Senate Bill sb0042Cc1

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    Florida Senate - 2001                           CS for SB 42-C

    By the Committee on Appropriations; and Senator Silver





    309-751-02

  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:

28

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.

11

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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    Florida Senate - 2001                           CS for SB 42-C
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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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    Florida Senate - 2001                           CS for SB 42-C
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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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    Florida Senate - 2001                           CS for SB 42-C
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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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    Florida Senate - 2001                           CS for SB 42-C
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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.
  8

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