CODING: Words stricken are deletions; words underlined are additions.



                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)

                            CHAMBER ACTION
              Senate                               House
                                   .
                                   .
  1                                .
                                   .
  2                                .
                                   .
  3                                .
                                   .
  4  ______________________________________________________________

  5                                           ORIGINAL STAMP BELOW

  6

  7

  8

  9

10  ______________________________________________________________

11  Representative(s) Green offered the following:

12

13         Amendment (with title amendment) 

14  Remove everything after the enacting clause

15

16  and insert:

17         Section 1.  Subsection (4) of section 20.41, Florida

18  Statutes, is amended to read:

19         20.41  Department of Elderly Affairs.--There is created

20  a Department of Elderly Affairs.

21         (4)  The department shall administer administratively

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

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

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

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

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

27  compliance with the Older Americans Act.  The councils in

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

29  supervision, or direction by the department.

30         Section 2.  Subsection (1) and paragraph (b) of

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

                                  1

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  amended to read:

  2         400.0063  Establishment of Office of State Long-Term

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

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

  5  Ombudsman, which shall be located for administrative purposes

  6  in the Department of Elderly Affairs.

  7         (2)

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

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

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

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

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

13  in the designation of the ombudsman.

14         Section 3.  Paragraphs (c) and (f) of subsection (2)

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

16  amended to read:

17         400.0065  State Long-Term Care Ombudsman; duties and

18  responsibilities; conflict of interest.--

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

20  duty and authority to:

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

22  authorized and appropriated, employ such personnel, including

23  staff for local ombudsman councils, as are necessary to

24  perform adequately the functions of the office and provide or

25  contract for legal services to assist the state and local

26  ombudsman councils in the performance of their duties.  Staff

27  positions for each local ombudsman council may be established

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

29  ombudsman after approval by the secretary consultation with

30  the respective local ombudsman council.

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

                                  2

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  submitted to the Governor by the department for transmittal to

  2  the Legislature.

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

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

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

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

  7  service.

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

  9  of, a long-term care facility.

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

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

12  compensation agreement with the owner or operator of a

13  long-term care facility.

14

15  The Department of Elderly Affairs, in consultation with the

16  ombudsman, shall adopt rules to establish procedures to

17  identify and eliminate conflicts of interest as described in

18  this subsection.

19         Section 4.  Paragraphs (c), (d), (f), and (g) of

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

21  400.0067, Florida Statutes, are amended to read:

22         400.0067  Establishment of State Long-Term Care

23  Ombudsman Council; duties; membership.--

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

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

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

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

28  The Department of Elderly Affairs shall develop procedures,

29  relating to such investigations. Investigations may consist,

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

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

                                  3

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





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

  2  of long-term care facility residents and in developing

  3  procedures, in consultation with the Department of Elderly

  4  Affairs, relating to the receipt and resolution of such

  5  complaints. The secretary shall approve all such procedures.

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

  7  state government for such professional assistance as may be

  8  needed in the discharge of its duties, including assistance

  9  from the adult protective services program of the Department

10  of Children and Family Services.

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

12  activities carried out by the ombudsman and the State

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

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

15  Council shall submit the report to the Secretary of Elderly

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

17  Commissioner of the United States Administration on Aging, the

18  Governor, the President of the Senate, the Speaker of the

19  House of Representatives, the minority leaders of the House

20  and Senate, the chairpersons of appropriate House and Senate

21  committees, the Secretary of Secretaries of Elderly Affairs

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

23  Care Administration.  The report shall be submitted by the

24  Secretary of Elderly Affairs at least 30 days before the

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

26  at a minimum:

27         1.  Contain and analyze data collected concerning

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

29         2.  Evaluate the problems experienced by residents of

30  long-term care facilities.

31         3.  Contain recommendations for improving the quality

                                  4

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





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

  2  safety, welfare, and rights of the residents.

  3         4.  Analyze the success of the ombudsman program during

  4  the preceding year and identify the barriers that prevent the

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

  6  successes shall also address the relationship between the

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

  8  Elderly Affairs, the Agency for Health Care Administration,

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

10  assessment of how successfully the state long-term care

11  ombudsman program has carried out its responsibilities under

12  the Older Americans Act.

13         5.  Provide policy and regulatory and legislative

14  recommendations to solve identified problems; resolve

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

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

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

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

19         6.  Contain recommendations from the local ombudsman

20  councils regarding program functions and activities.

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

22  advocate and other legal advocates acting on behalf of the

23  local and state councils.

24         (3)

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

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

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

28  serving on a local council.

29         2.  The Governor shall appoint three members chosen

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

31  age.

                                  5

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





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

  2  60 days after the ombudsman submits the list, the ombudsman,

  3  in consultation with the secretary State Long-Term Care

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

  5  must be over 60 years of age.

  6         Section 5.  Subsection (1) of section 400.0071, Florida

  7  Statutes, is amended to read:

  8         400.0071  Complaint procedures.--

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

10  ombudsman and the secretary establish state and local

11  procedures for receiving complaints against a nursing home or

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

13  be implemented after the approval of the ombudsman and the

14  secretary.

15         Section 6.  Subsections (1) and (2) of section

16  400.0087, Florida Statutes, are amended to read:

17         400.0087  Agency oversight.--

18         (1)  The Department of Elderly Affairs shall monitor

19  the local ombudsman councils responsible for carrying out the

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

21  department, in consultation with the ombudsman and the State

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

23  establish the policies and procedures for the monitoring of

24  local ombudsman councils.

25         (2)  The department is responsible for ensuring that

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

27  annual report; provides information to public and private

28  agencies, legislators, and others; provides appropriate

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

30  local long-term care ombudsman councils; and coordinates

31  ombudsman services with the Advocacy Center for Persons with

                                  6

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  Disabilities and with providers of legal services to residents

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

  3  federal laws.

  4         Section 7.  Section 400.0089, Florida Statutes, is

  5  amended to read:

  6         400.0089  Agency reports.--The State Long-Term Care

  7  Ombudsman Council, shall, in cooperation with the Department

  8  of Elderly Affairs shall, maintain a statewide uniform

  9  reporting system to collect and analyze data relating to

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

11  residents, for the purpose of identifying and resolving

12  significant problems. The State Long-Term Care Ombudsman

13  Council shall submit such data as part of its annual report

14  required pursuant to s. 400.0067(2)(g) to the Agency for

15  Health Care Administration, the Department of Children and

16  Family Services, the Florida Statewide Advocacy Council, the

17  Advocacy Center for Persons with Disabilities, the

18  Commissioner for the United States Administration on Aging,

19  the National Ombudsman Resource Center, and any other state or

20  federal entities that the ombudsman determines appropriate.

21         Section 8.  Subsections (2) and (3) of section

22  400.0066, Florida Statutes, are repealed.

23         Section 9.  Section 409.221, Florida Statutes, is

24  created to read:

25         409.221  Consumer-directed care program.--

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

27  "Florida Consumer-Directed Care Act."

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

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

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

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

                                  7

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  services the opportunity to select the services they need and

  2  the providers they want, including family and friends,

  3  enhances their sense of dignity and autonomy. The Legislature

  4  also finds that providing consumers choice and control, as

  5  tested in current research and demonstration projects, has

  6  been beneficial and should be developed further and

  7  implemented statewide.

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

  9  Legislature to nurture the autonomy of those citizens of the

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

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

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

13  give such individuals more choices in and greater control over

14  the purchased long-term care services they receive.

15         (4)  CONSUMER-DIRECTED CARE.--

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

17  Administration shall establish the consumer-directed care

18  program which shall be based on the principles of consumer

19  choice and control. The agency shall implement the program

20  upon federal approval. The agency shall establish interagency

21  cooperative agreements with and shall work with the

22  Departments of Elderly Affairs, Health, and Children and

23  Family Services to implement and administer the program. The

24  program shall allow enrolled persons to choose the providers

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

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

27  within the funds appropriated by the Legislature.

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

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

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

31  designate an eligible representative, may choose to

                                  8

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  participate in the consumer-directed care program.

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

  3  term:

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

  5  available each month to a consumer to purchase needed

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

  7  needs assessment.

  8         2.  "Consultant" means an individual who provides

  9  technical assistance to consumers in meeting their

10  responsibilities under this section.

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

12  participate in the program, has met the enrollment

13  requirements, and has received an approved budget allowance.

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

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

16  budget allowance, retains the funds, processes employment

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

18  ensure correctness, writes paychecks to providers, and

19  delivers paychecks to the consumer for distribution to

20  providers and caregivers.

21         5.  "Provider" means:

22         a.  A person licensed or otherwise permitted to render

23  services eligible for reimbursement under this program for

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

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

26  is the employer of record.

27         6.  "Representative" means an uncompensated individual

28  designated by the consumer to assist in managing the

29  consumer's budget allowance and needed services.

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

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

                                  9

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  results of their assessed functional needs and the financial

  2  resources of the program. Consumers shall receive the budget

  3  allowance directly from an agency-approved fiscal

  4  intermediary. Each department shall develop purchasing

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

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

  7  services.

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

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

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

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

12  are not limited to, the following:

13         1.  Personal care.

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

15  shopping, and transportation.

16         3.  Home modifications and assistive devices which may

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

18  avoid institutional placement.

19         4.  Assistance in taking self-administered medication.

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

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

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

23  400.554.

24         6.  Personal care and support services provided in an

25  assisted living facility.

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

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

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

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

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

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

                                  10

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  are not limited to, the following:

  2         a.  Developing a job description.

  3         b.  Selecting caregivers and submitting information for

  4  the background screening as required in s. 435.05.

  5         c.  Communicating needs, preferences, and expectations

  6  about services being purchased.

  7         d.  Providing the fiscal intermediary with all

  8  information necessary for provider payments and tax

  9  requirements.

10         e.  Ending the employment of an unsatisfactory

11  caregiver.

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

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

14  are not limited to, the following:

15         a.  Communicating needs, preferences, and expectations

16  about services being purchased.

17         b.  Ending the services of an unsatisfactory provider.

18         c.  Providing the fiscal agent with all information

19  necessary for provider payments and tax requirements.

20         (g)  Agency and departments roles and

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

22  responsibilities include, but are not limited to, the

23  following:

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

25  with the service plan, and providing ongoing assistance with

26  the service plan.

27         2.  Offering the services of consultants who shall

28  provide training, technical assistance, and support to the

29  consumer.

30         3.  Completing the background screening for providers.

31         4.  Approving fiscal intermediaries.

                                  11

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  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, reviewing records

11  to ensure correctness, writing paychecks to providers, and

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

27  this section:

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

29  Health, and Children and Family Services are authorized to

30  adopt and enforce rules.

31         2.  The agency shall take all necessary action to

                                  12

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  ensure state compliance with federal regulations. The agency

  2  shall apply for any necessary federal waivers or waiver

  3  amendments needed to implement the program.

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

  5  Departments of Elderly Affairs, Health, and Children and

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

  7  assess the implementation of the consumer-directed care

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

  9  written report to the Legislature that includes each

10  department's review of the program and contains

11  recommendations for improvements to the program.

12         Section 10.  (1)  Prior to December 1, 2002, the Agency

13  for Health Care Administration in consultation with the

14  Department of Elderly Affairs shall submit to the Governor,

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

16  Representatives a plan to reduce the number of nursing home

17  bed days purchased by the state Medicaid program and to

18  replace such nursing home care with care provided in less

19  costly alternative settings.

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

21  Medicaid-funded bed days and recommend specific statutory and

22  operational changes necessary to achieve such reduction.

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

24  cost-effectiveness and the relative strengths and weaknesses

25  of programs that serve as alternatives to nursing homes.

26         Section 11.  Paragraph (d) of subsection (5) of section

27  400.179, Florida Statutes, is amended to read:

28         400.179  Sale or transfer of ownership of a nursing

29  facility; liability for Medicaid underpayments and

30  overpayments.--

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

                                  13

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  expose the fact that Medicaid may have underpaid or overpaid

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

  3  underpayment or overpayment can only be determined following a

  4  formal field audit, the liabilities for any such underpayments

  5  or overpayments shall be as follows:

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

  7  been leased by the transferor:

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

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

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

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

12  months Medicaid payments to the facility computed on the basis

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

14  facility.

15         2.  The leasehold operator may meet the bond

16  requirement through other arrangements acceptable to the

17  department.

18         3.  All existing nursing facility licensees, operating

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

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

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

22  license renewal.

23         4.  It shall be the responsibility of all nursing

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

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

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

27  renewal.

28         5.  Any failure of the nursing facility operator to

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

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

31  revoke, or suspend the facility license to operate such

                                  14

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





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

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

  3  applying for a receiver, deemed necessary to ensure compliance

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

  5  safety, and welfare of the facility's residents.

  6

  7  However, notwithstanding any provision of this section to the

  8  contrary, a lease agreement required as a condition of bond

  9  financing or refinancing under s. 154.213 by a health

10  facilities authority or under s. 159.30 by a county or

11  municipality is not considered to be a leasehold and,

12  therefore, is not subject to the bond requirements of this

13  paragraph.

14         Section 12.  Section 408.034, Florida Statutes, is

15  amended to read:

16         408.034  Duties and responsibilities of agency;

17  rules.--

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

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

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

21  review in accordance with the district plans and present and

22  future federal and state statutes.  The agency is designated

23  as the state health planning agency for purposes of federal

24  law.

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

26  to health care facilities and health service providers, as

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

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

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

30  health care facility which fails to receive a certificate of

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

                                  15

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





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

  2  methodologies for health services and health facilities. In

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

  4  minimum, consider the demographic characteristics of the

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

  6  patterns, standards and trends, geographic accessibility, and

  7  market economics.

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

  9  additional community nursing facility beds in any area of the

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

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

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

13  shall examine nursing home placement patterns and demographic

14  patterns of persons entering nursing homes and the

15  availability of and effectiveness of existing home-based and

16  community-based service delivery systems at meeting the

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

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

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

20  delivery systems to lessen the need for additional nursing

21  facility beds.

22         (5)(4)  The agency shall establish by rule a

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

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

25  agency establishes pilot community diversion programs through

26  the Title XIX aging waiver program.

27         (6)(5)  The agency may adopt rules necessary to

28  implement ss. 408.031-408.045.

29         Section 13.  Present subsections (13) through (39) of

30  section 409.912, Florida Statutes, are renumbered as

31  subsections (14) through (40), respectively, and subsection

                                  16

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  (13) is added to said section, to read:

  2         409.912  Cost-effective purchasing of health care.--The

  3  agency shall purchase goods and services for Medicaid

  4  recipients in the most cost-effective manner consistent with

  5  the delivery of quality medical care.  The agency shall

  6  maximize the use of prepaid per capita and prepaid aggregate

  7  fixed-sum basis services when appropriate and other

  8  alternative service delivery and reimbursement methodologies,

  9  including competitive bidding pursuant to s. 287.057, designed

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

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

12  minimize the exposure of recipients to the need for acute

13  inpatient, custodial, and other institutional care and the

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

15  agency may establish prior authorization requirements for

16  certain populations of Medicaid beneficiaries, certain drug

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

18  and possible dangerous drug interactions. The Pharmaceutical

19  and Therapeutics Committee shall make recommendations to the

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

21  agency shall inform the Pharmaceutical and Therapeutics

22  Committee of its decisions regarding drugs subject to prior

23  authorization.

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

25  Assessment and Review (CARES) nursing facility preadmission

26  screening program to ensure that Medicaid payment for nursing

27  facility care is made only for individuals whose conditions

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

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

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

31  CARES program shall also ensure that individuals participating

                                  17

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  in Medicaid home and community-based waiver programs meet

  2  criteria for those programs, consistent with approved federal

  3  waivers.

  4         (b)  The agency may operate the CARES program using its

  5  own staff or may contract with another state agency or other

  6  provider. If the agency contracts for the operation of the

  7  program, the agency must maintain policy control of all

  8  operations of the program, including the criteria applied and

  9  forms used, and perform regular monitoring to ensure effective

10  and efficient operation of the program and ensure that the

11  operation of the program is consistent with state and federal

12  law and rules.

13         (c)  The agency shall develop performance standards for

14  the CARES program.

15         (d)  Prior to making payment for nursing facility

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

17  the nursing facility preadmission screening program has

18  determined that the individual requires nursing facility care

19  and that the individual cannot be safely served in

20  community-based programs. The nursing facility preadmission

21  screening program shall refer a Medicaid recipient to a

22  community-based program if the individual could be safely

23  served at a lower cost and the recipient chooses to

24  participate in such program.

25         (e)  By January 1 of each year, the agency shall submit

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

27  Policy describing the operations of the CARES program. The

28  report must describe:

29         1.  Rate of diversion to community alternative

30  programs.

31         2.  CARES program staffing needs to achieve additional

                                  18

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  diversions.

  2         3.  Reasons the program is unable to place individuals

  3  in less restrictive settings when such individuals desired

  4  such services and could have been served in such settings.

  5         4.  Barriers to appropriate placement, including

  6  barriers due to policies or operations of other agencies or

  7  state-funded programs.

  8         5.  Statutory changes necessary to ensure that

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

10  the least restrictive environment.

11         Section 14.  Section 430.03, Florida Statutes, is

12  amended to read:

13         430.03  Purposes.--The purposes of the Department of

14  Elderly Affairs are to:

15         (1)  Serve as the primary state agency responsible for

16  administering human services programs for the elderly and for

17  developing policy recommendations for long-term care.

18         (2)  Combat ageism and create public awareness and

19  understanding of the potentials and needs of elderly persons.

20         (3)  Study and plan for programs and services to meet

21  identified and projected needs and to provide opportunities

22  for personal development and achievement of persons aged 60

23  years and older.

24         (4)  Advocate quality programs and services for the

25  state's elderly population and on behalf of the individual

26  citizen's needs.

27         (5)  Coordinate interdepartmental policy development

28  and program planning for all state agencies that provide

29  services for the elderly population in order to prevent

30  duplicative efforts, to maximize utilization of resources, and

31  to ensure cooperation, communication, and departmental

                                  19

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  linkages.

  2         (6)  Recommend state and local level organizational

  3  models for the planning, coordination, implementation, and

  4  evaluation of programs serving the elderly population.

  5         (5)(7)  Oversee implementation of federally funded and

  6  state-funded programs and services for the state's elderly

  7  population.

  8         (6)(8)  Recommend legislative budget requests for

  9  programs and services for the state's elderly population.

10         (7)(9)  Serve as a state-level information

11  clearinghouse and encourage the development of local-level

12  identifiable points of information and referral regarding all

13  federal, state, and local resources of assistance to elderly

14  citizens.

15         (8)(10)  Assist elderly persons to secure needed

16  services in accordance with personal choice and in a manner

17  that achieves or maintains autonomy and prevents, reduces, or

18  eliminates dependency.

19         (9)(11)  Promote the maintenance and improvement of the

20  physical well-being and mental health of elderly persons.

21         (10)(12)  Promote opportunities for volunteerism among

22  the elderly population.

23         (11)(13)  Promote the prevention of neglect, abuse, or

24  exploitation of elderly persons unable to protect their own

25  interests.

26         (12)(14)  Eliminate and prevent inappropriate

27  institutionalization of elderly persons by promoting

28  community-based care, home-based care, or other forms of less

29  intensive care.

30         (13)(15)  Aid in the support of families and other

31  caregivers of elderly persons.

                                  20

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         (14)(16)  Promote intergenerational relationships.

  2         (17)  Oversee aging research conducted or funded by any

  3  state agency to ensure that such activities are coordinated

  4  and directed to fulfill the intent and purposes of this act.

  5         Section 15.  Section 430.04, Florida Statutes, is

  6  amended to read:

  7         430.04  Duties and responsibilities of the Department

  8  of Elderly Affairs.--The Department of Elderly Affairs shall:

  9         (1)  Administer human services and long-term care

10  programs, including programs funded under the federal Older

11  Americans Act of 1965, as amended, and other programs that are

12  assigned to it by law.

13         (2)  Be responsible for ensuring that each area agency

14  on aging operates in a manner to ensure that the elderly of

15  this state receive the best services possible.  The department

16  shall rescind designation of an area agency on aging or take

17  intermediate measures against the agency, including corrective

18  action, unannounced special monitoring, temporary assumption

19  of operation of one or more programs by the department,

20  placement on probationary status, imposing a moratorium on

21  agency action, imposing financial penalties for

22  nonperformance, or other administrative action pursuant to

23  chapter 120, if the department finds that:

24         (a)  An intentional or negligent act of the agency has

25  materially affected the health, welfare, or safety of clients,

26  or substantially and negatively affected the operation of an

27  aging services program.

28         (b)  The agency lacks financial stability sufficient to

29  meet contractual obligations or that contractual funds have

30  been misappropriated.

31         (c)  The agency has committed multiple or repeated

                                  21

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  violations of legal and regulatory requirements or department

  2  standards.

  3         (d)  The agency has failed to continue the provision or

  4  expansion of services after the declaration of a state of

  5  emergency.

  6         (e)  The agency has failed to adhere to the terms of

  7  its contract with the department.

  8         (f)  The agency has failed to implement and maintain a

  9  department-approved client grievance resolution procedure.

10         (3)  Prepare and submit the state plan as required by

11  the United States Administration on Aging. to the Governor,

12  each Cabinet member, the President of the Senate, the Speaker

13  of the House of Representatives, the minority leaders of the

14  House and Senate, and chairpersons of appropriate House and

15  Senate committees a master plan for policies and programs in

16  the state related to aging. The plan must identify and assess

17  the needs of the elderly population in the areas of housing,

18  employment, education and training, medical care, long-term

19  care, preventive care, protective services, social services,

20  mental health, transportation, and long-term care insurance,

21  and other areas considered appropriate by the department.  The

22  plan must assess the needs of particular subgroups of the

23  population and evaluate the capacity of existing programs,

24  both public and private and in state and local agencies, to

25  respond effectively to identified needs.  If the plan

26  recommends the transfer of any program or service from the

27  Department of Children and Family Services to another state

28  department, the plan must also include recommendations that

29  provide for an independent third-party mechanism, as currently

30  exists in the Florida advocacy councils established in ss.

31  402.165 and 402.166, for protecting the constitutional and

                                  22

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  human rights of recipients of departmental services. The plan

  2  must include policy goals and program strategies designed to

  3  respond efficiently to current and projected needs. The plan

  4  must also include policy goals and program strategies to

  5  promote intergenerational relationships and activities.

  6  Public hearings and other appropriate processes shall be

  7  utilized by the department to solicit input for the

  8  development and updating of the master plan from parties

  9  including, but not limited to, the following:

10         (a)  Elderly citizens and their families and

11  caregivers.

12         (b)  Local-level public and private service providers,

13  advocacy organizations, and other organizations relating to

14  the elderly.

15         (c)  Local governments.

16         (d)  All state agencies that provide services to the

17  elderly.

18         (e)  University centers on aging.

19         (f)  Area agency on aging and community care for the

20  elderly lead agencies.

21         (4)  Serve as an information clearinghouse at the state

22  level, and assist local-level information and referral

23  resources as a repository and means for dissemination of

24  information regarding all federal, state, and local resources

25  for assistance to the elderly in the areas of, but not limited

26  to, health, social welfare, long-term care, protective

27  services, consumer protection, education and training,

28  housing, employment, recreation, transportation, insurance,

29  and retirement.

30         (5)  Recommend guidelines for the development of roles

31  for state agencies that provide services for the aging, review

                                  23

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  plans of agencies that provide such services, and relay these

  2  plans to the Governor, each Cabinet member, the President of

  3  the Senate, the Speaker of the House of Representatives, the

  4  minority leaders of the House and Senate, and chairpersons of

  5  appropriate House and Senate committees.

  6         (6)  Recommend to the Governor, each Cabinet member,

  7  the President of the Senate, the Speaker of the House of

  8  Representatives, the minority leaders of the House and Senate,

  9  and chairpersons of appropriate House and Senate committees an

10  organizational framework for the planning, coordination,

11  implementation, and evaluation of programs related to aging,

12  with the purpose of expanding and improving programs and

13  opportunities available to the state's elderly population and

14  enhancing a continuum of long-term care.  This framework must

15  assure that:

16         (a)  Performance objectives are established.

17         (b)  Program reviews are conducted statewide.

18         (c)  Each major program related to aging is reviewed

19  every 3 years.

20         (d)  Agency budget requests reflect the results and

21  recommendations of such program reviews.

22         (e)  Program decisions lead to the distinctive roles

23  established for state agencies that provide aging services.

24         (7)  Advise the Governor, each Cabinet member, the

25  President of the Senate, the Speaker of the House of

26  Representatives, the minority leaders of the House and Senate,

27  and the chairpersons of appropriate House and Senate

28  committees regarding the need for and location of programs

29  related to aging.

30         (8)  Review and coordinate aging research plans of all

31  state agencies to ensure the conformance of research

                                  24

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  objectives to issues and needs addressed in the master plan

  2  for policies and programs related to aging.  The research

  3  activities that must be reviewed and coordinated by the

  4  department include, but are not limited to, contracts with

  5  academic institutions, development of educational and training

  6  curriculums, Alzheimer's disease and other medical research,

  7  studies of long-term care and other personal assistance needs,

  8  and design of adaptive or modified living environments.

  9         (9)  Review budget requests for programs related to

10  aging for compliance with the master plan for policies and

11  programs related to aging before submission to the Governor

12  and the Legislature.

13         (10)  Update the master plan for policies and programs

14  related to aging every 3 years.

15         (11)  Review implementation of the master plan for

16  programs and policies related to aging and annually report to

17  the Governor, each Cabinet member, the President of the

18  Senate, the Speaker of the House of Representatives, the

19  minority leaders of the House and Senate, and the chairpersons

20  of appropriate House and Senate committees the progress

21  towards implementation of the plan.

22         (12)  Request other departments that administer

23  programs affecting the state's elderly population to amend

24  their plans, rules, policies, and research objectives as

25  necessary to conform with the master plan for policies and

26  programs related to aging.

27         (5)(13)  Hold public meetings regularly throughout the

28  state for purposes of receiving information and maximizing the

29  visibility of important issues.

30         (6)(14)  Conduct policy analysis and program evaluation

31  studies assigned by the Legislature.

                                  25

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         (7)(15)  Assist the Governor, each Cabinet member, the

  2  President of the Senate, the Speaker of the House of

  3  Representatives, the minority leaders of the House and Senate,

  4  and the chairpersons of appropriate House and Senate

  5  committees in the conduct of their responsibilities in such

  6  capacities as they consider appropriate.

  7         (8)(16)  Call upon appropriate agencies of state

  8  government for such assistance as is needed in the discharge

  9  of its duties. All agencies shall cooperate in assisting the

10  department in carrying out its responsibilities as prescribed

11  by this section. However, no provision of law with respect to

12  confidentiality of information may be violated.

13         Section 16.  Section 430.041, Florida Statutes, is

14  created to read:

15         430.041  Office of Long-Term Care Policy.--

16         (1)  There is established within the Department of

17  Elderly Affairs the Office of Long-Term Care Policy to analyze

18  the state's long-term care system and increase the

19  availability and the use of noninstitutional settings to

20  provide care to the elderly and to ensure coordination among

21  the agencies responsible for the long-term care continuum. The

22  Department of Elderly Affairs shall provide administrative

23  support and service to the Office of Long-Term Care Policy.

24  The office is not subject to control, supervision, or

25  direction by the Department of Elderly Affairs in the

26  performance of its duties.

27         (2)  The Office of Long-Term Care Policy shall:

28         (a)  Ensure close communication and coordination among

29  state agencies involved in developing and administering a more

30  efficient and coordinated long-term care service delivery

31  system in this state.

                                  26

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         (b)  Ensure that state agencies involved in developing

  2  long-term care policy have considered the preferences of

  3  consumers, providers, and local elected officials.

  4         (c)  Study and plan for programs to meet identified and

  5  projected needs of people who need long-term care.

  6         (d)  Develop a State Long-Term Care Plan and policy

  7  recommendations to ensure that appropriate long-term care is

  8  available in institutional and community-based settings.

  9         (e)  Update the State Long-Term Care Plan every 3

10  years.

11         (f)  Recommend state and local organizational models

12  for the planning, coordination, implementation, and evaluation

13  of programs serving people with long-term care needs.

14         (g)  Make recommendations to agencies for budget

15  requests for long-term care programs to ensure consistency

16  with the State Long-Term Care Plan.

17         (h)  Develop and recommend strategies for ensuring

18  compliance with all federal requirements regarding access to

19  and choice of services and providers.

20         (i)  Identify duplication and unnecessary service

21  provision in the long-term care system and make

22  recommendations to decrease inappropriate service provision.

23         (j)  Make recommendations to increase consistency in

24  administering the state's long-term care programs.

25         (k)  Ensure regular periodic evaluations of all

26  programs providing long-term care services to determine

27  whether the programs are cost-effective, of high quality,

28  operating efficiently, and consistent with state policy.

29         (l)  Monitor characteristics of people applying for and

30  entering institutional and community-based long-term care, and

31  changes to these characteristics over time, to determine the

                                  27

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  reasons and causes for changing levels of state expenditures

  2  and to determine services that the state's system of

  3  community-based care could provide to lessen the need for

  4  facility-based care.

  5         (m)  Recommend changes to the preadmission screening

  6  system of state nursing homes to ensure that individuals in

  7  need of long-term care are served in settings most appropriate

  8  to their needs.

  9         (n)  Recommend mechanisms to encourage families and

10  other caregivers to assist people in need of long-term care

11  services to remain as independent as possible.

12         (o)  Analyze waiting lists for long-term care services

13  and recommend strategies to reduce the time applicants wait

14  for services.

15         (p)  Oversee research on aging conducted or funded by

16  any state agency to ensure that such research is coordinated

17  and directed to fulfill the intent and purposes of this act.

18         (3)  The director of the Office of Long-Term Care

19  Policy shall be appointed by and serve at the pleasure of the

20  Governor. The director of the Office of Long-Term Care Policy

21  shall report to the Governor.

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

23  advisory board, whose chair is to be selected by the board.

24  The board shall consist of:

25         (a)  A member of the Senate, appointed by the President

26  of the Senate.

27         (b)  A member of the House of Representatives,

28  appointed by the Speaker of the House of Representatives.

29         (c)  The Secretary of Health Care Administration.

30         (d)  The Secretary of Elderly Affairs.

31         (e)  The state Medicaid Director.

                                  28

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         (f)  Two representatives of providers of long-term care

  2  services for elderly persons, appointed by the Governor.

  3         (g)  Two representatives of people receiving long-term

  4  care services, appointed by the Governor from groups

  5  representing elderly persons.

  6         (5)  Members of the advisory board shall serve without

  7  compensation, but are entitled to receive reimbursement for

  8  travel and per diem as provided in s. 112.061.

  9         (6)  The advisory board shall meet at least monthly or

10  more often at the call of its chair or at the request of a

11  majority of its members.

12         (7)  The office shall submit a report of its policy,

13  legislative, and funding recommendations to the Governor and

14  the Legislature by January 1 of each year.

15         (8)  Personnel who are solely under the direction of

16  the Office of Long-Term Care Policy shall be provided by the

17  Agency for Health Care Administration and the Department of

18  Elderly Affairs. The office shall call upon appropriate

19  agencies of state government, including the centers on aging

20  in the State University System, for assistance needed in

21  discharging its duties. All agencies shall assist the office

22  in carrying out its responsibilities prescribed by this

23  section.

24         Section 17.  Section 430.7031, Florida Statutes, is

25  created to read:

26         430.7031  Nursing home transition program.--The

27  department and the Agency for Health Care Administration:

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

29  assist individuals residing in nursing homes to regain

30  independence and to move to less costly settings.

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

                                  29

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  nursing home residents who are able to move to community

  2  placements, and to provide case management and supportive

  3  services to such individuals while they are in nursing homes

  4  to assist such individuals in moving to less expensive and

  5  less restrictive settings.

  6         (3)  Shall modify existing service delivery systems or

  7  develop new service delivery systems to economically and

  8  efficiently meet such individuals' care needs.

  9         (4)  Shall offer such individuals priority placement

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

11  programs, and shall ensure that funds are available to provide

12  services to individuals to whom services are offered.

13         (5)  May seek federal waivers necessary to administer

14  this section.

15         Section 18.  Subsection (4) of section 409.908, Florida

16  Statutes, is amended to read:

17         409.908  Reimbursement of Medicaid providers.--Subject

18  to specific appropriations, the agency shall reimburse

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

20  according to methodologies set forth in the rules of the

21  agency and in policy manuals and handbooks incorporated by

22  reference therein.  These methodologies may include fee

23  schedules, reimbursement methods based on cost reporting,

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

25  and other mechanisms the agency considers efficient and

26  effective for purchasing services or goods on behalf of

27  recipients.  Payment for Medicaid compensable services made on

28  behalf of Medicaid eligible persons is subject to the

29  availability of moneys and any limitations or directions

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

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

                                  30

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





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

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

  3  making any other adjustments necessary to comply with the

  4  availability of moneys and any limitations or directions

  5  provided for in the General Appropriations Act, provided the

  6  adjustment is consistent with legislative intent.

  7         (4)  Subject to any limitations or directions provided

  8  for in the General Appropriations Act, alternative health

  9  plans, health maintenance organizations, and prepaid health

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

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

12  prospectively paid to the provider monthly for each Medicaid

13  recipient enrolled.  The amount may not exceed the average

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

15  claims experience, for recipients in the same or similar

16  category of eligibility.  The agency shall calculate

17  capitation rates on a regional basis and, beginning September

18  1, 1995, shall include age-band differentials in such

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

20  statutory teaching hospitals, specialty hospitals, and

21  community hospital education program hospitals from

22  reimbursement ceilings and the cost of special Medicaid

23  payments shall not be included in premiums paid to health

24  maintenance organizations or prepaid health care plans. Each

25  rate semester, the agency shall calculate and publish a

26  Medicaid hospital rate schedule that does not reflect either

27  special Medicaid payments or the elimination of rate

28  reimbursement ceilings, to be used by hospitals and Medicaid

29  health maintenance organizations, in order to determine the

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

31  409.9128(5), and 641.513(6).

                                  31

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         Section 19.  Section 430.708, Florida Statutes, is

  2  amended to read:

  3         430.708  Certificate of need.--To ensure that Medicaid

  4  community diversion pilot projects result in a reduction in

  5  the projected average monthly nursing home caseload, the

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

  7  408.034(5) s. 408.034(4):

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

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

10  pilot project areas.

11         (2)  Reduce the conditions imposed on existing nursing

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

13  number of projected community diversion slots.

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

15  Medicaid-participating nursing homes eligible for Medicaid,

16  through a Medicaid-selective contracting process or some other

17  appropriate method.

18         (4)  Determine the feasibility of increasing the

19  nursing home occupancy threshold used in determining nursing

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

21         Section 20.  Subsection (4) of section 641.386, Florida

22  Statutes, is amended to read:

23         641.386  Agent licensing and appointment required;

24  exceptions.--

25         (4)  All agents and health maintenance organizations

26  shall comply with and be subject to the applicable provisions

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

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

29  when marketing for any health maintenance organization

30  licensed pursuant to this part, including those organizations

31  under contract with the Agency for Health Care Administration

                                  32

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  to provide health care services to Medicaid recipients or any

  2  private entity providing health care services to Medicaid

  3  recipients pursuant to a prepaid health plan contract with the

  4  Agency for Health Care Administration.

  5         Section 21.  By July 1, 2002, the Agency for Health

  6  Care Administration shall solicit two private nursing homes,

  7  one for-profit and one not-for-profit, in two different

  8  geographic areas of the state to participate in a 1-year pilot

  9  project to demonstrate the use of electronic monitoring

10  equipment in nursing homes licensed under part II of chapter

11  400, Florida Statutes. If no nursing homes volunteer, the

12  agency shall select the two facilities with the lowest rank in

13  quality-of-care performance under s. 400.191, Florida

14  Statutes, and applicable rules. This selection shall not be

15  subject to review or challenge. If more than two nursing homes

16  apply, the Agency for Health Care Administration shall select

17  two nursing homes, the one with the highest ranking and the

18  one with the lowest ranking in quality-of-care performance

19  under s. 400.191, Florida Statutes, and applicable rules.

20         (1)  The nursing homes that participate in the pilot

21  project shall develop policies and procedures that permit each

22  resident or, if appropriate, the resident's legal

23  representative, to request electronic monitoring of the

24  resident's room. The nursing homes that participate in the

25  pilot project shall also install equipment to electronically

26  monitor and shall monitor activities in common areas of the

27  facility. The policies and procedures must include steps to

28  address the privacy and dignity of residents, roommates, and

29  visitors.

30         (2)  The request for electronic monitoring of a

31  resident's room must be in writing and signed by the resident

                                  33

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  or the resident's representative.

  2         (a)  If a resident has the capacity to request

  3  electronic monitoring and has not been judicially declared to

  4  lack the required capacity, only the resident may request the

  5  electronic monitoring, notwithstanding the terms of any

  6  durable power of attorney or similar instrument.

  7         (b)  If a resident has been judicially declared to lack

  8  the capacity required to request electronic monitoring, only

  9  the guardian of the resident may request electronic

10  monitoring.

11         (c)  If a resident does not have the capacity to

12  request electronic monitoring and has not been judicially

13  declared to lack the required capacity, the resident's

14  physician may make the determination regarding the capacity of

15  the resident to request electronic monitoring and must

16  document the determination in the resident's clinical record.

17  In that case, only the legal representative of the resident

18  may request the electronic monitoring. A person from the

19  following list, in order of priority, may act as the

20  resident's legal representative for the limited purpose of

21  requesting electronic monitoring of the resident's room.

22         1.  A person named in the resident's medical power of

23  attorney or other advance directive.

24         2.  The resident's spouse.

25         3.  An adult child of the resident who has the waiver

26  and consent of all other qualified adult children of the

27  resident to act as the sole decision-maker.

28         4.  A majority of the resident's reasonably available

29  adult children.

30         5.  The resident's parents.

31         6.  The individual clearly identified as suitable to

                                  34

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  act for the resident by the resident before the resident

  2  became incapacitated or the resident's nearest living

  3  relative.

  4         (3)  A resident, or resident's legal representative,

  5  who wishes to conduct electronic monitoring must obtain the

  6  written, signed consent of other residents in the room. The

  7  written consent must be submitted to the administrator of the

  8  nursing home or his or her designee.

  9         (a)  Consent of other residents may be given only by:

10         1.  The other resident or residents in the room;

11         2.  The guardian of the other resident, if the resident

12  has been judicially declared to lack the required capacity; or

13         3.  The legal representative of the other resident,

14  determined by following the same procedure established under

15  (2)(c).

16         (b)  Another resident in the room may condition consent

17  on:

18         1.  Pointing the camera away from the consenting

19  resident, when the proposed electronic monitoring device is a

20  video surveillance camera; and

21         2.  Limiting or prohibiting the use of an audio

22  electronic monitoring device.

23         (c)  Electronic monitoring must be conducted in

24  accordance with any limitations placed on the monitoring as a

25  condition of the consent given by or on behalf of another

26  resident of the room.

27         (4)  When the request for electronic monitoring and all

28  required consents have been given to the nursing home

29  administrator or his or her designee, electronic monitoring

30  may begin. If electronic monitoring is being conducted in a

31  resident's room, and another resident is moved into the room

                                  35

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  who has not yet consented to electronic monitoring, the

  2  monitoring must cease until the new resident, or the

  3  resident's legal representative, consents.

  4         (5)  Anyone conducting electronic monitoring must post

  5  and maintain a conspicuous notice at the entrance to the

  6  resident's room stating that the room is being monitored by an

  7  electronic monitoring device. The nursing homes participating

  8  in the pilot project must post a notice in a prominent

  9  location in common areas that the areas are being

10  electronically monitored.

11         (6)  The resident or resident's legal representative

12  who requests the electronic monitoring of the resident's room

13  is responsible for the costs associated with conducting

14  electronic monitoring in the resident's room, including the

15  equipment and tapes and the installation, maintenance, or

16  removal of the equipment, other than the costs of electricity.

17  The electronic monitoring equipment and tapes must be the

18  property of the resident. The nursing home must make

19  reasonable physical accommodation for electronic monitoring

20  which includes:

21         (a)  A reasonably secure place to mount the video

22  surveillance camera or other electronic monitoring device; and

23         (b)  Access to power sources for the video surveillance

24  camera or other electronic monitoring device.

25         (7)  The nursing home may:

26         (a)  Require an electronic monitoring device to be

27  installed in a manner that is safe for residents, employees,

28  or visitors who may be moving about the room and that meets

29  all local and state regulations;

30         (b)  Require the electronic monitoring to be conducted

31  in plain view; and

                                  36

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         (c)  Place a resident in a different room to

  2  accommodate a request for electronic monitoring.

  3         (8)  A participating nursing home may not refuse to

  4  admit an individual and may not discharge a resident solely

  5  because of a request to conduct electronic monitoring.

  6         (9)  Any questionable activity discovered as a result

  7  of viewing a tape produced by the electronic monitoring

  8  equipment shall be reported to the nursing home's

  9  administrator and the Agency for Health Care Administration

10  within 24 hours after discovery of the questionable activity.

11         (a)  When a questionable activity that occurred in a

12  resident's room has been reported to the nursing home

13  administrator and the Agency for Health Care Administration,

14  the nursing home administrator shall arrange a meeting for

15  viewing or listening to the recording of the activity as soon

16  as is practicable. The following persons must be at the

17  meeting:

18         1.  The resident or the resident's legal

19  representative;

20         2.  A long-term care ombudsman, if requested by the

21  resident or the resident's legal representative;

22         3.  A quality-of-care monitor from the Agency for

23  Health Care Administration;

24         4.  The nursing home's designated risk manager; and

25         5.  The nursing home administrator.

26         (b)  When a questionable activity that has purportedly

27  occurred in a common area of the nursing home is reported to

28  the nursing home administrator and the Agency for Health Care

29  Administration, the nursing home administrator shall arrange a

30  meeting for viewing or listening to the recording of the

31  activity as soon as is practicable. The following persons must

                                  37

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  be at the meeting:

  2         1.  The resident or residents involved in the

  3  questionable activity, or the resident's or residents' legal

  4  representatives;

  5         2.  A long-term care ombudsman, if requested by the

  6  resident or the resident's legal representative;

  7         3.  A representative of the nursing home's resident

  8  council;

  9         4.  A quality-of-care monitor from the Agency for

10  Health Care Administration;

11         5.  The nursing home's designated risk manager; and

12         6.  The nursing home administrator.

13         (c)  The purpose of such a meeting is to facilitate

14  discussion of the quality of care being provided to the

15  resident and, if necessary, how to improve the quality of care

16  being provided.

17         (d)  The Agency for Health Care Administration may take

18  any regulatory action authorized under part II of chapter 400,

19  Florida Statutes, in response to a questionable activity

20  documented through electronic monitoring and reported to the

21  agency.

22         (10)  Because of the nature of the pilot project, any

23  activity or information recorded on tape shall be used to

24  improve care and is not admissible as evidence in civil

25  litigation against the nursing home, a licensed health care

26  practitioner, or staff of the nursing home.

27         (11)  Each nursing home that participates in the pilot

28  project shall receive the sum of $10,000 to:

29         (a)  Research and purchase an electronic monitoring

30  system for common areas which would tape activities in the

31  common areas so as to minimize security risks; and

                                  38

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         (b)  Submit 6-month progress reports to the Agency for

  2  Health Care Administration on the status of the pilot project.

  3  The reports must describe efforts by the nursing home to

  4  inform residents and their legal representatives of the

  5  circumstances under which electronic monitoring equipment will

  6  be installed in residents' rooms; must provide an evaluation

  7  of resident, family, and staff response to the availability

  8  and use of electronic monitoring equipment; and must document

  9  staff turnover and changes in liability insurance premiums and

10  deductibles attributed to the use of electronic monitoring

11  equipment.

12         (12)  The nursing homes that participate in the pilot

13  project are entitled to a one-time rebasing of operating costs

14  under the Medicaid program to cover any increased costs in

15  liability insurance because of the installation of the

16  electronic monitoring equipment during the 12 months that the

17  pilot project is in effect and for 6 months thereafter.

18         (13)  The Agency for Health Care Administration shall

19  convene a panel to advise the agency as it reviews the outcome

20  of the pilot project and produces a report. The panel shall be

21  comprised of a representative of the American Association of

22  Retired Persons, a member of the clergy, a registered nurse, a

23  physician licensed under chapter 458 or chapter 459, Florida

24  Statutes, a long-term care ombudsman, a representative of the

25  Agency for Health Care Administration, and a representative of

26  the Office of the Attorney General. The Agency for Health Care

27  Administration shall submit to the Governor, the President of

28  the Senate, and the Speaker of the House of Representatives,

29  by October 1, 2003, a report on the outcome of the pilot

30  project.

31         Section 22.  This act shall take effect July 1, 2002.

                                  39

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1  ================ T I T L E   A M E N D M E N T ===============

  2  And the title is amended as follows:

  3  remove:  the entire title

  4

  5  and insert:

  6                      A bill to be entitled

  7         An act relating to long-term care; amending s.

  8         20.41, F.S.; providing for administration of

  9         the State Long-Term Care Ombudsman Council by

10         the Department of Elderly Affairs; amending s.

11         400.0063, F.S.; locating the Office of the

12         State Long-Term Care Ombudsman in the

13         department; providing for appointment of the

14         ombudsman by the Secretary of Elderly Affairs;

15         amending s. 400.0065, F.S.; requiring the

16         secretary's approval of staff for the local

17         ombudsman councils; deleting requirement that

18         the ombudsman prepare an annual legislative

19         budget request; revising rulemaking authority;

20         amending s. 400.0067, F.S.; revising duties of

21         the State Long-Term Care Ombudsman Council;

22         providing duties of the department and

23         secretary; amending s. 400.0071, F.S.; revising

24         procedures relating to complaints; amending s.

25         400.0087, F.S.; revising provisions relating to

26         agency oversight; amending s. 400.0089, F.S.;

27         revising reporting responsibilities; repealing

28         s. 400.0066(2) and (3), F.S., relating to

29         administrative support for the ombudsman

30         program and interference with ombudsman staff

31         or volunteers; creating s. 409.221, F.S.;

                                  40

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         creating the "Florida Consumer-Directed Care

  2         Act"; providing legislative findings; providing

  3         legislative intent; establishing the

  4         consumer-directed care program; providing for

  5         consumer selection of certain long-term care

  6         services and providers; providing for

  7         interagency agreements between the Agency for

  8         Health Care Administration and the Department

  9         of Elderly Affairs, the Department of Health,

10         and the Department of Children and Family

11         Services; providing for program eligibility and

12         enrollment; providing definitions; providing

13         for consumer budget allowances and purchasing

14         guidelines; specifying authorized services;

15         providing roles and responsibilities of

16         consumers, the agency and departments, and

17         fiduciary intermediaries; providing background

18         screening requirements for persons who render

19         care under the program; providing rulemaking

20         authority of the agency and departments;

21         requiring the agency to apply for federal

22         waivers as necessary; requiring ongoing program

23         reviews and annual reports; requiring the

24         Agency for Health Care Administration and the

25         Department of Elderly Affairs to submit a plan

26         to the Governor and Legislature for reducing

27         nursing home bed days funded under the Medicaid

28         program; amending s. 400.179, F.S.; providing

29         an exception from a bond requirement for

30         certain mortgage arrangements; amending s.

31         408.034, F.S.; providing additional

                                  41

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         requirements for the Agency for Health Care

  2         Administration in determining the need for

  3         additional nursing facility beds; amending s.

  4         409.912, F.S.; requiring the Agency for Health

  5         Care Administration to establish a nursing

  6         facility preadmission screening program;

  7         authorizing the agency to operate the program

  8         by contract; requiring an annual report to the

  9         Legislature and the Office of Long-Term Care

10         Policy; amending s. 430.03, F.S.; revising the

11         purposes of the Department of Elderly Affairs

12         with respect to developing policy, making

13         recommendations, coordinating activities, and

14         overseeing research; amending s. 430.04, F.S.;

15         revising the duties of the Department of

16         Elderly Affairs with respect to developing

17         programs and policies related to aging;

18         creating s. 430.041, F.S.; establishing the

19         Office of Long-Term Care Policy within the

20         Department of Elderly Affairs; requiring the

21         office to develop a State Long-Term Care Plan;

22         requiring the office to make recommendations

23         for coordinating the services provided by state

24         agencies; providing for appointment of the

25         director of the Office of Long-Term Care

26         Policy; providing for the appointment of an

27         advisory board to the Office of Long-Term Care

28         Policy; specifying membership in the advisory

29         board; providing for reimbursement of per diem

30         and travel expenses for members of the advisory

31         board; requiring that the office submit an

                                  42

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         annual report to the Governor and Legislature;

  2         requiring the Agency for Health Care

  3         Administration and the Department of Elderly

  4         Affairs to provide staff and support services

  5         for the Office of Long-Term Care Policy;

  6         creating s. 430.7031, F.S.; requiring the

  7         Department of Elderly Affairs and the Agency

  8         for Health Care Administration to implement a

  9         nursing home transition program; providing

10         requirements for the program; amending ss.

11         409.908, 430.708, and 641.386, F.S., relating

12         to reimbursement of Medicaid providers,

13         certificates of need, and agent licensing and

14         appointment; conforming cross references to

15         changes made by the act; requiring the Agency

16         for Health Care Administration to conduct a

17         pilot project to demonstrate the use of

18         electronic monitoring equipment in nursing

19         homes; establishing requirements for nursing

20         homes participating in the pilot project;

21         establishing procedures for the use of

22         electronic monitoring equipment; specifying who

23         may request electronic monitoring; providing

24         for conditional consent to electronic

25         monitoring; providing for review of tapes

26         documenting questionable activity; prohibiting

27         the admission of tapes as evidence in civil

28         litigation against a nursing home, a licensed

29         health care practitioner, or staff of a nursing

30         home; providing for rebasing of Medicaid costs;

31         requiring the Agency for Health Care

                                  43

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261




                                                   HOUSE AMENDMENT

    705-165AXC-08                                  Bill No. HB 703

    Amendment No. ___ (for drafter's use only)





  1         Administration to convene an advisory panel;

  2         requiring a report; providing an effective

  3         date.

  4

  5

  6

  7

  8

  9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

                                  44

    File original & 9 copies    03/12/02
    hbd0005                     08:58 am         00703-0075-782261