failed to make a choice.
29 4. The managed care plan's or MediPass primary care
30 providers are geographically accessible to the recipient's
31 residence.
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1 Section 9. Effective upon this act becoming a law,
2 subsections (15) and (21), paragraph (a) of subsection (22),
3 and paragraph (a) of subsection (24) of section 409.913,
4 Florida Statutes, are amended, and subsections (26) and (27)
5 are added to that section, to read:
6 409.913 Oversight of the integrity of the Medicaid
7 program.--The agency shall operate a program to oversee the
8 activities of Florida Medicaid recipients, and providers and
9 their representatives, to ensure that fraudulent and abusive
10 behavior and neglect of recipients occur to the minimum extent
11 possible, and to recover overpayments and impose sanctions as
12 appropriate.
13 (15) The agency may impose any of the following
14 sanctions on a provider or a person for any of the acts
15 described in subsection (14):
16 (a) Suspension for a specific period of time of not
17 more than 1 year.
18 (b) Termination for a specific period of time of from
19 more than 1 year to 20 years.
20 (c) Imposition of a fine of up to $5,000 for each
21 violation. Each day that an ongoing violation continues, such
22 as refusing to furnish Medicaid-related records or refusing
23 access to records, is considered, for the purposes of this
24 section, to be a separate violation. Each instance of
25 improper billing of a Medicaid recipient; each instance of
26 including an unallowable cost on a hospital or nursing home
27 Medicaid cost report after the provider or authorized
28 representative has been advised in an audit exit conference or
29 previous audit report of the cost unallowability; each
30 instance of furnishing a Medicaid recipient goods or
31 professional services that are inappropriate or of inferior
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1 quality as determined by competent peer judgment; each
2 instance of knowingly submitting a materially false or
3 erroneous Medicaid provider enrollment application, request
4 for prior authorization for Medicaid services, drug exception
5 request, or cost report; each instance of inappropriate
6 prescribing of drugs for a Medicaid recipient as determined by
7 competent peer judgment; and each false or erroneous Medicaid
8 claim leading to an overpayment to a provider is considered,
9 for the purposes of this section, to be a separate violation.
10 (d) Immediate suspension, if the agency has received
11 information of patient abuse or neglect or of any act
12 prohibited by s. 409.920. Upon suspension, the agency must
13 issue an immediate final order under s. 120.569(2)(n).
14 (e) A fine, not to exceed $10,000, for a violation of
15 paragraph (14)(i).
16 (f) Imposition of liens against provider assets,
17 including, but not limited to, financial assets and real
18 property, not to exceed the amount of fines or recoveries
19 sought, upon entry of an order determining that such moneys
20 are due or recoverable.
21 (g) Other remedies as permitted by law to effect the
22 recovery of a fine or overpayment.
23 (21) The audit report, supported by agency work
24 papers, showing an overpayment to a provider constitutes
25 evidence of the overpayment. A provider may not present or
26 elicit testimony, either on direct examination or
27 cross-examination in any court or administrative proceeding,
28 regarding the purchase or acquisition by any means of drugs,
29 goods, or supplies; sales or divestment by any means of drugs,
30 goods, or supplies; or inventory of drugs, goods, or supplies,
31 unless such acquisition, sales, divestment, or inventory is
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1 documented by written invoices, written inventory records, or
2 other competent written documentary evidence maintained in the
3 normal course of the provider's business. Notwithstanding the
4 applicable rules of discovery, all documentation related to
5 the rendering of services by a provider which is used in
6 support of a provider's position must be timely filed with
7 agency counsel not less than 14 days before any administrative
8 hearing or else must be excluded from consideration.
9 (22)(a) In an audit or investigation of a violation
10 committed by a provider which is conducted pursuant to this
11 section, the agency is entitled to recover all up to $15,000
12 in investigative, legal, and expert witness costs if the
13 agency's findings were not contested by the provider or, if
14 contested, the agency ultimately prevailed.
15 (24)(a) The agency may withhold Medicaid payments, in
16 whole or in part, to a provider upon receipt of reliable
17 evidence that the circumstances giving rise to the need for a
18 withholding of payments involve fraud, or willful
19 misrepresentation, or abuse under the Medicaid program, or a
20 crime committed while rendering goods or services to Medicaid
21 recipients, pending completion of legal proceedings. If it is
22 determined that fraud, willful misrepresentation, abuse, or a
23 crime did not occur, the payments withheld must be paid to the
24 provider within 14 days after such determination with interest
25 at the rate of 10 percent a year. Any money withheld in
26 accordance with this paragraph shall be placed in a suspended
27 account, readily accessible to the agency, so that any payment
28 ultimately due the provider shall be made within 14 days.
29 Furthermore, the authority to withhold payments under this
30 paragraph shall not apply to physicians whose alleged
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1 overpayments are being determined by administrative
2 proceedings pursuant to chapter 120.
3 (26) When the Agency for Health Care Administration
4 has made a probable cause determination and alleged that an
5 overpayment to a Medicaid provider has occurred, the agency,
6 after notice to the provider, may:
7 (a) Withhold, and continue to withhold during the
8 pendency of an administrative hearing pursuant to chapter 120,
9 any medical assistance reimbursement payments until such time
10 as the overpayment is recovered, unless within 30 days after
11 receiving notice thereof the provider:
12 1. Makes repayment in full; or
13 2. Establishes a repayment plan that is satisfactory
14 to the Agency for Health Care Administration.
15 (b) Withhold, and continue to withhold during the
16 pendency of an administrative hearing pursuant to chapter 120,
17 medical assistance reimbursement payments if the terms of a
18 repayment plan are not adhered to by the provider.
19
20 If a provider requests an administrative hearing pursuant to
21 chapter 120, such hearing must be conducted within 90 days
22 following receipt by the provider of the final audit report,
23 absent exceptionally good cause shown as determined by the
24 administrative law judge or hearing officer. Upon issuance of
25 a final order, the balance outstanding of the amount
26 determined to constitute the overpayment shall become due.
27 Any withholding of payments by the Agency for Health Care
28 Administration pursuant to this section shall be limited so
29 that the monthly medical assistance payment is not reduced by
30 more than 10 percent.
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1 (27) Venue for all Medicaid program integrity
2 overpayment cases shall lie in Leon County, at the discretion
3 of the agency.
4 Section 10. Subsection (4) of section 414.41, Florida
5 Statutes, is repealed.
6 Section 11. Subsection (14) of section 409.908,
7 Florida Statutes, is amended to read:
8 409.908 Reimbursement of Medicaid providers.--Subject
9 to specific appropriations, the agency shall reimburse
10 Medicaid providers, in accordance with state and federal law,
11 according to methodologies set forth in the rules of the
12 agency and in policy manuals and handbooks incorporated by
13 reference therein. These methodologies may include fee
14 schedules, reimbursement methods based on cost reporting,
15 negotiated fees, competitive bidding pursuant to s. 287.057,
16 and other mechanisms the agency considers efficient and
17 effective for purchasing services or goods on behalf of
18 recipients. Payment for Medicaid compensable services made on
19 behalf of Medicaid eligible persons is subject to the
20 availability of moneys and any limitations or directions
21 provided for in the General Appropriations Act or chapter 216.
22 Further, nothing in this section shall be construed to prevent
23 or limit the agency from adjusting fees, reimbursement rates,
24 lengths of stay, number of visits, or number of services, or
25 making any other adjustments necessary to comply with the
26 availability of moneys and any limitations or directions
27 provided for in the General Appropriations Act, provided the
28 adjustment is consistent with legislative intent.
29 (14) A provider of prescribed drugs shall be
30 reimbursed the least of the amount billed by the provider, the
31 provider's usual and customary charge, or the Medicaid maximum
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1 allowable fee established by the agency, plus a dispensing
2 fee. The agency is directed to implement a variable dispensing
3 fee for payments for prescribed medicines while ensuring
4 continued access for Medicaid recipients. The variable
5 dispensing fee may be based upon, but not limited to, either
6 or both the volume of prescriptions dispensed by a specific
7 pharmacy provider, and the volume of prescriptions dispensed
8 to an individual recipient, and dispensing of
9 preferred-drug-list products. The agency shall increase the
10 pharmacy dispensing fee authorized by statute and in the
11 annual General Appropriations Act by $0.50 for the dispensing
12 of a Medicaid preferred-drug-list product and reduce the
13 pharmacy dispensing fee by $0.50 for the dispensing of a
14 Medicaid product that is not included on the preferred-drug
15 list. The agency is authorized to limit reimbursement for
16 prescribed medicine in order to comply with any limitations or
17 directions provided for in the General Appropriations Act,
18 which may include implementing a prospective or concurrent
19 utilization review program.
20 Section 12. Section 400.0225, Florida Statutes, is
21 repealed.
22 Section 13. Paragraph (c) of subsection (5) of section
23 400.179, Florida Statutes, is amended to read:
24 400.179 Sale or transfer of ownership of a nursing
25 facility; liability for Medicaid underpayments and
26 overpayments.--
27 (5) Because any transfer of a nursing facility may
28 expose the fact that Medicaid may have underpaid or overpaid
29 the transferor, and because in most instances, any such
30 underpayment or overpayment can only be determined following a
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1 formal field audit, the liabilities for any such underpayments
2 or overpayments shall be as follows:
3 (c) Where the facility transfer takes any form of a
4 sale of assets, in addition to the transferor's continuing
5 liability for any such overpayments, if the transferor fails
6 to meet these obligations, the transferee shall be liable for
7 all liabilities that can be readily identifiable 90 days in
8 advance of the transfer. Such liability shall continue in
9 succession until the debt is ultimately paid or otherwise
10 resolved. It shall be the burden of the transferee to
11 determine the amount of all such readily identifiable
12 overpayments from the Agency for Health Care Administration,
13 and the agency shall cooperate in every way with the
14 identification of such amounts. Readily identifiable
15 overpayments shall include overpayments that will result from,
16 but not be limited to:
17 1. Medicaid rate changes or adjustments;
18 2. Any depreciation recapture;
19 3. Any recapture of fair rental value system indexing;
20 or and/or
21 4. Audits completed by the agency.
22
23 The transferor shall remain liable for any such Medicaid
24 overpayments that were not readily identifiable 90 days in
25 advance of the nursing facility transfer.
26 Section 14. Paragraph (a) of subsection (2) of section
27 400.191, Florida Statutes, is amended to read:
28 400.191 Availability, distribution, and posting of
29 reports and records.--
30 (2) The agency shall provide additional information in
31 consumer-friendly printed and electronic formats to assist
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1 consumers and their families in comparing and evaluating
2 nursing home facilities.
3 (a) The agency shall provide an Internet site which
4 shall include at least the following information either
5 directly or indirectly through a link to another established
6 site or sites of the agency's choosing:
7 1. A list by name and address of all nursing home
8 facilities in this state.
9 2. Whether such nursing home facilities are
10 proprietary or nonproprietary.
11 3. The current owner of the facility's license and the
12 year that that entity became the owner of the license.
13 4. The name of the owner or owners of each facility
14 and whether the facility is affiliated with a company or other
15 organization owning or managing more than one nursing facility
16 in this state.
17 5. The total number of beds in each facility.
18 6. The number of private and semiprivate rooms in each
19 facility.
20 7. The religious affiliation, if any, of each
21 facility.
22 8. The languages spoken by the administrator and staff
23 of each facility.
24 9. Whether or not each facility accepts Medicare or
25 Medicaid recipients or insurance, health maintenance
26 organization, Veterans Administration, CHAMPUS program, or
27 workers' compensation coverage.
28 10. Recreational and other programs available at each
29 facility.
30 11. Special care units or programs offered at each
31 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 Section 15. Paragraph (c) of subsection (5) of section
28 400.235, Florida Statutes, is amended to read:
29 400.235 Nursing home quality and licensure status;
30 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 consistently in a 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 16. Section 400.071, Florida Statutes, is
19 amended to read:
20 400.071 Application for license.--
21 (1) An application for a license as required by s.
22 400.062 shall be made to the agency on forms furnished by it
23 and shall be accompanied by the appropriate license fee.
24 (2) The application shall be under oath and shall
25 contain the following:
26 (a) The name, address, and social security number of
27 the applicant if an individual; if the applicant is a firm,
28 partnership, or association, its name, address, and employer
29 identification number (EIN), and the name and address of any
30 controlling interest; and the name by which the facility is to
31 be known.
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1 (b) The name of any person whose name is required on
2 the application under the provisions of paragraph (a) and who
3 owns at least a 10-percent interest in any professional
4 service, firm, association, partnership, or corporation
5 providing goods, leases, or services to the facility for which
6 the application is made, and the name and address of the
7 professional service, firm, association, partnership, or
8 corporation in which such interest is held.
9 (c) The location of the facility for which a license
10 is sought and an indication, as in the original application,
11 that such location conforms to the local zoning ordinances.
12 (d) The name of the person or persons under whose
13 management or supervision the facility will be conducted and
14 the name of the administrator.
15 (e) A signed affidavit disclosing any financial or
16 ownership interest that a person or entity described in
17 paragraph (a) or paragraph (d) has held in the last 5 years in
18 any entity licensed by this state or any other state to
19 provide health or residential care which has closed
20 voluntarily or involuntarily; has filed for bankruptcy; has
21 had a receiver appointed; has had a license denied, suspended,
22 or revoked; or has had an injunction issued against it which
23 was initiated by a regulatory agency. The affidavit must
24 disclose the reason any such entity was closed, whether
25 voluntarily or involuntarily.
26 (f) The total number of beds and the total number of
27 Medicare and Medicaid certified beds.
28 (g) Information relating to the number, experience,
29 and training of the employees of the facility and of the moral
30 character of the applicant and employees which the agency
31 requires by rule, including the name and address of any
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1 nursing home with which the applicant or employees have been
2 affiliated through ownership or employment within 5 years of
3 the date of the application for a license and the record of
4 any criminal convictions involving the applicant and any
5 criminal convictions involving an employee if known by the
6 applicant after inquiring of the employee. The applicant must
7 demonstrate that sufficient numbers of qualified staff, by
8 training or experience, will be employed to properly care for
9 the type and number of residents who will reside in the
10 facility.
11 (h) Copies of any civil verdict or judgment involving
12 the applicant rendered within the 10 years preceding the
13 application, relating to medical negligence, violation of
14 residents' rights, or wrongful death. As a condition of
15 licensure, the licensee agrees to provide to the agency copies
16 of any new verdict or judgment involving the applicant,
17 relating to such matters, within 30 days after filing with the
18 clerk of the court. The information required in this
19 paragraph shall be maintained in the facility's licensure file
20 and in an agency database which is available as a public
21 record.
22 (3) The applicant shall submit evidence which
23 establishes the good moral character of the applicant,
24 manager, supervisor, and administrator. No applicant, if the
25 applicant is an individual; no member of a board of directors
26 or officer of an applicant, if the applicant is a firm,
27 partnership, association, or corporation; and no licensed
28 nursing home administrator shall have been convicted, or found
29 guilty, regardless of adjudication, of a crime in any
30 jurisdiction which affects or may potentially affect residents
31 in the facility.
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1 (4) Each applicant for licensure must comply with the
2 following requirements:
3 (a) Upon receipt of a completed, signed, and dated
4 application, the agency shall require background screening of
5 the applicant, in accordance with the level 2 standards for
6 screening set forth in chapter 435. As used in this
7 subsection, the term "applicant" means the facility
8 administrator, or similarly titled individual who is
9 responsible for the day-to-day operation of the licensed
10 facility, and the facility financial officer, or similarly
11 titled individual who is responsible for the financial
12 operation of the licensed facility.
13 (b) The agency may require background screening for a
14 member of the board of directors of the licensee or an officer
15 or an individual owning 5 percent or more of the licensee if
16 the agency has probable cause to believe that such individual
17 has been convicted of an offense prohibited under the level 2
18 standards for screening set forth in chapter 435.
19 (c) Proof of compliance with the level 2 background
20 screening requirements of chapter 435 which has been submitted
21 within the previous 5 years in compliance with any other
22 health care or assisted living licensure requirements of this
23 state is acceptable in fulfillment of paragraph (a). Proof of
24 compliance with background screening which has been submitted
25 within the previous 5 years to fulfill the requirements of the
26 Department of Insurance pursuant to chapter 651 as part of an
27 application for a certificate of authority to operate a
28 continuing care retirement community is acceptable in
29 fulfillment of the Department of Law Enforcement and Federal
30 Bureau of Investigation background check.
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1 (d) A provisional license may be granted to an
2 applicant when each individual required by this section to
3 undergo background screening has met the standards for the
4 Department of Law Enforcement background check, but the agency
5 has not yet received background screening results from the
6 Federal Bureau of Investigation, or a request for a
7 disqualification exemption has been submitted to the agency as
8 set forth in chapter 435, but a response has not yet been
9 issued. A license may be granted to the applicant upon the
10 agency's receipt of a report of the results of the Federal
11 Bureau of Investigation background screening for each
12 individual required by this section to undergo background
13 screening which confirms that all standards have been met, or
14 upon the granting of a disqualification exemption by the
15 agency as set forth in chapter 435. Any other person who is
16 required to undergo level 2 background screening may serve in
17 his or her capacity pending the agency's receipt of the report
18 from the Federal Bureau of Investigation; however, the person
19 may not continue to serve if the report indicates any
20 violation of background screening standards and a
21 disqualification exemption has not been requested of and
22 granted by the agency as set forth in chapter 435.
23 (e) Each applicant must submit to the agency, with its
24 application, a description and explanation of any exclusions,
25 permanent suspensions, or terminations of the applicant from
26 the Medicare or Medicaid programs. Proof of compliance with
27 disclosure of ownership and control interest requirements of
28 the Medicaid or Medicare programs shall be accepted in lieu of
29 this submission.
30 (f) Each applicant must submit to the agency a
31 description and explanation of any conviction of an offense
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1 prohibited under the level 2 standards of chapter 435 by a
2 member of the board of directors of the applicant, its
3 officers, or any individual owning 5 percent or more of the
4 applicant. This requirement shall not apply to a director of a
5 not-for-profit corporation or organization if the director
6 serves solely in a voluntary capacity for the corporation or
7 organization, does not regularly take part in the day-to-day
8 operational decisions of the corporation or organization,
9 receives no remuneration for his or her services on the
10 corporation or organization's board of directors, and has no
11 financial interest and has no family members with a financial
12 interest in the corporation or organization, provided that the
13 director and the not-for-profit corporation or organization
14 include in the application a statement affirming that the
15 director's relationship to the corporation satisfies the
16 requirements of this paragraph.
17 (g) An application for license renewal must contain
18 the information required under paragraphs (e) and (f).
19 (5) The applicant shall furnish satisfactory proof of
20 financial ability to operate and conduct the nursing home in
21 accordance with the requirements of this part and all rules
22 adopted under this part, and the agency shall establish
23 standards for this purpose, including information reported
24 under paragraph (2)(e). The agency also shall establish
25 documentation requirements, to be completed by each applicant,
26 that show anticipated facility revenues and expenditures, the
27 basis for financing the anticipated cash-flow requirements of
28 the facility, and an applicant's access to contingency
29 financing.
30 (6) If the applicant offers continuing care agreements
31 as defined in chapter 651, proof shall be furnished that such
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1 applicant has obtained a certificate of authority as required
2 for operation under that chapter.
3 (7) As a condition of licensure, each licensee, except
4 one offering continuing care agreements as defined in chapter
5 651, must agree to accept recipients of Title XIX of the
6 Social Security Act on a temporary, emergency basis. The
7 persons whom the agency may require such licensees to accept
8 are those recipients of Title XIX of the Social Security Act
9 who are residing in a facility in which existing conditions
10 constitute an immediate danger to the health, safety, or
11 security of the residents of the facility.
12 (8) As a condition of licensure, each facility must
13 agree to participate in a consumer satisfaction measurement
14 process as prescribed by the agency.
15 (8)(9) The agency may not issue a license to a nursing
16 home that fails to receive a certificate of need under the
17 provisions of ss. 408.031-408.045. It is the intent of the
18 Legislature that, in reviewing a certificate-of-need
19 application to add beds to an existing nursing home facility,
20 preference be given to the application of a licensee who has
21 been awarded a Gold Seal as provided for in s. 400.235, if the
22 applicant otherwise meets the review criteria specified in s.
23 408.035.
24 (9)(10) The agency may develop an abbreviated survey
25 for licensure renewal applicable to a licensee that has
26 continuously operated as a nursing facility since 1991 or
27 earlier, has operated under the same management for at least
28 the preceding 30 months, and has had during the preceding 30
29 months no class I or class II deficiencies.
30 (10)(11) The agency may issue an inactive license to a
31 nursing home that will be temporarily unable to provide
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1 services but that is reasonably expected to resume services.
2 Such designation may be made for a period not to exceed 12
3 months but may be renewed by the agency for up to 6 additional
4 months. Any request by a licensee that a nursing home become
5 inactive must be submitted to the agency and approved by the
6 agency prior to initiating any suspension of service or
7 notifying residents. Upon agency approval, the nursing home
8 shall notify residents of any necessary discharge or transfer
9 as provided in s. 400.0255.
10 (11)(12) As a condition of licensure, each facility
11 must establish and submit with its application a plan for
12 quality assurance and for conducting risk management.
13 Section 17. Paragraph (q) of subsection (2) of section
14 409.815, Florida Statutes, is amended to read:
15 409.815 Health benefits coverage; limitations.--
16 (2) BENCHMARK BENEFITS.--In order for health benefits
17 coverage to qualify for premium assistance payments for an
18 eligible child under ss. 409.810-409.820, the health benefits
19 coverage, except for coverage under Medicaid and Medikids,
20 must include the following minimum benefits, as medically
21 necessary.
22 (q) Dental services.--Subject to a specific
23 appropriation for this benefit, covered services include those
24 dental services provided to children by the Florida Medicaid
25 program under s. 409.906(5) s. 409.906(6).
26 Section 18. Except as otherwise specifically provided
27 in this act, this act shall take effect January 1, 2002.
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2 SENATE SUMMARY
3 Revises and repeals various provisions of law relating to
programs administered by the Agency for Health Care
4 Administration. (See bill for details.)
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