CODING: Words stricken are deletions; words underlined are additions.
HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
CHAMBER ACTION
Senate House
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11 Representative(s) Green offered the following:
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13 Amendment (with title amendment)
14 Remove everything after the enacting clause
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16 and insert:
17 Section 1. Section 409.221, Florida Statutes, is
18 created to read:
19 409.221 Consumer-directed care program.--
20 (1) SHORT TITLE.--This section may be cited as the
21 "Florida Consumer-Directed Care Act."
22 (2) LEGISLATIVE FINDINGS.--The Legislature finds that
23 alternatives to institutional care, such as in-home and
24 community-based care, should be encouraged. The Legislature
25 finds that giving recipients of in-home and community-based
26 services the opportunity to select the services they need and
27 the providers they want, including family and friends,
28 enhances their sense of dignity and autonomy. The Legislature
29 also finds that providing consumers choice and control, as
30 tested in current research and demonstration projects, has
31 been beneficial and should be developed further and
1
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 implemented statewide.
2 (3) LEGISLATIVE INTENT.--It is the intent of the
3 Legislature to nurture the autonomy of those citizens of the
4 state, of all ages, who have disabilities by providing the
5 long-term care services they need in the least restrictive,
6 appropriate setting. It is the intent of the Legislature to
7 give such individuals more choices in and greater control over
8 the purchased long-term care services they receive.
9 (4) CONSUMER-DIRECTED CARE.--
10 (a) Program established.--The Agency for Health Care
11 Administration shall establish the consumer-directed care
12 program which shall be based on the principles of consumer
13 choice and control. The agency shall implement the program
14 upon federal approval. The agency shall establish interagency
15 cooperative agreements with and shall work with the
16 Departments of Elderly Affairs, Health, and Children and
17 Family Services to implement and administer the program. The
18 program shall allow enrolled persons to choose the providers
19 of services and to direct the delivery of services, to best
20 meet their long-term care needs. The program must operate
21 within the funds appropriated by the Legislature.
22 (b) Eligibility and enrollment.--Persons who are
23 enrolled in one of the Medicaid home and community-based
24 waiver programs and are able to direct their own care, or to
25 designate an eligible representative, may choose to
26 participate in the consumer-directed care program.
27 (c) Definitions.--For purposes of this section, the
28 term:
29 1. "Budget allowance" means the amount of money made
30 available each month to a consumer to purchase needed
31 long-term care services, based on the results of a functional
2
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 needs assessment.
2 2. "Consultant" means an individual who provides
3 technical assistance to consumers in meeting their
4 responsibilities under this section.
5 3. "Consumer" means a person who has chosen to
6 participate in the program, has met the enrollment
7 requirements, and has received an approved budget allowance.
8 4. "Fiscal intermediary" means an entity approved by
9 the agency that helps the consumer manage the consumer's
10 budget allowance, retains the funds, processes employment
11 information, if any, and tax information, reviews records to
12 ensure correctness, writes paychecks to providers, and
13 delivers paychecks to the consumer for distribution to
14 providers and caregivers.
15 5. "Provider" means:
16 a. A person licensed or otherwise permitted to render
17 services eligible for reimbursement under this program for
18 whom the consumer is not the employer of record; or
19 b. A consumer-employed caregiver for whom the consumer
20 is the employer of record.
21 6. "Representative" means an uncompensated individual
22 designated by the consumer to assist in managing the
23 consumer's budget allowance and needed services.
24 (d) Budget allowances.--Consumers enrolled in the
25 program shall be given a monthly budget allowance based on the
26 results of their assessed functional needs and the financial
27 resources of the program. Consumers shall receive the budget
28 allowance directly from an agency-approved fiscal
29 intermediary. Each department shall develop purchasing
30 guidelines, approved by the agency, to assist consumers in
31 using the budget allowance to purchase needed, cost-effective
3
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 services.
2 (e) Services.--Consumers shall use the budget
3 allowance only to pay for home and community-based services
4 that meet the consumer's long-term care needs and are a
5 cost-efficient use of funds. Such services may include, but
6 are not limited to, the following:
7 1. Personal care.
8 2. Homemaking and chores, including housework, meals,
9 shopping, and transportation.
10 3. Home modifications and assistive devices which may
11 increase the consumer's independence or make it possible to
12 avoid institutional placement.
13 4. Assistance in taking self-administered medication.
14 5. Day care and respite care services, including those
15 provided by nursing home facilities pursuant to s. 400.141(6)
16 or by adult day care facilities licensed pursuant to s.
17 400.554.
18 6. Personal care and support services provided in an
19 assisted living facility.
20 (f) Consumer roles and responsibilities.--Consumers
21 shall be allowed to choose the providers of services, as well
22 as when and how the services are provided. Providers may
23 include a consumer's neighbor, friend, spouse, or relative.
24 1. In cases where a consumer is the employer of
25 record, the consumer's roles and responsibilities include, but
26 are not limited to, the following:
27 a. Developing a job description.
28 b. Selecting caregivers and submitting information for
29 the background screening as required in s. 435.05.
30 c. Communicating needs, preferences, and expectations
31 about services being purchased.
4
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 d. Providing the fiscal intermediary with all
2 information necessary for provider payments and tax
3 requirements.
4 e. Ending the employment of an unsatisfactory
5 caregiver.
6 2. In cases where a consumer is not the employer of
7 record, the consumer's roles and responsibilities include, but
8 are not limited to, the following:
9 a. Communicating needs, preferences, and expectations
10 about services being purchased.
11 b. Ending the services of an unsatisfactory provider.
12 c. Providing the fiscal agent with all information
13 necessary for provider payments and tax requirements.
14 (g) Agency and departments roles and
15 responsibilities.--The agency's and the departments' roles and
16 responsibilities include, but are not limited to, the
17 following:
18 1. Assessing each consumer's functional needs, helping
19 with the service plan, and providing ongoing assistance with
20 the service plan.
21 2. Offering the services of consultants who shall
22 provide training, technical assistance, and support to the
23 consumer.
24 3. Completing the background screening for providers.
25 4. Approving fiscal intermediaries.
26 5. Establishing the minimum qualifications for all
27 caregivers and providers and being the final arbiter of the
28 fitness of any individual to be a caregiver or provider.
29 (h) Fiscal intermediary roles and
30 responsibilities.--The fiscal intermediary's roles and
31 responsibilities include, but are not limited to, the
5
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 following:
2 1. Providing recordkeeping services.
3 2. Retaining the consumer-directed care funds,
4 processing employment and tax information, if any, reviewing
5 records to ensure correctness, writing paychecks to providers,
6 and delivering paychecks to the consumer for distribution.
7 (i) Background screening requirements.--All persons
8 who render care under this section shall comply with the
9 requirements of s. 435.05. Persons shall be excluded from
10 employment pursuant to s. 435.06.
11 1. Persons excluded from employment may request an
12 exemption from disqualification, as provided in s. 435.07.
13 Persons not subject to certification or professional licensure
14 may request an exemption from the agency. In considering a
15 request for an exemption, the agency shall comply with the
16 provisions of s. 435.07.
17 2. The agency shall, as allowable, reimburse
18 consumer-employed caregivers for the cost of conducting
19 background screening as required by this section.
20
21 For purposes of this section, a person who has undergone
22 screening, who is qualified for employment under this section
23 and applicable rule, and who has not been unemployed for more
24 than 180 days following such screening is not required to be
25 rescreened. Such person must attest under penalty of perjury
26 to not having been convicted of a disqualifying offense since
27 completing such screening.
28 (j) Rules; federal waivers.--In order to implement
29 this section:
30 1. The agency and the Departments of Elderly Affairs,
31 Health, and Children and Family Services are authorized to
6
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 adopt and enforce rules.
2 2. The agency shall take all necessary action to
3 ensure state compliance with federal regulations. The agency
4 shall apply for any necessary federal waivers or waiver
5 amendments needed to implement the program.
6 (k) Reviews and reports.--The agency and the
7 Departments of Elderly Affairs, Health, and Children and
8 Family Services shall each, on an ongoing basis, review and
9 assess the implementation of the consumer-directed care
10 program. By January 15 of each year, the agency shall submit a
11 written report to the Legislature that includes each
12 department's review of the program and contains
13 recommendations for improvements to the program.
14 Section 2. The Legislature finds that the State of
15 Florida does not have a comprehensive and effective strategy
16 for economically and efficiently meeting the long-term care
17 needs of an increasingly elderly population; that multiple
18 state agencies have responsibilities for oversight, planning,
19 and operation of long-term care programs; that long-term care
20 is provided by a complex array of public and private entities
21 delivering services; that there has not been a focus on
22 evaluation of innovative and pilot projects and expansion of
23 pilot projects that are successful; that the provision of
24 long-term care services has not been approached holistically;
25 and that the state does not have a mechanism for ensuring that
26 long-term care programs are effectively and efficiently
27 operated and coordinated to comply with the policies set out
28 in Florida Statutes. It is therefore the intent of the
29 Legislature to increase the rate of diversion of elderly
30 persons in need of long-term care to noninstitutional
31 alternatives; to increase coordination, evaluation, and
7
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 planning for the state's long-term care system; to expand
2 successful pilot programs; and to establish a nursing facility
3 preadmission screening program.
4 Section 3. (1) Prior to December 1, 2002, the Agency
5 for Health Care Administration, in consultation with the
6 Department of Elderly Affairs, shall submit to the Governor,
7 the President of the Senate, and the Speaker of the House of
8 Representatives a plan to reduce the number of nursing home
9 bed days purchased by the state Medicaid program and to
10 replace such nursing home care with care provided in less
11 costly alternative settings.
12 (2) The plan must include specific goals for reducing
13 Medicaid-funded bed days and recommend specific statutory and
14 operational changes necessary to achieve such reduction.
15 (3) The plan must include an evaluation of the
16 cost-effectiveness and the relative strengths and weaknesses
17 of programs that serve as alternatives to nursing homes.
18 Section 4. Section 408.034, Florida Statutes, is
19 amended to read:
20 408.034 Duties and responsibilities of agency;
21 rules.--
22 (1) The agency is designated as the single state
23 agency to issue, revoke, or deny certificates of need and to
24 issue, revoke, or deny exemptions from certificate-of-need
25 review in accordance with the district plans and present and
26 future federal and state statutes. The agency is designated
27 as the state health planning agency for purposes of federal
28 law.
29 (2) In the exercise of its authority to issue licenses
30 to health care facilities and health service providers, as
31 provided under chapters 393, 395, and parts II and VI of
8
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 chapter 400, the agency may not issue a license to any health
2 care facility, health service provider, hospice, or part of a
3 health care facility which fails to receive a certificate of
4 need or an exemption for the licensed facility or service.
5 (3) The agency shall establish, by rule, uniform need
6 methodologies for health services and health facilities. In
7 developing uniform need methodologies, the agency shall, at a
8 minimum, consider the demographic characteristics of the
9 population, the health status of the population, service use
10 patterns, standards and trends, geographic accessibility, and
11 market economics.
12 (4) Prior to determining that there is a need for
13 additional community nursing facility beds in any area of the
14 state, the agency shall determine that the need cannot be met
15 through the provision, enhancement, or expansion of home and
16 community-based services. In determining such need, the agency
17 shall examine nursing home placement patterns and demographic
18 patterns of persons entering nursing homes and the
19 availability of and effectiveness of existing home-based and
20 community-based service delivery systems at meeting the
21 long-term care needs of the population. The agency shall
22 recommend to the Office of Long-Term Care Policy changes that
23 could be made to existing home-based and community-based
24 delivery systems to lessen the need for additional nursing
25 facility beds.
26 (5)(4) The agency shall establish by rule a
27 nursing-home-bed-need methodology that reduces the community
28 nursing home bed need for the areas of the state where the
29 agency establishes pilot community diversion programs through
30 the Title XIX aging waiver program.
31 (6)(5) The agency may adopt rules necessary to
9
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 implement ss. 408.031-408.045.
2 Section 5. Paragraph (f) of subsection (3) of section
3 409.912, Florida Statutes, is amended, and present subsections
4 (13) through (39) of said section are renumbered as
5 subsections (14) through (40), respectively, and a new
6 subsection (13) is added to that section, to read:
7 409.912 Cost-effective purchasing of health care.--The
8 agency shall purchase goods and services for Medicaid
9 recipients in the most cost-effective manner consistent with
10 the delivery of quality medical care. The agency shall
11 maximize the use of prepaid per capita and prepaid aggregate
12 fixed-sum basis services when appropriate and other
13 alternative service delivery and reimbursement methodologies,
14 including competitive bidding pursuant to s. 287.057, designed
15 to facilitate the cost-effective purchase of a case-managed
16 continuum of care. The agency shall also require providers to
17 minimize the exposure of recipients to the need for acute
18 inpatient, custodial, and other institutional care and the
19 inappropriate or unnecessary use of high-cost services. The
20 agency may establish prior authorization requirements for
21 certain populations of Medicaid beneficiaries, certain drug
22 classes, or particular drugs to prevent fraud, abuse, overuse,
23 and possible dangerous drug interactions. The Pharmaceutical
24 and Therapeutics Committee shall make recommendations to the
25 agency on drugs for which prior authorization is required. The
26 agency shall inform the Pharmaceutical and Therapeutics
27 Committee of its decisions regarding drugs subject to prior
28 authorization.
29 (3) The agency may contract with:
30 (f) An entity that provides in-home physician services
31 to test the cost-effectiveness of enhanced home-based medical
10
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 care to Medicaid recipients with degenerative neurological
2 diseases and other diseases or disabling conditions associated
3 with high costs to Medicaid. The program shall be designed to
4 serve very disabled persons and to reduce Medicaid reimbursed
5 costs for inpatient, outpatient, and emergency department
6 services. The agency shall contract with vendors on a
7 risk-sharing basis. in Pasco County or Pinellas County that
8 provides in-home physician services to Medicaid recipients
9 with degenerative neurological diseases in order to test the
10 cost-effectiveness of enhanced home-based medical care. The
11 entity providing the services shall be reimbursed on a
12 fee-for-service basis at a rate not less than comparable
13 Medicare reimbursement rates. The agency may apply for waivers
14 of federal regulations necessary to implement such program.
15 This paragraph shall be repealed on July 1, 2002.
16 (13)(a) The agency shall operate the Comprehensive
17 Assessment and Review (CARES) nursing facility preadmission
18 screening program to ensure that Medicaid payment for nursing
19 facility care is made only for individuals whose conditions
20 require such care and to ensure that long-term care services
21 are provided in the setting most appropriate to the needs of
22 the person and in the most economical manner possible. The
23 CARES program shall also ensure that individuals participating
24 in Medicaid home and community-based waiver programs meet
25 criteria for those programs, consistent with approved federal
26 waivers.
27 (b) The agency shall operate the CARES program through
28 an interagency agreement with the Department of Elderly
29 Affairs.
30 (c) Prior to making payment for nursing facility
31 services for a Medicaid recipient, the agency must verify that
11
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the nursing facility preadmission screening program has
2 determined that the individual requires nursing facility care
3 and that the individual cannot be safely served in
4 community-based programs. The nursing facility preadmission
5 screening program shall refer a Medicaid recipient to a
6 community-based program if the individual could be safely
7 served at a lower cost and the recipient chooses to
8 participate in such program.
9 (d) By January 1 of each year, the agency shall submit
10 a report to the Legislature and the Office of Long-Term Care
11 Policy describing the operations of the CARES program. The
12 report must describe:
13 1. Rate of diversion to community alternative
14 programs;
15 2. CARES program staffing needs to achieve additional
16 diversions;
17 3. Reasons the program is unable to place individuals
18 in less restrictive settings when such individuals desired
19 such services and could have been served in such settings;
20 4. Barriers to appropriate placement, including
21 barriers due to policies or operations of other agencies or
22 state-funded programs; and
23 5. Statutory changes necessary to ensure that
24 individuals in need of long-term care services receive care in
25 the least restrictive environment.
26 Section 6. Section 430.041, Florida Statutes, is
27 created to read:
28 430.041 Office of Long-Term Care Policy.--
29 (1) There is established in the Department of Elderly
30 Affairs the Office of Long-Term Care Policy to evaluate the
31 state's long-term care service delivery system and make
12
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 recommendations to increase the availability and the use of
2 noninstitutional settings to provide care to the elderly and
3 ensure coordination among the agencies responsible for the
4 long-term care continuum.
5 (2) The purpose of the Office of Long-Term Care Policy
6 is to:
7 (a) Ensure close communication and coordination among
8 state agencies involved in developing and administering a more
9 efficient and coordinated long-term care service delivery
10 system in this state.
11 (b) Identify duplication and unnecessary service
12 provision in the long-term care system and make
13 recommendations to decrease inappropriate service provision.
14 (c) Review current programs providing long-term care
15 services to determine whether the programs are cost effective,
16 of high quality, and operating efficiently and make
17 recommendations to increase consistency and effectiveness in
18 the state's long-term care programs.
19 (d) Develop strategies for promoting and implementing
20 cost-effective home and community-based services as an
21 alternative to institutional care which coordinate and
22 integrate the continuum of care needs of the elderly.
23 (e) Assist the Office of Long-Term Care Policy
24 Advisory Council as necessary to help implement this section.
25 (3) The Director of the Office of Long-Term Care
26 Policy shall be appointed by, and serve at the pleasure of,
27 the Governor. The director shall report to, and be under the
28 general supervision of, the Secretary of Elderly Affairs and
29 shall not be subject to supervision by any other employee of
30 the department.
31 (4) The Office of Long-Term Care Policy shall have an
13
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 advisory council, whose chair shall be the Director of the
2 Office of Long-Term Care Policy. The purposes of the advisory
3 council are to provide assistance and direction to the office
4 and to ensure that the appropriate state agencies are properly
5 implementing recommendations from the office.
6 (a) The advisory council shall consist of:
7 1. A member of the Senate, appointed by the President
8 of the Senate.
9 2. A member of the House of Representatives, appointed
10 by the Speaker of the House of Representatives.
11 3. The Director of the Office of Long-Term Care
12 Policy.
13 4. The Secretary of Health Care Administration.
14 5. The Secretary of Elderly Affairs.
15 6. The Secretary of Children and Family Services.
16 7. The Secretary of Health.
17 8. The Executive Director of the Department of
18 Veterans' Affairs.
19 9. A representative of the Florida Association of Area
20 Agencies on Aging, appointed by the Governor.
21 10. A representative of the Florida Association of
22 Aging Service Providers, appointed by the Governor.
23 11. Three persons possessing broad knowledge and
24 experience in the delivery of long-term care services,
25 appointed by the Governor.
26 12. Two representatives of persons using long-term
27 care services, appointed by the Governor from groups
28 representing elderly persons.
29 (b) Members shall serve without compensation but are
30 entitled to receive reimbursement for travel and per diem as
31 provided in s. 112.061.
14
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
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 Long-Term
11 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 Long-Term
24 Care Policy and its participation on the advisory council. The
25 Department of Elderly Affairs shall be responsible for
26 expenses related to participation on the advisory council by
27 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 must contain recommendations and
15
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
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 7. Section 430.7031, Florida Statutes, is
21 created to read:
22 430.7031 Nursing home transition program.--The
23 department and the Agency for Health Care Administration:
24 (1) Shall implement a system of care designed to
25 assist individuals residing in nursing homes to regain
26 independence and to move to less costly settings.
27 (2) Shall collaboratively work to identify long-stay
28 nursing home residents who are able to move to community
29 placements, and to provide case management and supportive
30 services to such individuals while they are in nursing homes
31 to assist such individuals in moving to less expensive and
16
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 less restrictive settings.
2 (3) Shall modify existing service delivery systems or
3 develop new service delivery systems to economically and
4 efficiently meet such individuals' care needs.
5 (4) Shall offer such individuals priority placement
6 and services in all home-based and community-based care
7 programs and shall ensure that funds are available to provide
8 services to individuals to whom services are offered.
9 (5) May seek federal waivers necessary to administer
10 this section.
11 Section 8. Subsection (4) of section 409.908, Florida
12 Statutes, is amended to read:
13 409.908 Reimbursement of Medicaid providers.--Subject
14 to specific appropriations, the agency shall reimburse
15 Medicaid providers, in accordance with state and federal law,
16 according to methodologies set forth in the rules of the
17 agency and in policy manuals and handbooks incorporated by
18 reference therein. These methodologies may include fee
19 schedules, reimbursement methods based on cost reporting,
20 negotiated fees, competitive bidding pursuant to s. 287.057,
21 and other mechanisms the agency considers efficient and
22 effective for purchasing services or goods on behalf of
23 recipients. Payment for Medicaid compensable services made on
24 behalf of Medicaid eligible persons is subject to the
25 availability of moneys and any limitations or directions
26 provided for in the General Appropriations Act or chapter 216.
27 Further, nothing in this section shall be construed to prevent
28 or limit the agency from adjusting fees, reimbursement rates,
29 lengths of stay, number of visits, or number of services, or
30 making any other adjustments necessary to comply with the
31 availability of moneys and any limitations or directions
17
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 provided for in the General Appropriations Act, provided the
2 adjustment is consistent with legislative intent.
3 (4) Subject to any limitations or directions provided
4 for in the General Appropriations Act, alternative health
5 plans, health maintenance organizations, and prepaid health
6 plans shall be reimbursed a fixed, prepaid amount negotiated,
7 or competitively bid pursuant to s. 287.057, by the agency and
8 prospectively paid to the provider monthly for each Medicaid
9 recipient enrolled. The amount may not exceed the average
10 amount the agency determines it would have paid, based on
11 claims experience, for recipients in the same or similar
12 category of eligibility. The agency shall calculate
13 capitation rates on a regional basis and, beginning September
14 1, 1995, shall include age-band differentials in such
15 calculations. Effective July 1, 2001, the cost of exempting
16 statutory teaching hospitals, specialty hospitals, and
17 community hospital education program hospitals from
18 reimbursement ceilings and the cost of special Medicaid
19 payments shall not be included in premiums paid to health
20 maintenance organizations or prepaid health care plans. Each
21 rate semester, the agency shall calculate and publish a
22 Medicaid hospital rate schedule that does not reflect either
23 special Medicaid payments or the elimination of rate
24 reimbursement ceilings, to be used by hospitals and Medicaid
25 health maintenance organizations, in order to determine the
26 Medicaid rate referred to in ss. 409.912(17) 409.912(16),
27 409.9128(5), and 641.513(6).
28 Section 9. Section 430.708, Florida Statutes, is
29 amended to read:
30 430.708 Certificate of need.--To ensure that Medicaid
31 community diversion pilot projects result in a reduction in
18
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the projected average monthly nursing home caseload, the
2 agency shall, in accordance with the provisions of s.
3 408.034(5) s. 408.034(4):
4 (1) Reduce the projected nursing home bed need in each
5 certificate-of-need batching cycle in the community diversion
6 pilot project areas.
7 (2) Reduce the conditions imposed on existing nursing
8 homes or those to be constructed, in accordance with the
9 number of projected community diversion slots.
10 (3) Adopt rules to reduce the number of beds in
11 Medicaid-participating nursing homes eligible for Medicaid,
12 through a Medicaid-selective contracting process or some other
13 appropriate method.
14 (4) Determine the feasibility of increasing the
15 nursing home occupancy threshold used in determining nursing
16 home bed needs under the certificate-of-need process.
17 Section 10. Subsection (4) of section 641.386, Florida
18 Statutes, is amended to read:
19 641.386 Agent licensing and appointment required;
20 exceptions.--
21 (4) All agents and health maintenance organizations
22 shall comply with and be subject to the applicable provisions
23 of ss. 641.309 and 409.912(19) 409.912(18), and all companies
24 and entities appointing agents shall comply with s. 626.451,
25 when marketing for any health maintenance organization
26 licensed pursuant to this part, including those organizations
27 under contract with the Agency for Health Care Administration
28 to provide health care services to Medicaid recipients or any
29 private entity providing health care services to Medicaid
30 recipients pursuant to a prepaid health plan contract with the
31 Agency for Health Care Administration.
19
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Section 11. Subsection (4) of section 20.41, Florida
2 Statutes, is amended to read:
3 20.41 Department of Elderly Affairs.--There is created
4 a Department of Elderly Affairs.
5 (4) The department shall administer administratively
6 house the State Long-Term Care Ombudsman Council, created by
7 s. 400.0067, and the local long-term care ombudsman councils,
8 created by s. 400.0069 and shall, as required by s. 712 of the
9 federal Older Americans Act of 1965, ensure that both the
10 state and local long-term care ombudsman councils operate in
11 compliance with the Older Americans Act. The councils in
12 performance of their duties shall not be subject to control,
13 supervision, or direction by the department.
14 Section 12. Subsection (1) and paragraph (b) of
15 subsection (2) of section 400.0063, Florida Statutes, are
16 amended to read:
17 400.0063 Establishment of Office of State Long-Term
18 Care Ombudsman; designation of ombudsman and legal advocate.--
19 (1) There is created an Office of State Long-Term Care
20 Ombudsman, which shall be located for administrative purposes
21 in the Department of Elderly Affairs.
22 (2)
23 (b) The State Long-Term Care Ombudsman shall be
24 appointed by and shall serve at the pleasure of the Secretary
25 of Elderly Affairs State Long-Term Care Ombudsman Council. No
26 person who has a conflict of interest, or has an immediate
27 family member who has a conflict of interest, may be involved
28 in the designation of the ombudsman.
29 Section 13. Paragraphs (c) and (f) of subsection (2)
30 and subsection (3) of section 400.0065, Florida Statutes, are
31 amended to read:
20
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 400.0065 State Long-Term Care Ombudsman; duties and
2 responsibilities; conflict of interest.--
3 (2) The State Long-Term Care Ombudsman shall have the
4 duty and authority to:
5 (c) Within the limits of federal and state funding
6 authorized and appropriated, employ such personnel, including
7 staff for local ombudsman councils, as are necessary to
8 perform adequately the functions of the office and provide or
9 contract for legal services to assist the state and local
10 ombudsman councils in the performance of their duties. Staff
11 positions for each local ombudsman council may be established
12 as career service positions, and shall be filled by the
13 ombudsman after approval by the secretary consultation with
14 the respective local ombudsman council.
15 (f) Annually prepare a budget request that shall be
16 submitted to the Governor by the department for transmittal to
17 the Legislature.
18 (3) The State Long-Term Care Ombudsman shall not:
19 (a) Have a direct involvement in the licensing or
20 certification of, or an ownership or investment interest in, a
21 long-term care facility or a provider of a long-term care
22 service.
23 (b) Be employed by, or participate in the management
24 of, a long-term care facility.
25 (c) Receive, or have a right to receive, directly or
26 indirectly, remuneration, in cash or in kind, under a
27 compensation agreement with the owner or operator of a
28 long-term care facility.
29
30 The Department of Elderly Affairs, in consultation with the
31 ombudsman, shall adopt rules to establish procedures to
21
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 identify and eliminate conflicts of interest as described in
2 this subsection.
3 Section 14. Paragraphs (c), (d), (f), and (g) of
4 subsection (2) and paragraph (b) of subsection (3) of section
5 400.0067, Florida Statutes, are amended to read:
6 400.0067 Establishment of State Long-Term Care
7 Ombudsman Council; duties; membership.--
8 (2) The State Long-Term Care Ombudsman Council shall:
9 (c) Assist the ombudsman to discover, investigate, and
10 determine the existence of abuse or neglect in any long-term
11 care facility. and to develop procedures, in consultation with
12 The Department of Elderly Affairs shall develop procedures,
13 relating to such investigations. Investigations may consist,
14 in part, of one or more onsite administrative inspections.
15 (d) Assist the ombudsman in eliciting, receiving,
16 responding to, and resolving complaints made by or on behalf
17 of long-term care facility residents and in developing
18 procedures, in consultation with the Department of Elderly
19 Affairs, relating to the receipt and resolution of such
20 complaints. The secretary shall approve all such procedures.
21 (f) Be authorized to call upon appropriate agencies of
22 state government for such professional assistance as may be
23 needed in the discharge of its duties, including assistance
24 from the adult protective services program of the Department
25 of Children and Family Services.
26 (f)(g) Prepare an annual report describing the
27 activities carried out by the ombudsman and the State
28 Long-Term Care Ombudsman Council in the year for which the
29 report is prepared. The State Long-Term Care Ombudsman
30 Council shall submit the report to the Secretary of Elderly
31 Affairs. The secretary shall in turn submit the report to the
22
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Commissioner of the United States Administration on Aging, the
2 Governor, the President of the Senate, the Speaker of the
3 House of Representatives, the minority leaders of the House
4 and Senate, the chairpersons of appropriate House and Senate
5 committees, the Secretary of Secretaries of Elderly Affairs
6 and Children and Family Services, and the Secretary of Health
7 Care Administration. The report shall be submitted by the
8 Secretary of Elderly Affairs at least 30 days before the
9 convening of the regular session of the Legislature and shall,
10 at a minimum:
11 1. Contain and analyze data collected concerning
12 complaints about and conditions in long-term care facilities.
13 2. Evaluate the problems experienced by residents of
14 long-term care facilities.
15 3. Contain recommendations for improving the quality
16 of life of the residents and for protecting the health,
17 safety, welfare, and rights of the residents.
18 4. Analyze the success of the ombudsman program during
19 the preceding year and identify the barriers that prevent the
20 optimal operation of the program. The report of the program's
21 successes shall also address the relationship between the
22 state long-term care ombudsman program, the Department of
23 Elderly Affairs, the Agency for Health Care Administration,
24 and the Department of Children and Family Services, and an
25 assessment of how successfully the state long-term care
26 ombudsman program has carried out its responsibilities under
27 the Older Americans Act.
28 5. Provide policy and regulatory and legislative
29 recommendations to solve identified problems; resolve
30 residents' complaints; improve the quality of care and life of
31 the residents; protect the health, safety, welfare, and rights
23
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 of the residents; and remove the barriers to the optimal
2 operation of the state long-term care ombudsman program.
3 6. Contain recommendations from the local ombudsman
4 councils regarding program functions and activities.
5 7. Include a report on the activities of the legal
6 advocate and other legal advocates acting on behalf of the
7 local and state councils.
8 (3)
9 (b)1. The ombudsman, in consultation with the
10 secretary and the state ombudsman council, shall submit to the
11 Governor a list of at least eight names of persons who are not
12 serving on a local council.
13 2. The Governor shall appoint three members chosen
14 from the list, at least one of whom must be over 60 years of
15 age.
16 3. If the Governor's appointments are not made within
17 60 days after the ombudsman submits the list, the ombudsman,
18 in consultation with the secretary State Long-Term Care
19 Ombudsman Council, shall appoint three members, one of whom
20 must be over 60 years of age.
21 Section 15. Subsection (4) of section 400.0069,
22 Florida Statutes, is amended to read:
23 400.0069 Local long-term care ombudsman councils;
24 duties; membership.--
25 (4) Each local ombudsman council shall be composed of
26 no less than 15 members and no more than 40 30 members from
27 the local planning and service area, to include the following:
28 one medical or osteopathic physician whose practice includes
29 or has included a substantial number of geriatric patients and
30 who may have limited practice in a long-term care facility;
31 one registered nurse who has geriatric experience, if
24
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 possible; one licensed pharmacist; one registered dietitian;
2 at least six nursing home residents or representative consumer
3 advocates for nursing home residents; at least three residents
4 of assisted living facilities or adult family-care homes or
5 three representative consumer advocates for long-term care
6 facility residents; one attorney; and one professional social
7 worker. In no case shall the medical director of a long-term
8 care facility or an employee of the Agency for Health Care
9 Administration, the Department of Children and Family
10 Services, or the Department of Elderly Affairs serve as a
11 member or as an ex officio member of a council. Each member
12 of the council shall certify that neither the council member
13 nor any member of the council member's immediate family has
14 any conflict of interest pursuant to subsection (10). Local
15 ombudsman councils are encouraged to recruit council members
16 who are 60 years of age or older.
17 Section 16. Subsection (1) of section 400.0071,
18 Florida Statutes, is amended to read:
19 400.0071 Complaint procedures.--
20 (1) The state ombudsman council shall recommend to the
21 ombudsman and the secretary establish state and local
22 procedures for receiving complaints against a nursing home or
23 long-term care facility or its employee. The procedures shall
24 be implemented after the approval of the ombudsman and the
25 secretary.
26 Section 17. Subsections (1) and (2) of section
27 400.0087, Florida Statutes, are amended to read:
28 400.0087 Agency oversight.--
29 (1) The Department of Elderly Affairs shall monitor
30 the local ombudsman councils responsible for carrying out the
31 duties delegated by s. 400.0069 and federal law. The
25
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 department, in consultation with the ombudsman and the State
2 Long-Term Care Ombudsman Council, shall adopt rules to
3 establish the policies and procedures for the monitoring of
4 local ombudsman councils.
5 (2) The department is responsible for ensuring that
6 the Office of State Long-Term Care Ombudsman prepares its
7 annual report; provides information to public and private
8 agencies, legislators, and others; provides appropriate
9 training to representatives of the office or of the state or
10 local long-term care ombudsman councils; and coordinates
11 ombudsman services with the Advocacy Center for Persons with
12 Disabilities and with providers of legal services to residents
13 of long-term care facilities in compliance with state and
14 federal laws.
15 Section 18. Section 400.0089, Florida Statutes, is
16 amended to read:
17 400.0089 Agency reports.--The State Long-Term Care
18 Ombudsman Council, shall, in cooperation with the Department
19 of Elderly Affairs shall, maintain a statewide uniform
20 reporting system to collect and analyze data relating to
21 complaints and conditions in long-term care facilities and to
22 residents, for the purpose of identifying and resolving
23 significant problems. The department and the State Long-Term
24 Care Ombudsman Council shall submit such data as part of its
25 annual report required pursuant to s. 400.0067(2)(g) to the
26 Agency for Health Care Administration, the Department of
27 Children and Family Services, the Florida Statewide Advocacy
28 Council, the Advocacy Center for Persons with Disabilities,
29 the Commissioner for the United States Administration on
30 Aging, the National Ombudsman Resource Center, and any other
31 state or federal entities that the ombudsman determines
26
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 appropriate. The State Long-Term Care Ombudsman Council shall
2 publish quarterly and make readily available information
3 pertaining to the number and types of complaints received by
4 the long-term care ombudsman program.
5 Section 19. Section 400.0091, Florida Statutes, is
6 amended to read:
7 400.0091 Training.--The ombudsman shall provide
8 appropriate training to all employees of the Office of State
9 Long-Term Care Ombudsman and to the state and local long-term
10 care ombudsman councils, including all unpaid volunteers. All
11 volunteers and appropriate employees of the Office of the
12 State Long-Term Care Ombudsman must be given a minimum of 20
13 hours of training upon employment or enrollment as a volunteer
14 and 10 hours of continuing education annually thereafter.
15 Training must cover, at a minimum, guardianships and powers of
16 attorney, medication administration, care and medication of
17 residents with dementia and Alzheimer's disease, accounting
18 for residents' funds, discharge rights and responsibilities,
19 and cultural sensitivity. No employee, officer, or
20 representative of the office or of the state or local
21 long-term care ombudsman councils, other than the ombudsman,
22 may carry out any authorized ombudsman duty or responsibility
23 unless the person has received the training required by this
24 section and has been approved by the ombudsman as qualified to
25 carry out ombudsman activities on behalf of the office or the
26 state or local long-term care ombudsman councils.
27 Section 20. Paragraph (d) of subsection (5) of section
28 400.179, Florida Statutes, is amended to read:
29 400.179 Sale or transfer of ownership of a nursing
30 facility; liability for Medicaid underpayments and
31 overpayments.--
27
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (5) Because any transfer of a nursing facility may
2 expose the fact that Medicaid may have underpaid or overpaid
3 the transferor, and because in most instances, any such
4 underpayment or overpayment can only be determined following a
5 formal field audit, the liabilities for any such underpayments
6 or overpayments shall be as follows:
7 (d) Where the transfer involves a facility that has
8 been leased by the transferor:
9 1. The transferee shall, as a condition to being
10 issued a license by the agency, acquire, maintain, and provide
11 proof to the agency of a bond with a term of 30 months,
12 renewable annually, in an amount not less than the total of 3
13 months Medicaid payments to the facility computed on the basis
14 of the preceding 12-month average Medicaid payments to the
15 facility.
16 2. The leasehold operator may meet the bond
17 requirement through other arrangements acceptable to the
18 department.
19 3. All existing nursing facility licensees, operating
20 the facility as a leasehold, shall acquire, maintain, and
21 provide proof to the agency of the 30-month bond required in
22 subparagraph 1., above, on and after July 1, 1993, for each
23 license renewal.
24 4. It shall be the responsibility of all nursing
25 facility operators, operating the facility as a leasehold, to
26 renew the 30-month bond and to provide proof of such renewal
27 to the agency annually at the time of application for license
28 renewal.
29 5. Any failure of the nursing facility operator to
30 acquire, maintain, renew annually, or provide proof to the
31 agency shall be grounds for the agency to deny, cancel,
28
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 revoke, or suspend the facility license to operate such
2 facility and to take any further action, including, but not
3 limited to, enjoining the facility, asserting a moratorium, or
4 applying for a receiver, deemed necessary to ensure compliance
5 with this section and to safeguard and protect the health,
6 safety, and welfare of the facility's residents. A lease
7 agreement required as a condition of bond financing or
8 refinancing under s. 154.213 by a health facilities authority
9 or required under s. 159.30 by a county or municipality is not
10 a leasehold for purposes of this paragraph and is not subject
11 to the bond requirement of this paragraph.
12 Section 21. Section 627.9408, Florida Statutes, is
13 amended to read:
14 627.9408 Rules.--
15 (1) The department has authority to adopt rules
16 pursuant to ss. 120.536(1) and 120.54 to implement the
17 provisions of this part.
18 (2) The department may adopt by rule the provisions of
19 the Long-Term Care Insurance Model Regulation adopted by the
20 National Association of Insurance Commissioners in the second
21 quarter of the year 2000 which are not in conflict with the
22 Florida Insurance Code.
23 Section 22. This act shall take effect July 1, 2002.
24
25
26 ================ T I T L E A M E N D M E N T ===============
27 And the title is amended as follows:
28 remove: the entire title
29
30 and insert:
31 A bill to be entitled
29
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 An act relating to long-term care; creating s.
2 409.221, F.S.; creating the "Florida
3 Consumer-Directed Care Act"; providing
4 legislative findings; providing legislative
5 intent; establishing the consumer-directed care
6 program; providing for consumer selection of
7 certain long-term care services and providers;
8 providing for interagency agreements among the
9 Agency for Health Care Administration and the
10 Department of Elderly Affairs, the Department
11 of Health, and the Department of Children and
12 Family Services; providing for program
13 eligibility and enrollment; providing
14 definitions; providing for consumer budget
15 allowances and purchasing guidelines;
16 specifying authorized services; providing roles
17 and responsibilities of consumers, the agency
18 and departments, and fiduciary intermediaries;
19 providing background screening requirements for
20 persons who render care under the program;
21 providing rulemaking authority of the agency
22 and departments; requiring the agency to apply
23 for federal waivers as necessary; requiring
24 ongoing program reviews and annual reports;
25 providing legislative findings and intent with
26 respect to the needs of the state's elderly
27 population; requiring the Agency for Health
28 Care Administration and the Department of
29 Elderly Affairs to submit a plan to the
30 Governor and Legislature for reducing nursing
31 home bed days funded under the Medicaid
30
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 program; amending s. 408.034, F.S.; providing
2 additional requirements for the Agency for
3 Health Care Administration in determining the
4 need for additional nursing facility beds;
5 amending s. 409.912, F.S.; authorizing the
6 Agency for Health Care Administration to
7 contract with vendors on a risk-sharing basis
8 for in-home physician services; requiring the
9 Agency for Health Care Administration to
10 establish a nursing facility preadmission
11 screening program through an interagency
12 agreement with the Department of Elderly
13 Affairs; requiring an annual report to the
14 Legislature and the Office of Long-Term Care
15 Policy; creating s. 430.041, F.S.; establishing
16 the Office of Long-Term Care Policy within the
17 Department of Elderly Affairs; requiring the
18 office to make recommendations for coordinating
19 the services provided by state agencies;
20 providing for the appointment of a director and
21 an advisory council to the Office of Long-Term
22 Care Policy; specifying membership and duties
23 of the director and advisory council; providing
24 for reimbursement of per diem and travel
25 expenses for members of the advisory council;
26 requiring that the office submit an annual
27 report to the Governor and Legislature;
28 requiring assistance to the office by state
29 agencies and universities; creating s.
30 430.7031, F.S.; requiring the Department of
31 Elderly Affairs and the Agency for Health Care
31
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Administration to implement a nursing home
2 transition program; providing requirements for
3 the program; amending ss. 409.908, 430.708, and
4 641.386, F.S., relating to reimbursement of
5 Medicaid providers, certificates of need, and
6 agent licensing and appointment; conforming
7 cross references to changes made by the act;
8 amending s. 20.41, F.S.; providing for
9 administration of the State Long-Term Care
10 Ombudsman Council by the Department of Elderly
11 Affairs; amending s. 400.0063, F.S.; locating
12 the Office of the State Long-Term Care
13 Ombudsman in the department; providing for
14 appointment of the ombudsman by the Secretary
15 of Elderly Affairs; amending s. 400.0065, F.S.;
16 requiring the secretary's approval of staff for
17 the local ombudsman councils; deleting
18 requirement that the ombudsman prepare an
19 annual legislative budget request; revising
20 rulemaking authority; amending s. 400.0067,
21 F.S.; revising duties of the State Long-Term
22 Care Ombudsman Council; providing duties of the
23 department and secretary; amending s. 400.0069,
24 F.S.; increasing the maximum membership of the
25 local long-term care ombudsman councils;
26 amending s. 400.0071, F.S.; revising procedures
27 relating to complaints; amending s. 400.0087,
28 F.S.; revising provisions relating to agency
29 oversight; amending s. 400.0089, F.S.; revising
30 reporting responsibilities; requiring the State
31 Long-Term Care Ombudsman Council to publish
32
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HOUSE AMENDMENT
705-165AXE-08 Bill No. HB 703, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 complaint information quarterly; amending s.
2 400.0091, F.S.; specifying training
3 requirements for employees of the Office of the
4 State Long-Term Care Ombudsman and its
5 volunteers; amending s. 400.179, F.S.;
6 providing an exemption from certain
7 requirements that the transferor of a nursing
8 facility maintain a bond; amending s. 627.9408,
9 F.S.; authorizing the department to adopt by
10 rule certain provisions of the Long-Term Care
11 Insurance Model Regulation, as adopted by the
12 National Association of Insurance
13 Commissioners; providing an effective date.
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
33
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