Senate Bill sb1276er

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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1

  2         An act relating to access to health and human

  3         services; creating s. 408.911, F.S.; providing

  4         a short title; creating s. 408.913, F.S.;

  5         requiring the Agency for Health Care

  6         Administration to establish as a pilot project

  7         a comprehensive health and human services

  8         eligibility access system; establishing

  9         requirements for each component of the system;

10         creating s. 408.914, F.S.; requiring the Agency

11         for Health Care Administration to phase in

12         implementation of the comprehensive health and

13         human services eligibility access system;

14         specifying timeframes for each implementation

15         phase; requiring that the agency submit a plan

16         for statewide implementation to the Governor

17         and Legislature; creating s. 408.915, F.S.;

18         requiring the Agency for Health Care

19         Administration to develop and implement a pilot

20         project to integrate eligibility determination

21         and information and referral services;

22         establishing requirements for the pilot

23         project; establishing requirements for

24         information and referral; specifying the scope

25         of the project; authorizing the agency to

26         request federal waivers; creating s. 408.916,

27         F.S.; establishing the Health Care Access

28         Steering Committee; providing for membership of

29         the steering committee; providing duties;

30         establishing an expiration date for the

31         steering committee; creating s. 408.917, F.S.;


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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1         requiring an evaluation of the pilot project;

  2         requiring a report to the Governor and

  3         Legislature; specifying issues to be addressed

  4         in the report; creating s. 408.918, F.S.;

  5         authorizing the planning, development, and

  6         implementation of the Florida 211 Network;

  7         providing objectives for the Florida 211

  8         Network; requiring the Agency for Health Care

  9         Administration to establish criteria for

10         certification of information and referral

11         entities to participate in the Florida 211

12         Network; providing for revocation of 211

13         numbers from uncertified information and

14         referral entities; providing for assistance in

15         resolving disputes from the Public Service

16         Commission and the Federal Communications

17         Commission; amending s. 409.912, F.S.;

18         authorizing the Agency for Health Care

19         Administration to contract with an entity

20         providing prepaid or fixed-sum health care and

21         social services to elderly recipients; amending

22         s. 430.205, F.S.; requiring the Department of

23         Elderly Affairs and the Agency for Health Care

24         Administration to develop a managed, integrated

25         long-term-care delivery system under a single

26         entity; providing for a pilot project;

27         specifying requirements of the pilot project;

28         specifying requirements for payment rates and

29         risk-sharing agreements; authorizing the

30         Department of Elderly Affairs and the Agency

31         for Health Care Administration to seek federal


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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1         waivers to implement the pilot; specifying

  2         requirements for the Department of Children and

  3         Family Services and the Department of Elderly

  4         Affairs concerning eligibility determination

  5         and nursing home preadmission screening;

  6         requiring an evaluation of the pilot project;

  7         requiring a report to the Governor and

  8         Legislature; specifying issues to be addressed

  9         in this report; creating s. 430.041, F.S.;

10         establishing the Office of Long-Term-Care

11         Policy within the Department of Elderly

12         Affairs; requiring the office to make

13         recommendations for coordinating the services

14         provided by state agencies; providing for the

15         appointment of an advisory board to the Office

16         of Long-Term-Care Policy; specifying membership

17         in the advisory board; providing for

18         reimbursement of per diem and travel expenses

19         for members of the advisory board; requiring

20         that the office submit an annual report to the

21         Governor and Legislature; requiring assistance

22         to the office by state agencies and

23         universities; creating s. 409.221, F.S.;

24         creating the "Florida Consumer-Directed Care

25         Act"; providing legislative findings; providing

26         legislative intent; establishing the

27         consumer-directed care program; providing for

28         consumer selection of certain long-term care

29         services and providers; providing for

30         interagency agreements among the Agency for

31         Health Care Administration and the Department


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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1         of Elderly Affairs, the Department of Health,

  2         and the Department of Children and Family

  3         Services; providing for program eligibility and

  4         enrollment; providing definitions; providing

  5         for consumer budget allowances and purchasing

  6         guidelines; specifying authorized services;

  7         providing roles and responsibilities of

  8         consumers, the agency and departments, and

  9         fiduciary intermediaries; providing background

10         screening requirements for persons who render

11         care under the program; providing rulemaking

12         authority of the agency and departments;

13         requiring the agency to apply for federal

14         waivers as necessary; requiring ongoing program

15         reviews and annual reports; requiring the

16         Agency for Health Care Administration and the

17         Department of Elderly Affairs to submit a plan

18         to the Governor and Legislature for reducing

19         nursing home bed days funded under the Medicaid

20         program; amending s. 408.034, F.S.; providing

21         additional requirements for the Agency for

22         Health Care Administration in determining the

23         need for additional nursing facility beds;

24         amending s. 409.912, F.S.; authorizing the

25         Agency for Health Care Administration to

26         contract with vendors on a risk-sharing basis

27         for in-home physician services; requiring the

28         Agency for Health Care Administration to

29         establish a nursing facility preadmission

30         screening program through an interagency

31         agreement with the Department of Elderly


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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1         Affairs; requiring an annual report to the

  2         Legislature and the Office of Long-Term-Care

  3         Policy; creating s. 430.7031, F.S.; requiring

  4         the Department of Elderly Affairs and the

  5         Agency for Health Care Administration to

  6         implement a nursing home transition program;

  7         providing requirements for the program;

  8         amending ss. 409.908, 430.708, and 641.386,

  9         F.S., relating to reimbursement of Medicaid

10         providers, certificates of need, and agent

11         licensing and appointment; conforming

12         cross-references to changes made by the act;

13         amending s. 20.41, F.S.; providing for

14         administration of the State Long-Term Care

15         Ombudsman Council by the Department of Elderly

16         Affairs; amending s. 400.0063, F.S.; locating

17         the Office of the State Long-Term Care

18         Ombudsman in the department; providing for

19         appointment of the ombudsman by the Secretary

20         of Elderly Affairs; amending s. 400.0065, F.S.;

21         requiring the secretary's approval of staff for

22         the local ombudsman councils; deleting

23         requirement that the ombudsman prepare an

24         annual legislative budget request; revising

25         rulemaking authority; amending s. 400.0067,

26         F.S.; revising duties of the State Long-Term

27         Care Ombudsman Council; providing duties of the

28         department and secretary; amending s. 400.0069,

29         F.S.; increasing the maximum membership of the

30         local long-term care ombudsman councils;

31         amending s. 400.0071, F.S.; revising procedures


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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1         relating to complaints; amending s. 400.0087,

  2         F.S.; revising provisions relating to agency

  3         oversight; amending s. 400.0089, F.S.; revising

  4         reporting responsibilities; requiring the State

  5         Long-Term Care Ombudsman Council to publish

  6         complaint information quarterly; amending s.

  7         400.0091, F.S.; specifying training

  8         requirements for employees of the Office of the

  9         State Long-Term Care Ombudsman and its

10         volunteers; amending s. 400.179, F.S.;

11         providing an exemption from certain

12         requirements that the transferor of a nursing

13         facility maintain a bond; amending s. 400.141,

14         F.S.; requiring nursing home facilities to

15         maintain general and professional liability

16         insurance coverage; authorizing

17         state-designated teaching nursing homes to

18         demonstrate certain proof of financial

19         responsibility; amending s. 430.80, F.S.;

20         specifying the minimum proof of financial

21         responsibility required for state-designated

22         teaching nursing homes; amending s. 477.025,

23         F.S.; exempting certain facilities from a

24         provision of law requiring licensing as a

25         cosmetology salon; amending s. 627.9408, F.S.;

26         authorizing the department to adopt by rule

27         certain provisions of the Long-Term Care

28         Insurance Model Regulation, as adopted by the

29         National Association of Insurance

30         Commissioners; repealing s. 400.0066(2) and

31         (3), F.S., relating to the Office of State


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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1         Long-Term Care Ombudsman; deleting a

  2         prohibition on interference with the official

  3         duty of any ombudsman staff or volunteers;

  4         deleting reference to administrative support by

  5         the Department of Elderly Affairs; providing an

  6         effective date.

  7

  8  Be It Enacted by the Legislature of the State of Florida:

  9

10         Section 1.  Section 408.911, Florida Statutes, is

11  created to read:

12         408.911  Short title.--Sections 408.911-408.918 may be

13  cited as the "Florida Health and Human Services Access Act."

14         Section 2.  Section 408.913, Florida Statutes, is

15  created to read:

16         408.913  Comprehensive Health and Human Services

17  Eligibility Access System.--

18         (1)  The Agency for Health Care Administration shall

19  develop a comprehensive, automated system for access to health

20  care services. This system shall, to the greatest extent

21  possible, use the capacity of existing automated systems so as

22  to maximize the benefit of investments already made in

23  information technology and minimize additional costs.

24         (2)  The benefit-eligibility component of the system

25  shall include simplified access through coordination with

26  information and referral telephone systems. This does not

27  preclude use of other methods of application, including

28  mail-in applications, office visits, or on-line applications

29  via the Internet. The eligibility component of the system

30  shall include:

31         (a) Improved access to eligibility-status information.


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  1         (b) Development and sharing of information with

  2  eligible individuals and families regarding choices available

  3  to them for using health care services.

  4         (3)  The state agencies providing the medical,

  5  clinical, and related health care support services for special

  6  populations, including frail elders, adults with disabilities,

  7  and children with special needs shall develop systems for

  8  these populations which integrate and coordinate care and

  9  improved communication. These systems must include development

10  of standard protocols for care planning and assessment, a

11  focus on family involvement, and methods to communicate across

12  systems, including automated methods, in order to improve

13  integration and coordination of services.

14         Section 3.  Section 408.914, Florida Statutes, is

15  created to read:

16         408.914  Phased implementation plan.--The Agency for

17  Health Care Administration, in consultation with the Health

18  Care Access Steering Committee created in s. 408.916, shall

19  phase in the implementation of the Comprehensive Health and

20  Human Services Eligibility Access System.

21         (1)  The first phase of implementation shall be a pilot

22  project in one or more counties to demonstrate the feasibility

23  of integrating eligibility determination for health care

24  services with information and referral services. The

25  department shall, when selecting an area to be designated as a

26  model area, give consideration to an entity that is a

27  community care for the elderly lead agency and has developed,

28  through a joint effort, an integrated service delivery

29  information network.

30         (2)  Upon demonstration of the feasibility of the first

31  phase of implementation, and subject to appropriation of any


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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1  necessary resources, the steering committee shall develop a

  2  detailed implementation plan for the care-management component

  3  of the system. The implementation plan must include the

  4  steering committee's recommendation of one or more state

  5  agencies that should be designated to implement the

  6  care-management component of the system.

  7         (3)  Options for further implementation of the system

  8  may include a phased implementation of the eligibility

  9  component in additional sites before implementing the

10  remaining components of the system or may include

11  implementation of the care management and service system

12  components along with the eligibility components.

13         (4)  The Agency for Health Care Administration, in

14  consultation with the steering committee, shall complete

15  analysis of the initial pilot project by November 1, 2003, and

16  by January 1, 2004, shall submit a plan to the Governor, the

17  President of the Senate, and the Speaker of the House of

18  Representatives for statewide implementation of all components

19  of the system, if warranted. This plan must also include

20  recommendations for incorporating additional public assistance

21  and human services programs into the Comprehensive Health and

22  Human Services Eligibility Access System.

23         Section 4.  Section 408.915, Florida Statutes, is

24  created to read:

25         408.915  Eligibility pilot project.--The Agency for

26  Health Care Administration, in consultation with the steering

27  committee established in s. 408.916, shall develop and

28  implement a pilot project to integrate the determination of

29  eligibility for health care services with information and

30  referral services.

31


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    2002 Legislature                 CS for SB 1276, 2nd Engrossed



  1         (1)  The pilot project shall operate in one or more

  2  contiguous counties, as selected by the agency in consultation

  3  with the steering committee.

  4         (2)  The pilot project shall focus on developing, to

  5  the maximum extent possible, a process for eligibility

  6  application which:

  7         (a)  Uses a single uniform electronic application

  8  process, but permits applying for health services through

  9  various entry points, including information and referral

10  providers, state agency program personnel or contracted

11  providers, the mail, or the Internet;

12         (b)  Is linked to a shared database that will have the

13  capability to sort or store information by families as well as

14  individuals;

15         (c)  Permits electronic input and storage of data and

16  electronic verification and exchange of information;

17         (d)  Is compliant with the federal Health Insurance

18  Portability and Accountability Act, as well as all other

19  applicable state and federal confidentiality, financial, and

20  insurance requirements;

21         (e)  Includes an initial screening component for

22  referring applicants to other health and human services

23  programs provided through state agencies and the Florida

24  Healthy Kids Corporation, including programs addressing

25  developmental delays, developmental disabilities, chronic

26  physical illness, mental health needs, substance-abuse

27  treatment needs, elder and aging needs, and other health care

28  needs; and

29         (f)  Includes the level of customer service available

30  to applicants and participants in the pilot project.

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  1         (3)  The information and referral provider in the site

  2  selected as the pilot project shall, at a minimum:

  3         (a)  Execute a memorandum of understanding with the

  4  local community volunteer placement centers;

  5         (b)  Implement, or be in the process of implementing, a

  6  shared, web-based, information and eligibility database with

  7  community health providers and funders;

  8         (c)  Provide comprehensive information and referral

  9  services 24 hours per day, 7 days per week;

10         (d)  Agree, in writing, to become accredited within 3

11  years by a nationally recognized information and referral

12  accrediting agency;

13         (e)  Execute a memorandum of understanding with 911 and

14  other emergency response agencies in the pilot area;

15         (f)  Implement policies and structured training to

16  effectively respond to crisis calls or obtain accreditation by

17  a nationally recognized mental health or crisis accrediting

18  agency;

19         (g)  Obtain teletypewriter and multi-language

20  accessibility, either on-site or through a translation

21  service;

22         (h)  Develop resources to support and publicize

23  information and referral services and provide ongoing

24  education to the public on the availability of such services;

25  and

26         (i)  Provide periodic reports to the Governor, the

27  President of the Senate, and the Speaker of the House of

28  Representatives on the use of the information and referral

29  system and on measures that demonstrate the effectiveness and

30  efficiency of the information and referral services provided.

31


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  1         (4)  The pilot project shall include eligibility

  2  determinations for the following programs:

  3         (a)  Medicaid under Title XIX of the Social Security

  4  Act.

  5         (b)  Medikids as created in s. 409.8132.

  6         (c)  Florida Healthy Kids as described in s. 624.91 and

  7  within eligibility guidelines provided in s. 409.814.

  8         (d)  Eligibility for Florida Kidcare services outside

  9  of the scope of Title XIX or Title XXI of the Social Security

10  Act as provided in s. 409.814.

11         (e)  State and local publicly funded health and social

12  services programs as determined appropriate by the steering

13  committee.

14         (5)  If the Secretary of Health Care Administration, in

15  consultation with the steering committee established in s.

16  408.916, determines that it would facilitate operation of the

17  pilot project to obtain federal waiver authority, the

18  appropriate state agency shall request such waiver authority

19  from the appropriate federal agency.

20         Section 5.  Section 408.916, Florida Statutes, is

21  created to read:

22         408.916  Steering committee.--In order to guide the

23  implementation of the pilot project, there is created a Health

24  Care Access Steering Committee.

25         (1)  The steering committee shall be composed of the

26  following members:

27         (a)  The Secretary of Health Care Administration.

28         (b)  The Secretary of Children and Family Services.

29         (c)  The Secretary of Elderly Affairs.

30         (d)  The Secretary of Health.

31


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  1         (e)  A representative of the Florida Alliance of

  2  Information and Referral Services.

  3         (f)  A representative of the Florida Healthy Kids

  4  Corporation.

  5         (2)  The steering committee may designate additional ad

  6  hoc members or technical advisors as the committee finds is

  7  appropriate.

  8         (3)  The Secretary of Health Care Administration shall

  9  be the chairperson of the steering committee.

10         (4)  The steering committee shall provide oversight to

11  the ongoing implementation of the pilot project, provide

12  consultation and guidance on matters of policy, and provide

13  oversight to the evaluation of the pilot project.

14         (5)  The steering committee shall complete its

15  activities by June 30, 2004, and the authorization for the

16  steering committee ends on that date.

17         Section 6.  Section 408.917, Florida Statutes, is

18  created to read:

19         408.917  Evaluation of the pilot project.--The Agency

20  for Health Care Administration, in consultation with the

21  steering committee, shall conduct or contract for an

22  evaluation of the pilot project under the guidance and

23  oversight of the steering committee. The agency shall ensure

24  that the evaluation is submitted to the Governor and

25  Legislature by January 1, 2004. The evaluation report must

26  address at least the following questions:

27         (1)  What has been the impact of the pilot project on

28  improving access to the process of determining eligibility?

29         (2)  Based on the experience of the pilot project, what

30  is the projected cost of statewide implementation?

31


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  1         (3)  What has been the impact of the pilot project on

  2  the caseload trends in publicly funded programs and what is

  3  the projected impact of statewide implementation?

  4         (4)  How has the implementation of the pilot project

  5  affected customer satisfaction with access to eligibility

  6  determination for state-funded health services?

  7         (5)  Does the experience of the pilot project support

  8  continued expansion of the concept?

  9         (6)  What changes or modifications to the concepts of

10  the pilot project are recommended for future sites?

11         Section 7.  Section 408.918, Florida Statutes, is

12  created to read:

13         408.918  Florida 211 Network; uniform certification

14  requirements.--

15         (1)  The Legislature authorizes the planning,

16  development, and, subject to appropriations, the

17  implementation of a statewide Florida 211 Network, which shall

18  serve as the single point of coordination for information and

19  referral for health and human services. The objectives for

20  establishing the Florida 211 Network shall be to:

21         (a)  Provide comprehensive and cost-effective access to

22  health and human services information.

23         (b)  Improve access to accurate information by

24  simplifying and enhancing state and local health and human

25  services information and referral systems and by fostering

26  collaboration among information and referral systems.

27         (c)  Electronically connect local information and

28  referral systems to each other, to service providers, and to

29  consumers of information and referral services.

30

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  1         (d)  Establish and promote standards for data

  2  collection and for distributing information among state and

  3  local organizations.

  4         (e)  Promote the use of a common dialing access code

  5  and the visibility and public awareness of the availability of

  6  information and referral services.

  7         (f)  Provide a management and administrative structure

  8  to support the Florida 211 Network and establish technical

  9  assistance, training, and support programs for information and

10  referral-service programs.

11         (g)  Test methods for integrating information and

12  referral services with local and state health and human

13  services programs and for consolidating and streamlining

14  eligibility and case-management processes.

15         (h)  Provide access to standardized, comprehensive data

16  to assist in identifying gaps and needs in health and human

17  services programs.

18         (i)  Provide a unified systems plan with a developed

19  platform, taxonomy, and standards for data management and

20  access.

21         (2)  In order to participate in the Florida 211

22  Network, a 211 provider must be certified by the Agency for

23  Health Care Administration. The agency shall develop criteria

24  for certification, as recommended by the Florida Alliance of

25  Information and Referral Services, and shall adopt the

26  criteria as administrative rules.

27         (a)  If any provider of information and referral

28  services or other entity leases a 211 number from a local

29  exchange company and is not certified by the agency, the

30  agency shall, after consultation with the local exchange

31  company and the Public Service Commission, request that the


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  1  Federal Communications Commission direct the local exchange

  2  company to revoke the use of the 211 number.

  3         (b)  The agency shall seek the assistance and guidance

  4  of the Public Service Commission and the Federal

  5  Communications Commission in resolving any disputes arising

  6  over jurisdiction related to 211 numbers.

  7         Section 8.  Subsection (3) of section 409.912, Florida

  8  Statutes, is amended to read:

  9         409.912  Cost-effective purchasing of health care.--The

10  agency shall purchase goods and services for Medicaid

11  recipients in the most cost-effective manner consistent with

12  the delivery of quality medical care.  The agency shall

13  maximize the use of prepaid per capita and prepaid aggregate

14  fixed-sum basis services when appropriate and other

15  alternative service delivery and reimbursement methodologies,

16  including competitive bidding pursuant to s. 287.057, designed

17  to facilitate the cost-effective purchase of a case-managed

18  continuum of care. The agency shall also require providers to

19  minimize the exposure of recipients to the need for acute

20  inpatient, custodial, and other institutional care and the

21  inappropriate or unnecessary use of high-cost services. The

22  agency may establish prior authorization requirements for

23  certain populations of Medicaid beneficiaries, certain drug

24  classes, or particular drugs to prevent fraud, abuse, overuse,

25  and possible dangerous drug interactions. The Pharmaceutical

26  and Therapeutics Committee shall make recommendations to the

27  agency on drugs for which prior authorization is required. The

28  agency shall inform the Pharmaceutical and Therapeutics

29  Committee of its decisions regarding drugs subject to prior

30  authorization.

31         (3)  The agency may contract with:


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  1         (a)  An entity that provides no prepaid health care

  2  services other than Medicaid services under contract with the

  3  agency and which is owned and operated by a county, county

  4  health department, or county-owned and operated hospital to

  5  provide health care services on a prepaid or fixed-sum basis

  6  to recipients, which entity may provide such prepaid services

  7  either directly or through arrangements with other providers.

  8  Such prepaid health care services entities must be licensed

  9  under parts I and III by January 1, 1998, and until then are

10  exempt from the provisions of part I of chapter 641. An entity

11  recognized under this paragraph which demonstrates to the

12  satisfaction of the Department of Insurance that it is backed

13  by the full faith and credit of the county in which it is

14  located may be exempted from s. 641.225.

15         (b)  An entity that is providing comprehensive

16  behavioral health care services to certain Medicaid recipients

17  through a capitated, prepaid arrangement pursuant to the

18  federal waiver provided for by s. 409.905(5). Such an entity

19  must be licensed under chapter 624, chapter 636, or chapter

20  641 and must possess the clinical systems and operational

21  competence to manage risk and provide comprehensive behavioral

22  health care to Medicaid recipients. As used in this paragraph,

23  the term "comprehensive behavioral health care services" means

24  covered mental health and substance abuse treatment services

25  that are available to Medicaid recipients. The secretary of

26  the Department of Children and Family Services shall approve

27  provisions of procurements related to children in the

28  department's care or custody prior to enrolling such children

29  in a prepaid behavioral health plan. Any contract awarded

30  under this paragraph must be competitively procured. In

31  developing the behavioral health care prepaid plan procurement


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  1  document, the agency shall ensure that the procurement

  2  document requires the contractor to develop and implement a

  3  plan to ensure compliance with s. 394.4574 related to services

  4  provided to residents of licensed assisted living facilities

  5  that hold a limited mental health license. The agency must

  6  ensure that Medicaid recipients have available the choice of

  7  at least two managed care plans for their behavioral health

  8  care services. The agency may reimburse for

  9  substance-abuse-treatment services on a fee-for-service basis

10  until the agency finds that adequate funds are available for

11  capitated, prepaid arrangements.

12         1.  By January 1, 2001, the agency shall modify the

13  contracts with the entities providing comprehensive inpatient

14  and outpatient mental health care services to Medicaid

15  recipients in Hillsborough, Highlands, Hardee, Manatee, and

16  Polk Counties, to include substance-abuse-treatment services.

17         2.  By December 31, 2001, the agency shall contract

18  with entities providing comprehensive behavioral health care

19  services to Medicaid recipients through capitated, prepaid

20  arrangements in Charlotte, Collier, DeSoto, Escambia, Glades,

21  Hendry, Lee, Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota,

22  and Walton Counties. The agency may contract with entities

23  providing comprehensive behavioral health care services to

24  Medicaid recipients through capitated, prepaid arrangements in

25  Alachua County. The agency may determine if Sarasota County

26  shall be included as a separate catchment area or included in

27  any other agency geographic area.

28         3.  Children residing in a Department of Juvenile

29  Justice residential program approved as a Medicaid behavioral

30  health overlay services provider shall not be included in a

31


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  1  behavioral health care prepaid health plan pursuant to this

  2  paragraph.

  3         4.  In converting to a prepaid system of delivery, the

  4  agency shall in its procurement document require an entity

  5  providing comprehensive behavioral health care services to

  6  prevent the displacement of indigent care patients by

  7  enrollees in the Medicaid prepaid health plan providing

  8  behavioral health care services from facilities receiving

  9  state funding to provide indigent behavioral health care, to

10  facilities licensed under chapter 395 which do not receive

11  state funding for indigent behavioral health care, or

12  reimburse the unsubsidized facility for the cost of behavioral

13  health care provided to the displaced indigent care patient.

14         5.  Traditional community mental health providers under

15  contract with the Department of Children and Family Services

16  pursuant to part IV of chapter 394 and inpatient mental health

17  providers licensed pursuant to chapter 395 must be offered an

18  opportunity to accept or decline a contract to participate in

19  any provider network for prepaid behavioral health services.

20         (c)  A federally qualified health center or an entity

21  owned by one or more federally qualified health centers or an

22  entity owned by other migrant and community health centers

23  receiving non-Medicaid financial support from the Federal

24  Government to provide health care services on a prepaid or

25  fixed-sum basis to recipients.  Such prepaid health care

26  services entity must be licensed under parts I and III of

27  chapter 641, but shall be prohibited from serving Medicaid

28  recipients on a prepaid basis, until such licensure has been

29  obtained.  However, such an entity is exempt from s. 641.225

30  if the entity meets the requirements specified in subsections

31  (14) and (15).


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  1         (d)  No more than four provider service networks for

  2  demonstration projects to test Medicaid direct contracting.

  3  The demonstration projects may be reimbursed on a

  4  fee-for-service or prepaid basis.  A provider service network

  5  which is reimbursed by the agency on a prepaid basis shall be

  6  exempt from parts I and III of chapter 641, but must meet

  7  appropriate financial reserve, quality assurance, and patient

  8  rights requirements as established by the agency.  The agency

  9  shall award contracts on a competitive bid basis and shall

10  select bidders based upon price and quality of care. Medicaid

11  recipients assigned to a demonstration project shall be chosen

12  equally from those who would otherwise have been assigned to

13  prepaid plans and MediPass.  The agency is authorized to seek

14  federal Medicaid waivers as necessary to implement the

15  provisions of this section.  A demonstration project awarded

16  pursuant to this paragraph shall be for 4 years from the date

17  of implementation.

18         (e)  An entity that provides comprehensive behavioral

19  health care services to certain Medicaid recipients through an

20  administrative services organization agreement. Such an entity

21  must possess the clinical systems and operational competence

22  to provide comprehensive health care to Medicaid recipients.

23  As used in this paragraph, the term "comprehensive behavioral

24  health care services" means covered mental health and

25  substance abuse treatment services that are available to

26  Medicaid recipients. Any contract awarded under this paragraph

27  must be competitively procured. The agency must ensure that

28  Medicaid recipients have available the choice of at least two

29  managed care plans for their behavioral health care services.

30         (f)  An entity in Pasco County or Pinellas County that

31  provides in-home physician services to Medicaid recipients


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  1  with degenerative neurological diseases in order to test the

  2  cost-effectiveness of enhanced home-based medical care. The

  3  entity providing the services shall be reimbursed on a

  4  fee-for-service basis at a rate not less than comparable

  5  Medicare reimbursement rates. The agency may apply for waivers

  6  of federal regulations necessary to implement such program.

  7  This paragraph expires shall be repealed on July 1, 2002.

  8         (g)  Children's provider networks that provide care

  9  coordination and care management for Medicaid-eligible

10  pediatric patients, primary care, authorization of specialty

11  care, and other urgent and emergency care through organized

12  providers designed to service Medicaid eligibles under age 18.

13  The networks shall provide after-hour operations, including

14  evening and weekend hours, to promote, when appropriate, the

15  use of the children's networks rather than hospital emergency

16  departments.

17         (h)  An entity authorized in s. 430.205 to contract

18  with the agency and the Department of Elderly Affairs to

19  provide health care and social services on a prepaid or

20  fixed-sum basis to elderly recipients. Such prepaid healthcare

21  services entities are exempt from the provisions of part I of

22  chapter 641 for the first 3 years of operation. An entity

23  recognized under this paragraph that demonstrates to the

24  satisfaction of the Department of Insurance that it is backed

25  by the full faith and credit of one or more counties in which

26  it operates may be exempted from s. 641.225.

27         Section 9.  Section 430.205, Florida Statutes is

28  amended to read:

29         430.205  Community care service system.--

30         (1)(a)  The department, through the area agency on

31  aging, shall fund in each planning and service area at least


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  1  one community care service system that provides case

  2  management and other in-home and community services as needed

  3  to help the older person maintain independence and prevent or

  4  delay more costly institutional care.

  5         (b)  For fiscal year 2001-2002 only, in each county

  6  having a population over 2 million, the department, through

  7  the area agency on aging, shall fund in each planning and

  8  service area more than one community care service system that

  9  provides case management and other in-home and community

10  services as needed to help elderly persons maintain

11  independence and prevent or delay more costly institutional

12  care. This paragraph expires July 1, 2002.

13         (2)  Core services and other support services may be

14  furnished by public or private agencies or organizations.

15  Each community care service system must be under the direction

16  of a lead agency that coordinates the activities of individual

17  contracting agencies providing community-care-for-the-elderly

18  services.  When practicable, the activities of a community

19  care service area must be directed from a multiservice senior

20  center and coordinated with other services offered therein.

21  This subsection does not require programs in existence prior

22  to the effective date of this act to be relocated.

23         (3)  The department shall define each core service that

24  is to be provided or coordinated within a community care

25  service area and establish rules and minimum standards for the

26  delivery of core services. The department may conduct or

27  contract for demonstration projects to determine the

28  desirability of new concepts of organization, administration,

29  or service delivery designed to prevent the

30  institutionalization of functionally impaired elderly persons.

31  Evaluations shall be made of the cost-avoidance of such


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  1  demonstration projects, the ability of the projects to reduce

  2  the rate of placement of functionally impaired elderly persons

  3  in institutions, and the impact of projects on the use of

  4  institutional services and facilities.

  5         (4)  A preservice and inservice training program for

  6  community-care-for-the-elderly service providers and staff may

  7  be designed and implemented to help assure the delivery of

  8  quality services. The department shall specify in rules the

  9  training standards and requirements for the

10  community-care-for-the-elderly service providers and staff.

11  Training must be sufficient to ensure that quality services

12  are provided to clients and that appropriate skills are

13  developed to conduct the program.

14         (5)  Any person who has been classified as a

15  functionally impaired elderly person is eligible to receive

16  community-care-for-the-elderly core services. Those elderly

17  persons who are determined by protective investigations to be

18  vulnerable adults in need of services, pursuant to s.

19  415.104(3)(b), or to be victims of abuse, neglect, or

20  exploitation who are in need of immediate services to prevent

21  further harm and are referred by the adult protective services

22  program, shall be given primary consideration for receiving

23  community-care-for-the-elderly services. As used in this

24  subsection, "primary consideration" means that an assessment

25  and services must commence within 72 hours after referral to

26  the department or as established in accordance with department

27  contracts by local protocols developed between department

28  service providers and the adult protective services program.

29         (6) Notwithstanding other requirements of this chapter,

30  the Department of Elderly Affairs and the Agency for Health

31  Care Administration shall develop a model system to transition


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  1  all state-funded services for elderly individuals in one of

  2  the department's planning and service areas to a managed,

  3  integrated long-term-care delivery system under the direction

  4  of a single entity.

  5         (a)  The duties of the model system shall include

  6  organizing and administering service delivery for the elderly;

  7  obtaining contracts for services with providers in the area;

  8  monitoring the quality of services provided; determining

  9  levels of need and disability for payment purposes; and other

10  activities determined by the department and the agency in

11  order to operate the model system.

12         (b)  The agency and the department shall integrate all

13  funding for services to individuals over the age of 65 in the

14  model planning and service areas into a single per-person

15  per-month payment rate, except that funds for Medicaid

16  behavioral health care services are exempt from this section.

17  The funds to be integrated shall include:

18         1.  Community-care-for-the-elderly funds;

19         2.  Home-care-for-the-elderly funds;

20         3.  Local services program funds;

21         4.  Contracted services funds;

22         5.  Alzheimer's disease initiative funds;

23         6.  Medicaid home and community-based waiver services

24  funds;

25         7.  Funds for all Medicaid services authorized in ss.

26  409.905 and 409.906, including Medicaid nursing home services;

27  and

28         8.  Funds paid for Medicare premiums, coinsurance and

29  deductibles for persons dually eligible for Medicaid and

30  Medicare as prescribed in s. 409.908(13).

31


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  1  The department and the agency shall not make payments for

  2  services for people age 65 and older except through the model

  3  delivery system.

  4         (c)  The entity selected to administer the model system

  5  shall develop a comprehensive health and long-term-care

  6  service delivery system through contracts with providers of

  7  medical, social, and long-term-care services sufficient to

  8  meet the needs of the population age 65 and older. The entity

  9  selected to administer the model system shall not directly

10  provide services other than intake, assessment, and referral

11  services.

12         (d)  The department shall determine which of the

13  department's planning and services areas is to be designated

14  as a model area by means of a request for proposals. The

15  department shall select an area to be designated as a model

16  area and the entity to administer the model system based on

17  demonstration of capacity of the entity to:

18         1.  Develop contracts with providers currently under

19  contract with the department, area agencies on aging, or

20  community-care-for-the-elderly lead agencies;

21         2.  Provide a comprehensive system of appropriate

22  medical and long-term-care services that provides high-quality

23  medical and social services to assist older individuals in

24  remaining in the least-restrictive setting;

25         3.  Demonstrate a quality assurance and quality

26  improvement system satisfactory to the department and the

27  agency;

28         4.  Develop a system to identify participants who have

29  special health care needs such as polypharmacy, mental health

30  and substance abuse problems, falls, chronic pain, nutritional

31


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  1  deficits, and cognitive deficits, in order to respond to and

  2  meet these needs;

  3         5.  Use a multi-discliplinary team approach to

  4  participant management which ensures that information is

  5  shared among providers responsible for delivering care to a

  6  participant;

  7         6.  Ensure medical oversight of care plans and service

  8  delivery, regular medical evaluation of care plans, and the

  9  availability of medical consultation for case managers and

10  service coordinators;

11         7.  Develop, monitor, and enforce quality-of-care

12  requirements;

13         8.  Secure subcontracts with providers of medical,

14  nursing home, and community-based long-term-care services

15  sufficient to assure access to and choice of providers;

16         9.  Ensure a system of case management and service

17  coordination which includes educational and training standards

18  for case managers and service coordinators;

19         10.  Develop a business plan that considers the ability

20  of the applicant to organize and operate a risk-bearing

21  entity;

22         11.  Furnish evidence of adequate liability insurance

23  coverage or an adequate plan of self-insurance to respond to

24  claims for injuries arising out of the furnishing of health

25  care; and

26         12.  Provide, through contract or otherwise, for

27  periodic review of its medical facilities as required by the

28  department and the agency.

29

30  The department shall give preference in selecting an area to

31  be designated as a model area to that in which the


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  1  administering entity is an existing area agency on aging or

  2  community-care-for-the-elderly lead agency demonstrating the

  3  ability to perform the functions described in this paragraph.

  4         (e)  The department in consultation with the selected

  5  entity shall develop a statewide proposal regarding the

  6  long-term use and structure of a program that addresses a risk

  7  pool to reduce financial risk.

  8         (f)  The department and the agency shall develop

  9  capitation rates based on the historical cost experience of

10  the state in providing acute and long-term-care services to

11  the population over 65 years of age in the area served.

12         1.  Payment rates in the first 2 years of operation

13  shall be set at no more than 100 percent of the costs to the

14  state of providing equivalent services to the population of

15  the model area for the year prior to the year in which the

16  model system is implemented, adjusted forward to account for

17  inflation and population growth. In subsequent years, the rate

18  shall be negotiated based on the cost experience of the model

19  system in providing contracted services, but may not exceed 95

20  percent of the amount that would have been paid by the state

21  in the model planning and service area absent the model

22  integrated service delivery system.

23         2.  The agency and the department may develop

24  innovative risk-sharing agreements that limit the level of

25  custodial nursing home risk that the administering entity

26  assumes, consistent with the intent of the Legislature to

27  reduce the use and cost of nursing home care. Under

28  risk-sharing arrangements, the agency and the department may

29  reimburse the administering entity for the cost of providing

30  nursing home care for Medicaid-eligible participants who have

31


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  1  been permanently placed and remain in nursing home care for

  2  more than 1 year.

  3         (g)  The department and the Agency for Health Care

  4  Administration shall seek federal waivers necessary to

  5  implement the requirements of this section.

  6         (h)  The Department of Children and Family Services

  7  shall develop a streamlined and simplified eligibility system

  8  and shall outstation a sufficient number and quality of

  9  eligibility-determination staff with the administering entity

10  to assure determination of Medicaid eligibility for the

11  integrated service delivery system in the model planning and

12  service area within 10 days after receipt of a complete

13  application.

14         (i)  The Department of Elderly Affairs shall make

15  arrangements to outstation a sufficient number of nursing home

16  preadmission screening staff with the administering entity to

17  assure timely assessment of level of need for long-term-care

18  services in the model area.

19         (j)  The Department of Elderly Affairs shall conduct or

20  contract for an evaluation of the pilot project. The

21  department shall submit the evaluation to the Governor and the

22  Legislature by January 1, 2005.  The evaluation must address

23  the effects of the pilot project on the effectiveness of the

24  entity providing a comprehensive system of appropriate and

25  high-quality medical and long-term-care services to elders in

26  the least-restrictive setting and make recommendations on a

27  phased-in implementation expansion for the rest of the state.

28         Section 10.  Section 430.041, Florida Statutes, is

29  created to read:

30         430.041  Office of Long-Term-Care Policy.--

31


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  1         (1)  There is established in the Department of Elderly

  2  Affairs the Office of Long-Term-Care Policy to evaluate the

  3  state's long-term-care service delivery system and make

  4  recommendations to increase the availability and the use of

  5  noninstitutional settings to provide care to the elderly and

  6  ensure coordination among the agencies responsible for the

  7  long-term-care continuum.

  8         (2)  The purpose of the Office of Long-Term-Care Policy

  9  is to:

10         (a)  Ensure close communication and coordination among

11  state agencies involved in developing and administering a more

12  efficient and coordinated long-term-care service delivery

13  system in this state;

14         (b)  Identify duplication and unnecessary service

15  provision in the long-term-care system and make

16  recommendations to decrease inappropriate service provision;

17         (c)  Review current programs providing long-term-care

18  services to determine whether the programs are cost effective,

19  of high quality, and operating efficiently and make

20  recommendations to increase consistency and effectiveness in

21  the state's long-term-care programs;

22         (d)  Develop strategies for promoting and implementing

23  cost-effective home and community-based services as an

24  alternative to institutional care which coordinate and

25  integrate the continuum of care needs of the elderly; and

26         (e)  Assist the Office of Long-Term-Care Policy

27  Advisory Council as necessary to help implement this section.

28         (3)  The Director of the Office of Long-Term-Care

29  Policy shall be appointed by, and serve at the pleasure of,

30  the Governor. The director shall report to, and be under the

31  general supervision of, the Secretary of Elderly Affairs and


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  1  shall not be subject to supervision by any other employee of

  2  the department.

  3         (4)  The Office of Long-Term-Care Policy shall have an

  4  advisory council, whose chair shall be the Director of the

  5  Office of Long-Term-Care Policy. The purposes of the advisory

  6  council are to provide assistance and direction to the office

  7  and to ensure that the appropriate state agencies are properly

  8  implementing recommendations from the office.

  9         (a)  The advisory council shall consist of:

10         1.  A member of the Senate, appointed by the President

11  of the Senate;

12         2.  A member of the House of Representatives, appointed

13  by the Speaker of the House of Representatives;

14         3.  The Director of the Office of Long-Term-Care

15  Policy;

16         4.  The Secretary of Health Care Administration;

17         5.  The Secretary of Elderly Affairs;

18         6.  The Secretary of Children and Family Services;

19         7.  The Secretary of Health;

20         8.  The Executive Director of the Department of

21  Veterans' Affairs;

22         9.  Three people with broad knowledge and experience in

23  the delivery of long-term care services, appointed by the

24  Governor from groups representing elderly persons; and

25         10.  Two representatives of people using long-term-care

26  services, appointed by the Governor from groups representing

27  elderly persons.

28         (b)  Members shall serve without compensation, but are

29  entitled to receive reimbursement for travel and per diem as

30  provided in s. 112.061.

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  1         (c)  The advisory council shall meet at the call of its

  2  chair or at the request of a majority of its members. During

  3  its first year of existence, the advisory council shall meet

  4  at least monthly.

  5         (d)  Members of the advisory council appointed by the

  6  Governor shall serve at the pleasure of the Governor and shall

  7  be appointed to 4-year staggered terms in accordance with s.

  8  20.052.

  9         (5)(a)  The Department of Elderly Affairs shall provide

10  administrative support and services to the Office of

11  Long-Term-Care Policy.

12         (b)  The office shall call upon appropriate agencies of

13  state government, including the centers on aging in the State

14  University System, for assistance needed in discharging its

15  duties.

16         (c)  Each state agency represented on the Office of

17  Long-Term-Care Policy Advisory Council shall make at least one

18  employee available to work with the Office of Long-Term-Care

19  Policy. All state agencies and universities shall assist the

20  office in carrying out its responsibilities prescribed by this

21  section.

22         (d)  Each state agency shall pay from its own funds any

23  expenses related to its support of the Office of

24  Long-Term-Care Policy and its participation on the advisory

25  council. The Department of Elderly Affairs shall be

26  responsible for expenses related to participation on the

27  advisory council by members appointed by the Governor.

28         (6)(a)  By December 1, 2002, the office shall submit to

29  the advisory council a preliminary report of its findings and

30  recommendations on improving the long-term-care continuum in

31  this state. The report shall contain recommendations and


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  1  implementation proposals for policy changes, as well as

  2  legislative and funding recommendations that will make the

  3  system more effective and efficient. The report shall contain

  4  a specific plan for accomplishing the recommendations and

  5  proposals. Thereafter, the office shall revise and update the

  6  report annually and resubmit it to the advisory council for

  7  review and comments by November 1 of each year.

  8         (b)  The advisory council shall review and recommend

  9  any suggested changes to the preliminary report, and each

10  subsequent annual update of the report, within 30 days after

11  the receipt of the preliminary report. Suggested revisions,

12  additions, or deletions shall be made to the Director of the

13  Office of Long-Term-Care Policy.

14         (c)  The office shall submit its final report, and each

15  subsequent annual update of the report, to the Governor and

16  the Legislature within 30 days after the receipt of any

17  revisions, additions, or deletions suggested by the advisory

18  council, or after the time such comments are due to the

19  office.

20         Section 11.  Section 409.221, Florida Statutes, is

21  created to read:

22         409.221  Consumer-directed care program.--

23         (1)  SHORT TITLE.--This section may be cited as the

24  "Florida Consumer-Directed Care Act."

25         (2)  LEGISLATIVE FINDINGS.--The Legislature finds that

26  alternatives to institutional care, such as in-home and

27  community-based care, should be encouraged. The Legislature

28  finds that giving recipients of in-home and community-based

29  services the opportunity to select the services they need and

30  the providers they want, including family and friends,

31  enhances their sense of dignity and autonomy. The Legislature


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  1  also finds that providing consumers choice and control, as

  2  tested in current research and demonstration projects, has

  3  been beneficial and should be developed further and

  4  implemented statewide.

  5         (3)  LEGISLATIVE INTENT.--It is the intent of the

  6  Legislature to nurture the autonomy of those citizens of the

  7  state, of all ages, who have disabilities by providing the

  8  long-term care services they need in the least restrictive,

  9  appropriate setting. It is the intent of the Legislature to

10  give such individuals more choices in and greater control over

11  the purchased long-term care services they receive.

12         (4)  CONSUMER-DIRECTED CARE.--

13         (a)  Program established.--The Agency for Health Care

14  Administration shall establish the consumer-directed care

15  program which shall be based on the principles of consumer

16  choice and control. The agency shall implement the program

17  upon federal approval. The agency shall establish interagency

18  cooperative agreements with and shall work with the

19  Departments of Elderly Affairs, Health, and Children and

20  Family Services to implement and administer the program. The

21  program shall allow enrolled persons to choose the providers

22  of services and to direct the delivery of services, to best

23  meet their long-term care needs. The program must operate

24  within the funds appropriated by the Legislature.

25         (b)  Eligibility and enrollment.--Persons who are

26  enrolled in one of the Medicaid home and community-based

27  waiver programs and are able to direct their own care, or to

28  designate an eligible representative, may choose to

29  participate in the consumer-directed care program.

30         (c)  Definitions.--For purposes of this section, the

31  term:


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  1         1.  "Budget allowance" means the amount of money made

  2  available each month to a consumer to purchase needed

  3  long-term care services, based on the results of a functional

  4  needs assessment.

  5         2.  "Consultant" means an individual who provides

  6  technical assistance to consumers in meeting their

  7  responsibilities under this section.

  8         3.  "Consumer" means a person who has chosen to

  9  participate in the program, has met the enrollment

10  requirements, and has received an approved budget allowance.

11         4.  "Fiscal intermediary" means an entity approved by

12  the agency that helps the consumer manage the consumer's

13  budget allowance, retains the funds, processes employment

14  information, if any, and tax information, reviews records to

15  ensure correctness, writes paychecks to providers, and

16  delivers paychecks to the consumer for distribution to

17  providers and caregivers.

18         5.  "Provider" means:

19         a.  A person licensed or otherwise permitted to render

20  services eligible for reimbursement under this program for

21  whom the consumer is not the employer of record; or

22         b.  A consumer-employed caregiver for whom the consumer

23  is the employer of record.

24         6.  "Representative" means an uncompensated individual

25  designated by the consumer to assist in managing the

26  consumer's budget allowance and needed services.

27         (d)  Budget allowances.--Consumers enrolled in the

28  program shall be given a monthly budget allowance based on the

29  results of their assessed functional needs and the financial

30  resources of the program. Consumers shall receive the budget

31  allowance directly from an agency-approved fiscal


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  1  intermediary. Each department shall develop purchasing

  2  guidelines, approved by the agency, to assist consumers in

  3  using the budget allowance to purchase needed, cost-effective

  4  services.

  5         (e)  Services.--Consumers shall use the budget

  6  allowance only to pay for home and community-based services

  7  that meet the consumer's long-term care needs and are a

  8  cost-efficient use of funds. Such services may include, but

  9  are not limited to, the following:

10         1.  Personal care.

11         2.  Homemaking and chores, including housework, meals,

12  shopping, and transportation.

13         3.  Home modifications and assistive devices which may

14  increase the consumer's independence or make it possible to

15  avoid institutional placement.

16         4.  Assistance in taking self-administered medication.

17         5.  Day care and respite care services, including those

18  provided by nursing home facilities pursuant to s. 400.141(6)

19  or by adult day care facilities licensed pursuant to s.

20  400.554.

21         6.  Personal care and support services provided in an

22  assisted living facility.

23         (f)  Consumer roles and responsibilities.--Consumers

24  shall be allowed to choose the providers of services, as well

25  as when and how the services are provided. Providers may

26  include a consumer's neighbor, friend, spouse, or relative.

27         1.  In cases where a consumer is the employer of

28  record, the consumer's roles and responsibilities include, but

29  are not limited to, the following:

30         a.  Developing a job description.

31


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  1         b.  Selecting caregivers and submitting information for

  2  the background screening as required in s. 435.05.

  3         c.  Communicating needs, preferences, and expectations

  4  about services being purchased.

  5         d.  Providing the fiscal intermediary with all

  6  information necessary for provider payments and tax

  7  requirements.

  8         e.  Ending the employment of an unsatisfactory

  9  caregiver.

10         2.  In cases where a consumer is not the employer of

11  record, the consumer's roles and responsibilities include, but

12  are not limited to, the following:

13         a.  Communicating needs, preferences, and expectations

14  about services being purchased.

15         b.  Ending the services of an unsatisfactory provider.

16         c.  Providing the fiscal agent with all information

17  necessary for provider payments and tax requirements.

18         (g)  Agency and departments roles and

19  responsibilities.--The agency's and the departments' roles and

20  responsibilities include, but are not limited to, the

21  following:

22         1.  Assessing each consumer's functional needs, helping

23  with the service plan, and providing ongoing assistance with

24  the service plan.

25         2.  Offering the services of consultants who shall

26  provide training, technical assistance, and support to the

27  consumer.

28         3.  Completing the background screening for providers.

29         4.  Approving fiscal intermediaries.

30

31


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  1         5.  Establishing the minimum qualifications for all

  2  caregivers and providers and being the final arbiter of the

  3  fitness of any individual to be a caregiver or provider.

  4         (h)  Fiscal intermediary roles and

  5  responsibilities.--The fiscal intermediary's roles and

  6  responsibilities include, but are not limited to, the

  7  following:

  8         1.  Providing recordkeeping services.

  9         2.  Retaining the consumer-directed care funds,

10  processing employment and tax information, if any, reviewing

11  records to ensure correctness, writing paychecks to providers,

12  and delivering paychecks to the consumer for distribution.

13         (i)  Background screening requirements.--All persons

14  who render care under this section shall comply with the

15  requirements of s. 435.05. Persons shall be excluded from

16  employment pursuant to s. 435.06.

17         1.  Persons excluded from employment may request an

18  exemption from disqualification, as provided in s. 435.07.

19  Persons not subject to certification or professional licensure

20  may request an exemption from the agency. In considering a

21  request for an exemption, the agency shall comply with the

22  provisions of s. 435.07.

23         2.  The agency shall, as allowable, reimburse

24  consumer-employed caregivers for the cost of conducting

25  background screening as required by this section.

26

27  For purposes of this section, a person who has undergone

28  screening, who is qualified for employment under this section

29  and applicable rule, and who has not been unemployed for more

30  than 180 days following such screening is not required to be

31  rescreened. Such person must attest under penalty of perjury


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  1  to not having been convicted of a disqualifying offense since

  2  completing such screening.

  3         (j)  Rules; federal waivers.--In order to implement

  4  this section:

  5         1.  The agency and the Departments of Elderly Affairs,

  6  Health, and Children and Family Services are authorized to

  7  adopt and enforce rules.

  8         2.  The agency shall take all necessary action to

  9  ensure state compliance with federal regulations. The agency

10  shall apply for any necessary federal waivers or waiver

11  amendments needed to implement the program.

12         (k)  Reviews and reports.--The agency and the

13  Departments of Elderly Affairs, Health, and Children and

14  Family Services shall each, on an ongoing basis, review and

15  assess the implementation of the consumer-directed care

16  program. By January 15 of each year, the agency shall submit a

17  written report to the Legislature that includes each

18  department's review of the program and contains

19  recommendations for improvements to the program.

20         Section 12.  (1)  Prior to December 1, 2002, the Agency

21  for Health Care Administration, in consultation with the

22  Department of Elderly Affairs, shall submit to the Governor,

23  the President of the Senate, and the Speaker of the House of

24  Representatives a plan to reduce the number of nursing home

25  bed days purchased by the state Medicaid program and to

26  replace such nursing home care with care provided in less

27  costly alternative settings.

28         (2)  The plan must include specific goals for reducing

29  Medicaid-funded bed days and recommend specific statutory and

30  operational changes necessary to achieve such reduction.

31


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  1         (3)  The plan must include an evaluation of the

  2  cost-effectiveness and the relative strengths and weaknesses

  3  of programs that serve as alternatives to nursing homes.

  4         Section 13.  Section 408.034, Florida Statutes, is

  5  amended to read:

  6         408.034  Duties and responsibilities of agency;

  7  rules.--

  8         (1)  The agency is designated as the single state

  9  agency to issue, revoke, or deny certificates of need and to

10  issue, revoke, or deny exemptions from certificate-of-need

11  review in accordance with the district plans and present and

12  future federal and state statutes.  The agency is designated

13  as the state health planning agency for purposes of federal

14  law.

15         (2)  In the exercise of its authority to issue licenses

16  to health care facilities and health service providers, as

17  provided under chapters 393, 395, and parts II and VI of

18  chapter 400, the agency may not issue a license to any health

19  care facility, health service provider, hospice, or part of a

20  health care facility which fails to receive a certificate of

21  need or an exemption for the licensed facility or service.

22         (3)  The agency shall establish, by rule, uniform need

23  methodologies for health services and health facilities. In

24  developing uniform need methodologies, the agency shall, at a

25  minimum, consider the demographic characteristics of the

26  population, the health status of the population, service use

27  patterns, standards and trends, geographic accessibility, and

28  market economics.

29         (4)  Prior to determining that there is a need for

30  additional community nursing facility beds in any area of the

31  state, the agency shall determine that the need cannot be met


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  1  through the provision, enhancement, or expansion of home and

  2  community-based services. In determining such need, the agency

  3  shall examine nursing home placement patterns and demographic

  4  patterns of persons entering nursing homes and the

  5  availability of and effectiveness of existing home-based and

  6  community-based service delivery systems at meeting the

  7  long-term care needs of the population. The agency shall

  8  recommend to the Office of Long-Term Care Policy changes that

  9  could be made to existing home-based and community-based

10  delivery systems to lessen the need for additional nursing

11  facility beds.

12         (5)(4)  The agency shall establish by rule a

13  nursing-home-bed-need methodology that reduces the community

14  nursing home bed need for the areas of the state where the

15  agency establishes pilot community diversion programs through

16  the Title XIX aging waiver program.

17         (6)(5)  The agency may adopt rules necessary to

18  implement ss. 408.031-408.045.

19         Section 14.  Paragraph (f) of subsection (3) of section

20  409.912, Florida Statutes, is amended, and present subsections

21  (13) through (39) of said section are renumbered as

22  subsections (14) through (40), respectively, and a new

23  subsection (13) is added to that section, to read:

24         409.912  Cost-effective purchasing of health care.--The

25  agency shall purchase goods and services for Medicaid

26  recipients in the most cost-effective manner consistent with

27  the delivery of quality medical care.  The agency shall

28  maximize the use of prepaid per capita and prepaid aggregate

29  fixed-sum basis services when appropriate and other

30  alternative service delivery and reimbursement methodologies,

31  including competitive bidding pursuant to s. 287.057, designed


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  1  to facilitate the cost-effective purchase of a case-managed

  2  continuum of care. The agency shall also require providers to

  3  minimize the exposure of recipients to the need for acute

  4  inpatient, custodial, and other institutional care and the

  5  inappropriate or unnecessary use of high-cost services. The

  6  agency may establish prior authorization requirements for

  7  certain populations of Medicaid beneficiaries, certain drug

  8  classes, or particular drugs to prevent fraud, abuse, overuse,

  9  and possible dangerous drug interactions. The Pharmaceutical

10  and Therapeutics Committee shall make recommendations to the

11  agency on drugs for which prior authorization is required. The

12  agency shall inform the Pharmaceutical and Therapeutics

13  Committee of its decisions regarding drugs subject to prior

14  authorization.

15         (3)  The agency may contract with:

16         (f)  An entity that provides in-home physician services

17  to test the cost-effectiveness of enhanced home-based medical

18  care to Medicaid recipients with degenerative neurological

19  diseases and other diseases or disabling conditions associated

20  with high costs to Medicaid. The program shall be designed to

21  serve very disabled persons and to reduce Medicaid reimbursed

22  costs for inpatient, outpatient, and emergency department

23  services. The agency shall contract with vendors on a

24  risk-sharing basis. in Pasco County or Pinellas County that

25  provides in-home physician services to Medicaid recipients

26  with degenerative neurological diseases in order to test the

27  cost-effectiveness of enhanced home-based medical care. The

28  entity providing the services shall be reimbursed on a

29  fee-for-service basis at a rate not less than comparable

30  Medicare reimbursement rates. The agency may apply for waivers

31


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  1  of federal regulations necessary to implement such program.

  2  This paragraph shall be repealed on July 1, 2002.

  3         (13)(a)  The agency shall operate the Comprehensive

  4  Assessment and Review (CARES) nursing facility preadmission

  5  screening program to ensure that Medicaid payment for nursing

  6  facility care is made only for individuals whose conditions

  7  require such care and to ensure that long-term care services

  8  are provided in the setting most appropriate to the needs of

  9  the person and in the most economical manner possible. The

10  CARES program shall also ensure that individuals participating

11  in Medicaid home and community-based waiver programs meet

12  criteria for those programs, consistent with approved federal

13  waivers.

14         (b)  The agency shall operate the CARES program through

15  an interagency agreement with the Department of Elderly

16  Affairs.

17         (c)  Prior to making payment for nursing facility

18  services for a Medicaid recipient, the agency must verify that

19  the nursing facility preadmission screening program has

20  determined that the individual requires nursing facility care

21  and that the individual cannot be safely served in

22  community-based programs. The nursing facility preadmission

23  screening program shall refer a Medicaid recipient to a

24  community-based program if the individual could be safely

25  served at a lower cost and the recipient chooses to

26  participate in such program.

27         (d)  By January 1 of each year, the agency shall submit

28  a report to the Legislature and the Office of Long-Term Care

29  Policy describing the operations of the CARES program. The

30  report must describe:

31


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  1         1.  Rate of diversion to community alternative

  2  programs;

  3         2.  CARES program staffing needs to achieve additional

  4  diversions;

  5         3.  Reasons the program is unable to place individuals

  6  in less restrictive settings when such individuals desired

  7  such services and could have been served in such settings;

  8         4.  Barriers to appropriate placement, including

  9  barriers due to policies or operations of other agencies or

10  state-funded programs; and

11         5.  Statutory changes necessary to ensure that

12  individuals in need of long-term care services receive care in

13  the least restrictive environment.

14         Section 15.  Section 430.7031, Florida Statutes, is

15  created to read:

16         430.7031  Nursing home transition program.--The

17  department and the Agency for Health Care Administration:

18         (1)  Shall implement a system of care designed to

19  assist individuals residing in nursing homes to regain

20  independence and to move to less costly settings.

21         (2)  Shall collaboratively work to identify long-stay

22  nursing home residents who are able to move to community

23  placements, and to provide case management and supportive

24  services to such individuals while they are in nursing homes

25  to assist such individuals in moving to less expensive and

26  less restrictive settings.

27         (3)  Shall modify existing service delivery systems or

28  develop new service delivery systems to economically and

29  efficiently meet such individuals' care needs.

30         (4)  Shall offer such individuals priority placement

31  and services in all home-based and community-based care


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  1  programs and shall ensure that funds are available to provide

  2  services to individuals to whom services are offered.

  3         (5)  May seek federal waivers necessary to administer

  4  this section.

  5         Section 16.  Subsection (4) of section 409.908, Florida

  6  Statutes, is amended to read:

  7         409.908  Reimbursement of Medicaid providers.--Subject

  8  to specific appropriations, the agency shall reimburse

  9  Medicaid providers, in accordance with state and federal law,

10  according to methodologies set forth in the rules of the

11  agency and in policy manuals and handbooks incorporated by

12  reference therein.  These methodologies may include fee

13  schedules, reimbursement methods based on cost reporting,

14  negotiated fees, competitive bidding pursuant to s. 287.057,

15  and other mechanisms the agency considers efficient and

16  effective for purchasing services or goods on behalf of

17  recipients.  Payment for Medicaid compensable services made on

18  behalf of Medicaid eligible persons is subject to the

19  availability of moneys and any limitations or directions

20  provided for in the General Appropriations Act or chapter 216.

21  Further, nothing in this section shall be construed to prevent

22  or limit the agency from adjusting fees, reimbursement rates,

23  lengths of stay, number of visits, or number of services, or

24  making any other adjustments necessary to comply with the

25  availability of moneys and any limitations or directions

26  provided for in the General Appropriations Act, provided the

27  adjustment is consistent with legislative intent.

28         (4)  Subject to any limitations or directions provided

29  for in the General Appropriations Act, alternative health

30  plans, health maintenance organizations, and prepaid health

31  plans shall be reimbursed a fixed, prepaid amount negotiated,


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  1  or competitively bid pursuant to s. 287.057, by the agency and

  2  prospectively paid to the provider monthly for each Medicaid

  3  recipient enrolled.  The amount may not exceed the average

  4  amount the agency determines it would have paid, based on

  5  claims experience, for recipients in the same or similar

  6  category of eligibility.  The agency shall calculate

  7  capitation rates on a regional basis and, beginning September

  8  1, 1995, shall include age-band differentials in such

  9  calculations. Effective July 1, 2001, the cost of exempting

10  statutory teaching hospitals, specialty hospitals, and

11  community hospital education program hospitals from

12  reimbursement ceilings and the cost of special Medicaid

13  payments shall not be included in premiums paid to health

14  maintenance organizations or prepaid health care plans. Each

15  rate semester, the agency shall calculate and publish a

16  Medicaid hospital rate schedule that does not reflect either

17  special Medicaid payments or the elimination of rate

18  reimbursement ceilings, to be used by hospitals and Medicaid

19  health maintenance organizations, in order to determine the

20  Medicaid rate referred to in ss. 409.912(17) 409.912(16),

21  409.9128(5), and 641.513(6).

22         Section 17.  Section 430.708, Florida Statutes, is

23  amended to read:

24         430.708  Certificate of need.--To ensure that Medicaid

25  community diversion pilot projects result in a reduction in

26  the projected average monthly nursing home caseload, the

27  agency shall, in accordance with the provisions of s.

28  408.034(5) s. 408.034(4):

29         (1)  Reduce the projected nursing home bed need in each

30  certificate-of-need batching cycle in the community diversion

31  pilot project areas.


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  1         (2)  Reduce the conditions imposed on existing nursing

  2  homes or those to be constructed, in accordance with the

  3  number of projected community diversion slots.

  4         (3)  Adopt rules to reduce the number of beds in

  5  Medicaid-participating nursing homes eligible for Medicaid,

  6  through a Medicaid-selective contracting process or some other

  7  appropriate method.

  8         (4)  Determine the feasibility of increasing the

  9  nursing home occupancy threshold used in determining nursing

10  home bed needs under the certificate-of-need process.

11         Section 18.  Subsection (4) of section 641.386, Florida

12  Statutes, is amended to read:

13         641.386  Agent licensing and appointment required;

14  exceptions.--

15         (4)  All agents and health maintenance organizations

16  shall comply with and be subject to the applicable provisions

17  of ss. 641.309 and 409.912(19) 409.912(18), and all companies

18  and entities appointing agents shall comply with s. 626.451,

19  when marketing for any health maintenance organization

20  licensed pursuant to this part, including those organizations

21  under contract with the Agency for Health Care Administration

22  to provide health care services to Medicaid recipients or any

23  private entity providing health care services to Medicaid

24  recipients pursuant to a prepaid health plan contract with the

25  Agency for Health Care Administration.

26         Section 19.  Subsection (4) of section 20.41, Florida

27  Statutes, is amended to read:

28         20.41  Department of Elderly Affairs.--There is created

29  a Department of Elderly Affairs.

30         (4)  The department shall administer administratively

31  house the State Long-Term Care Ombudsman Council, created by


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  1  s. 400.0067, and the local long-term care ombudsman councils,

  2  created by s. 400.0069 and shall, as required by s. 712 of the

  3  federal Older Americans Act of 1965, ensure that both the

  4  state and local long-term care ombudsman councils operate in

  5  compliance with the Older Americans Act.  The councils in

  6  performance of their duties shall not be subject to control,

  7  supervision, or direction by the department.

  8         Section 20.  Subsection (1) and paragraph (b) of

  9  subsection (2) of section 400.0063, Florida Statutes, are

10  amended to read:

11         400.0063  Establishment of Office of State Long-Term

12  Care Ombudsman; designation of ombudsman and legal advocate.--

13         (1)  There is created an Office of State Long-Term Care

14  Ombudsman, which shall be located for administrative purposes

15  in the Department of Elderly Affairs.

16         (2)

17         (b)  The State Long-Term Care Ombudsman shall be

18  appointed by and shall serve at the pleasure of the Secretary

19  of Elderly Affairs State Long-Term Care Ombudsman Council.  No

20  person who has a conflict of interest, or has an immediate

21  family member who has a conflict of interest, may be involved

22  in the designation of the ombudsman.

23         Section 21.  Paragraphs (c) and (f) of subsection (2)

24  and subsection (3) of section 400.0065, Florida Statutes, are

25  amended to read:

26         400.0065  State Long-Term Care Ombudsman; duties and

27  responsibilities; conflict of interest.--

28         (2)  The State Long-Term Care Ombudsman shall have the

29  duty and authority to:

30         (c)  Within the limits of federal and state funding

31  authorized and appropriated, employ such personnel, including


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  1  staff for local ombudsman councils, as are necessary to

  2  perform adequately the functions of the office and provide or

  3  contract for legal services to assist the state and local

  4  ombudsman councils in the performance of their duties.  Staff

  5  positions for each local ombudsman council may be established

  6  as career service positions, and shall be filled by the

  7  ombudsman after approval by the secretary consultation with

  8  the respective local ombudsman council.

  9         (f)  Annually prepare a budget request that shall be

10  submitted to the Governor by the department for transmittal to

11  the Legislature.

12         (3)  The State Long-Term Care Ombudsman shall not:

13         (a)  Have a direct involvement in the licensing or

14  certification of, or an ownership or investment interest in, a

15  long-term care facility or a provider of a long-term care

16  service.

17         (b)  Be employed by, or participate in the management

18  of, a long-term care facility.

19         (c)  Receive, or have a right to receive, directly or

20  indirectly, remuneration, in cash or in kind, under a

21  compensation agreement with the owner or operator of a

22  long-term care facility.

23

24  The Department of Elderly Affairs, in consultation with the

25  ombudsman, shall adopt rules to establish procedures to

26  identify and eliminate conflicts of interest as described in

27  this subsection.

28         Section 22.  Paragraphs (c), (d), (f), and (g) of

29  subsection (2) and paragraph (b) of subsection (3) of section

30  400.0067, Florida Statutes, are amended to read:

31


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  1         400.0067  Establishment of State Long-Term Care

  2  Ombudsman Council; duties; membership.--

  3         (2)  The State Long-Term Care Ombudsman Council shall:

  4         (c)  Assist the ombudsman to discover, investigate, and

  5  determine the existence of abuse or neglect in any long-term

  6  care facility. and to develop procedures, in consultation with

  7  The Department of Elderly Affairs shall develop procedures,

  8  relating to such investigations. Investigations may consist,

  9  in part, of one or more onsite administrative inspections.

10         (d)  Assist the ombudsman in eliciting, receiving,

11  responding to, and resolving complaints made by or on behalf

12  of long-term care facility residents and in developing

13  procedures, in consultation with the Department of Elderly

14  Affairs, relating to the receipt and resolution of such

15  complaints. The secretary shall approve all such procedures.

16         (f)  Be authorized to call upon appropriate agencies of

17  state government for such professional assistance as may be

18  needed in the discharge of its duties, including assistance

19  from the adult protective services program of the Department

20  of Children and Family Services.

21         (f)(g)  Prepare an annual report describing the

22  activities carried out by the ombudsman and the State

23  Long-Term Care Ombudsman Council in the year for which the

24  report is prepared.  The State Long-Term Care Ombudsman

25  Council shall submit the report to the Secretary of Elderly

26  Affairs. The secretary shall in turn submit the report to the

27  Commissioner of the United States Administration on Aging, the

28  Governor, the President of the Senate, the Speaker of the

29  House of Representatives, the minority leaders of the House

30  and Senate, the chairpersons of appropriate House and Senate

31  committees, the Secretary of Secretaries of Elderly Affairs


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  1  and Children and Family Services, and the Secretary of Health

  2  Care Administration.  The report shall be submitted by the

  3  Secretary of Elderly Affairs at least 30 days before the

  4  convening of the regular session of the Legislature and shall,

  5  at a minimum:

  6         1.  Contain and analyze data collected concerning

  7  complaints about and conditions in long-term care facilities.

  8         2.  Evaluate the problems experienced by residents of

  9  long-term care facilities.

10         3.  Contain recommendations for improving the quality

11  of life of the residents and for protecting the health,

12  safety, welfare, and rights of the residents.

13         4.  Analyze the success of the ombudsman program during

14  the preceding year and identify the barriers that prevent the

15  optimal operation of the program.  The report of the program's

16  successes shall also address the relationship between the

17  state long-term care ombudsman program, the Department of

18  Elderly Affairs, the Agency for Health Care Administration,

19  and the Department of Children and Family Services, and an

20  assessment of how successfully the state long-term care

21  ombudsman program has carried out its responsibilities under

22  the Older Americans Act.

23         5.  Provide policy and regulatory and legislative

24  recommendations to solve identified problems; resolve

25  residents' complaints; improve the quality of care and life of

26  the residents; protect the health, safety, welfare, and rights

27  of the residents; and remove the barriers to the optimal

28  operation of the state long-term care ombudsman program.

29         6.  Contain recommendations from the local ombudsman

30  councils regarding program functions and activities.

31


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  1         7.  Include a report on the activities of the legal

  2  advocate and other legal advocates acting on behalf of the

  3  local and state councils.

  4         (3)

  5         (b)1.  The ombudsman, in consultation with the

  6  secretary and the state ombudsman council, shall submit to the

  7  Governor a list of at least eight names of persons who are not

  8  serving on a local council.

  9         2.  The Governor shall appoint three members chosen

10  from the list, at least one of whom must be over 60 years of

11  age.

12         3.  If the Governor's appointments are not made within

13  60 days after the ombudsman submits the list, the ombudsman,

14  in consultation with the secretary State Long-Term Care

15  Ombudsman Council, shall appoint three members, one of whom

16  must be over 60 years of age.

17         Section 23.  Subsection (4) of section 400.0069,

18  Florida Statutes, is amended to read:

19         400.0069  Local long-term care ombudsman councils;

20  duties; membership.--

21         (4)  Each local ombudsman council shall be composed of

22  no less than 15 members and no more than 40 30 members from

23  the local planning and service area, to include the following:

24  one medical or osteopathic physician whose practice includes

25  or has included a substantial number of geriatric patients and

26  who may have limited practice in a long-term care facility;

27  one registered nurse who has geriatric experience, if

28  possible; one licensed pharmacist; one registered dietitian;

29  at least six nursing home residents or representative consumer

30  advocates for nursing home residents; at least three residents

31  of assisted living facilities or adult family-care homes or


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  1  three representative consumer advocates for long-term care

  2  facility residents; one attorney; and one professional social

  3  worker.  In no case shall the medical director of a long-term

  4  care facility or an employee of the Agency for Health Care

  5  Administration, the Department of Children and Family

  6  Services, or the Department of Elderly Affairs serve as a

  7  member or as an ex officio member of a council.  Each member

  8  of the council shall certify that neither the council member

  9  nor any member of the council member's immediate family has

10  any conflict of interest pursuant to subsection (10).  Local

11  ombudsman councils are encouraged to recruit council members

12  who are 60 years of age or older.

13         Section 24.  Subsection (1) of section 400.0071,

14  Florida Statutes, is amended to read:

15         400.0071  Complaint procedures.--

16         (1)  The state ombudsman council shall recommend to the

17  ombudsman and the secretary establish state and local

18  procedures for receiving complaints against a nursing home or

19  long-term care facility or its employee. The procedures shall

20  be implemented after the approval of the ombudsman and the

21  secretary.

22         Section 25.  Subsections (1) and (2) of section

23  400.0087, Florida Statutes, are amended to read:

24         400.0087  Agency oversight.--

25         (1)  The Department of Elderly Affairs shall monitor

26  the local ombudsman councils responsible for carrying out the

27  duties delegated by s. 400.0069 and federal law.  The

28  department, in consultation with the ombudsman and the State

29  Long-Term Care Ombudsman Council, shall adopt rules to

30  establish the policies and procedures for the monitoring of

31  local ombudsman councils.


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  1         (2)  The department is responsible for ensuring that

  2  the Office of State Long-Term Care Ombudsman prepares its

  3  annual report; provides information to public and private

  4  agencies, legislators, and others; provides appropriate

  5  training to representatives of the office or of the state or

  6  local long-term care ombudsman councils; and coordinates

  7  ombudsman services with the Advocacy Center for Persons with

  8  Disabilities and with providers of legal services to residents

  9  of long-term care facilities in compliance with state and

10  federal laws.

11         Section 26.  Section 400.0089, Florida Statutes, is

12  amended to read:

13         400.0089  Agency reports.--The State Long-Term Care

14  Ombudsman Council, shall, in cooperation with the Department

15  of Elderly Affairs shall, maintain a statewide uniform

16  reporting system to collect and analyze data relating to

17  complaints and conditions in long-term care facilities and to

18  residents, for the purpose of identifying and resolving

19  significant problems. The department and the State Long-Term

20  Care Ombudsman Council shall submit such data as part of its

21  annual report required pursuant to s. 400.0067(2)(g) to the

22  Agency for Health Care Administration, the Department of

23  Children and Family Services, the Florida Statewide Advocacy

24  Council, the Advocacy Center for Persons with Disabilities,

25  the Commissioner for the United States Administration on

26  Aging, the National Ombudsman Resource Center, and any other

27  state or federal entities that the ombudsman determines

28  appropriate. The State Long-Term Care Ombudsman Council shall

29  publish quarterly and make readily available information

30  pertaining to the number and types of complaints received by

31  the long-term care ombudsman program.


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  1         Section 27.  Section 400.0091, Florida Statutes, is

  2  amended to read:

  3         400.0091  Training.--The ombudsman shall provide

  4  appropriate training to all employees of the Office of State

  5  Long-Term Care Ombudsman and to the state and local long-term

  6  care ombudsman councils, including all unpaid volunteers. All

  7  volunteers and appropriate employees of the Office of the

  8  State Long-Term Care Ombudsman must be given a minimum of 20

  9  hours of training upon employment or enrollment as a volunteer

10  and 10 hours of continuing education annually thereafter.

11  Training must cover, at a minimum, guardianships and powers of

12  attorney, medication administration, care and medication of

13  residents with dementia and Alzheimer's disease, accounting

14  for residents' funds, discharge rights and responsibilities,

15  and cultural sensitivity. No employee, officer, or

16  representative of the office or of the state or local

17  long-term care ombudsman councils, other than the ombudsman,

18  may carry out any authorized ombudsman duty or responsibility

19  unless the person has received the training required by this

20  section and has been approved by the ombudsman as qualified to

21  carry out ombudsman activities on behalf of the office or the

22  state or local long-term care ombudsman councils.

23         Section 28.  Paragraph (d) of subsection (5) of section

24  400.179, Florida Statutes, is amended to read:

25         400.179  Sale or transfer of ownership of a nursing

26  facility; liability for Medicaid underpayments and

27  overpayments.--

28         (5)  Because any transfer of a nursing facility may

29  expose the fact that Medicaid may have underpaid or overpaid

30  the transferor, and because in most instances, any such

31  underpayment or overpayment can only be determined following a


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  1  formal field audit, the liabilities for any such underpayments

  2  or overpayments shall be as follows:

  3         (d)  Where the transfer involves a facility that has

  4  been leased by the transferor:

  5         1.  The transferee shall, as a condition to being

  6  issued a license by the agency, acquire, maintain, and provide

  7  proof to the agency of a bond with a term of 30 months,

  8  renewable annually, in an amount not less than the total of 3

  9  months Medicaid payments to the facility computed on the basis

10  of the preceding 12-month average Medicaid payments to the

11  facility.

12         2.  The leasehold operator may meet the bond

13  requirement through other arrangements acceptable to the

14  department.

15         3.  All existing nursing facility licensees, operating

16  the facility as a leasehold, shall acquire, maintain, and

17  provide proof to the agency of the 30-month bond required in

18  subparagraph 1., above, on and after July 1, 1993, for each

19  license renewal.

20         4.  It shall be the responsibility of all nursing

21  facility operators, operating the facility as a leasehold, to

22  renew the 30-month bond and to provide proof of such renewal

23  to the agency annually at the time of application for license

24  renewal.

25         5.  Any failure of the nursing facility operator to

26  acquire, maintain, renew annually, or provide proof to the

27  agency shall be grounds for the agency to deny, cancel,

28  revoke, or suspend the facility license to operate such

29  facility and to take any further action, including, but not

30  limited to, enjoining the facility, asserting a moratorium, or

31  applying for a receiver, deemed necessary to ensure compliance


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  1  with this section and to safeguard and protect the health,

  2  safety, and welfare of the facility's residents. A lease

  3  agreement required as a condition of bond financing or

  4  refinancing under s. 154.213 by a health facilities authority

  5  or required under s. 159.30 by a county or municipality is not

  6  a leasehold for purposes of this paragraph and is not subject

  7  to the bond requirement of this paragraph.

  8         Section 29.  Subsection (20) of section 400.141,

  9  Florida Statutes, is amended to read:

10         400.141  Administration and management of nursing home

11  facilities.--Every licensed facility shall comply with all

12  applicable standards and rules of the agency and shall:

13         (20)  Maintain liability insurance coverage that is in

14  force at all times. In lieu of general and professional

15  liability insurance coverage, a state-designated teaching

16  nursing home and its affiliated assisted living facilities

17  created under s. 430.80 may demonstrate proof of financial

18  responsibility as provided in s. 430.80(3)(h); the exception

19  provided in this paragraph shall expire July 1, 2005.

20         Section 30.  Paragraph (h) is added to subsection (3)

21  of section 430.80, Florida Statutes, to read:

22         430.80  Implementation of a teaching nursing home pilot

23  project.--

24         (3)  To be designated as a teaching nursing home, a

25  nursing home licensee must, at a minimum:

26         (h)  Maintain insurance coverage pursuant to s.

27  400.141(20) or proof of financial responsibility in a minimum

28  amount of $750,000. Such proof of financial responsibility may

29  include:

30         1.  Maintaining an escrow account consisting of cash or

31  assets eligible for deposit in accordance with s. 625.52; or


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  1         2.  Obtaining and maintaining pursuant to chapter 675

  2  an unexpired, irrevocable, nontransferable and nonassignable

  3  letter of credit issued by any bank or savings association

  4  organized and existing under the laws of this state or any

  5  bank or savings association organized under the laws of the

  6  United States that has its principal place of business in this

  7  state or has a branch office which is authorized to receive

  8  deposits in this state. The letter of credit shall be used to

  9  satisfy the obligation of the facility to the claimant upon

10  presentment of a final judgment indicating liability and

11  awarding damages to be paid by the facility or upon

12  presentment of a settlement agreement signed by all parties to

13  the agreement when such final judgment or settlement is a

14  result of a liability claim against the facility.

15         Section 31.  Subsection (1) of section 477.025, Florida

16  Statutes, is amended, and subsection (11) is added to said

17  section, to read:

18         477.025  Cosmetology salons; specialty salons;

19  requisites; licensure; inspection; mobile cosmetology

20  salons.--

21         (1)  No cosmetology salon or specialty salon shall be

22  permitted to operate without a license issued by the

23  department except as provided in subsection (11).

24         (11)  Facilities licensed under part II or part III of

25  chapter 400 shall be exempt from the provisions of this

26  section and a cosmetologist licensed pursuant to s. 477.019

27  may provide salon services exclusively for facility residents.

28         Section 32.  Section 627.9408, Florida Statutes, is

29  amended to read:

30         627.9408  Rules.--

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  1         (1)  The department has authority to adopt rules

  2  pursuant to ss. 120.536(1) and 120.54 to implement the

  3  provisions of this part.

  4         (2)  The department may adopt by rule the provisions of

  5  the Long-Term Care Insurance Model Regulation adopted by the

  6  National Association of Insurance Commissioners in the second

  7  quarter of the year 2000 which are not in conflict with the

  8  Florida Insurance Code.

  9         Section 33.  Subsections (2) and (3) of section

10  400.0066, Florida Statutes, are repealed.

11         Section 34.  This act shall take effect upon becoming a

12  law.

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