Senate Bill sb0042Cc1
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By the Committee on Appropriations; and Senator Silver
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1 A bill to be entitled
2 An act relating to the Agency for Health Care
3 Administration; 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. 409.908,
11 F.S.; revising pharmacy dispensing fees for
12 Medicaid drugs; repealing s. 400.0225, F.S.,
13 relating to consumer-satisfaction surveys;
14 amending s. 400.179, F.S.; declaring liability
15 for overpayment when a nursing facility is
16 sold; amending s. 400.191, F.S.; eliminating a
17 provision relating to consumer-satisfaction and
18 family-satisfaction surveys; amending s.
19 400.235, F.S.; eliminating a provision relating
20 to participation in the consumer-satisfaction
21 process; amending s. 400.071, F.S.; eliminating
22 a provision relating to participation in a
23 consumer-satisfaction-measurement process;
24 amending s. 409.815, F.S.; conforming a
25 cross-reference; providing effective dates.
26
27 Be It Enacted by the Legislature of the State of Florida:
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29 Section 1. Effective July 1, 2002, subsection (11) of
30 section 409.904, Florida Statutes, is repealed.
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1 Section 2. Subsection (1) of section 409.904, Florida
2 Statutes, is amended to read:
3 409.904 Optional payments for eligible persons.--The
4 agency may make payments for medical assistance and related
5 services on behalf of the following persons who are determined
6 to be eligible subject to the income, assets, and categorical
7 eligibility tests set forth in federal and state law. Payment
8 on behalf of these Medicaid eligible persons is subject to the
9 availability of moneys and any limitations established by the
10 General Appropriations Act or chapter 216.
11 (1) A person who is age 65 or older or is determined
12 to be disabled, whose income is at or below 89 100 percent of
13 federal poverty level, and whose assets do not exceed
14 established limitations.
15 Section 3. Effective July 1, 2002, subsection (2) of
16 section 409.904, Florida Statutes, is amended to read:
17 409.904 Optional payments for eligible persons.--The
18 agency may make payments for medical assistance and related
19 services on behalf of the following persons who are determined
20 to be eligible subject to the income, assets, and categorical
21 eligibility tests set forth in federal and state law. Payment
22 on behalf of these Medicaid eligible persons is subject to the
23 availability of moneys and any limitations established by the
24 General Appropriations Act or chapter 216.
25 (2)(a) A pregnant woman who would otherwise qualify
26 for Medicaid under s. 409.903(5) except for her level of
27 income and whose assets fall within the limits established by
28 the Department of Children and Family Services for the
29 medically needy. A pregnant woman who applies for medically
30 needy eligibility may not be made presumptively eligible.
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1 (b) A child under age 21 who would otherwise qualify
2 for Medicaid or the Florida Kidcare program except for the
3 family's level of income and whose assets fall within the
4 limits established by the Department of Children and Family
5 Services for the medically needy. A family, a pregnant woman,
6 a child under age 18, a person age 65 or over, or a blind or
7 disabled person who would be eligible under any group listed
8 in s. 409.903(1), (2), or (3), except that the income or
9 assets of such family or person exceed established
10 limitations.
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12 For a family or person in this group, medical expenses are
13 deductible from income in accordance with federal requirements
14 in order to make a determination of eligibility. A family or
15 person in this group, which group is known as the "medically
16 needy," is eligible to receive the same services as other
17 Medicaid recipients, with the exception of services in skilled
18 nursing facilities and intermediate care facilities for the
19 developmentally disabled.
20 Section 4. Effective July 1, 2002, subsections (1),
21 (12), and (23) of section 409.906, Florida Statutes, are
22 amended to read:
23 409.906 Optional Medicaid services.--Subject to
24 specific appropriations, the agency may make payments for
25 services which are optional to the state under Title XIX of
26 the Social Security Act and are furnished by Medicaid
27 providers to recipients who are determined to be eligible on
28 the dates on which the services were provided. Any optional
29 service that is provided shall be provided only when medically
30 necessary and in accordance with state and federal law.
31 Optional services rendered by providers in mobile units to
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1 Medicaid recipients may be restricted or prohibited by the
2 agency. 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 or chapter 216.
8 If necessary to safeguard the state's systems of providing
9 services to elderly and disabled persons and subject to the
10 notice and review provisions of s. 216.177, the Governor may
11 direct the Agency for Health Care Administration to amend the
12 Medicaid state plan to delete the optional Medicaid service
13 known as "Intermediate Care Facilities for the Developmentally
14 Disabled." Optional services may include:
15 (1) ADULT DENTURE SERVICES.--The agency may pay for
16 dentures, the procedures required to seat dentures, and the
17 repair and reline of dentures, provided by or under the
18 direction of a licensed dentist, for a recipient who is age 21
19 or older. However, Medicaid will not provide reimbursement for
20 dental services provided in a mobile dental unit, except for a
21 mobile dental unit:
22 (a) Owned by, operated by, or having a contractual
23 agreement with the Department of Health and complying with
24 Medicaid's county health department clinic services program
25 specifications as a county health department clinic services
26 provider.
27 (b) Owned by, operated by, or having a contractual
28 arrangement with a federally qualified health center and
29 complying with Medicaid's federally qualified health center
30 specifications as a federally qualified health center
31 provider.
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1 (c) Rendering dental services to Medicaid recipients,
2 21 years of age and older, at nursing facilities.
3 (d) Owned by, operated by, or having a contractual
4 agreement with a state-approved dental educational
5 institution.
6 (e) This subsection is repealed July 1, 2002.
7 (12) CHILDREN'S HEARING SERVICES.--The agency may pay
8 for hearing and related services, including hearing
9 evaluations, hearing aid devices, dispensing of the hearing
10 aid, and related repairs, if provided to a recipient under age
11 21 by a licensed hearing aid specialist, otolaryngologist,
12 otologist, audiologist, or physician.
13 (23) CHILDREN'S VISUAL SERVICES.--The agency may pay
14 for visual examinations, eyeglasses, and eyeglass repairs for
15 a recipient under age 21, if they are prescribed by a licensed
16 physician specializing in diseases of the eye or by a licensed
17 optometrist.
18 Section 5. Subsections (13) and (20) of section
19 409.906, Florida Statutes, are amended to read:
20 409.906 Optional Medicaid services.--Subject to
21 specific appropriations, the agency may make payments for
22 services which are optional to the state under Title XIX of
23 the Social Security Act and are furnished by Medicaid
24 providers to recipients who are determined to be eligible on
25 the dates on which the services were provided. Any optional
26 service that is provided shall be provided only when medically
27 necessary and in accordance with state and federal law.
28 Optional services rendered by providers in mobile units to
29 Medicaid recipients may be restricted or prohibited by the
30 agency. Nothing in this section shall be construed to prevent
31 or limit the agency from adjusting fees, reimbursement rates,
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1 lengths of stay, number of visits, or number of services, or
2 making any other adjustments necessary to comply with the
3 availability of moneys and any limitations or directions
4 provided for in the General Appropriations Act or chapter 216.
5 If necessary to safeguard the state's systems of providing
6 services to elderly and disabled persons and subject to the
7 notice and review provisions of s. 216.177, the Governor may
8 direct the Agency for Health Care Administration to amend the
9 Medicaid state plan to delete the optional Medicaid service
10 known as "Intermediate Care Facilities for the Developmentally
11 Disabled." Optional services may include:
12 (13) HOME AND COMMUNITY-BASED SERVICES.--The agency
13 may pay for home-based or community-based services that are
14 rendered to a recipient in accordance with a federally
15 approved waiver program. The agency may limit or eliminate
16 coverage for certain Project AIDS Care Waiver services,
17 preauthorize high-cost or highly utilized services, or make
18 any other adjustments necessary to comply with any limitations
19 or directions provided for in the General Appropriations Act.
20 (20) PRESCRIBED DRUG SERVICES.--The agency may pay for
21 medications that are prescribed for a recipient by a physician
22 or other licensed practitioner of the healing arts authorized
23 to prescribe medications and that are dispensed to the
24 recipient by a licensed pharmacist or physician in accordance
25 with applicable state and federal law. The agency may use
26 mail-order pharmacy services for dispensing drugs.
27 Section 6. Subsections (2), (3), and (5) of section
28 409.9065, Florida Statutes, are amended to read:
29 409.9065 Pharmaceutical expense assistance.--
30 (2) ELIGIBILITY.--Eligibility for the program is
31 limited to those individuals who qualify for limited
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1 assistance under the Florida Medicaid program as a result of
2 being dually eligible for both Medicare and Medicaid, but
3 whose limited assistance or Medicare coverage does not include
4 any pharmacy benefit. Specifically eligible are low-income
5 senior citizens who:
6 (a) Are Florida residents age 65 and over;
7 (b) Have an income between 89 90 and 120 percent of
8 the federal poverty level;
9 (c) Are eligible for both Medicare and Medicaid;
10 (d) Are not enrolled in a Medicare health maintenance
11 organization that provides a pharmacy benefit; and
12 (e) Request to be enrolled in the program.
13 (3) BENEFITS.--Medications covered under the
14 pharmaceutical expense assistance program are those covered
15 under the Medicaid program in s. 409.906(19) s. 409.906(20).
16 Monthly benefit payments shall be limited to $80 per program
17 participant. Participants are required to make a 10-percent
18 coinsurance payment for each prescription purchased through
19 this program.
20 (5) NONENTITLEMENT.--The pharmaceutical expense
21 assistance program established by this section is not an
22 entitlement. Enrollment levels are limited to those authorized
23 by the Legislature in the annual General Appropriations Act.
24 If funds are insufficient to serve all individuals eligible
25 under subsection (2) and seeking coverage, the agency may
26 develop a waiting list based on application dates to use in
27 enrolling individuals in unfilled enrollment slots.
28 Section 7. Effective upon this act becoming a law,
29 subsections (7) and (9) of section 409.907, Florida Statutes,
30 are amended to read:
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1 409.907 Medicaid provider agreements.--The agency may
2 make payments for medical assistance and related services
3 rendered to Medicaid recipients only to an individual or
4 entity who has a provider agreement in effect with the agency,
5 who is performing services or supplying goods in accordance
6 with federal, state, and local law, and who agrees that no
7 person shall, on the grounds of handicap, race, color, or
8 national origin, or for any other reason, be subjected to
9 discrimination under any program or activity for which the
10 provider receives payment from the agency.
11 (7) The agency may require, as a condition of
12 participating in the Medicaid program and before entering into
13 the provider agreement, that the provider submit information,
14 in an initial and any required renewal applications,
15 concerning the professional, business, and personal background
16 of the provider and permit an onsite inspection of the
17 provider's service location by agency staff or other personnel
18 designated by the agency to perform this function. As a
19 continuing condition of participation in the Medicaid program,
20 a provider shall immediately notify the agency of any current
21 or pending bankruptcy filing. Before entering into the
22 provider agreement, or as a condition of continuing
23 participation in the Medicaid program, the agency may also
24 require that Medicaid providers reimbursed on a
25 fee-for-services basis or fee schedule basis which is not
26 cost-based, post a surety bond not to exceed $50,000 or the
27 total amount billed by the provider to the program during the
28 current or most recent calendar year, whichever is greater.
29 For new providers, the amount of the surety bond shall be
30 determined by the agency based on the provider's estimate of
31 its first year's billing. If the provider's billing during the
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1 first year exceeds the bond amount, the agency may require the
2 provider to acquire an additional bond equal to the actual
3 billing level of the provider. A provider's bond shall not
4 exceed $50,000 if a physician or group of physicians licensed
5 under chapter 458, chapter 459, or chapter 460 has a 50
6 percent or greater ownership interest in the provider or if
7 the provider is an assisted living facility licensed under
8 part III of chapter 400. The bonds permitted by this section
9 are in addition to the bonds referenced in s. 400.179(4)(d).
10 If the provider is a corporation, partnership, association, or
11 other entity, the agency may require the provider to submit
12 information concerning the background of that entity and of
13 any principal of the entity, including any partner or
14 shareholder having an ownership interest in the entity equal
15 to 5 percent or greater, and any treating provider who
16 participates in or intends to participate in Medicaid through
17 the entity. The information must include:
18 (a) Proof of holding a valid license or operating
19 certificate, as applicable, if required by the state or local
20 jurisdiction in which the provider is located or if required
21 by the Federal Government.
22 (b) Information concerning any prior violation, fine,
23 suspension, termination, or other administrative action taken
24 under the Medicaid laws, rules, or regulations of this state
25 or of any other state or the Federal Government; any prior
26 violation of the laws, rules, or regulations relating to the
27 Medicare program; any prior violation of the rules or
28 regulations of any other public or private insurer; and any
29 prior violation of the laws, rules, or regulations of any
30 regulatory body of this or any other state.
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1 (c) Full and accurate disclosure of any financial or
2 ownership interest that the provider, or any principal,
3 partner, or major shareholder thereof, may hold in any other
4 Medicaid provider or health care related entity or any other
5 entity that is licensed by the state to provide health or
6 residential care and treatment to persons.
7 (d) If a group provider, identification of all members
8 of the group and attestation that all members of the group are
9 enrolled in or have applied to enroll in the Medicaid program.
10 (9) Upon receipt of a completed, signed, and dated
11 application, and completion of any necessary background
12 investigation and criminal history record check, the agency
13 must either:
14 (a) Enroll the applicant as a Medicaid provider no
15 earlier than the effective date of the approval of the
16 provider application; or
17 (b) Deny the application if the agency finds that it
18 is in the best interest of the Medicaid program to do so. The
19 agency may consider the factors listed in subsection (10), as
20 well as any other factor that could affect the effective and
21 efficient administration of the program, including, but not
22 limited to, the current availability of medical care,
23 services, or supplies to recipients, taking into account
24 geographic location and reasonable travel time; the number of
25 providers of the same type already enrolled in the same
26 geographic area; and the credentials, experience, success, and
27 patient outcomes of the provider for the services that it is
28 making application to provide in the Medicaid program.
29 Section 8. Paragraph (a) of subsection (37) of section
30 409.912, Florida Statutes, is amended to read:
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1 409.912 Cost-effective purchasing of health care.--The
2 agency shall purchase goods and services for Medicaid
3 recipients in the most cost-effective manner consistent with
4 the delivery of quality medical care. The agency shall
5 maximize the use of prepaid per capita and prepaid aggregate
6 fixed-sum basis services when appropriate and other
7 alternative service delivery and reimbursement methodologies,
8 including competitive bidding pursuant to s. 287.057, designed
9 to facilitate the cost-effective purchase of a case-managed
10 continuum of care. The agency shall also require providers to
11 minimize the exposure of recipients to the need for acute
12 inpatient, custodial, and other institutional care and the
13 inappropriate or unnecessary use of high-cost services. The
14 agency may establish prior authorization requirements for
15 certain populations of Medicaid beneficiaries, certain drug
16 classes, or particular drugs to prevent fraud, abuse, overuse,
17 and possible dangerous drug interactions. The Pharmaceutical
18 and Therapeutics Committee shall make recommendations to the
19 agency on drugs for which prior authorization is required. The
20 agency shall inform the Pharmaceutical and Therapeutics
21 Committee of its decisions regarding drugs subject to prior
22 authorization.
23 (37)(a) The agency shall implement a Medicaid
24 prescribed-drug spending-control program that includes the
25 following components:
26 1. Medicaid prescribed-drug coverage for brand-name
27 drugs for adult Medicaid recipients is limited to the
28 dispensing of four brand-name drugs per month per recipient.
29 Children are exempt from this restriction. Antiretroviral
30 agents are excluded from this limitation. No requirements for
31 prior authorization or other restrictions on medications used
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1 to treat mental illnesses such as schizophrenia, severe
2 depression, or bipolar disorder may be imposed on Medicaid
3 recipients. Medications that will be available without
4 restriction for persons with mental illnesses include atypical
5 antipsychotic medications, conventional antipsychotic
6 medications, selective serotonin reuptake inhibitors, and
7 other medications used for the treatment of serious mental
8 illnesses. The agency shall also limit the amount of a
9 prescribed drug dispensed to no more than a 34-day supply. The
10 agency shall continue to provide unlimited generic drugs,
11 contraceptive drugs and items, and diabetic supplies. Although
12 a drug may be included on the preferred drug formulary, it
13 would not be exempt from the four-brand limit. The agency may
14 authorize exceptions to the brand-name-drug restriction based
15 upon the treatment needs of the patients, only when such
16 exceptions are based on prior consultation provided by the
17 agency or an agency contractor, but the agency must establish
18 procedures to ensure that:
19 a. There will be a response to a request for prior
20 consultation by telephone or other telecommunication device
21 within 24 hours after receipt of a request for prior
22 consultation;
23 b. A 72-hour supply of the drug prescribed will be
24 provided in an emergency or when the agency does not provide a
25 response within 24 hours as required by sub-subparagraph a.;
26 and
27 c. Except for the exception for nursing home residents
28 and other institutionalized adults and except for drugs on the
29 restricted formulary for which prior authorization may be
30 sought by an institutional or community pharmacy, prior
31 authorization for an exception to the brand-name-drug
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1 restriction is sought by the prescriber and not by the
2 pharmacy. When prior authorization is granted for a patient in
3 an institutional setting beyond the brand-name-drug
4 restriction, such approval is authorized for 12 months and
5 monthly prior authorization is not required for that patient.
6 2. Reimbursement to pharmacies for Medicaid prescribed
7 drugs shall be set at the average wholesale price less 13.75
8 13.25 percent.
9 3. The agency shall develop and implement a process
10 for managing the drug therapies of Medicaid recipients who are
11 using significant numbers of prescribed drugs each month. The
12 management process may include, but is not limited to,
13 comprehensive, physician-directed medical-record reviews,
14 claims analyses, and case evaluations to determine the medical
15 necessity and appropriateness of a patient's treatment plan
16 and drug therapies. The agency may contract with a private
17 organization to provide drug-program-management services. The
18 Medicaid drug benefit management program shall include
19 initiatives to manage drug therapies for HIV/AIDS patients,
20 patients using 20 or more unique prescriptions in a 180-day
21 period, and the top 1,000 patients in annual spending.
22 4. The agency may limit the size of its pharmacy
23 network based on need, competitive bidding, price
24 negotiations, credentialing, or similar criteria. The agency
25 shall give special consideration to rural areas in determining
26 the size and location of pharmacies included in the Medicaid
27 pharmacy network. A pharmacy credentialing process may include
28 criteria such as a pharmacy's full-service status, location,
29 size, patient educational programs, patient consultation,
30 disease-management services, and other characteristics. The
31 agency may impose a moratorium on Medicaid pharmacy enrollment
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1 when it is determined that it has a sufficient number of
2 Medicaid-participating providers.
3 5. The agency shall develop and implement a program
4 that requires Medicaid practitioners who prescribe drugs to
5 use a counterfeit-proof prescription pad for Medicaid
6 prescriptions. The agency shall require the use of
7 standardized counterfeit-proof prescription pads by
8 Medicaid-participating prescribers or prescribers who write
9 prescriptions for Medicaid recipients. The agency may
10 implement the program in targeted geographic areas or
11 statewide.
12 6. The agency may enter into arrangements that require
13 manufacturers of generic drugs prescribed to Medicaid
14 recipients to provide rebates of at least 15.1 percent of the
15 average manufacturer price for the manufacturer's generic
16 products. These arrangements shall require that if a
17 generic-drug manufacturer pays federal rebates for
18 Medicaid-reimbursed drugs at a level below 15.1 percent, the
19 manufacturer must provide a supplemental rebate to the state
20 in an amount necessary to achieve a 15.1-percent rebate level.
21 7. The agency may establish a preferred drug formulary
22 in accordance with 42 U.S.C. s. 1396r-8, and, pursuant to the
23 establishment of such formulary, it is authorized to negotiate
24 supplemental rebates from manufacturers that are in addition
25 to those required by Title XIX of the Social Security Act and
26 at no less than 10 percent of the average manufacturer price
27 as defined in 42 U.S.C. s. 1936 on the last day of a quarter
28 unless the federal or supplemental rebate, or both, equals or
29 exceeds 25 percent. There is no upper limit on the
30 supplemental rebates the agency may negotiate. The agency may
31 determine that specific products, brand-name or generic, are
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1 competitive at lower rebate percentages. Agreement to pay the
2 minimum supplemental rebate percentage will guarantee a
3 manufacturer that the Medicaid Pharmaceutical and Therapeutics
4 Committee will consider a product for inclusion on the
5 preferred drug formulary. However, a pharmaceutical
6 manufacturer is not guaranteed placement on the formulary by
7 simply paying the minimum supplemental rebate. Agency
8 decisions will be made on the clinical efficacy of a drug and
9 recommendations of the Medicaid Pharmaceutical and
10 Therapeutics Committee, as well as the price of competing
11 products minus federal and state rebates. The agency is
12 authorized to contract with an outside agency or contractor to
13 conduct negotiations for supplemental rebates. For the
14 purposes of this section, the term "supplemental rebates" may
15 include, at the agency's discretion, cash rebates and other
16 program benefits that offset a Medicaid expenditure. Such
17 other program benefits may include, but are not limited to,
18 disease management programs, drug product donation programs,
19 drug utilization control programs, prescriber and beneficiary
20 counseling and education, fraud and abuse initiatives, and
21 other services or administrative investments with guaranteed
22 savings to the Medicaid program in the same year the rebate
23 reduction is included in the General Appropriations Act. The
24 agency is authorized to seek any federal waivers to implement
25 this initiative.
26 8. The agency shall establish an advisory committee
27 for the purposes of studying the feasibility of using a
28 restricted drug formulary for nursing home residents and other
29 institutionalized adults. The committee shall be comprised of
30 seven members appointed by the Secretary of Health Care
31 Administration. The committee members shall include two
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1 physicians licensed under chapter 458 or chapter 459; three
2 pharmacists licensed under chapter 465 and appointed from a
3 list of recommendations provided by the Florida Long-Term Care
4 Pharmacy Alliance; and two pharmacists licensed under chapter
5 465.
6 9. The Agency for Health Care Administration shall
7 expand home delivery of pharmacy products. To assist Medicaid
8 patients in securing their prescriptions and reduce program
9 costs, the agency shall expand its current mail-order-pharmacy
10 diabetes-supply program to include all generic and brand-name
11 drugs used by Medicaid patients with diabetes. Medicaid
12 recipients in the current program may obtain nondiabetes drugs
13 on a voluntary basis. To further reduce program costs and
14 expand access to home delivery of pharmacy products for
15 diabetic recipients, the agency shall offer home delivery of
16 pharmacy products to Medicaid recipients with diabetes. This
17 mail-order feature for drugs will be voluntary on the part of
18 a Medicaid recipient with diabetes. The agency will allow all
19 qualified and enrolled pharmacies to provide this mail-order
20 program to Medicaid-eligible diabetic recipients who are not
21 eligible for the current mail-order diabetes-supply program,
22 provided such pharmacies accept the same reimbursement rates
23 as its current mail-order diabetes-supply program and offer
24 equivalent levels of patient education and support services.
25 The agency may seek and implement any federal waivers
26 necessary to implement this subparagraph.
27 Section 9. Paragraphs (e) and (f) of subsection (2) of
28 section 409.9122, Florida Statutes, are amended to read:
29 409.9122 Mandatory Medicaid managed care enrollment;
30 programs and procedures.--
31 (2)
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1 (e) Prior to requesting a Medicaid recipient who is
2 subject to mandatory managed care enrollment to make a choice
3 between a managed care plan or MediPass, the agency shall
4 contact and provide choice counseling to the recipient.
5 Medicaid recipients who are already enrolled in a managed care
6 plan or MediPass shall be offered the opportunity to change
7 managed care plans or MediPass providers on a staggered basis,
8 as defined by the agency. All Medicaid recipients shall have
9 90 days in which to make a choice of managed care plans or
10 MediPass providers. Those Medicaid recipients who do not make
11 a choice shall be assigned to a managed care plan or MediPass
12 in accordance with paragraph (f). To facilitate continuity of
13 care, for a Medicaid recipient who is also a recipient of
14 Supplemental Security Income (SSI), prior to assigning the SSI
15 recipient to a managed care plan or MediPass, the agency shall
16 determine whether the SSI recipient has an ongoing
17 relationship with a MediPass provider or managed care plan,
18 and if so, the agency shall assign the SSI recipient to that
19 MediPass provider or managed care plan. Those SSI recipients
20 who do not have such a provider relationship shall be assigned
21 to a managed care plan or MediPass provider in accordance with
22 paragraph (f).
23 (f) When a Medicaid recipient does not choose a
24 managed care plan or MediPass provider, the agency shall
25 assign the Medicaid recipient to a managed care plan or
26 MediPass provider. Medicaid recipients who are subject to
27 mandatory assignment but who fail to make a choice shall be
28 assigned to managed care plans or provider service networks
29 until an equal enrollment of 50 percent in MediPass and
30 provider service networks and 50 percent in managed care plans
31 is achieved. Once equal enrollment is achieved, the
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1 assignments shall be divided in order to maintain an equal
2 enrollment in MediPass and managed care plans. Thereafter,
3 assignment of Medicaid recipients who fail to make a choice
4 shall be based proportionally on the preferences of recipients
5 who have made a choice in the previous period. Such
6 proportions shall be revised at least quarterly to reflect an
7 update of the preferences of Medicaid recipients. The agency
8 shall also disproportionately assign Medicaid-eligible
9 children in families who are required to but have failed to
10 make a choice of managed care plan or MediPass for their child
11 and who are to be assigned to the MediPass program to
12 children's networks as described in s. 409.912(3)(g) and where
13 available. The disproportionate assignment of children to
14 children's networks shall be made until the agency has
15 determined that the children's networks have sufficient
16 numbers to be economically operated. For purposes of this
17 paragraph, when referring to assignment, the term "managed
18 care plans" includes exclusive provider organizations,
19 provider service networks, minority physician networks, and
20 pediatric emergency department diversion programs authorized
21 by this chapter or the General Appropriations Act. When making
22 assignments, the agency shall take into account the following
23 criteria:
24 1. A managed care plan has sufficient network capacity
25 to meet the need of members.
26 2. The managed care plan or MediPass has previously
27 enrolled the recipient as a member, or one of the managed care
28 plan's primary care providers or MediPass providers has
29 previously provided health care to the recipient.
30 3. The agency has knowledge that the member has
31 previously expressed a preference for a particular managed
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1 care plan or MediPass provider as indicated by Medicaid
2 fee-for-service claims data, but has failed to make a choice.
3 4. The managed care plan's or MediPass primary care
4 providers are geographically accessible to the recipient's
5 residence.
6 Section 10. Effective upon this act becoming a law,
7 subsections (15) and (21), paragraph (a) of subsection (22),
8 and paragraph (a) of subsection (24) of section 409.913,
9 Florida Statutes, are amended, and subsections (26) and (27)
10 are added to that section, to read:
11 409.913 Oversight of the integrity of the Medicaid
12 program.--The agency shall operate a program to oversee the
13 activities of Florida Medicaid recipients, and providers and
14 their representatives, to ensure that fraudulent and abusive
15 behavior and neglect of recipients occur to the minimum extent
16 possible, and to recover overpayments and impose sanctions as
17 appropriate.
18 (15) The agency may impose any of the following
19 sanctions on a provider or a person for any of the acts
20 described in subsection (14):
21 (a) Suspension for a specific period of time of not
22 more than 1 year.
23 (b) Termination for a specific period of time of from
24 more than 1 year to 20 years.
25 (c) Imposition of a fine of up to $5,000 for each
26 violation. Each day that an ongoing violation continues, such
27 as refusing to furnish Medicaid-related records or refusing
28 access to records, is considered, for the purposes of this
29 section, to be a separate violation. Each instance of
30 improper billing of a Medicaid recipient; each instance of
31 including an unallowable cost on a hospital or nursing home
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1 Medicaid cost report after the provider or authorized
2 representative has been advised in an audit exit conference or
3 previous audit report of the cost unallowability; each
4 instance of furnishing a Medicaid recipient goods or
5 professional services that are inappropriate or of inferior
6 quality as determined by competent peer judgment; each
7 instance of knowingly submitting a materially false or
8 erroneous Medicaid provider enrollment application, request
9 for prior authorization for Medicaid services, drug exception
10 request, or cost report; each instance of inappropriate
11 prescribing of drugs for a Medicaid recipient as determined by
12 competent peer judgment; and each false or erroneous Medicaid
13 claim leading to an overpayment to a provider is considered,
14 for the purposes of this section, to be a separate violation.
15 (d) Immediate suspension, if the agency has received
16 information of patient abuse or neglect or of any act
17 prohibited by s. 409.920. Upon suspension, the agency must
18 issue an immediate final order under s. 120.569(2)(n).
19 (e) A fine, not to exceed $10,000, for a violation of
20 paragraph (14)(i).
21 (f) Imposition of liens against provider assets,
22 including, but not limited to, financial assets and real
23 property, not to exceed the amount of fines or recoveries
24 sought, upon entry of an order determining that such moneys
25 are due or recoverable.
26 (g) Other remedies as permitted by law to effect the
27 recovery of a fine or overpayment.
28 (21) The audit report, supported by agency work
29 papers, showing an overpayment to a provider constitutes
30 evidence of the overpayment. A provider may not present or
31 elicit testimony, either on direct examination or
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1 cross-examination in any court or administrative proceeding,
2 regarding the purchase or acquisition by any means of drugs,
3 goods, or supplies; sales or divestment by any means of drugs,
4 goods, or supplies; or inventory of drugs, goods, or supplies,
5 unless such acquisition, sales, divestment, or inventory is
6 documented by written invoices, written inventory records, or
7 other competent written documentary evidence maintained in the
8 normal course of the provider's business. Notwithstanding the
9 applicable rules of discovery, all documentation related to
10 the rendering of services by a provider which is used in
11 support of a provider's position must be timely filed with
12 agency counsel not less than 14 days before any administrative
13 hearing or else must be excluded from consideration.
14 (22)(a) In an audit or investigation of a violation
15 committed by a provider which is conducted pursuant to this
16 section, the agency is entitled to recover all up to $15,000
17 in investigative, legal, and expert witness costs if the
18 agency's findings were not contested by the provider or, if
19 contested, the agency ultimately prevailed.
20 (24)(a) The agency may withhold Medicaid payments, in
21 whole or in part, to a provider upon receipt of reliable
22 evidence that the circumstances giving rise to the need for a
23 withholding of payments involve fraud, or willful
24 misrepresentation, or abuse under the Medicaid program, or a
25 crime committed while rendering goods or services to Medicaid
26 recipients, pending completion of legal proceedings. If it is
27 determined that fraud, willful misrepresentation, abuse, or a
28 crime did not occur, the payments withheld must be paid to the
29 provider within 14 days after such determination with interest
30 at the rate of 10 percent a year. Any money withheld in
31 accordance with this paragraph shall be placed in a suspended
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1 account, readily accessible to the agency, so that any payment
2 ultimately due the provider shall be made within 14 days.
3 Furthermore, the authority to withhold payments under this
4 paragraph shall not apply to physicians whose alleged
5 overpayments are being determined by administrative
6 proceedings pursuant to chapter 120.
7 (26) When the Agency for Health Care Administration
8 has made a probable cause determination and alleged that an
9 overpayment to a Medicaid provider has occurred, the agency,
10 after notice to the provider, may:
11 (a) Withhold, and continue to withhold during the
12 pendency of an administrative hearing pursuant to chapter 120,
13 any medical assistance reimbursement payments until such time
14 as the overpayment is recovered, unless within 30 days after
15 receiving notice thereof the provider:
16 1. Makes repayment in full; or
17 2. Establishes a repayment plan that is satisfactory
18 to the Agency for Health Care Administration.
19 (b) Withhold, and continue to withhold during the
20 pendency of an administrative hearing pursuant to chapter 120,
21 medical assistance reimbursement payments if the terms of a
22 repayment plan are not adhered to by the provider.
23
24 If a provider requests an administrative hearing pursuant to
25 chapter 120, such hearing must be conducted within 90 days
26 following receipt by the provider of the final audit report,
27 absent exceptionally good cause shown as determined by the
28 administrative law judge or hearing officer. Upon issuance of
29 a final order, the balance outstanding of the amount
30 determined to constitute the overpayment shall become due.
31 Any withholding of payments by the Agency for Health Care
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1 Administration pursuant to this section shall be limited so
2 that the monthly medical assistance payment is not reduced by
3 more than 10 percent.
4 (27) Venue for all Medicaid program integrity
5 overpayment cases shall lie in Leon County, at the discretion
6 of the agency.
7 Section 11. Subsection (4) of section 414.41, Florida
8 Statutes, is repealed.
9 Section 12. Subsection (14) of section 409.908,
10 Florida Statutes, is amended to read:
11 409.908 Reimbursement of Medicaid providers.--Subject
12 to specific appropriations, the agency shall reimburse
13 Medicaid providers, in accordance with state and federal law,
14 according to methodologies set forth in the rules of the
15 agency and in policy manuals and handbooks incorporated by
16 reference therein. These methodologies may include fee
17 schedules, reimbursement methods based on cost reporting,
18 negotiated fees, competitive bidding pursuant to s. 287.057,
19 and other mechanisms the agency considers efficient and
20 effective for purchasing services or goods on behalf of
21 recipients. Payment for Medicaid compensable services made on
22 behalf of Medicaid eligible persons is subject to the
23 availability of moneys and any limitations or directions
24 provided for in the General Appropriations Act or chapter 216.
25 Further, 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, provided the
31 adjustment is consistent with legislative intent.
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1 (14) A provider of prescribed drugs shall be
2 reimbursed the least of the amount billed by the provider, the
3 provider's usual and customary charge, or the Medicaid maximum
4 allowable fee established by the agency, plus a dispensing
5 fee. The agency is directed to implement a variable dispensing
6 fee for payments for prescribed medicines while ensuring
7 continued access for Medicaid recipients. The variable
8 dispensing fee may be based upon, but not limited to, either
9 or both the volume of prescriptions dispensed by a specific
10 pharmacy provider, and the volume of prescriptions dispensed
11 to an individual recipient, and dispensing of
12 preferred-drug-list products. The agency shall increase the
13 pharmacy dispensing fee authorized by statute and in the
14 annual General Appropriations Act by $0.50 for the dispensing
15 of a Medicaid preferred-drug-list product and reduce the
16 pharmacy dispensing fee by $0.50 for the dispensing of a
17 Medicaid product that is not included on the preferred-drug
18 list. The agency is authorized to limit reimbursement for
19 prescribed medicine in order to comply with any limitations or
20 directions provided for in the General Appropriations Act,
21 which may include implementing a prospective or concurrent
22 utilization review program.
23 Section 13. Section 400.0225, Florida Statutes, is
24 repealed.
25 Section 14. Paragraph (c) of subsection (5) of section
26 400.179, Florida Statutes, is amended to read:
27 400.179 Sale or transfer of ownership of a nursing
28 facility; liability for Medicaid underpayments and
29 overpayments.--
30 (5) Because any transfer of a nursing facility may
31 expose the fact that Medicaid may have underpaid or overpaid
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1 the transferor, and because in most instances, any such
2 underpayment or overpayment can only be determined following a
3 formal field audit, the liabilities for any such underpayments
4 or overpayments shall be as follows:
5 (c) Where the facility transfer takes any form of a
6 sale of assets, in addition to the transferor's continuing
7 liability for any such overpayments, if the transferor fails
8 to meet these obligations, the transferee shall be liable for
9 all liabilities that can be readily identifiable 90 days in
10 advance of the transfer. Such liability shall continue in
11 succession until the debt is ultimately paid or otherwise
12 resolved. It shall be the burden of the transferee to
13 determine the amount of all such readily identifiable
14 overpayments from the Agency for Health Care Administration,
15 and the agency shall cooperate in every way with the
16 identification of such amounts. Readily identifiable
17 overpayments shall include overpayments that will result from,
18 but not be limited to:
19 1. Medicaid rate changes or adjustments;
20 2. Any depreciation recapture;
21 3. Any recapture of fair rental value system indexing;
22 or and/or
23 4. Audits completed by the agency.
24
25 The transferor shall remain liable for any such Medicaid
26 overpayments that were not readily identifiable 90 days in
27 advance of the nursing facility transfer.
28 Section 15. Paragraph (a) of subsection (2) of section
29 400.191, Florida Statutes, is 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 Section 16. Paragraph (c) of subsection (5) of section
30 400.235, Florida Statutes, is amended to read:
31
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1 400.235 Nursing home quality and licensure status;
2 Gold Seal Program.--
3 (5) Facilities must meet the following additional
4 criteria for recognition as a Gold Seal Program facility:
5 (c) Participate consistently in a the required
6 consumer satisfaction process as prescribed by the agency, and
7 demonstrate that information is elicited from residents,
8 family members, and guardians about satisfaction with the
9 nursing facility, its environment, the services and care
10 provided, the staff's skills and interactions with residents,
11 attention to resident's needs, and the facility's efforts to
12 act on information gathered from the consumer satisfaction
13 measures.
14
15 A facility assigned a conditional licensure status may not
16 qualify for consideration for the Gold Seal Program until
17 after it has operated for 30 months with no class I or class
18 II deficiencies and has completed a regularly scheduled
19 relicensure survey.
20 Section 17. Section 400.071, Florida Statutes, is
21 amended to read:
22 400.071 Application for license.--
23 (1) An application for a license as required by s.
24 400.062 shall be made to the agency on forms furnished by it
25 and shall be accompanied by the appropriate license fee.
26 (2) The application shall be under oath and shall
27 contain the following:
28 (a) The name, address, and social security number of
29 the applicant if an individual; if the applicant is a firm,
30 partnership, or association, its name, address, and employer
31 identification number (EIN), and the name and address of any
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1 controlling interest; and the name by which the facility is to
2 be known.
3 (b) The name of any person whose name is required on
4 the application under the provisions of paragraph (a) and who
5 owns at least a 10-percent interest in any professional
6 service, firm, association, partnership, or corporation
7 providing goods, leases, or services to the facility for which
8 the application is made, and the name and address of the
9 professional service, firm, association, partnership, or
10 corporation in which such interest is held.
11 (c) The location of the facility for which a license
12 is sought and an indication, as in the original application,
13 that such location conforms to the local zoning ordinances.
14 (d) The name of the person or persons under whose
15 management or supervision the facility will be conducted and
16 the name of the administrator.
17 (e) A signed affidavit disclosing any financial or
18 ownership interest that a person or entity described in
19 paragraph (a) or paragraph (d) has held in the last 5 years in
20 any entity licensed by this state or any other state to
21 provide health or residential care which has closed
22 voluntarily or involuntarily; has filed for bankruptcy; has
23 had a receiver appointed; has had a license denied, suspended,
24 or revoked; or has had an injunction issued against it which
25 was initiated by a regulatory agency. The affidavit must
26 disclose the reason any such entity was closed, whether
27 voluntarily or involuntarily.
28 (f) The total number of beds and the total number of
29 Medicare and Medicaid certified beds.
30 (g) Information relating to the number, experience,
31 and training of the employees of the facility and of the moral
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1 character of the applicant and employees which the agency
2 requires by rule, including the name and address of any
3 nursing home with which the applicant or employees have been
4 affiliated through ownership or employment within 5 years of
5 the date of the application for a license and the record of
6 any criminal convictions involving the applicant and any
7 criminal convictions involving an employee if known by the
8 applicant after inquiring of the employee. The applicant must
9 demonstrate that sufficient numbers of qualified staff, by
10 training or experience, will be employed to properly care for
11 the type and number of residents who will reside in the
12 facility.
13 (h) Copies of any civil verdict or judgment involving
14 the applicant rendered within the 10 years preceding the
15 application, relating to medical negligence, violation of
16 residents' rights, or wrongful death. As a condition of
17 licensure, the licensee agrees to provide to the agency copies
18 of any new verdict or judgment involving the applicant,
19 relating to such matters, within 30 days after filing with the
20 clerk of the court. The information required in this
21 paragraph shall be maintained in the facility's licensure file
22 and in an agency database which is available as a public
23 record.
24 (3) The applicant shall submit evidence which
25 establishes the good moral character of the applicant,
26 manager, supervisor, and administrator. No applicant, if the
27 applicant is an individual; no member of a board of directors
28 or officer of an applicant, if the applicant is a firm,
29 partnership, association, or corporation; and no licensed
30 nursing home administrator shall have been convicted, or found
31 guilty, regardless of adjudication, of a crime in any
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1 jurisdiction which affects or may potentially affect residents
2 in the facility.
3 (4) Each applicant for licensure must comply with the
4 following requirements:
5 (a) Upon receipt of a completed, signed, and dated
6 application, the agency shall require background screening of
7 the applicant, in accordance with the level 2 standards for
8 screening set forth in chapter 435. As used in this
9 subsection, the term "applicant" means the facility
10 administrator, or similarly titled individual who is
11 responsible for the day-to-day operation of the licensed
12 facility, and the facility financial officer, or similarly
13 titled individual who is responsible for the financial
14 operation of the licensed facility.
15 (b) The agency may require background screening for a
16 member of the board of directors of the licensee or an officer
17 or an individual owning 5 percent or more of the licensee if
18 the agency has probable cause to believe that such individual
19 has been convicted of an offense prohibited under the level 2
20 standards for screening set forth in chapter 435.
21 (c) Proof of compliance with the level 2 background
22 screening requirements of chapter 435 which has been submitted
23 within the previous 5 years in compliance with any other
24 health care or assisted living licensure requirements of this
25 state is acceptable in fulfillment of paragraph (a). Proof of
26 compliance with background screening which has been submitted
27 within the previous 5 years to fulfill the requirements of the
28 Department of Insurance pursuant to chapter 651 as part of an
29 application for a certificate of authority to operate a
30 continuing care retirement community is acceptable in
31
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1 fulfillment of the Department of Law Enforcement and Federal
2 Bureau of Investigation background check.
3 (d) A provisional license may be granted to an
4 applicant when each individual required by this section to
5 undergo background screening has met the standards for the
6 Department of Law Enforcement background check, but the agency
7 has not yet received background screening results from the
8 Federal Bureau of Investigation, or a request for a
9 disqualification exemption has been submitted to the agency as
10 set forth in chapter 435, but a response has not yet been
11 issued. A license may be granted to the applicant upon the
12 agency's receipt of a report of the results of the Federal
13 Bureau of Investigation background screening for each
14 individual required by this section to undergo background
15 screening which confirms that all standards have been met, or
16 upon the granting of a disqualification exemption by the
17 agency as set forth in chapter 435. Any other person who is
18 required to undergo level 2 background screening may serve in
19 his or her capacity pending the agency's receipt of the report
20 from the Federal Bureau of Investigation; however, the person
21 may not continue to serve if the report indicates any
22 violation of background screening standards and a
23 disqualification exemption has not been requested of and
24 granted by the agency as set forth in chapter 435.
25 (e) Each applicant must submit to the agency, with its
26 application, a description and explanation of any exclusions,
27 permanent suspensions, or terminations of the applicant from
28 the Medicare or Medicaid programs. Proof of compliance with
29 disclosure of ownership and control interest requirements of
30 the Medicaid or Medicare programs shall be accepted in lieu of
31 this submission.
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1 (f) Each applicant must submit to the agency a
2 description and explanation of any conviction of an offense
3 prohibited under the level 2 standards of chapter 435 by a
4 member of the board of directors of the applicant, its
5 officers, or any individual owning 5 percent or more of the
6 applicant. This requirement shall not apply to a director of a
7 not-for-profit corporation or organization if the director
8 serves solely in a voluntary capacity for the corporation or
9 organization, does not regularly take part in the day-to-day
10 operational decisions of the corporation or organization,
11 receives no remuneration for his or her services on the
12 corporation or organization's board of directors, and has no
13 financial interest and has no family members with a financial
14 interest in the corporation or organization, provided that the
15 director and the not-for-profit corporation or organization
16 include in the application a statement affirming that the
17 director's relationship to the corporation satisfies the
18 requirements of this paragraph.
19 (g) An application for license renewal must contain
20 the information required under paragraphs (e) and (f).
21 (5) The applicant shall furnish satisfactory proof of
22 financial ability to operate and conduct the nursing home in
23 accordance with the requirements of this part and all rules
24 adopted under this part, and the agency shall establish
25 standards for this purpose, including information reported
26 under paragraph (2)(e). The agency also shall establish
27 documentation requirements, to be completed by each applicant,
28 that show anticipated facility revenues and expenditures, the
29 basis for financing the anticipated cash-flow requirements of
30 the facility, and an applicant's access to contingency
31 financing.
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1 (6) If the applicant offers continuing care agreements
2 as defined in chapter 651, proof shall be furnished that such
3 applicant has obtained a certificate of authority as required
4 for operation under that chapter.
5 (7) As a condition of licensure, each licensee, except
6 one offering continuing care agreements as defined in chapter
7 651, must agree to accept recipients of Title XIX of the
8 Social Security Act on a temporary, emergency basis. The
9 persons whom the agency may require such licensees to accept
10 are those recipients of Title XIX of the Social Security Act
11 who are residing in a facility in which existing conditions
12 constitute an immediate danger to the health, safety, or
13 security of the residents of the facility.
14 (8) As a condition of licensure, each facility must
15 agree to participate in a consumer satisfaction measurement
16 process as prescribed by the agency.
17 (8)(9) The agency may not issue a license to a nursing
18 home that fails to receive a certificate of need under the
19 provisions of ss. 408.031-408.045. It is the intent of the
20 Legislature that, in reviewing a certificate-of-need
21 application to add beds to an existing nursing home facility,
22 preference be given to the application of a licensee who has
23 been awarded a Gold Seal as provided for in s. 400.235, if the
24 applicant otherwise meets the review criteria specified in s.
25 408.035.
26 (9)(10) The agency may develop an abbreviated survey
27 for licensure renewal applicable to a licensee that has
28 continuously operated as a nursing facility since 1991 or
29 earlier, has operated under the same management for at least
30 the preceding 30 months, and has had during the preceding 30
31 months no class I or class II deficiencies.
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1 (10)(11) The agency may issue an inactive license to a
2 nursing home that will be temporarily unable to provide
3 services but that is reasonably expected to resume services.
4 Such designation may be made for a period not to exceed 12
5 months but may be renewed by the agency for up to 6 additional
6 months. Any request by a licensee that a nursing home become
7 inactive must be submitted to the agency and approved by the
8 agency prior to initiating any suspension of service or
9 notifying residents. Upon agency approval, the nursing home
10 shall notify residents of any necessary discharge or transfer
11 as provided in s. 400.0255.
12 (11)(12) As a condition of licensure, each facility
13 must establish and submit with its application a plan for
14 quality assurance and for conducting risk management.
15 Section 18. Paragraph (q) of subsection (2) of section
16 409.815, Florida Statutes, is amended to read:
17 409.815 Health benefits coverage; limitations.--
18 (2) BENCHMARK BENEFITS.--In order for health benefits
19 coverage to qualify for premium assistance payments for an
20 eligible child under ss. 409.810-409.820, the health benefits
21 coverage, except for coverage under Medicaid and Medikids,
22 must include the following minimum benefits, as medically
23 necessary.
24 (q) Dental services.--Subject to a specific
25 appropriation for this benefit, covered services include those
26 dental services provided to children by the Florida Medicaid
27 program under s. 409.906(5) s. 409.906(6).
28 Section 19. Except as otherwise specifically provided
29 in this act, this act shall take effect January 1, 2002.
30
31
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1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 42-C
3
4 Deletes title language related to Medicaid county billing.
5 Separates Section 2 into two sections due to different
effective dates.
6
Deletes language related to dispensing of generic drug
7 products for adults eligible through the Medically Needy
Program.
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