CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
CHAMBER ACTION
Senate House
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11 The Conference Committee on HB 59-E offered the following:
12
13 Conference Committee Amendment (with title amendment)
14 Remove everything after the enacting clause
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16 and insert:
17 Section 1. Section 16.59, Florida Statutes, is amended
18 to read:
19 16.59 Medicaid fraud control.--There is created in the
20 Department of Legal Affairs the Medicaid Fraud Control Unit,
21 which may investigate all violations of s. 409.920 and any
22 criminal violations discovered during the course of those
23 investigations. The Medicaid Fraud Control Unit may refer any
24 criminal violation so uncovered to the appropriate prosecuting
25 authority. Offices of the Medicaid Fraud Control Unit and the
26 offices of the Agency for Health Care Administration Medicaid
27 program integrity program shall, to the extent possible, be
28 collocated. The agency and the Department of Legal Affairs
29 shall conduct joint training and other joint activities
30 designed to increase communication and coordination in
31 recovering overpayments.
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Section 2. Subsections (3), (5), and (7) of section
2 112.3187, Florida Statutes, are amended to read:
3 112.3187 Adverse action against employee for
4 disclosing information of specified nature prohibited;
5 employee remedy and relief.--
6 (3) DEFINITIONS.--As used in this act, unless
7 otherwise specified, the following words or terms shall have
8 the meanings indicated:
9 (a) "Agency" means any state, regional, county, local,
10 or municipal government entity, whether executive, judicial,
11 or legislative; any official, officer, department, division,
12 bureau, commission, authority, or political subdivision
13 therein; or any public school, community college, or state
14 university.
15 (b) "Employee" means a person who performs services
16 for, and under the control and direction of, or contracts
17 with, an agency or independent contractor for wages or other
18 remuneration.
19 (c) "Adverse personnel action" means the discharge,
20 suspension, transfer, or demotion of any employee or the
21 withholding of bonuses, the reduction in salary or benefits,
22 or any other adverse action taken against an employee within
23 the terms and conditions of employment by an agency or
24 independent contractor.
25 (d) "Independent contractor" means a person, other
26 than an agency, engaged in any business and who enters into a
27 contract, including a provider agreement, with an agency.
28 (e) "Gross mismanagement" means a continuous pattern
29 of managerial abuses, wrongful or arbitrary and capricious
30 actions, or fraudulent or criminal conduct which may have a
31 substantial adverse economic impact.
2
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (5) NATURE OF INFORMATION DISCLOSED.--The information
2 disclosed under this section must include:
3 (a) Any violation or suspected violation of any
4 federal, state, or local law, rule, or regulation committed by
5 an employee or agent of an agency or independent contractor
6 which creates and presents a substantial and specific danger
7 to the public's health, safety, or welfare.
8 (b) Any act or suspected act of gross mismanagement,
9 malfeasance, misfeasance, gross waste of public funds,
10 suspected or actual Medicaid fraud or abuse, or gross neglect
11 of duty committed by an employee or agent of an agency or
12 independent contractor.
13 (7) EMPLOYEES AND PERSONS PROTECTED.--This section
14 protects employees and persons who disclose information on
15 their own initiative in a written and signed complaint; who
16 are requested to participate in an investigation, hearing, or
17 other inquiry conducted by any agency or federal government
18 entity; who refuse to participate in any adverse action
19 prohibited by this section; or who initiate a complaint
20 through the whistle-blower's hotline or the hotline of the
21 Medicaid Fraud Control Unit of the Department of Legal
22 Affairs; or employees who file any written complaint to their
23 supervisory officials or employees who submit a complaint to
24 the Chief Inspector General in the Executive Office of the
25 Governor, to the employee designated as agency inspector
26 general under s. 112.3189(1), or to the Florida Commission on
27 Human Relations. The provisions of this section may not be
28 used by a person while he or she is under the care, custody,
29 or control of the state correctional system or, after release
30 from the care, custody, or control of the state correctional
31 system, with respect to circumstances that occurred during any
3
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 period of incarceration. No remedy or other protection under
2 ss. 112.3187-112.31895 applies to any person who has committed
3 or intentionally participated in committing the violation or
4 suspected violation for which protection under ss.
5 112.3187-112.31895 is being sought.
6 Section 3. Paragraph (a) of subsection (7) of section
7 240.4075, Florida Statutes, is amended to read:
8 240.4075 Nursing Student Loan Forgiveness Program.--
9 (7)(a) Funds contained in the Nursing Student Loan
10 Forgiveness Trust Fund which are to be used for loan
11 forgiveness for those nurses employed by hospitals, birth
12 centers, and nursing homes must be matched on a
13 dollar-for-dollar basis by contributions from the employing
14 institutions, except that this provision shall not apply to
15 state-operated medical and health care facilities, public
16 schools, county health departments, federally sponsored
17 community health centers, teaching hospitals as defined in s.
18 408.07, family practice teaching hospitals as defined in s.
19 395.805, or specialty hospitals for children as used in s.
20 409.9119. An estimate of the annual trust fund dollars shall
21 be made at the beginning of the fiscal year based on historic
22 expenditures from the trust fund. Applicant requests shall be
23 reviewed on a quarterly basis, and applicant awards shall be
24 based on the following priority of employer until all such
25 estimated trust funds are awarded: state-operated medical and
26 health care facilities; public schools; If in any given fiscal
27 quarter there are insufficient funds in the trust fund to
28 grant all eligible applicant requests, awards shall be based
29 on the following priority of employer: county health
30 departments; federally sponsored community health centers;
31 state-operated medical and health care facilities; public
4
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 schools; teaching hospitals as defined in s. 408.07; family
2 practice teaching hospitals as defined in s. 395.805;
3 specialty hospitals for children as used in s. 409.9119; and
4 other hospitals, birth centers, and nursing homes.
5 Section 4. Subsection (24) of section 395.002, Florida
6 Statutes, is amended to read:
7 395.002 Definitions.--As used in this chapter:
8 (24) "Premises" means those buildings, beds, and
9 equipment located at the address of the licensed facility and
10 all other buildings, beds, and equipment for the provision of
11 hospital, ambulatory surgical, or mobile surgical care located
12 in such reasonable proximity to the address of the licensed
13 facility as to appear to the public to be under the dominion
14 and control of the licensee. For any licensee that is a
15 teaching hospital as defined in s. 408.07(44), reasonable
16 proximity includes any buildings, beds, services, programs,
17 and equipment under the dominion and control of the licensee
18 that are located at a site with a main address that is within
19 1 mile of the main address of the licensed facility; and all
20 such buildings, beds, and equipment may, at the request of a
21 licensee or applicant, be included on the facility license as
22 a single premises.
23 Section 5. Subsection (2) of section 395.003, Florida
24 Statutes, is amended to read:
25 395.003 Licensure; issuance, renewal, denial, and
26 revocation.--
27 (2)(a) Upon the receipt of an application for a
28 license and the license fee, the agency shall issue a license
29 if the applicant and facility have received all approvals
30 required by law and meet the requirements established under
31 this part and in rules. Such license shall include all beds
5
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 and services located on the premises of the facility.
2 (b) A provisional license may be issued to a new
3 facility or a facility that is in substantial compliance with
4 this part and with the rules of the agency. A provisional
5 license shall be granted for a period of no more than 1 year
6 and shall expire automatically at the end of its term. A
7 provisional license may not be renewed.
8 (c) A license, unless sooner suspended or revoked,
9 shall automatically expire 2 years from the date of issuance
10 and shall be renewable biennially upon application for renewal
11 and payment of the fee prescribed by s. 395.004(2), provided
12 the applicant and licensed facility meet the requirements
13 established under this part and in rules. An application for
14 renewal of a license shall be made 90 days prior to expiration
15 of the license, on forms provided by the agency.
16 (d) The agency shall, at the request of a licensee,
17 issue a single license to a licensee for facilities located on
18 separate premises. Such a license shall specifically state
19 the location of the facilities, the services, and the licensed
20 beds available on each separate premises. If a licensee
21 requests a single license, the licensee shall designate which
22 facility or office is responsible for receipt of information,
23 payment of fees, service of process, and all other activities
24 necessary for the agency to carry out the provisions of this
25 part.
26 (e) The agency shall, at the request of a licensee
27 that is a teaching hospital as defined in s. 408.07(44), issue
28 a single license to a licensee for facilities that have been
29 previously licensed as separate premises, provided such
30 separately licensed facilities, taken together, constitute the
31 same premises as defined in s. 395.002(24). Such license for
6
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the single premises shall include all of the beds, services,
2 and programs that were previously included on the licenses for
3 the separate premises. The granting of a single license under
4 this paragraph shall not in any manner reduce the number of
5 beds, services, or programs operated by the licensee.
6 (f)(e) Intensive residential treatment programs for
7 children and adolescents which have received accreditation
8 from the Joint Commission on Accreditation of Healthcare
9 Organizations and which meet the minimum standards developed
10 by rule of the agency for such programs shall be licensed by
11 the agency under this part.
12 Section 6. Subsection (20) of section 400.141, Florida
13 Statutes, is amended to read:
14 400.141 Administration and management of nursing home
15 facilities.--Every licensed facility shall comply with all
16 applicable standards and rules of the agency and shall:
17 (20) Maintain general and professional liability
18 insurance coverage that is in force at all times.
19 Section 7. (1) For the period beginning June 30,
20 2001, and ending June 30, 2005, the Agency for Health Care
21 Administration shall provide a report to the Governor, the
22 President of the Senate, and the Speaker of the House of
23 Representatives with respect to nursing homes. The first
24 report shall be submitted no later than December 30, 2002, and
25 subsequent reports shall be submitted every 6 months
26 thereafter. The report shall identify facilities based on
27 their ownership characteristics, size, business structure,
28 for-profit or not-for-profit status, and any other
29 characteristics the agency determines useful in analyzing the
30 varied segments of the nursing home industry and shall
31 report:
7
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (a) The number of Notices of Intent to litigate
2 received by each facility each month.
3 (b) The number of complaints on behalf of a resident
4 or resident legal representative that were filed with the
5 clerk of the court each month.
6 (c) The month in which the injury which is the basis
7 for the suit occurred or was discovered or, if unavailable,
8 the dates of residency of the resident involved, beginning
9 with the date of initial admission and latest discharge date.
10 (d) Information regarding deficiencies cited,
11 including information used to develop the Nursing Home Guide
12 WATCH LIST pursuant to s. 400.191, Florida Statutes, and
13 applicable rules, a summary of data generated on nursing homes
14 by Centers for Medicare and Medicaid Services Nursing Home
15 Quality Information Project, and information collected
16 pursuant to s. 400.147(9), Florida Statutes, relating to
17 litigation.
18 (2) Facilities subject to part II of chapter 400,
19 Florida Statutes, must submit the information necessary to
20 compile this report each month on existing forms, as modified,
21 provided by the agency.
22 (3) The agency shall delineate the available
23 information on a monthly basis.
24 Section 8. Subsection (9) of section 400.147, Florida
25 Statutes, is amended to read:
26 400.147 Internal risk management and quality assurance
27 program.--
28 (9) By the 10th of each month, each facility subject
29 to this section shall report monthly any notice received
30 pursuant to s. 400.0233(2) and each initial complaint that was
31 filed with the clerk of the court and served on the facility
8
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 during the previous month by a resident or a resident's family
2 member, guardian, conservator, or personal legal
3 representative liability claim filed against it. The report
4 must include the name of the resident, the resident's date of
5 birth and social security number, the Medicaid identification
6 number for Medicaid-eligible persons, the date or dates of the
7 incident leading to the claim or dates of residency, if
8 applicable, and the type of injury or violation of rights
9 alleged to have occurred. Each facility shall also submit a
10 copy of the notices received pursuant to s. 400.0233(2) and
11 complaints filed with the clerk of the court. This report is
12 confidential as provided by law and is not discoverable or
13 admissible in any civil or administrative action, except in
14 such actions brought by the agency to enforce the provisions
15 of this part.
16 Section 9. In order to expedite the availability of
17 general and professional liability insurance for nursing
18 homes, the Agency for Health Care Administration, subject to
19 appropriations included in the General Appropriation Act,
20 shall advance $6 million for the purpose of capitalizing the
21 risk retention group. The terms of repayment may not extend
22 beyond 3 years from the date of funding. For purposes of this
23 project, notwithstanding the provisions of s. 631.271, Florida
24 Statutes, the agency's claim shall be considered a class 3
25 claim.
26 Section 10. Effective upon becoming a law and
27 applicable to any pending license renewal, paragraph (d) of
28 subsection (5) of section 400.179, Florida Statutes, is
29 amended to read:
30 400.179 Sale or transfer of ownership of a nursing
31 facility; liability for Medicaid underpayments and
9
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 overpayments.--
2 (5) Because any transfer of a nursing facility may
3 expose the fact that Medicaid may have underpaid or overpaid
4 the transferor, and because in most instances, any such
5 underpayment or overpayment can only be determined following a
6 formal field audit, the liabilities for any such underpayments
7 or overpayments shall be as follows:
8 (d) Where the transfer involves a facility that has
9 been leased by the transferor:
10 1. The transferee shall, as a condition to being
11 issued a license by the agency, acquire, maintain, and provide
12 proof to the agency of a bond with a term of 30 months,
13 renewable annually, in an amount not less than the total of 3
14 months Medicaid payments to the facility computed on the basis
15 of the preceding 12-month average Medicaid payments to the
16 facility.
17 2. A leasehold licensee may meet the requirements of
18 subparagraph 1. by payment of a nonrefundable fee, paid at
19 initial licensure, paid at the time of any subsequent change
20 of ownership, and paid at the time of any subsequent annual
21 license renewal, in the amount of 2 percent of the total of 3
22 months' Medicaid payments to the facility computed on the
23 basis of the preceding 12-month average Medicaid payments to
24 the facility. If a preceding 12-month average is not
25 available, projected Medicaid payments may be used. The fee
26 shall be deposited into the Health Care Trust Fund and shall
27 be accounted for separately as a Medicaid nursing home
28 overpayment account. These fees shall be used at the sole
29 discretion of the agency to repay nursing home Medicaid
30 overpayments. Payment of this fee shall not release the
31 licensee from any liability for any Medicaid overpayments, nor
10
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 shall payment bar the agency from seeking to recoup
2 overpayments from the licensee and any other liable party. As
3 a condition of exercising this lease bond alternative,
4 licensees paying this fee must maintain an existing lease bond
5 through the end of the 30-month term period of that bond. The
6 agency is herein granted specific authority to promulgate all
7 rules pertaining to the administration and management of this
8 account, including withdrawals from the account, subject to
9 federal review and approval. This subparagraph is repealed on
10 June 30, 2003. This provision shall take effect upon becoming
11 law and shall apply to any leasehold license application.
12 a. The financial viability of the Medicaid nursing
13 home overpayment account shall be determined by the agency
14 through annual review of the account balance and the amount of
15 total outstanding, unpaid Medicaid overpayments owing from
16 leasehold licensees to the agency as determined by final
17 agency audits.
18 b. The agency, in consultation with the Florida Health
19 Care Association and the Florida Association of Homes for the
20 Aging, shall study and make recommendations on the minimum
21 amount to be held in reserve to protect against Medicaid
22 overpayments to leasehold licensees and on the issue of
23 successor liability for Medicaid overpayments upon sale or
24 transfer of ownership of a nursing facility. The agency shall
25 submit the findings and recommendations of the study to the
26 Governor, the President of the Senate, and the Speaker of the
27 House of Representatives by January 1, 2003.
28 3.2. The leasehold licensee operator may meet the bond
29 requirement through other arrangements acceptable to the
30 agency Department. The agency is herein granted specific
31 authority to promulgate rules pertaining to lease bond
11
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 arrangements.
2 4.3. All existing nursing facility licensees,
3 operating the facility as a leasehold, shall acquire,
4 maintain, and provide proof to the agency of the 30-month bond
5 required in subparagraph 1., above, on and after July 1, 1993,
6 for each license renewal.
7 5.4. It shall be the responsibility of all nursing
8 facility operators, operating the facility as a leasehold, to
9 renew the 30-month bond and to provide proof of such renewal
10 to the agency annually at the time of application for license
11 renewal.
12 6.5. Any failure of the nursing facility operator to
13 acquire, maintain, renew annually, or provide proof to the
14 agency shall be grounds for the agency to deny, cancel,
15 revoke, or suspend the facility license to operate such
16 facility and to take any further action, including, but not
17 limited to, enjoining the facility, asserting a moratorium, or
18 applying for a receiver, deemed necessary to ensure compliance
19 with this section and to safeguard and protect the health,
20 safety, and welfare of the facility's residents.
21 Section 11. Subsection (8) of section 400.925, Florida
22 Statutes, is amended to read:
23 400.925 Definitions.--As used in this part, the term:
24 (8) "Home medical equipment" includes any product as
25 defined by the Federal Drug Administration's Drugs, Devices
26 and Cosmetics Act, any products reimbursed under the Medicare
27 Part B Durable Medical Equipment benefits, or any products
28 reimbursed under the Florida Medicaid durable medical
29 equipment program. Home medical equipment includes, but is not
30 limited to, oxygen and related respiratory equipment; manual,
31 motorized, or. Home medical equipment includes customized
12
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 wheelchairs and related seating and positioning, but does not
2 include prosthetics or orthotics or any splints, braces, or
3 aids custom fabricated by a licensed health care
4 practitioner;. Home medical equipment includes assistive
5 technology devices, including: manual wheelchairs, motorized
6 wheelchairs, motorized scooters;, voice-synthesized computer
7 modules, optical scanners, talking software, braille printers,
8 environmental control devices for use by person with
9 quadriplegia, motor vehicle adaptive transportation aids,
10 devices that enable persons with severe speech disabilities to
11 in effect speak, personal transfer systems; and specialty
12 beds, including demonstrator, for use by a person with a
13 medical need.
14 Section 12. Section 408.831, Florida Statutes, is
15 created to read:
16 408.831 Denial, suspension, or revocation of a
17 license, registration, certificate, or application.--
18 (1) In addition to any other remedies provided by law,
19 the agency may deny each application or suspend or revoke each
20 license, registration, or certificate of entities regulated or
21 licensed by it:
22 (a) If the applicant, licensee, registrant, or
23 certificateholder, or, in the case of a corporation,
24 partnership, or other business entity, if any officer,
25 director, agent, or managing employee of that business entity
26 or any affiliated person, partner, or shareholder having an
27 ownership interest equal to 5 percent or greater in that
28 business entity, has failed to pay all outstanding fines,
29 liens, or overpayments assessed by final order of the agency
30 or final order of the Centers for Medicare and Medicaid
31 Services, not subject to further appeal, unless a repayment
13
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 plan is approved by the agency; or
2 (b) For failure to comply with any repayment plan.
3 (2) This section provides standards of enforcement
4 applicable to all entities licensed or regulated by the Agency
5 for Health Care Administration. This section controls over any
6 conflicting provisions of chapters 39, 381, 383, 390, 391,
7 393, 394, 395, 400, 408, 468, 483, and 641 or rules adopted
8 pursuant to those chapters.
9 Section 13. For the purpose of incorporating the
10 amendments made by this act to sections 409.902, 409.907,
11 409.908, and 409.913, Florida Statutes, in references thereto,
12 subsection (4) of section 409.8132, Florida Statutes, is
13 reenacted to read:
14 409.8132 Medikids program component.--
15 (4) APPLICABILITY OF LAWS RELATING TO MEDICAID.--The
16 provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908,
17 409.912, 409.9121, 409.9122, 409.9123, 409.9124, 409.9127,
18 409.9128, 409.913, 409.916, 409.919, 409.920, and 409.9205
19 apply to the administration of the Medikids program component
20 of the Florida Kidcare program, except that s. 409.9122
21 applies to Medikids as modified by the provisions of
22 subsection (7).
23 Section 14. Section 409.8177, Florida Statutes, is
24 amended to read:
25 409.8177 Program evaluation.--
26 (1) The agency, in consultation with the Department of
27 Health, the Department of Children and Family Services, and
28 the Florida Healthy Kids Corporation, shall contract for an
29 evaluation of the Florida Kidcare program and shall by January
30 1 of each year submit to the Governor, the President of the
31 Senate, and the Speaker of the House of Representatives a
14
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 report of the Florida Kidcare program. In addition to the
2 items specified under s. 2108 of Title XXI of the Social
3 Security Act, the report shall include an assessment of
4 crowd-out and access to health care, as well as the following:
5 (a)(1) An assessment of the operation of the program,
6 including the progress made in reducing the number of
7 uncovered low-income children.
8 (b)(2) An assessment of the effectiveness in
9 increasing the number of children with creditable health
10 coverage, including an assessment of the impact of outreach.
11 (c)(3) The characteristics of the children and
12 families assisted under the program, including ages of the
13 children, family income, and access to or coverage by other
14 health insurance prior to the program and after disenrollment
15 from the program.
16 (d)(4) The quality of health coverage provided,
17 including the types of benefits provided.
18 (e)(5) The amount and level, including payment of part
19 or all of any premium, of assistance provided.
20 (f)(6) The average length of coverage of a child under
21 the program.
22 (g)(7) The program's choice of health benefits
23 coverage and other methods used for providing child health
24 assistance.
25 (h)(8) The sources of nonfederal funding used in the
26 program.
27 (i)(9) An assessment of the effectiveness of Medikids,
28 Children's Medical Services network, and other public and
29 private programs in the state in increasing the availability
30 of affordable quality health insurance and health care for
31 children.
15
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (j)(10) A review and assessment of state activities to
2 coordinate the program with other public and private programs.
3 (k)(11) An analysis of changes and trends in the state
4 that affect the provision of health insurance and health care
5 to children.
6 (l)(12) A description of any plans the state has for
7 improving the availability of health insurance and health care
8 for children.
9 (m)(13) Recommendations for improving the program.
10 (n)(14) Other studies as necessary.
11 (2) The agency shall also submit each month to the
12 Governor, the President of the Senate, and the Speaker of the
13 House of Representatives a report of enrollment for each
14 program component of the Florida Kidcare program.
15 Section 15. Section 409.902, Florida Statutes, is
16 amended to read:
17 409.902 Designated single state agency; payment
18 requirements; program title; release of medical records.--The
19 Agency for Health Care Administration is designated as the
20 single state agency authorized to make payments for medical
21 assistance and related services under Title XIX of the Social
22 Security Act. These payments shall be made, subject to any
23 limitations or directions provided for in the General
24 Appropriations Act, only for services included in the program,
25 shall be made only on behalf of eligible individuals, and
26 shall be made only to qualified providers in accordance with
27 federal requirements for Title XIX of the Social Security Act
28 and the provisions of state law. This program of medical
29 assistance is designated the "Medicaid program." The
30 Department of Children and Family Services is responsible for
31 Medicaid eligibility determinations, including, but not
16
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 limited to, policy, rules, and the agreement with the Social
2 Security Administration for Medicaid eligibility
3 determinations for Supplemental Security Income recipients, as
4 well as the actual determination of eligibility. As a
5 condition of Medicaid eligibility, subject to federal
6 approval, the Agency for Health Care Administration and the
7 Department of Children and Family Services shall ensure that
8 each recipient of Medicaid consents to the release of her or
9 his medical records to the Agency for Health Care
10 Administration and the Medicaid Fraud Control Unit of the
11 Department of Legal Affairs.
12 Section 16. Effective July 1, 2002, subsection (2) of
13 section 409.904, Florida Statutes, as amended by section 2 of
14 chapter 2001-377, Laws of Florida, is amended to read:
15 409.904 Optional payments for eligible persons.--The
16 agency may make payments for medical assistance and related
17 services on behalf of the following persons who are determined
18 to be eligible subject to the income, assets, and categorical
19 eligibility tests set forth in federal and state law. Payment
20 on behalf of these Medicaid eligible persons is subject to the
21 availability of moneys and any limitations established by the
22 General Appropriations Act or chapter 216.
23 (2)(a) A caretaker relative or parent, a pregnant
24 woman, a child under age 19 who would otherwise qualify for
25 Florida Kidcare Medicaid, a child up to age 21 who would
26 otherwise qualify under s. 409.903(1), a person age 65 or
27 over, or a blind or disabled person, who would otherwise be
28 eligible for Florida Medicaid, except that the income or
29 assets of such family or person exceed established
30 limitations. A pregnant woman who would otherwise qualify for
31 Medicaid under s. 409.903(5) except for her level of income
17
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Amendment No. ___ (for drafter's use only)
1 and whose assets fall within the limits established by the
2 Department of Children and Family Services for the medically
3 needy. A pregnant woman who applies for medically needy
4 eligibility may not be made presumptively eligible.
5 (b) A child under age 21 who would otherwise qualify
6 for Medicaid or the Florida Kidcare program except for the
7 family's level of income and whose assets fall within the
8 limits established by the Department of Children and Family
9 Services for the medically needy.
10
11 For a family or person in one of these coverage groups this
12 group, medical expenses are deductible from income in
13 accordance with federal requirements in order to make a
14 determination of eligibility. Expenses used to meet spend-down
15 liability are not reimbursable by Medicaid. Effective May 1,
16 2003, when determining the eligibility of a pregnant woman, a
17 child, or an aged, blind, or disabled individual, $270 shall
18 be deducted from the countable income of the filing unit. When
19 determining the eligibility of the parent or caretaker
20 relative as defined by Title XIX of the Social Security Act,
21 the additional income disregard of $270 does not apply. A
22 family or person eligible under the coverage in this group,
23 which group is known as the "medically needy," is eligible to
24 receive the same services as other Medicaid recipients, with
25 the exception of services in skilled nursing facilities and
26 intermediate care facilities for the developmentally disabled.
27 Section 17. Subsection (10) of section 409.904,
28 Florida Statutes, is amended to read:
29 409.904 Optional payments for eligible persons.--The
30 agency may make payments for medical assistance and related
31 services on behalf of the following persons who are determined
18
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 to be eligible subject to the income, assets, and categorical
2 eligibility tests set forth in federal and state law. Payment
3 on behalf of these Medicaid eligible persons is subject to the
4 availability of moneys and any limitations established by the
5 General Appropriations Act or chapter 216.
6 (10)(a) Eligible women with incomes at or below 200
7 percent of the federal poverty level and under age 65, for
8 cancer treatment pursuant to the federal Breast and Cervical
9 Cancer Prevention and Treatment Act of 2000, screened through
10 the Mary Brogan National Breast and Cervical Cancer Early
11 Detection Program established under s. 381.93.
12 (b) A woman who has not attained 65 years of age and
13 who has been screened for breast or cervical cancer by a
14 qualified entity under the Mary Brogan Breast and Cervical
15 Cancer Early Detection Program of the Department of Health and
16 needs treatment for breast or cervical cancer and is not
17 otherwise covered under creditable coverage, as defined in s.
18 2701(c) of the Public Health Service Act. For purposes of this
19 subsection, the term "qualified entity" means a county public
20 health department or other entity that has contracted with the
21 Department of Health to provide breast and cervical cancer
22 screening services paid for under this act. In determining the
23 eligibility of such a woman, an assets test is not required. A
24 presumptive eligibility period begins on the date on which all
25 eligibility criteria appear to be met and ends on the date
26 determination is made with respect to the eligibility of such
27 woman for services under the state plan or, in the case of
28 such a woman who does not file an application, by the last day
29 of the month following the month in which the presumptive
30 eligibility determination is made. A woman is eligible until
31 she gains creditable coverage, until treatment is no longer
19
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 necessary, or until attainment of 65 years of age.
2 Section 18. Paragraph (c) of subsection (5) of section
3 409.905, Florida Statutes, is amended to read:
4 409.905 Mandatory Medicaid services.--The agency may
5 make payments for the following services, which are required
6 of the state by Title XIX of the Social Security Act,
7 furnished by Medicaid providers to recipients who are
8 determined to be eligible on the dates on which the services
9 were provided. Any service under this section shall be
10 provided only when medically necessary and in accordance with
11 state and federal law. Mandatory services rendered by
12 providers in mobile units to Medicaid recipients may be
13 restricted by the agency. Nothing in this section shall be
14 construed to prevent or limit the agency from adjusting fees,
15 reimbursement rates, lengths of stay, number of visits, number
16 of services, or any other adjustments necessary to comply with
17 the availability of moneys and any limitations or directions
18 provided for in the General Appropriations Act or chapter 216.
19 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay
20 for all covered services provided for the medical care and
21 treatment of a recipient who is admitted as an inpatient by a
22 licensed physician or dentist to a hospital licensed under
23 part I of chapter 395. However, the agency shall limit the
24 payment for inpatient hospital services for a Medicaid
25 recipient 21 years of age or older to 45 days or the number of
26 days necessary to comply with the General Appropriations Act.
27 (c) Agency for Health Care Administration shall adjust
28 a hospital's current inpatient per diem rate to reflect the
29 cost of serving the Medicaid population at that institution
30 if:
31 1. The hospital experiences an increase in Medicaid
20
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 caseload by more than 25 percent in any year, primarily
2 resulting from the closure of a hospital in the same service
3 area occurring after July 1, 1995; or
4 2. The hospital's Medicaid per diem rate is at least
5 25 percent below the Medicaid per patient cost for that year;
6 or.
7 3. The hospital is located in a county that has five
8 or fewer hospitals, began offering obstetrical services on or
9 after September 1999, and has submitted a request in writing
10 to the agency for a rate adjustment after July 1, 2000, but
11 before September 30, 2000, in which case such hospital's
12 Medicaid inpatient per diem rate shall be adjusted to cost,
13 effective July 1, 2002.
14
15 No later than October 1 of each year November 1, 2001, the
16 agency must provide estimated costs for any adjustment in a
17 hospital inpatient per diem pursuant to this paragraph to the
18 Executive Office of the Governor, the House of Representatives
19 General Appropriations Committee, and the Senate
20 Appropriations Committee. Before the agency implements a
21 change in a hospital's inpatient per diem rate pursuant to
22 this paragraph, the Legislature must have specifically
23 appropriated sufficient funds in the General Appropriations
24 Act to support the increase in cost as estimated by the
25 agency.
26 Section 19. Effective July 1, 2002, subsections (1),
27 (12), and (23) of section 409.906, Florida Statutes, as
28 amended by section 3 of chapter 2001-377, Laws of Florida, are
29 amended to read:
30 409.906 Optional Medicaid services.--Subject to
31 specific appropriations, the agency may make payments for
21
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 services which are optional to the state under Title XIX of
2 the Social Security Act and are furnished by Medicaid
3 providers to recipients who are determined to be eligible on
4 the dates on which the services were provided. Any optional
5 service that is provided shall be provided only when medically
6 necessary and in accordance with state and federal law.
7 Optional services rendered by providers in mobile units to
8 Medicaid recipients may be restricted or prohibited by the
9 agency. Nothing in this section shall be construed to prevent
10 or limit the agency from adjusting fees, reimbursement rates,
11 lengths of stay, number of visits, or number of services, or
12 making any other adjustments necessary to comply with the
13 availability of moneys and any limitations or directions
14 provided for in the General Appropriations Act or chapter 216.
15 If necessary to safeguard the state's systems of providing
16 services to elderly and disabled persons and subject to the
17 notice and review provisions of s. 216.177, the Governor may
18 direct the Agency for Health Care Administration to amend the
19 Medicaid state plan to delete the optional Medicaid service
20 known as "Intermediate Care Facilities for the Developmentally
21 Disabled." Optional services may include:
22 (1) ADULT DENTAL DENTURE SERVICES.--The agency may pay
23 for medically necessary, emergency dental procedures to
24 alleviate pain or infection. Emergency dental care shall be
25 limited to emergency oral examinations, necessary radiographs,
26 extractions, and incision and drainage of abscess dentures,
27 the procedures required to seat dentures, and the repair and
28 reline of dentures, provided by or under the direction of a
29 licensed dentist, for a recipient who is age 21 or older.
30 However, Medicaid will not provide reimbursement for dental
31 services provided in a mobile dental unit, except for a mobile
22
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 dental unit:
2 (a) Owned by, operated by, or having a contractual
3 agreement with the Department of Health and complying with
4 Medicaid's county health department clinic services program
5 specifications as a county health department clinic services
6 provider.
7 (b) Owned by, operated by, or having a contractual
8 arrangement with a federally qualified health center and
9 complying with Medicaid's federally qualified health center
10 specifications as a federally qualified health center
11 provider.
12 (c) Rendering dental services to Medicaid recipients,
13 21 years of age and older, at nursing facilities.
14 (d) Owned by, operated by, or having a contractual
15 agreement with a state-approved dental educational
16 institution.
17 (e) This subsection is repealed July 1, 2002.
18 (12) CHILDREN'S HEARING SERVICES.--The agency may pay
19 for hearing and related services, including hearing
20 evaluations, hearing aid devices, dispensing of the hearing
21 aid, and related repairs, if provided to a recipient under age
22 21 by a licensed hearing aid specialist, otolaryngologist,
23 otologist, audiologist, or physician.
24 (23) CHILDREN'S VISUAL SERVICES.--The agency may pay
25 for visual examinations, eyeglasses, and eyeglass repairs for
26 a recipient under age 21, if they are prescribed by a licensed
27 physician specializing in diseases of the eye or by a licensed
28 optometrist.
29 Section 20. Subsections (1) and (2) of section
30 409.9065, Florida Statutes, as amended by section 5 of chapter
31 2001-377, Laws of Florida, are amended to read:
23
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 409.9065 Pharmaceutical expense assistance.--
2 (1) PROGRAM ESTABLISHED.--There is established a
3 program to provide pharmaceutical expense assistance to
4 certain low-income elderly individuals, which shall be known
5 as the "Ron Silver Senior Drug Program."
6 (2) ELIGIBILITY.--Eligibility for the program is
7 limited to those individuals who qualify for limited
8 assistance under the Florida Medicaid program as a result of
9 being dually eligible for both Medicare and Medicaid, but
10 whose limited assistance or Medicare coverage does not include
11 any pharmacy benefit. To the extent funds are appropriated,
12 specifically eligible individuals are individuals low-income
13 senior citizens who:
14 (a) Are Florida residents age 65 and over;
15 (b) Have an income:
16 1. Between 88 90 and 120 percent of the federal
17 poverty level;
18 2. Between 88 and 150 percent of the federal poverty
19 level if the Federal Government increases the federal Medicaid
20 match for persons between 100 and 150 percent of the federal
21 poverty level; or
22 3. Between 88 percent of the federal poverty level and
23 a level that can be supported with funds provided in the
24 General Appropriations Act for the program offered under this
25 section along with federal matching funds approved by the
26 Federal Government under a s. 1115 waiver. The agency is
27 authorized to submit and implement a federal waiver pursuant
28 to this subparagraph. The agency shall design a pharmacy
29 benefit that includes annual per-member benefit limits and
30 cost-sharing provisions and limits enrollment to available
31 appropriations and matching federal funds. Prior to
24
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 implementing this program, the agency must submit a budget
2 amendment pursuant to chapter 216;
3 (c) Are eligible for both Medicare and Medicaid;
4 (d) Are not enrolled in a Medicare health maintenance
5 organization that provides a pharmacy benefit; and
6 (e) Request to be enrolled in the program.
7 Section 21. Subsections (7) and (9) of section
8 409.907, Florida Statutes, as amended by section 6 of chapter
9 2001-377, Laws of Florida, are amended to read:
10 409.907 Medicaid provider agreements.--The agency may
11 make payments for medical assistance and related services
12 rendered to Medicaid recipients only to an individual or
13 entity who has a provider agreement in effect with the agency,
14 who is performing services or supplying goods in accordance
15 with federal, state, and local law, and who agrees that no
16 person shall, on the grounds of handicap, race, color, or
17 national origin, or for any other reason, be subjected to
18 discrimination under any program or activity for which the
19 provider receives payment from the agency.
20 (7) The agency may require, as a condition of
21 participating in the Medicaid program and before entering into
22 the provider agreement, that the provider submit information,
23 in an initial and any required renewal applications,
24 concerning the professional, business, and personal background
25 of the provider and permit an onsite inspection of the
26 provider's service location by agency staff or other personnel
27 designated by the agency to perform this function. The agency
28 shall perform a random onsite inspection, within 60 days after
29 receipt of a fully complete new provider's application, of the
30 provider's service location prior to making its first payment
31 to the provider for Medicaid services to determine the
25
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 applicant's ability to provide the services that the applicant
2 is proposing to provide for Medicaid reimbursement. The agency
3 is not required to perform an onsite inspection of a provider
4 or program that is licensed by the agency, that provides
5 services under waiver programs for home and community-based
6 services, or that is licensed as a medical foster home by the
7 Department of Children and Family Services. As a continuing
8 condition of participation in the Medicaid program, a provider
9 shall immediately notify the agency of any current or pending
10 bankruptcy filing. Before entering into the provider
11 agreement, or as a condition of continuing participation in
12 the Medicaid program, the agency may also require that
13 Medicaid providers reimbursed on a fee-for-services basis or
14 fee schedule basis which is not cost-based, post a surety bond
15 not to exceed $50,000 or the total amount billed by the
16 provider to the program during the current or most recent
17 calendar year, whichever is greater. For new providers, the
18 amount of the surety bond shall be determined by the agency
19 based on the provider's estimate of its first year's billing.
20 If the provider's billing during the first year exceeds the
21 bond amount, the agency may require the provider to acquire an
22 additional bond equal to the actual billing level of the
23 provider. A provider's bond shall not exceed $50,000 if a
24 physician or group of physicians licensed under chapter 458,
25 chapter 459, or chapter 460 has a 50 percent or greater
26 ownership interest in the provider or if the provider is an
27 assisted living facility licensed under part III of chapter
28 400. The bonds permitted by this section are in addition to
29 the bonds referenced in s. 400.179(4)(d). If the provider is a
30 corporation, partnership, association, or other entity, the
31 agency may require the provider to submit information
26
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 concerning the background of that entity and of any principal
2 of the entity, including any partner or shareholder having an
3 ownership interest in the entity equal to 5 percent or
4 greater, and any treating provider who participates in or
5 intends to participate in Medicaid through the entity. The
6 information must include:
7 (a) Proof of holding a valid license or operating
8 certificate, as applicable, if required by the state or local
9 jurisdiction in which the provider is located or if required
10 by the Federal Government.
11 (b) Information concerning any prior violation, fine,
12 suspension, termination, or other administrative action taken
13 under the Medicaid laws, rules, or regulations of this state
14 or of any other state or the Federal Government; any prior
15 violation of the laws, rules, or regulations relating to the
16 Medicare program; any prior violation of the rules or
17 regulations of any other public or private insurer; and any
18 prior violation of the laws, rules, or regulations of any
19 regulatory body of this or any other state.
20 (c) Full and accurate disclosure of any financial or
21 ownership interest that the provider, or any principal,
22 partner, or major shareholder thereof, may hold in any other
23 Medicaid provider or health care related entity or any other
24 entity that is licensed by the state to provide health or
25 residential care and treatment to persons.
26 (d) If a group provider, identification of all members
27 of the group and attestation that all members of the group are
28 enrolled in or have applied to enroll in the Medicaid program.
29 (9) Upon receipt of a completed, signed, and dated
30 application, and completion of any necessary background
31 investigation and criminal history record check, the agency
27
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 must either:
2 (a) Enroll the applicant as a Medicaid provider no
3 earlier than the effective date of the approval of the
4 provider application. With respect to providers who were
5 recently granted a change of ownership and those who primarily
6 provide emergency medical services transportation or emergency
7 services and care pursuant to s. 401.45 or s. 395.1041, and
8 out-of-state providers, upon approval of the provider
9 application, the effective date of approval is considered to
10 be the date the agency receives the provider application; or
11 (b) Deny the application if the agency finds that it
12 is in the best interest of the Medicaid program to do so. The
13 agency may consider the factors listed in subsection (10), as
14 well as any other factor that could affect the effective and
15 efficient administration of the program, including, but not
16 limited to, the applicant's demonstrated ability to provide
17 services, conduct business, and operate a financially viable
18 concern; the current availability of medical care, services,
19 or supplies to recipients, taking into account geographic
20 location and reasonable travel time; the number of providers
21 of the same type already enrolled in the same geographic area;
22 and the credentials, experience, success, and patient outcomes
23 of the provider for the services that it is making application
24 to provide in the Medicaid program. The agency shall deny the
25 application if the agency finds that a provider; any officer,
26 director, agent, managing employee, or affiliated person; or
27 any partner or shareholder having an ownership interest equal
28 to 5 percent or greater in the provider if the provider is a
29 corporation, partnership, or other business entity, has failed
30 to pay all outstanding fines or overpayments assessed by final
31 order of the agency or final order of the Centers for Medicare
28
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 and Medicaid Services, not subject to further appeal, unless
2 the provider agrees to a repayment plan that includes
3 withholding Medicaid reimbursement until the amount due is
4 paid in full.
5 Section 22. Section 409.908, Florida Statutes, as
6 amended by section 7 of chapter 2001-377, Laws of Florida, is
7 amended to read:
8 409.908 Reimbursement of Medicaid providers.--Subject
9 to specific appropriations, the agency shall reimburse
10 Medicaid providers, in accordance with state and federal law,
11 according to methodologies set forth in the rules of the
12 agency and in policy manuals and handbooks incorporated by
13 reference therein. These methodologies may include fee
14 schedules, reimbursement methods based on cost reporting,
15 negotiated fees, competitive bidding pursuant to s. 287.057,
16 and other mechanisms the agency considers efficient and
17 effective for purchasing services or goods on behalf of
18 recipients. If a provider is reimbursed based on cost
19 reporting and submits a cost report late and that cost report
20 would have been used to set a lower reimbursement rate for a
21 rate semester, then the provider's rate for that semester
22 shall be retroactively calculated using the new cost report,
23 and full payment at the recalculated rate shall be affected
24 retroactively. Medicare-granted extensions for filing cost
25 reports, if applicable, shall also apply to Medicaid cost
26 reports. Payment for Medicaid compensable services made on
27 behalf of Medicaid eligible persons is subject to the
28 availability of moneys and any limitations or directions
29 provided for in the General Appropriations Act or chapter 216.
30 Further, nothing in this section shall be construed to prevent
31 or limit the agency from adjusting fees, reimbursement rates,
29
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 lengths of stay, number of visits, or number of services, or
2 making any other adjustments necessary to comply with the
3 availability of moneys and any limitations or directions
4 provided for in the General Appropriations Act, provided the
5 adjustment is consistent with legislative intent.
6 (1) Reimbursement to hospitals licensed under part I
7 of chapter 395 must be made prospectively or on the basis of
8 negotiation.
9 (a) Reimbursement for inpatient care is limited as
10 provided for in s. 409.905(5), except for:
11 1. The raising of rate reimbursement caps, excluding
12 rural hospitals.
13 2. Recognition of the costs of graduate medical
14 education.
15 3. Other methodologies recognized in the General
16 Appropriations Act.
17 4. Hospital inpatient rates shall be reduced by 6
18 percent effective July 1, 2001, and restored effective April
19 1, 2002.
20
21 During the years funds are transferred from the Department of
22 Health, any reimbursement supported by such funds shall be
23 subject to certification by the Department of Health that the
24 hospital has complied with s. 381.0403. The agency is
25 authorized to receive funds from state entities, including,
26 but not limited to, the Department of Health, local
27 governments, and other local political subdivisions, for the
28 purpose of making special exception payments, including
29 federal matching funds, through the Medicaid inpatient
30 reimbursement methodologies. Funds received from state
31 entities or local governments for this purpose shall be
30
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 separately accounted for and shall not be commingled with
2 other state or local funds in any manner. The agency may
3 certify all local governmental funds used as state match under
4 Title XIX of the Social Security Act, to the extent that the
5 identified local health care provider that is otherwise
6 entitled to and is contracted to receive such local funds is
7 the benefactor under the state's Medicaid program as
8 determined under the General Appropriations Act and pursuant
9 to an agreement between the Agency for Health Care
10 Administration and the local governmental entity. The local
11 governmental entity shall use a certification form prescribed
12 by the agency. At a minimum, the certification form shall
13 identify the amount being certified and describe the
14 relationship between the certifying local governmental entity
15 and the local health care provider. The agency shall prepare
16 an annual statement of impact which documents the specific
17 activities undertaken during the previous fiscal year pursuant
18 to this paragraph, to be submitted to the Legislature no later
19 than January 1, annually.
20 (b) Reimbursement for hospital outpatient care is
21 limited to $1,500 per state fiscal year per recipient, except
22 for:
23 1. Such care provided to a Medicaid recipient under
24 age 21, in which case the only limitation is medical
25 necessity.
26 2. Renal dialysis services.
27 3. Other exceptions made by the agency.
28
29 The agency is authorized to receive funds from state entities,
30 including, but not limited to, the Department of Health, the
31 Board of Regents, local governments, and other local political
31
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 subdivisions, for the purpose of making payments, including
2 federal matching funds, through the Medicaid outpatient
3 reimbursement methodologies. Funds received from state
4 entities and local governments for this purpose shall be
5 separately accounted for and shall not be commingled with
6 other state or local funds in any manner.
7 (c) Hospitals that provide services to a
8 disproportionate share of low-income Medicaid recipients, or
9 that participate in the regional perinatal intensive care
10 center program under chapter 383, or that participate in the
11 statutory teaching hospital disproportionate share program may
12 receive additional reimbursement. The total amount of payment
13 for disproportionate share hospitals shall be fixed by the
14 General Appropriations Act. The computation of these payments
15 must be made in compliance with all federal regulations and
16 the methodologies described in ss. 409.911, 409.9112, and
17 409.9113.
18 (d) The agency is authorized to limit inflationary
19 increases for outpatient hospital services as directed by the
20 General Appropriations Act.
21 (2)(a)1. Reimbursement to nursing homes licensed under
22 part II of chapter 400 and state-owned-and-operated
23 intermediate care facilities for the developmentally disabled
24 licensed under chapter 393 must be made prospectively.
25 2. Unless otherwise limited or directed in the General
26 Appropriations Act, reimbursement to hospitals licensed under
27 part I of chapter 395 for the provision of swing-bed nursing
28 home services must be made on the basis of the average
29 statewide nursing home payment, and reimbursement to a
30 hospital licensed under part I of chapter 395 for the
31 provision of skilled nursing services must be made on the
32
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 basis of the average nursing home payment for those services
2 in the county in which the hospital is located. When a
3 hospital is located in a county that does not have any
4 community nursing homes, reimbursement must be determined by
5 averaging the nursing home payments, in counties that surround
6 the county in which the hospital is located. Reimbursement to
7 hospitals, including Medicaid payment of Medicare copayments,
8 for skilled nursing services shall be limited to 30 days,
9 unless a prior authorization has been obtained from the
10 agency. Medicaid reimbursement may be extended by the agency
11 beyond 30 days, and approval must be based upon verification
12 by the patient's physician that the patient requires
13 short-term rehabilitative and recuperative services only, in
14 which case an extension of no more than 15 days may be
15 approved. Reimbursement to a hospital licensed under part I of
16 chapter 395 for the temporary provision of skilled nursing
17 services to nursing home residents who have been displaced as
18 the result of a natural disaster or other emergency may not
19 exceed the average county nursing home payment for those
20 services in the county in which the hospital is located and is
21 limited to the period of time which the agency considers
22 necessary for continued placement of the nursing home
23 residents in the hospital.
24 (b) Subject to any limitations or directions provided
25 for in the General Appropriations Act, the agency shall
26 establish and implement a Florida Title XIX Long-Term Care
27 Reimbursement Plan (Medicaid) for nursing home care in order
28 to provide care and services in conformance with the
29 applicable state and federal laws, rules, regulations, and
30 quality and safety standards and to ensure that individuals
31 eligible for medical assistance have reasonable geographic
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 access to such care.
2 1. Changes of ownership or of licensed operator do not
3 qualify for increases in reimbursement rates associated with
4 the change of ownership or of licensed operator. The agency
5 shall amend the Title XIX Long Term Care Reimbursement Plan to
6 provide that the initial nursing home reimbursement rates, for
7 the operating, patient care, and MAR components, associated
8 with related and unrelated party changes of ownership or
9 licensed operator filed on or after September 1, 2001, are
10 equivalent to the previous owner's reimbursement rate.
11 2. The agency shall amend the long-term care
12 reimbursement plan and cost reporting system to create direct
13 care and indirect care subcomponents of the patient care
14 component of the per diem rate. These two subcomponents
15 together shall equal the patient care component of the per
16 diem rate. Separate cost-based ceilings shall be calculated
17 for each patient care subcomponent. The direct care
18 subcomponent of the per diem rate shall be limited by the
19 cost-based class ceiling, and the indirect care subcomponent
20 shall be limited by the lower of the cost-based class ceiling,
21 by the target rate class ceiling, or by the individual
22 provider target. The agency shall adjust the patient care
23 component effective January 1, 2002. The cost to adjust the
24 direct care subcomponent shall be net of the total funds
25 previously allocated for the case mix add-on. The agency shall
26 make the required changes to the nursing home cost reporting
27 forms to implement this requirement effective January 1, 2002.
28 3. The direct care subcomponent shall include salaries
29 and benefits of direct care staff providing nursing services
30 including registered nurses, licensed practical nurses, and
31 certified nursing assistants who deliver care directly to
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 residents in the nursing home facility. This excludes nursing
2 administration, MDS, and care plan coordinators, staff
3 development, and staffing coordinator.
4 4. All other patient care costs shall be included in
5 the indirect care cost subcomponent of the patient care per
6 diem rate. There shall be no costs directly or indirectly
7 allocated to the direct care subcomponent from a home office
8 or management company.
9 5. On July 1 of each year, the agency shall report to
10 the Legislature direct and indirect care costs, including
11 average direct and indirect care costs per resident per
12 facility and direct care and indirect care salaries and
13 benefits per category of staff member per facility.
14 6. In order to offset the cost of general and
15 professional liability insurance, the agency shall amend Under
16 the plan to allow for, interim rate adjustments shall not be
17 granted to reflect increases in the cost of general or
18 professional liability insurance for nursing homes unless the
19 following criteria are met: have at least a 65 percent
20 Medicaid utilization in the most recent cost report submitted
21 to the agency, and the increase in general or professional
22 liability costs to the facility for the most recent policy
23 period affects the total Medicaid per diem by at least 5
24 percent. This rate adjustment shall not result in the per diem
25 exceeding the class ceiling. This provision shall be
26 implemented to the extent existing appropriations are
27 available.
28
29 It is the intent of the Legislature that the reimbursement
30 plan achieve the goal of providing access to health care for
31 nursing home residents who require large amounts of care while
35
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 encouraging diversion services as an alternative to nursing
2 home care for residents who can be served within the
3 community. The agency shall base the establishment of any
4 maximum rate of payment, whether overall or component, on the
5 available moneys as provided for in the General Appropriations
6 Act. The agency may base the maximum rate of payment on the
7 results of scientifically valid analysis and conclusions
8 derived from objective statistical data pertinent to the
9 particular maximum rate of payment.
10 (3) Subject to any limitations or directions provided
11 for in the General Appropriations Act, the following Medicaid
12 services and goods may be reimbursed on a fee-for-service
13 basis. For each allowable service or goods furnished in
14 accordance with Medicaid rules, policy manuals, handbooks, and
15 state and federal law, the payment shall be the amount billed
16 by the provider, the provider's usual and customary charge, or
17 the maximum allowable fee established by the agency, whichever
18 amount is less, with the exception of those services or goods
19 for which the agency makes payment using a methodology based
20 on capitation rates, average costs, or negotiated fees.
21 (a) Advanced registered nurse practitioner services.
22 (b) Birth center services.
23 (c) Chiropractic services.
24 (d) Community mental health services.
25 (e) Dental services, including oral and maxillofacial
26 surgery.
27 (f) Durable medical equipment.
28 (g) Hearing services.
29 (h) Occupational therapy for Medicaid recipients under
30 age 21.
31 (i) Optometric services.
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (j) Orthodontic services.
2 (k) Personal care for Medicaid recipients under age
3 21.
4 (l) Physical therapy for Medicaid recipients under age
5 21.
6 (m) Physician assistant services.
7 (n) Podiatric services.
8 (o) Portable X-ray services.
9 (p) Private-duty nursing for Medicaid recipients under
10 age 21.
11 (q) Registered nurse first assistant services.
12 (r) Respiratory therapy for Medicaid recipients under
13 age 21.
14 (s) Speech therapy for Medicaid recipients under age
15 21.
16 (t) Visual services.
17 (4) Subject to any limitations or directions provided
18 for in the General Appropriations Act, alternative health
19 plans, health maintenance organizations, and prepaid health
20 plans shall be reimbursed a fixed, prepaid amount negotiated,
21 or competitively bid pursuant to s. 287.057, by the agency and
22 prospectively paid to the provider monthly for each Medicaid
23 recipient enrolled. The amount may not exceed the average
24 amount the agency determines it would have paid, based on
25 claims experience, for recipients in the same or similar
26 category of eligibility. The agency shall calculate
27 capitation rates on a regional basis and, beginning September
28 1, 1995, shall include age-band differentials in such
29 calculations. Effective July 1, 2001, the cost of exempting
30 statutory teaching hospitals, specialty hospitals, and
31 community hospital education program hospitals from
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 reimbursement ceilings and the cost of special Medicaid
2 payments shall not be included in premiums paid to health
3 maintenance organizations or prepaid health care plans. Each
4 rate semester, the agency shall calculate and publish a
5 Medicaid hospital rate schedule that does not reflect either
6 special Medicaid payments or the elimination of rate
7 reimbursement ceilings, to be used by hospitals and Medicaid
8 health maintenance organizations, in order to determine the
9 Medicaid rate referred to in ss. 409.912(16), 409.9128(5), and
10 641.513(6).
11 (5) An ambulatory surgical center shall be reimbursed
12 the lesser of the amount billed by the provider or the
13 Medicare-established allowable amount for the facility.
14 (6) A provider of early and periodic screening,
15 diagnosis, and treatment services to Medicaid recipients who
16 are children under age 21 shall be reimbursed using an
17 all-inclusive rate stipulated in a fee schedule established by
18 the agency. A provider of the visual, dental, and hearing
19 components of such services shall be reimbursed the lesser of
20 the amount billed by the provider or the Medicaid maximum
21 allowable fee established by the agency.
22 (7) A provider of family planning services shall be
23 reimbursed the lesser of the amount billed by the provider or
24 an all-inclusive amount per type of visit for physicians and
25 advanced registered nurse practitioners, as established by the
26 agency in a fee schedule.
27 (8) A provider of home-based or community-based
28 services rendered pursuant to a federally approved waiver
29 shall be reimbursed based on an established or negotiated rate
30 for each service. These rates shall be established according
31 to an analysis of the expenditure history and prospective
38
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 budget developed by each contract provider participating in
2 the waiver program, or under any other methodology adopted by
3 the agency and approved by the Federal Government in
4 accordance with the waiver. Effective July 1, 1996, privately
5 owned and operated community-based residential facilities
6 which meet agency requirements and which formerly received
7 Medicaid reimbursement for the optional intermediate care
8 facility for the mentally retarded service may participate in
9 the developmental services waiver as part of a
10 home-and-community-based continuum of care for Medicaid
11 recipients who receive waiver services.
12 (9) A provider of home health care services or of
13 medical supplies and appliances shall be reimbursed on the
14 basis of competitive bidding or for the lesser of the amount
15 billed by the provider or the agency's established maximum
16 allowable amount, except that, in the case of the rental of
17 durable medical equipment, the total rental payments may not
18 exceed the purchase price of the equipment over its expected
19 useful life or the agency's established maximum allowable
20 amount, whichever amount is less.
21 (10) A hospice shall be reimbursed through a
22 prospective system for each Medicaid hospice patient at
23 Medicaid rates using the methodology established for hospice
24 reimbursement pursuant to Title XVIII of the federal Social
25 Security Act.
26 (11) A provider of independent laboratory services
27 shall be reimbursed on the basis of competitive bidding or for
28 the least of the amount billed by the provider, the provider's
29 usual and customary charge, or the Medicaid maximum allowable
30 fee established by the agency.
31 (12)(a) A physician shall be reimbursed the lesser of
39
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the amount billed by the provider or the Medicaid maximum
2 allowable fee established by the agency.
3 (b) The agency shall adopt a fee schedule, subject to
4 any limitations or directions provided for in the General
5 Appropriations Act, based on a resource-based relative value
6 scale for pricing Medicaid physician services. Under this fee
7 schedule, physicians shall be paid a dollar amount for each
8 service based on the average resources required to provide the
9 service, including, but not limited to, estimates of average
10 physician time and effort, practice expense, and the costs of
11 professional liability insurance. The fee schedule shall
12 provide increased reimbursement for preventive and primary
13 care services and lowered reimbursement for specialty services
14 by using at least two conversion factors, one for cognitive
15 services and another for procedural services. The fee
16 schedule shall not increase total Medicaid physician
17 expenditures unless moneys are available, and shall be phased
18 in over a 2-year period beginning on July 1, 1994. The Agency
19 for Health Care Administration shall seek the advice of a
20 16-member advisory panel in formulating and adopting the fee
21 schedule. The panel shall consist of Medicaid physicians
22 licensed under chapters 458 and 459 and shall be composed of
23 50 percent primary care physicians and 50 percent specialty
24 care physicians.
25 (c) Notwithstanding paragraph (b), reimbursement fees
26 to physicians for providing total obstetrical services to
27 Medicaid recipients, which include prenatal, delivery, and
28 postpartum care, shall be at least $1,500 per delivery for a
29 pregnant woman with low medical risk and at least $2,000 per
30 delivery for a pregnant woman with high medical risk. However,
31 reimbursement to physicians working in Regional Perinatal
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Intensive Care Centers designated pursuant to chapter 383, for
2 services to certain pregnant Medicaid recipients with a high
3 medical risk, may be made according to obstetrical care and
4 neonatal care groupings and rates established by the agency.
5 Nurse midwives licensed under part I of chapter 464 or
6 midwives licensed under chapter 467 shall be reimbursed at no
7 less than 80 percent of the low medical risk fee. The agency
8 shall by rule determine, for the purpose of this paragraph,
9 what constitutes a high or low medical risk pregnant woman and
10 shall not pay more based solely on the fact that a caesarean
11 section was performed, rather than a vaginal delivery. The
12 agency shall by rule determine a prorated payment for
13 obstetrical services in cases where only part of the total
14 prenatal, delivery, or postpartum care was performed. The
15 Department of Health shall adopt rules for appropriate
16 insurance coverage for midwives licensed under chapter 467.
17 Prior to the issuance and renewal of an active license, or
18 reactivation of an inactive license for midwives licensed
19 under chapter 467, such licensees shall submit proof of
20 coverage with each application.
21 (d) For fiscal years 2001-2002 and 2002-2003 the
22 2001-2002 fiscal year only and if necessary to meet the
23 requirements for grants and donations for the special Medicaid
24 payments authorized in the 2001-2002 and 2002-2003 General
25 Appropriations Acts Act, the agency may make special Medicaid
26 payments to qualified Medicaid providers designated by the
27 agency, notwithstanding any provision of this subsection to
28 the contrary, and may use intergovernmental transfers from
29 state entities or other governmental entities to serve as the
30 state share of such payments.
31 (13) Medicare premiums for persons eligible for both
41
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Medicare and Medicaid coverage shall be paid at the rates
2 established by Title XVIII of the Social Security Act. For
3 Medicare services rendered to Medicaid-eligible persons,
4 Medicaid shall pay Medicare deductibles and coinsurance as
5 follows:
6 (a) Medicaid shall make no payment toward deductibles
7 and coinsurance for any service that is not covered by
8 Medicaid.
9 (b) Medicaid's financial obligation for deductibles
10 and coinsurance payments shall be based on Medicare allowable
11 fees, not on a provider's billed charges.
12 (c) Medicaid will pay no portion of Medicare
13 deductibles and coinsurance when payment that Medicare has
14 made for the service equals or exceeds what Medicaid would
15 have paid if it had been the sole payor. The combined payment
16 of Medicare and Medicaid shall not exceed the amount Medicaid
17 would have paid had it been the sole payor. The Legislature
18 finds that there has been confusion regarding the
19 reimbursement for services rendered to dually eligible
20 Medicare beneficiaries. Accordingly, the Legislature clarifies
21 that it has always been the intent of the Legislature before
22 and after 1991 that, in reimbursing in accordance with fees
23 established by Title XVIII for premiums, deductibles, and
24 coinsurance for Medicare services rendered by physicians to
25 Medicaid eligible persons, physicians be reimbursed at the
26 lesser of the amount billed by the physician or the Medicaid
27 maximum allowable fee established by the Agency for Health
28 Care Administration, as is permitted by federal law. It has
29 never been the intent of the Legislature with regard to such
30 services rendered by physicians that Medicaid be required to
31 provide any payment for deductibles, coinsurance, or
42
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 copayments for Medicare cost sharing, or any expenses incurred
2 relating thereto, in excess of the payment amount provided for
3 under the State Medicaid plan for such service. This payment
4 methodology is applicable even in those situations in which
5 the payment for Medicare cost sharing for a qualified Medicare
6 beneficiary with respect to an item or service is reduced or
7 eliminated. This expression of the Legislature is in
8 clarification of existing law and shall apply to payment for,
9 and with respect to provider agreements with respect to, items
10 or services furnished on or after the effective date of this
11 act. This paragraph applies to payment by Medicaid for items
12 and services furnished before the effective date of this act
13 if such payment is the subject of a lawsuit that is based on
14 the provisions of this section, and that is pending as of, or
15 is initiated after, the effective date of this act.
16 (d) Notwithstanding paragraphs (a)-(c):
17 1. Medicaid payments for Nursing Home Medicare part A
18 coinsurance shall be the lesser of the Medicare coinsurance
19 amount or the Medicaid nursing home per diem rate.
20 2. Medicaid shall pay all deductibles and coinsurance
21 for Medicare-eligible recipients receiving freestanding end
22 stage renal dialysis center services.
23 3. Medicaid payments for general hospital inpatient
24 services shall be limited to the Medicare deductible per spell
25 of illness. Medicaid shall make no payment toward coinsurance
26 for Medicare general hospital inpatient services.
27 4. Medicaid shall pay all deductibles and coinsurance
28 for Medicare emergency transportation services provided by
29 ambulances licensed pursuant to chapter 401.
30 (14) A provider of prescribed drugs shall be
31 reimbursed the least of the amount billed by the provider, the
43
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 provider's usual and customary charge, or the Medicaid maximum
2 allowable fee established by the agency, plus a dispensing
3 fee. The agency is directed to implement a variable dispensing
4 fee for payments for prescribed medicines while ensuring
5 continued access for Medicaid recipients. The variable
6 dispensing fee may be based upon, but not limited to, either
7 or both the volume of prescriptions dispensed by a specific
8 pharmacy provider, the volume of prescriptions dispensed to an
9 individual recipient, and dispensing of preferred-drug-list
10 products. The agency shall increase the pharmacy dispensing
11 fee authorized by statute and in the annual General
12 Appropriations Act by $0.50 for the dispensing of a Medicaid
13 preferred-drug-list product and reduce the pharmacy dispensing
14 fee by $0.50 for the dispensing of a Medicaid product that is
15 not included on the preferred-drug list. The agency is
16 authorized to limit reimbursement for prescribed medicine in
17 order to comply with any limitations or directions provided
18 for in the General Appropriations Act, which may include
19 implementing a prospective or concurrent utilization review
20 program.
21 (15) A provider of primary care case management
22 services rendered pursuant to a federally approved waiver
23 shall be reimbursed by payment of a fixed, prepaid monthly sum
24 for each Medicaid recipient enrolled with the provider.
25 (16) A provider of rural health clinic services and
26 federally qualified health center services shall be reimbursed
27 a rate per visit based on total reasonable costs of the
28 clinic, as determined by the agency in accordance with federal
29 regulations.
30 (17) A provider of targeted case management services
31 shall be reimbursed pursuant to an established fee, except
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 where the Federal Government requires a public provider be
2 reimbursed on the basis of average actual costs.
3 (18) Unless otherwise provided for in the General
4 Appropriations Act, a provider of transportation services
5 shall be reimbursed the lesser of the amount billed by the
6 provider or the Medicaid maximum allowable fee established by
7 the agency, except when the agency has entered into a direct
8 contract with the provider, or with a community transportation
9 coordinator, for the provision of an all-inclusive service, or
10 when services are provided pursuant to an agreement negotiated
11 between the agency and the provider. The agency, as provided
12 for in s. 427.0135, shall purchase transportation services
13 through the community coordinated transportation system, if
14 available, unless the agency determines a more cost-effective
15 method for Medicaid clients. Nothing in this subsection shall
16 be construed to limit or preclude the agency from contracting
17 for services using a prepaid capitation rate or from
18 establishing maximum fee schedules, individualized
19 reimbursement policies by provider type, negotiated fees,
20 prior authorization, competitive bidding, increased use of
21 mass transit, or any other mechanism that the agency considers
22 efficient and effective for the purchase of services on behalf
23 of Medicaid clients, including implementing a transportation
24 eligibility process. The agency shall not be required to
25 contract with any community transportation coordinator or
26 transportation operator that has been determined by the
27 agency, the Department of Legal Affairs Medicaid Fraud Control
28 Unit, or any other state or federal agency to have engaged in
29 any abusive or fraudulent billing activities. The agency is
30 authorized to competitively procure transportation services or
31 make other changes necessary to secure approval of federal
45
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 waivers needed to permit federal financing of Medicaid
2 transportation services at the service matching rate rather
3 than the administrative matching rate.
4 (19) County health department services may be
5 reimbursed a rate per visit based on total reasonable costs of
6 the clinic, as determined by the agency in accordance with
7 federal regulations under the authority of 42 C.F.R. s.
8 431.615.
9 (20) A renal dialysis facility that provides dialysis
10 services under s. 409.906(9) must be reimbursed the lesser of
11 the amount billed by the provider, the provider's usual and
12 customary charge, or the maximum allowable fee established by
13 the agency, whichever amount is less.
14 (21) The agency shall reimburse school districts which
15 certify the state match pursuant to ss. 236.0812 and 409.9071
16 for the federal portion of the school district's allowable
17 costs to deliver the services, based on the reimbursement
18 schedule. The school district shall determine the costs for
19 delivering services as authorized in ss. 236.0812 and 409.9071
20 for which the state match will be certified. Reimbursement of
21 school-based providers is contingent on such providers being
22 enrolled as Medicaid providers and meeting the qualifications
23 contained in 42 C.F.R. s. 440.110, unless otherwise waived by
24 the federal Health Care Financing Administration. Speech
25 therapy providers who are certified through the Department of
26 Education pursuant to rule 6A-4.0176, Florida Administrative
27 Code, are eligible for reimbursement for services that are
28 provided on school premises. Any employee of the school
29 district who has been fingerprinted and has received a
30 criminal background check in accordance with Department of
31 Education rules and guidelines shall be exempt from any agency
46
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 requirements relating to criminal background checks.
2 (22) The agency shall request and implement Medicaid
3 waivers from the federal Health Care Financing Administration
4 to advance and treat a portion of the Medicaid nursing home
5 per diem as capital for creating and operating a
6 risk-retention group for self-insurance purposes, consistent
7 with federal and state laws and rules.
8 Section 23. Subsection (1) of section 409.911, Florida
9 Statutes, is amended to read:
10 409.911 Disproportionate share program.--Subject to
11 specific allocations established within the General
12 Appropriations Act and any limitations established pursuant to
13 chapter 216, the agency shall distribute, pursuant to this
14 section, moneys to hospitals providing a disproportionate
15 share of Medicaid or charity care services by making quarterly
16 Medicaid payments as required. Notwithstanding the provisions
17 of s. 409.915, counties are exempt from contributing toward
18 the cost of this special reimbursement for hospitals serving a
19 disproportionate share of low-income patients.
20 (1) Definitions.--As used in this section, and s.
21 409.9112, and the Florida Hospital Uniform Reporting System
22 manual:
23 (a) "Adjusted patient days" means the sum of acute
24 care patient days and intensive care patient days as reported
25 to the Agency for Health Care Administration, divided by the
26 ratio of inpatient revenues generated from acute, intensive,
27 ambulatory, and ancillary patient services to gross revenues.
28 (b) "Actual audited data" or "actual audited
29 experience" means data reported to the Agency for Health Care
30 Administration which has been audited in accordance with
31 generally accepted auditing standards by the agency or
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 representatives under contract with the agency.
2 (c) "Base Medicaid per diem" means the hospital's
3 Medicaid per diem rate initially established by the Agency for
4 Health Care Administration on January 1, 1999. The base
5 Medicaid per diem rate shall not include any additional per
6 diem increases received as a result of the disproportionate
7 share distribution.
8 (d) "Charity care" or "uncompensated charity care"
9 means that portion of hospital charges reported to the Agency
10 for Health Care Administration for which there is no
11 compensation, other than restricted or unrestricted revenues
12 provided to a hospital by local governments or tax districts
13 regardless of the method of payment, for care provided to a
14 patient whose family income for the 12 months preceding the
15 determination is less than or equal to 200 percent of the
16 federal poverty level, unless the amount of hospital charges
17 due from the patient exceeds 25 percent of the annual family
18 income. However, in no case shall the hospital charges for a
19 patient whose family income exceeds four times the federal
20 poverty level for a family of four be considered charity.
21 (e) "Charity care days" means the sum of the
22 deductions from revenues for charity care minus 50 percent of
23 restricted and unrestricted revenues provided to a hospital by
24 local governments or tax districts, divided by gross revenues
25 per adjusted patient day.
26 (f) "Disproportionate share percentage" means a rate
27 of increase in the Medicaid per diem rate as calculated under
28 this section.
29 (g) "Hospital" means a health care institution
30 licensed as a hospital pursuant to chapter 395, but does not
31 include ambulatory surgical centers.
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (h) "Medicaid days" means the number of actual days
2 attributable to Medicaid patients as determined by the Agency
3 for Health Care Administration.
4 Section 24. Subsection (7) of section 409.9116,
5 Florida Statutes, is amended to read:
6 409.9116 Disproportionate share/financial assistance
7 program for rural hospitals.--In addition to the payments made
8 under s. 409.911, the Agency for Health Care Administration
9 shall administer a federally matched disproportionate share
10 program and a state-funded financial assistance program for
11 statutory rural hospitals. The agency shall make
12 disproportionate share payments to statutory rural hospitals
13 that qualify for such payments and financial assistance
14 payments to statutory rural hospitals that do not qualify for
15 disproportionate share payments. The disproportionate share
16 program payments shall be limited by and conform with federal
17 requirements. Funds shall be distributed quarterly in each
18 fiscal year for which an appropriation is made.
19 Notwithstanding the provisions of s. 409.915, counties are
20 exempt from contributing toward the cost of this special
21 reimbursement for hospitals serving a disproportionate share
22 of low-income patients.
23 (7) This section applies only to hospitals that were
24 defined as statutory rural hospitals, or their
25 successor-in-interest hospital, prior to January 1, 2001 July
26 1, 1998. Any additional hospital that is defined as a
27 statutory rural hospital, or its successor-in-interest
28 hospital, on or after January 1, 2001 July 1, 1998, is not
29 eligible for programs under this section unless additional
30 funds are appropriated each fiscal year specifically to the
31 rural hospital disproportionate share and financial assistance
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 programs in an amount necessary to prevent any hospital, or
2 its successor-in-interest hospital, eligible for the programs
3 prior to January 1, 2001 July 1, 1998, from incurring a
4 reduction in payments because of the eligibility of an
5 additional hospital to participate in the programs. A
6 hospital, or its successor-in-interest hospital, which
7 received funds pursuant to this section before January 1, 2001
8 July 1, 1998, and which qualifies under s. 395.602(2)(e),
9 shall be included in the programs under this section and is
10 not required to seek additional appropriations under this
11 subsection.
12 Section 25. Subsection (7) of section 409.91195,
13 Florida Statutes, is amended to read:
14 409.91195 Medicaid Pharmaceutical and Therapeutics
15 Committee.--There is created a Medicaid Pharmaceutical and
16 Therapeutics Committee within the Agency for Health Care
17 Administration for the purpose of developing a preferred drug
18 formulary pursuant to 42 U.S.C. s. 1396r-8.
19 (7) The committee shall ensure that interested
20 parties, including pharmaceutical manufacturers agreeing to
21 provide a supplemental rebate as outlined in this chapter,
22 have an opportunity to present public testimony to the
23 committee with information or evidence supporting inclusion of
24 a product on the preferred drug list. Such public testimony
25 shall occur prior to any recommendations made by the committee
26 for inclusion or exclusion from the preferred drug list. Upon
27 timely notice, the agency shall ensure that any drug that has
28 been approved or had any of its particular uses approved by
29 the United States Food and Drug Administration under a
30 priority review classification will be reviewed by the
31 Medicaid Pharmaceutical and Therapeutics Committee at the next
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 regularly scheduled meeting. To the extent possible, upon
2 notice by a manufacturer the agency shall also schedule a
3 product review for any new product at the next regularly
4 scheduled Medicaid Pharmaceutical and Therapeutics Committee.
5 Section 26. Paragraph (b) of subsection (3) and
6 paragraph (b) of subsection (13) of section 409.912, Florida
7 Statutes, are amended to read:
8 409.912 Cost-effective purchasing of health care.--The
9 agency shall purchase goods and services for Medicaid
10 recipients in the most cost-effective manner consistent with
11 the delivery of quality medical care. The agency shall
12 maximize the use of prepaid per capita and prepaid aggregate
13 fixed-sum basis services when appropriate and other
14 alternative service delivery and reimbursement methodologies,
15 including competitive bidding pursuant to s. 287.057, designed
16 to facilitate the cost-effective purchase of a case-managed
17 continuum of care. The agency shall also require providers to
18 minimize the exposure of recipients to the need for acute
19 inpatient, custodial, and other institutional care and the
20 inappropriate or unnecessary use of high-cost services. The
21 agency may establish prior authorization requirements for
22 certain populations of Medicaid beneficiaries, certain drug
23 classes, or particular drugs to prevent fraud, abuse, overuse,
24 and possible dangerous drug interactions. The Pharmaceutical
25 and Therapeutics Committee shall make recommendations to the
26 agency on drugs for which prior authorization is required. The
27 agency shall inform the Pharmaceutical and Therapeutics
28 Committee of its decisions regarding drugs subject to prior
29 authorization.
30 (3) The agency may contract with:
31 (b) An entity that is providing comprehensive
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 behavioral health care services to certain Medicaid recipients
2 through a capitated, prepaid arrangement pursuant to the
3 federal waiver provided for by s. 409.905(5). Such an entity
4 must be licensed under chapter 624, chapter 636, or chapter
5 641 and must possess the clinical systems and operational
6 competence to manage risk and provide comprehensive behavioral
7 health care to Medicaid recipients. As used in this paragraph,
8 the term "comprehensive behavioral health care services" means
9 covered mental health and substance abuse treatment services
10 that are available to Medicaid recipients. The secretary of
11 the Department of Children and Family Services shall approve
12 provisions of procurements related to children in the
13 department's care or custody prior to enrolling such children
14 in a prepaid behavioral health plan. Any contract awarded
15 under this paragraph must be competitively procured. In
16 developing the behavioral health care prepaid plan procurement
17 document, the agency shall ensure that the procurement
18 document requires the contractor to develop and implement a
19 plan to ensure compliance with s. 394.4574 related to services
20 provided to residents of licensed assisted living facilities
21 that hold a limited mental health license. The agency must
22 ensure that Medicaid recipients have available the choice of
23 at least two managed care plans for their behavioral health
24 care services. To ensure unimpaired access to behavioral
25 health care services by Medicaid recipients, all contracts
26 issued pursuant to this paragraph shall require 80 percent of
27 the capitation paid to the managed care plan, including health
28 maintenance organizations, to be expended for the provision of
29 behavioral health care services. In the event the managed care
30 plan expends less than 80 percent of the capitation paid
31 pursuant to this paragraph for the provision of behavioral
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 health care services, the difference shall be returned to the
2 agency. The agency shall provide the managed care plan with a
3 certification letter indicating the amount of capitation paid
4 during each calendar year for the provision of behavioral
5 health care services pursuant to this section. The agency may
6 reimburse for substance-abuse-treatment services on a
7 fee-for-service basis until the agency finds that adequate
8 funds are available for capitated, prepaid arrangements.
9 1. By January 1, 2001, the agency shall modify the
10 contracts with the entities providing comprehensive inpatient
11 and outpatient mental health care services to Medicaid
12 recipients in Hillsborough, Highlands, Hardee, Manatee, and
13 Polk Counties, to include substance-abuse-treatment services.
14 2. By December 31, 2001, the agency shall contract
15 with entities providing comprehensive behavioral health care
16 services to Medicaid recipients through capitated, prepaid
17 arrangements in Charlotte, Collier, DeSoto, Escambia, Glades,
18 Hendry, Lee, Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota,
19 and Walton Counties. The agency may contract with entities
20 providing comprehensive behavioral health care services to
21 Medicaid recipients through capitated, prepaid arrangements in
22 Alachua County. The agency may determine if Sarasota County
23 shall be included as a separate catchment area or included in
24 any other agency geographic area.
25 3. Children residing in a Department of Juvenile
26 Justice residential program approved as a Medicaid behavioral
27 health overlay services provider shall not be included in a
28 behavioral health care prepaid health plan pursuant to this
29 paragraph.
30 4. In converting to a prepaid system of delivery, the
31 agency shall in its procurement document require an entity
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 providing comprehensive behavioral health care services to
2 prevent the displacement of indigent care patients by
3 enrollees in the Medicaid prepaid health plan providing
4 behavioral health care services from facilities receiving
5 state funding to provide indigent behavioral health care, to
6 facilities licensed under chapter 395 which do not receive
7 state funding for indigent behavioral health care, or
8 reimburse the unsubsidized facility for the cost of behavioral
9 health care provided to the displaced indigent care patient.
10 5. Traditional community mental health providers under
11 contract with the Department of Children and Family Services
12 pursuant to part IV of chapter 394 and inpatient mental health
13 providers licensed pursuant to chapter 395 must be offered an
14 opportunity to accept or decline a contract to participate in
15 any provider network for prepaid behavioral health services.
16 (13)
17 (b) The responsibility of the agency under this
18 subsection shall include the development of capabilities to
19 identify actual and optimal practice patterns; patient and
20 provider educational initiatives; methods for determining
21 patient compliance with prescribed treatments; fraud, waste,
22 and abuse prevention and detection programs; and beneficiary
23 case management programs.
24 1. The practice pattern identification program shall
25 evaluate practitioner prescribing patterns based on national
26 and regional practice guidelines, comparing practitioners to
27 their peer groups. The agency and its Drug Utilization Review
28 Board shall consult with a panel of practicing health care
29 professionals consisting of the following: the Speaker of the
30 House of Representatives and the President of the Senate shall
31 each appoint three physicians licensed under chapter 458 or
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 chapter 459; and the Governor shall appoint two pharmacists
2 licensed under chapter 465 and one dentist licensed under
3 chapter 466 who is an oral surgeon. Terms of the panel members
4 shall expire at the discretion of the appointing official. The
5 panel shall begin its work by August 1, 1999, regardless of
6 the number of appointments made by that date. The advisory
7 panel shall be responsible for evaluating treatment guidelines
8 and recommending ways to incorporate their use in the practice
9 pattern identification program. Practitioners who are
10 prescribing inappropriately or inefficiently, as determined by
11 the agency, may have their prescribing of certain drugs
12 subject to prior authorization.
13 2. The agency shall also develop educational
14 interventions designed to promote the proper use of
15 medications by providers and beneficiaries.
16 3. The agency shall implement a pharmacy fraud, waste,
17 and abuse initiative that may include a surety bond or letter
18 of credit requirement for participating pharmacies, enhanced
19 provider auditing practices, the use of additional fraud and
20 abuse software, recipient management programs for
21 beneficiaries inappropriately using their benefits, and other
22 steps that will eliminate provider and recipient fraud, waste,
23 and abuse. The initiative shall address enforcement efforts to
24 reduce the number and use of counterfeit prescriptions.
25 4. By September 30, 2002, the agency shall contract
26 with an entity in the state to implement a wireless handheld
27 clinical pharmacology drug information database for
28 practitioners. The initiative shall be designed to enhance the
29 agency's efforts to reduce fraud, abuse, and errors in the
30 prescription drug benefit program and to otherwise further the
31 intent of this paragraph.
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 5.4. The agency may apply for any federal waivers
2 needed to implement this paragraph.
3 Section 27. Paragraph (g) of subsection (3) and
4 paragraph (c) of subsection (37) of section 409.912, Florida
5 Statutes, as amended by sections 8 and 9 of chapter 2001-377,
6 Laws of Florida, are amended, and paragraph (h) is added to
7 said subsection (3), to read:
8 409.912 Cost-effective purchasing of health care.--The
9 agency shall purchase goods and services for Medicaid
10 recipients in the most cost-effective manner consistent with
11 the delivery of quality medical care. The agency shall
12 maximize the use of prepaid per capita and prepaid aggregate
13 fixed-sum basis services when appropriate and other
14 alternative service delivery and reimbursement methodologies,
15 including competitive bidding pursuant to s. 287.057, designed
16 to facilitate the cost-effective purchase of a case-managed
17 continuum of care. The agency shall also require providers to
18 minimize the exposure of recipients to the need for acute
19 inpatient, custodial, and other institutional care and the
20 inappropriate or unnecessary use of high-cost services. The
21 agency may establish prior authorization requirements for
22 certain populations of Medicaid beneficiaries, certain drug
23 classes, or particular drugs to prevent fraud, abuse, overuse,
24 and possible dangerous drug interactions. The Pharmaceutical
25 and Therapeutics Committee shall make recommendations to the
26 agency on drugs for which prior authorization is required. The
27 agency shall inform the Pharmaceutical and Therapeutics
28 Committee of its decisions regarding drugs subject to prior
29 authorization.
30 (3) The agency may contract with:
31 (g) Children's provider networks that provide care
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 coordination and care management for Medicaid-eligible
2 pediatric patients, primary care, authorization of specialty
3 care, and other urgent and emergency care through organized
4 providers designed to service Medicaid eligibles under age 18
5 and pediatric emergency departments' diversion programs. The
6 networks shall provide after-hour operations, including
7 evening and weekend hours, to promote, when appropriate, the
8 use of the children's networks rather than hospital emergency
9 departments.
10 (h) A Children's Medical Services network, as defined
11 in s. 391.021.
12 (37)
13 (c) The agency shall submit quarterly reports a report
14 to the Governor, the President of the Senate, and the Speaker
15 of the House of Representatives which by January 15 of each
16 year. The report must include, but need not be limited to, the
17 progress made in implementing this subsection and its Medicaid
18 cost-containment measures and their effect on Medicaid
19 prescribed-drug expenditures.
20 Section 28. Paragraphs (f) and (k) of subsection (2)
21 of section 409.9122, Florida Statutes, as amended by section
22 11 of chapter 2001-377, Laws of Florida, are amended to read:
23 409.9122 Mandatory Medicaid managed care enrollment;
24 programs and procedures.--
25 (2)
26 (f) When a Medicaid recipient does not choose a
27 managed care plan or MediPass provider, the agency shall
28 assign the Medicaid recipient to a managed care plan or
29 MediPass provider. Medicaid recipients who are subject to
30 mandatory assignment but who fail to make a choice shall be
31 assigned to managed care plans or provider service networks
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 until an equal enrollment of 45 50 percent in MediPass and 55
2 50 percent in managed care plans is achieved. Once this equal
3 enrollment is achieved, the assignments shall be divided in
4 order to maintain an equal enrollment in MediPass and managed
5 care plans which is in a 45 percent and 55 percent proportion,
6 respectively. Thereafter, assignment of Medicaid recipients
7 who fail to make a choice shall be based proportionally on the
8 preferences of recipients who have made a choice in the
9 previous period. Such proportions shall be revised at least
10 quarterly to reflect an update of the preferences of Medicaid
11 recipients. The agency shall also disproportionately assign
12 Medicaid-eligible recipients children in families who are
13 required to but have failed to make a choice of managed care
14 plan or MediPass, including children, for their child and who
15 are to be assigned to the MediPass program to children's
16 networks as described in s. 409.912(3)(g), Children's Medical
17 Services network as defined in s. 391.021, exclusive provider
18 organizations, provider service networks, minority physician
19 networks, and pediatric emergency department diversion
20 programs authorized by this chapter or the General
21 Appropriations Act, in such manner as the agency deems
22 appropriate, and where available. The disproportionate
23 assignment of children to children's networks shall be made
24 until the agency has determined that the children's networks
25 and programs have sufficient numbers to be economically
26 operated. For purposes of this paragraph, when referring to
27 assignment, the term "managed care plans" includes health
28 maintenance organizations, exclusive provider organizations,
29 provider service networks, minority physician networks,
30 Children's Medical Services network, and pediatric emergency
31 department diversion programs authorized by this chapter or
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the General Appropriations Act. Beginning July 1, 2002, the
2 agency shall assign all children in families who have not made
3 a choice of a managed care plan or MediPass in the required
4 timeframe to a pediatric emergency room diversion program
5 described in s. 409.912(3)(g) that, as of July 1, 2002, has
6 executed a contract with the agency, until such network or
7 program has reached an enrollment of 15,000 children. Once
8 that minimum enrollment level has been reached, the agency
9 shall assign children who have not chosen a managed care plan
10 or MediPass to the network or program in a manner that
11 maintains the minimum enrollment in the network or program at
12 not less than 15,000 children. To the extent practicable, the
13 agency shall also assign all eligible children in the same
14 family to such network or program. When making assignments,
15 the agency shall take into account the following criteria:
16 1. A managed care plan has sufficient network capacity
17 to meet the need of members.
18 2. The managed care plan or MediPass has previously
19 enrolled the recipient as a member, or one of the managed care
20 plan's primary care providers or MediPass providers has
21 previously provided health care to the recipient.
22 3. The agency has knowledge that the member has
23 previously expressed a preference for a particular managed
24 care plan or MediPass provider as indicated by Medicaid
25 fee-for-service claims data, but has failed to make a choice.
26 4. The managed care plan's or MediPass primary care
27 providers are geographically accessible to the recipient's
28 residence.
29 (k) When a Medicaid recipient does not choose a
30 managed care plan or MediPass provider, the agency shall
31 assign the Medicaid recipient to a managed care plan, except
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 in those counties in which there are fewer than two managed
2 care plans accepting Medicaid enrollees, in which case
3 assignment shall be to a managed care plan or a MediPass
4 provider. Medicaid recipients in counties with fewer than two
5 managed care plans accepting Medicaid enrollees who are
6 subject to mandatory assignment but who fail to make a choice
7 shall be assigned to managed care plans until an equal
8 enrollment of 45 50 percent in MediPass and provider service
9 networks and 55 50 percent in managed care plans is achieved.
10 Once that equal enrollment is achieved, the assignments shall
11 be divided in order to maintain an equal enrollment in
12 MediPass and managed care plans which is in a 45 percent and
13 55 percent proportion, respectively. In geographic areas where
14 the agency is contracting for the provision of comprehensive
15 behavioral health services through a capitated prepaid
16 arrangement, recipients who fail to make a choice shall be
17 assigned equally to MediPass or a managed care plan. For
18 purposes of this paragraph, when referring to assignment, the
19 term "managed care plans" includes exclusive provider
20 organizations, provider service networks, Children's Medical
21 Services network, minority physician networks, and pediatric
22 emergency department diversion programs authorized by this
23 chapter or the General Appropriations Act. When making
24 assignments, the agency shall take into account the following
25 criteria:
26 1. A managed care plan has sufficient network capacity
27 to meet the need of members.
28 2. The managed care plan or MediPass has previously
29 enrolled the recipient as a member, or one of the managed care
30 plan's primary care providers or MediPass providers has
31 previously provided health care to the recipient.
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 3. The agency has knowledge that the member has
2 previously expressed a preference for a particular managed
3 care plan or MediPass provider as indicated by Medicaid
4 fee-for-service claims data, but has failed to make a choice.
5 4. The managed care plan's or MediPass primary care
6 providers are geographically accessible to the recipient's
7 residence.
8 5. The agency has authority to make mandatory
9 assignments based on quality of service and performance of
10 managed care plans.
11 Section 29. Paragraph (l) is added to subsection (2)
12 of section 409.9122, Florida Statutes, to read:
13 409.9122 Mandatory Medicaid managed care enrollment;
14 programs and procedures.--
15 (2)
16 (l) Notwithstanding the provisions of chapter 287, the
17 agency may, at its discretion, renew cost-effective contracts
18 for choice counseling services once or more for such periods
19 as the agency may decide. However, all such renewals may not
20 combine to exceed a total period longer than the term of the
21 original contract.
22 Section 30. Section 409.913, Florida Statutes, as
23 amended by section 12 of chapter 2001-377, Laws of Florida, is
24 amended to read:
25 409.913 Oversight of the integrity of the Medicaid
26 program.--The agency shall operate a program to oversee the
27 activities of Florida Medicaid recipients, and providers and
28 their representatives, to ensure that fraudulent and abusive
29 behavior and neglect of recipients occur to the minimum extent
30 possible, and to recover overpayments and impose sanctions as
31 appropriate. Beginning January 1, 2003, and each year
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 thereafter, the agency and the Medicaid Fraud Control Unit of
2 the Department of Legal Affairs shall submit a joint report to
3 the Legislature documenting the effectiveness of the state's
4 efforts to control Medicaid fraud and abuse and to recover
5 Medicaid overpayments during the previous fiscal year. The
6 report must describe the number of cases opened and
7 investigated each year; the sources of the cases opened; the
8 disposition of the cases closed each year; the amount of
9 overpayments alleged in preliminary and final audit letters;
10 the number and amount of fines or penalties imposed; any
11 reductions in overpayment amounts negotiated in settlement
12 agreements or by other means; the amount of final agency
13 determinations of overpayments; the amount deducted from
14 federal claiming as a result of overpayments; the amount of
15 overpayments recovered each year; the amount of cost of
16 investigation recovered each year; the average length of time
17 to collect from the time the case was opened until the
18 overpayment is paid in full; the amount determined as
19 uncollectible and the portion of the uncollectible amount
20 subsequently reclaimed from the Federal Government; the number
21 of providers, by type, that are terminated from participation
22 in the Medicaid program as a result of fraud and abuse; and
23 all costs associated with discovering and prosecuting cases of
24 Medicaid overpayments and making recoveries in such cases. The
25 report must also document actions taken to prevent
26 overpayments and the number of providers prevented from
27 enrolling in or reenrolling in the Medicaid program as a
28 result of documented Medicaid fraud and abuse and must
29 recommend changes necessary to prevent or recover
30 overpayments. For the 2001-2002 fiscal year, the agency shall
31 prepare a report that contains as much of this information as
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 is available to it.
2 (1) For the purposes of this section, the term:
3 (a) "Abuse" means:
4 1. Provider practices that are inconsistent with
5 generally accepted business or medical practices and that
6 result in an unnecessary cost to the Medicaid program or in
7 reimbursement for goods or services that are not medically
8 necessary or that fail to meet professionally recognized
9 standards for health care.
10 2. Recipient practices that result in unnecessary cost
11 to the Medicaid program.
12 (b) "Complaint" means an allegation that fraud, abuse,
13 or an overpayment has occurred.
14 (c)(b) "Fraud" means an intentional deception or
15 misrepresentation made by a person with the knowledge that the
16 deception results in unauthorized benefit to herself or
17 himself or another person. The term includes any act that
18 constitutes fraud under applicable federal or state law.
19 (d)(c) "Medical necessity" or "medically necessary"
20 means any goods or services necessary to palliate the effects
21 of a terminal condition, or to prevent, diagnose, correct,
22 cure, alleviate, or preclude deterioration of a condition that
23 threatens life, causes pain or suffering, or results in
24 illness or infirmity, which goods or services are provided in
25 accordance with generally accepted standards of medical
26 practice. For purposes of determining Medicaid reimbursement,
27 the agency is the final arbiter of medical necessity.
28 Determinations of medical necessity must be made by a licensed
29 physician employed by or under contract with the agency and
30 must be based upon information available at the time the goods
31 or services are provided.
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (e)(d) "Overpayment" includes any amount that is not
2 authorized to be paid by the Medicaid program whether paid as
3 a result of inaccurate or improper cost reporting, improper
4 claiming, unacceptable practices, fraud, abuse, or mistake.
5 (f)(e) "Person" means any natural person, corporation,
6 partnership, association, clinic, group, or other entity,
7 whether or not such person is enrolled in the Medicaid program
8 or is a provider of health care.
9 (2) The agency shall conduct, or cause to be conducted
10 by contract or otherwise, reviews, investigations, analyses,
11 audits, or any combination thereof, to determine possible
12 fraud, abuse, overpayment, or recipient neglect in the
13 Medicaid program and shall report the findings of any
14 overpayments in audit reports as appropriate.
15 (3) The agency may conduct, or may contract for,
16 prepayment review of provider claims to ensure cost-effective
17 purchasing, billing, and provision of care to Medicaid
18 recipients. Such prepayment reviews may be conducted as
19 determined appropriate by the agency, without any suspicion or
20 allegation of fraud, abuse, or neglect.
21 (4) Any suspected criminal violation identified by the
22 agency must be referred to the Medicaid Fraud Control Unit of
23 the Office of the Attorney General for investigation. The
24 agency and the Attorney General shall enter into a memorandum
25 of understanding, which must include, but need not be limited
26 to, a protocol for regularly sharing information and
27 coordinating casework. The protocol must establish a
28 procedure for the referral by the agency of cases involving
29 suspected Medicaid fraud to the Medicaid Fraud Control Unit
30 for investigation, and the return to the agency of those cases
31 where investigation determines that administrative action by
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the agency is appropriate. Offices of the Medicaid program
2 integrity program and the Medicaid Fraud Control Unit of the
3 Department of Legal Affairs, shall, to the extent possible, be
4 collocated. The agency and the Department of Legal Affairs
5 shall periodically conduct joint training and other joint
6 activities designed to increase communication and coordination
7 in recovering overpayments.
8 (5) A Medicaid provider is subject to having goods and
9 services that are paid for by the Medicaid program reviewed by
10 an appropriate peer-review organization designated by the
11 agency. The written findings of the applicable peer-review
12 organization are admissible in any court or administrative
13 proceeding as evidence of medical necessity or the lack
14 thereof.
15 (6) Any notice required to be given to a provider
16 under this section is presumed to be sufficient notice if sent
17 to the address last shown on the provider enrollment file. It
18 is the responsibility of the provider to furnish and keep the
19 agency informed of the provider's current address. United
20 States Postal Service proof of mailing or certified or
21 registered mailing of such notice to the provider at the
22 address shown on the provider enrollment file constitutes
23 sufficient proof of notice. Any notice required to be given to
24 the agency by this section must be sent to the agency at an
25 address designated by rule.
26 (7) When presenting a claim for payment under the
27 Medicaid program, a provider has an affirmative duty to
28 supervise the provision of, and be responsible for, goods and
29 services claimed to have been provided, to supervise and be
30 responsible for preparation and submission of the claim, and
31 to present a claim that is true and accurate and that is for
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 goods and services that:
2 (a) Have actually been furnished to the recipient by
3 the provider prior to submitting the claim.
4 (b) Are Medicaid-covered goods or services that are
5 medically necessary.
6 (c) Are of a quality comparable to those furnished to
7 the general public by the provider's peers.
8 (d) Have not been billed in whole or in part to a
9 recipient or a recipient's responsible party, except for such
10 copayments, coinsurance, or deductibles as are authorized by
11 the agency.
12 (e) Are provided in accord with applicable provisions
13 of all Medicaid rules, regulations, handbooks, and policies
14 and in accordance with federal, state, and local law.
15 (f) Are documented by records made at the time the
16 goods or services were provided, demonstrating the medical
17 necessity for the goods or services rendered. Medicaid goods
18 or services are excessive or not medically necessary unless
19 both the medical basis and the specific need for them are
20 fully and properly documented in the recipient's medical
21 record.
22 (8) A Medicaid provider shall retain medical,
23 professional, financial, and business records pertaining to
24 services and goods furnished to a Medicaid recipient and
25 billed to Medicaid for a period of 5 years after the date of
26 furnishing such services or goods. The agency may investigate,
27 review, or analyze such records, which must be made available
28 during normal business hours. However, 24-hour notice must be
29 provided if patient treatment would be disrupted. The provider
30 is responsible for furnishing to the agency, and keeping the
31 agency informed of the location of, the provider's
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Medicaid-related records. The authority of the agency to
2 obtain Medicaid-related records from a provider is neither
3 curtailed nor limited during a period of litigation between
4 the agency and the provider.
5 (9) Payments for the services of billing agents or
6 persons participating in the preparation of a Medicaid claim
7 shall not be based on amounts for which they bill nor based on
8 the amount a provider receives from the Medicaid program.
9 (10) The agency may require repayment for
10 inappropriate, medically unnecessary, or excessive goods or
11 services from the person furnishing them, the person under
12 whose supervision they were furnished, or the person causing
13 them to be furnished.
14 (11) The complaint and all information obtained
15 pursuant to an investigation of a Medicaid provider, or the
16 authorized representative or agent of a provider, relating to
17 an allegation of fraud, abuse, or neglect are confidential and
18 exempt from the provisions of s. 119.07(1):
19 (a) Until the agency takes final agency action with
20 respect to the provider and requires repayment of any
21 overpayment, or imposes an administrative sanction;
22 (b) Until the Attorney General refers the case for
23 criminal prosecution;
24 (c) Until 10 days after the complaint is determined
25 without merit; or
26 (d) At all times if the complaint or information is
27 otherwise protected by law.
28 (12) The agency may terminate participation of a
29 Medicaid provider in the Medicaid program and may seek civil
30 remedies or impose other administrative sanctions against a
31 Medicaid provider, if the provider has been:
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Amendment No. ___ (for drafter's use only)
1 (a) Convicted of a criminal offense related to the
2 delivery of any health care goods or services, including the
3 performance of management or administrative functions relating
4 to the delivery of health care goods or services;
5 (b) Convicted of a criminal offense under federal law
6 or the law of any state relating to the practice of the
7 provider's profession; or
8 (c) Found by a court of competent jurisdiction to have
9 neglected or physically abused a patient in connection with
10 the delivery of health care goods or services.
11 (13) If the provider has been suspended or terminated
12 from participation in the Medicaid program or the Medicare
13 program by the Federal Government or any state, the agency
14 must immediately suspend or terminate, as appropriate, the
15 provider's participation in the Florida Medicaid program for a
16 period no less than that imposed by the Federal Government or
17 any other state, and may not enroll such provider in the
18 Florida Medicaid program while such foreign suspension or
19 termination remains in effect. This sanction is in addition
20 to all other remedies provided by law.
21 (14) The agency may seek any remedy provided by law,
22 including, but not limited to, the remedies provided in
23 subsections (12) and (15) and s. 812.035, if:
24 (a) The provider's license has not been renewed, or
25 has been revoked, suspended, or terminated, for cause, by the
26 licensing agency of any state;
27 (b) The provider has failed to make available or has
28 refused access to Medicaid-related records to an auditor,
29 investigator, or other authorized employee or agent of the
30 agency, the Attorney General, a state attorney, or the Federal
31 Government;
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Amendment No. ___ (for drafter's use only)
1 (c) The provider has not furnished or has failed to
2 make available such Medicaid-related records as the agency has
3 found necessary to determine whether Medicaid payments are or
4 were due and the amounts thereof;
5 (d) The provider has failed to maintain medical
6 records made at the time of service, or prior to service if
7 prior authorization is required, demonstrating the necessity
8 and appropriateness of the goods or services rendered;
9 (e) The provider is not in compliance with provisions
10 of Medicaid provider publications that have been adopted by
11 reference as rules in the Florida Administrative Code; with
12 provisions of state or federal laws, rules, or regulations;
13 with provisions of the provider agreement between the agency
14 and the provider; or with certifications found on claim forms
15 or on transmittal forms for electronically submitted claims
16 that are submitted by the provider or authorized
17 representative, as such provisions apply to the Medicaid
18 program;
19 (f) The provider or person who ordered or prescribed
20 the care, services, or supplies has furnished, or ordered the
21 furnishing of, goods or services to a recipient which are
22 inappropriate, unnecessary, excessive, or harmful to the
23 recipient or are of inferior quality;
24 (g) The provider has demonstrated a pattern of failure
25 to provide goods or services that are medically necessary;
26 (h) The provider or an authorized representative of
27 the provider, or a person who ordered or prescribed the goods
28 or services, has submitted or caused to be submitted false or
29 a pattern of erroneous Medicaid claims that have resulted in
30 overpayments to a provider or that exceed those to which the
31 provider was entitled under the Medicaid program;
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Amendment No. ___ (for drafter's use only)
1 (i) The provider or an authorized representative of
2 the provider, or a person who has ordered or prescribed the
3 goods or services, has submitted or caused to be submitted a
4 Medicaid provider enrollment application, a request for prior
5 authorization for Medicaid services, a drug exception request,
6 or a Medicaid cost report that contains materially false or
7 incorrect information;
8 (j) The provider or an authorized representative of
9 the provider has collected from or billed a recipient or a
10 recipient's responsible party improperly for amounts that
11 should not have been so collected or billed by reason of the
12 provider's billing the Medicaid program for the same service;
13 (k) The provider or an authorized representative of
14 the provider has included in a cost report costs that are not
15 allowable under a Florida Title XIX reimbursement plan, after
16 the provider or authorized representative had been advised in
17 an audit exit conference or audit report that the costs were
18 not allowable;
19 (l) The provider is charged by information or
20 indictment with fraudulent billing practices. The sanction
21 applied for this reason is limited to suspension of the
22 provider's participation in the Medicaid program for the
23 duration of the indictment unless the provider is found guilty
24 pursuant to the information or indictment;
25 (m) The provider or a person who has ordered, or
26 prescribed the goods or services is found liable for negligent
27 practice resulting in death or injury to the provider's
28 patient;
29 (n) The provider fails to demonstrate that it had
30 available during a specific audit or review period sufficient
31 quantities of goods, or sufficient time in the case of
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Amendment No. ___ (for drafter's use only)
1 services, to support the provider's billings to the Medicaid
2 program;
3 (o) The provider has failed to comply with the notice
4 and reporting requirements of s. 409.907; or
5 (p) The agency has received reliable information of
6 patient abuse or neglect or of any act prohibited by s.
7 409.920; or.
8 (q) The provider has failed to comply with an
9 agreed-upon repayment schedule.
10 (15) The agency shall may impose any of the following
11 sanctions or disincentives on a provider or a person for any
12 of the acts described in subsection (14):
13 (a) Suspension for a specific period of time of not
14 more than 1 year.
15 (b) Termination for a specific period of time of from
16 more than 1 year to 20 years.
17 (c) Imposition of a fine of up to $5,000 for each
18 violation. Each day that an ongoing violation continues, such
19 as refusing to furnish Medicaid-related records or refusing
20 access to records, is considered, for the purposes of this
21 section, to be a separate violation. Each instance of
22 improper billing of a Medicaid recipient; each instance of
23 including an unallowable cost on a hospital or nursing home
24 Medicaid cost report after the provider or authorized
25 representative has been advised in an audit exit conference or
26 previous audit report of the cost unallowability; each
27 instance of furnishing a Medicaid recipient goods or
28 professional services that are inappropriate or of inferior
29 quality as determined by competent peer judgment; each
30 instance of knowingly submitting a materially false or
31 erroneous Medicaid provider enrollment application, request
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Amendment No. ___ (for drafter's use only)
1 for prior authorization for Medicaid services, drug exception
2 request, or cost report; each instance of inappropriate
3 prescribing of drugs for a Medicaid recipient as determined by
4 competent peer judgment; and each false or erroneous Medicaid
5 claim leading to an overpayment to a provider is considered,
6 for the purposes of this section, to be a separate violation.
7 (d) Immediate suspension, if the agency has received
8 information of patient abuse or neglect or of any act
9 prohibited by s. 409.920. Upon suspension, the agency must
10 issue an immediate final order under s. 120.569(2)(n).
11 (e) A fine, not to exceed $10,000, for a violation of
12 paragraph (14)(i).
13 (f) Imposition of liens against provider assets,
14 including, but not limited to, financial assets and real
15 property, not to exceed the amount of fines or recoveries
16 sought, upon entry of an order determining that such moneys
17 are due or recoverable.
18 (g) Prepayment reviews of claims for a specified
19 period of time.
20 (h) Comprehensive follow-up reviews of providers every
21 6 months to ensure that they are billing Medicaid correctly.
22 (i) Corrective-action plans that would remain in
23 effect for providers for up to 3 years and that would be
24 monitored by the agency every 6 months while in effect.
25 (j)(g) Other remedies as permitted by law to effect
26 the recovery of a fine or overpayment.
27
28 The Secretary of Health Care Administration may make a
29 determination that imposition of a sanction or disincentive is
30 not in the best interest of the Medicaid program, in which
31 case a sanction or disincentive shall not be imposed.
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Amendment No. ___ (for drafter's use only)
1 (16) In determining the appropriate administrative
2 sanction to be applied, or the duration of any suspension or
3 termination, the agency shall consider:
4 (a) The seriousness and extent of the violation or
5 violations.
6 (b) Any prior history of violations by the provider
7 relating to the delivery of health care programs which
8 resulted in either a criminal conviction or in administrative
9 sanction or penalty.
10 (c) Evidence of continued violation within the
11 provider's management control of Medicaid statutes, rules,
12 regulations, or policies after written notification to the
13 provider of improper practice or instance of violation.
14 (d) The effect, if any, on the quality of medical care
15 provided to Medicaid recipients as a result of the acts of the
16 provider.
17 (e) Any action by a licensing agency respecting the
18 provider in any state in which the provider operates or has
19 operated.
20 (f) The apparent impact on access by recipients to
21 Medicaid services if the provider is suspended or terminated,
22 in the best judgment of the agency.
23
24 The agency shall document the basis for all sanctioning
25 actions and recommendations.
26 (17) The agency may take action to sanction, suspend,
27 or terminate a particular provider working for a group
28 provider, and may suspend or terminate Medicaid participation
29 at a specific location, rather than or in addition to taking
30 action against an entire group.
31 (18) The agency shall establish a process for
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Amendment No. ___ (for drafter's use only)
1 conducting followup reviews of a sampling of providers who
2 have a history of overpayment under the Medicaid program.
3 This process must consider the magnitude of previous fraud or
4 abuse and the potential effect of continued fraud or abuse on
5 Medicaid costs.
6 (19) In making a determination of overpayment to a
7 provider, the agency must use accepted and valid auditing,
8 accounting, analytical, statistical, or peer-review methods,
9 or combinations thereof. Appropriate statistical methods may
10 include, but are not limited to, sampling and extension to the
11 population, parametric and nonparametric statistics, tests of
12 hypotheses, and other generally accepted statistical methods.
13 Appropriate analytical methods may include, but are not
14 limited to, reviews to determine variances between the
15 quantities of products that a provider had on hand and
16 available to be purveyed to Medicaid recipients during the
17 review period and the quantities of the same products paid for
18 by the Medicaid program for the same period, taking into
19 appropriate consideration sales of the same products to
20 non-Medicaid customers during the same period. In meeting its
21 burden of proof in any administrative or court proceeding, the
22 agency may introduce the results of such statistical methods
23 as evidence of overpayment.
24 (20) When making a determination that an overpayment
25 has occurred, the agency shall prepare and issue an audit
26 report to the provider showing the calculation of
27 overpayments.
28 (21) The audit report, supported by agency work
29 papers, showing an overpayment to a provider constitutes
30 evidence of the overpayment. A provider may not present or
31 elicit testimony, either on direct examination or
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Amendment No. ___ (for drafter's use only)
1 cross-examination in any court or administrative proceeding,
2 regarding the purchase or acquisition by any means of drugs,
3 goods, or supplies; sales or divestment by any means of drugs,
4 goods, or supplies; or inventory of drugs, goods, or supplies,
5 unless such acquisition, sales, divestment, or inventory is
6 documented by written invoices, written inventory records, or
7 other competent written documentary evidence maintained in the
8 normal course of the provider's business. Notwithstanding the
9 applicable rules of discovery, all documentation that will be
10 offered as evidence at an administrative hearing on a Medicaid
11 overpayment must be exchanged by all parties at least 14 days
12 before the administrative hearing or must be excluded from
13 consideration.
14 (22)(a) In an audit or investigation of a violation
15 committed by a provider which is conducted pursuant to this
16 section, the agency is entitled to recover all investigative,
17 legal, and expert witness costs if the agency's findings were
18 not contested by the provider or, if contested, the agency
19 ultimately prevailed.
20 (b) The agency has the burden of documenting the
21 costs, which include salaries and employee benefits and
22 out-of-pocket expenses. The amount of costs that may be
23 recovered must be reasonable in relation to the seriousness of
24 the violation and must be set taking into consideration the
25 financial resources, earning ability, and needs of the
26 provider, who has the burden of demonstrating such factors.
27 (c) The provider may pay the costs over a period to be
28 determined by the agency if the agency determines that an
29 extreme hardship would result to the provider from immediate
30 full payment. Any default in payment of costs may be
31 collected by any means authorized by law.
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (23) If the agency imposes an administrative sanction
2 under this section upon any provider or other person who is
3 regulated by another state entity, the agency shall notify
4 that other entity of the imposition of the sanction. Such
5 notification must include the provider's or person's name and
6 license number and the specific reasons for sanction.
7 (24)(a) The agency may withhold Medicaid payments, in
8 whole or in part, to a provider upon receipt of reliable
9 evidence that the circumstances giving rise to the need for a
10 withholding of payments involve fraud, willful
11 misrepresentation, or abuse under the Medicaid program, or a
12 crime committed while rendering goods or services to Medicaid
13 recipients, pending completion of legal proceedings. If it is
14 determined that fraud, willful misrepresentation, abuse, or a
15 crime did not occur, the payments withheld must be paid to the
16 provider within 14 days after such determination with interest
17 at the rate of 10 percent a year. Any money withheld in
18 accordance with this paragraph shall be placed in a suspended
19 account, readily accessible to the agency, so that any payment
20 ultimately due the provider shall be made within 14 days.
21 (b) Overpayments owed to the agency bear interest at
22 the rate of 10 percent per year from the date of determination
23 of the overpayment by the agency, and payment arrangements
24 must be made at the conclusion of legal proceedings. A
25 provider who does not enter into or adhere to an agreed-upon
26 repayment schedule may be terminated by the agency for
27 nonpayment or partial payment.
28 (c) The agency, upon entry of a final agency order, a
29 judgment or order of a court of competent jurisdiction, or a
30 stipulation or settlement, may collect the moneys owed by all
31 means allowable by law, including, but not limited to,
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 notifying any fiscal intermediary of Medicare benefits that
2 the state has a superior right of payment. Upon receipt of
3 such written notification, the Medicare fiscal intermediary
4 shall remit to the state the sum claimed.
5 (25) The agency may impose administrative sanctions
6 against a Medicaid recipient, or the agency may seek any other
7 remedy provided by law, including, but not limited to, the
8 remedies provided in s. 812.035, if the agency finds that a
9 recipient has engaged in solicitation in violation of s.
10 409.920 or that the recipient has otherwise abused the
11 Medicaid program.
12 (26) When the Agency for Health Care Administration
13 has made a probable cause determination and alleged that an
14 overpayment to a Medicaid provider has occurred, the agency,
15 after notice to the provider, may:
16 (a) Withhold, and continue to withhold during the
17 pendency of an administrative hearing pursuant to chapter 120,
18 any medical assistance reimbursement payments until such time
19 as the overpayment is recovered, unless within 30 days after
20 receiving notice thereof the provider:
21 1. Makes repayment in full; or
22 2. Establishes a repayment plan that is satisfactory
23 to the Agency for Health Care Administration.
24 (b) Withhold, and continue to withhold during the
25 pendency of an administrative hearing pursuant to chapter 120,
26 medical assistance reimbursement payments if the terms of a
27 repayment plan are not adhered to by the provider.
28
29 If a provider requests an administrative hearing pursuant to
30 chapter 120, such hearing must be conducted within 90 days
31 following receipt by the provider of the final audit report,
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 absent exceptionally good cause shown as determined by the
2 administrative law judge or hearing officer. Upon issuance of
3 a final order, the balance outstanding of the amount
4 determined to constitute the overpayment shall become due. Any
5 withholding of payments by the Agency for Health Care
6 Administration pursuant to this section shall be limited so
7 that the monthly medical assistance payment is not reduced by
8 more than 10 percent.
9 (27) Venue for all Medicaid program integrity
10 overpayment cases shall lie in Leon County, at the discretion
11 of the agency.
12 (28) Notwithstanding other provisions of law, the
13 agency and the Medicaid Fraud Control Unit of the Department
14 of Legal Affairs may review a provider's Medicaid-related
15 records in order to determine the total output of a provider's
16 practice to reconcile quantities of goods or services billed
17 to Medicaid against quantities of goods or services used in
18 the provider's total practice.
19 (29) The agency may terminate a provider's
20 participation in the Medicaid program if the provider fails to
21 reimburse an overpayment that has been determined by final
22 order, not subject to further appeal, within 35 days after the
23 date of the final order, unless the provider and the agency
24 have entered into a repayment agreement.
25 (30) If a provider requests an administrative hearing
26 pursuant to chapter 120, such hearing must be conducted within
27 90 days following assignment of an administrative law judge,
28 absent exceptionally good cause shown as determined by the
29 administrative law judge or hearing officer. Upon issuance of
30 a final order, the outstanding balance of the amount
31 determined to constitute the overpayment shall become due. If
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Amendment No. ___ (for drafter's use only)
1 a provider fails to make payments in full, fails to enter into
2 a satisfactory repayment plan, or fails to comply with the
3 terms of a repayment plan or settlement agreement, the agency
4 may withhold medical assistance reimbursement payments until
5 the amount due is paid in full.
6 (31) Duly authorized agents and employees of the
7 agency shall have the power to inspect, during normal business
8 hours, the records of any pharmacy, wholesale establishment,
9 or manufacturer, or any other place in which drugs and medical
10 supplies are manufactured, packed, packaged, made, stored,
11 sold, or kept for sale, for the purpose of verifying the
12 amount of drugs and medical supplies ordered, delivered, or
13 purchased by a provider. The agency shall provide at least 2
14 business days' prior notice of any such inspection. The notice
15 must identify the provider whose records will be inspected,
16 and the inspection shall include only records specifically
17 related to that provider.
18 Section 31. Subsections (7) and (8) of section
19 409.920, Florida Statutes, are amended to read:
20 409.920 Medicaid provider fraud.--
21 (7) The Attorney General shall conduct a statewide
22 program of Medicaid fraud control. To accomplish this purpose,
23 the Attorney General shall:
24 (a) Investigate the possible criminal violation of any
25 applicable state law pertaining to fraud in the administration
26 of the Medicaid program, in the provision of medical
27 assistance, or in the activities of providers of health care
28 under the Medicaid program.
29 (b) Investigate the alleged abuse or neglect of
30 patients in health care facilities receiving payments under
31 the Medicaid program, in coordination with the agency.
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Amendment No. ___ (for drafter's use only)
1 (c) Investigate the alleged misappropriation of
2 patients' private funds in health care facilities receiving
3 payments under the Medicaid program.
4 (d) Refer to the Office of Statewide Prosecution or
5 the appropriate state attorney all violations indicating a
6 substantial potential for criminal prosecution.
7 (e) Refer to the agency all suspected abusive
8 activities not of a criminal or fraudulent nature.
9 (f) Refer to the agency for collection each instance
10 of overpayment to a provider of health care under the Medicaid
11 program which is discovered during the course of an
12 investigation.
13 (f)(g) Safeguard the privacy rights of all individuals
14 and provide safeguards to prevent the use of patient medical
15 records for any reason beyond the scope of a specific
16 investigation for fraud or abuse, or both, without the
17 patient's written consent.
18 (g) Publicize to state employees and the public the
19 ability of persons to bring suit under the provisions of the
20 Florida False Claims Act and the potential for the persons
21 bringing a civil action under the Florida False Claims Act to
22 obtain a monetary award.
23 (8) In carrying out the duties and responsibilities
24 under this section subsection, the Attorney General may:
25 (a) Enter upon the premises of any health care
26 provider, excluding a physician, participating in the Medicaid
27 program to examine all accounts and records that may, in any
28 manner, be relevant in determining the existence of fraud in
29 the Medicaid program, to investigate alleged abuse or neglect
30 of patients, or to investigate alleged misappropriation of
31 patients' private funds. A participating physician is required
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 to make available any accounts or records that may, in any
2 manner, be relevant in determining the existence of fraud in
3 the Medicaid program. The accounts or records of a
4 non-Medicaid patient may not be reviewed by, or turned over
5 to, the Attorney General without the patient's written
6 consent.
7 (b) Subpoena witnesses or materials, including medical
8 records relating to Medicaid recipients, within or outside the
9 state and, through any duly designated employee, administer
10 oaths and affirmations and collect evidence for possible use
11 in either civil or criminal judicial proceedings.
12 (c) Request and receive the assistance of any state
13 attorney or law enforcement agency in the investigation and
14 prosecution of any violation of this section.
15 (d) Seek any civil remedy provided by law, including,
16 but not limited to, the remedies provided in ss.
17 68.081-68.092, s. 812.035, and this chapter.
18 (e) Refer to the agency for collection each instance
19 of overpayment to a provider of health care under the Medicaid
20 program which is discovered during the course of an
21 investigation.
22 Section 32. Section 624.91, Florida Statutes, is
23 amended to read:
24 624.91 The Florida Healthy Kids Corporation Act.--
25 (1) SHORT TITLE.--This section may be cited as the
26 "William G. 'Doc' Myers Healthy Kids Corporation Act."
27 (2) LEGISLATIVE INTENT.--
28 (a) The Legislature finds that increased access to
29 health care services could improve children's health and
30 reduce the incidence and costs of childhood illness and
31 disabilities among children in this state. Many children do
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 not have comprehensive, affordable health care services
2 available. It is the intent of the Legislature that the
3 Florida Healthy Kids Corporation provide comprehensive health
4 insurance coverage to such children. The corporation is
5 encouraged to cooperate with any existing health service
6 programs funded by the public or the private sector and to
7 work cooperatively with the Florida Partnership for School
8 Readiness.
9 (b) It is the intent of the Legislature that the
10 Florida Healthy Kids Corporation serve as one of several
11 providers of services to children eligible for medical
12 assistance under Title XXI of the Social Security Act.
13 Although the corporation may serve other children, the
14 Legislature intends the primary recipients of services
15 provided through the corporation be school-age children with a
16 family income below 200 percent of the federal poverty level,
17 who do not qualify for Medicaid. It is also the intent of the
18 Legislature that state and local government Florida Healthy
19 Kids funds, to the extent permissible under federal law, be
20 used to continue and expand coverage, within available
21 appropriations, to children not eligible for federal matching
22 funds under Title XXI obtain matching federal dollars.
23 (3) NONENTITLEMENT.--Nothing in this section shall be
24 construed as providing an individual with an entitlement to
25 health care services. No cause of action shall arise against
26 the state, the Florida Healthy Kids Corporation, or a unit of
27 local government for failure to make health services available
28 under this section.
29 (4) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
30 (a) There is created the Florida Healthy Kids
31 Corporation, a not-for-profit corporation which operates on
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 sites designated by the corporation.
2 (b) The Florida Healthy Kids Corporation shall phase
3 in a program to:
4 1. Organize school children groups to facilitate the
5 provision of comprehensive health insurance coverage to
6 children;
7 2. Arrange for the collection of any family, local
8 contributions, or employer payment or premium, in an amount to
9 be determined by the board of directors, to provide for
10 payment of premiums for comprehensive insurance coverage and
11 for the actual or estimated administrative expenses;
12 3. Arrange for the collection of any voluntary
13 contributions to provide for payment of premiums for children
14 who are not eligible for medical assistance under Title XXI of
15 the Social Security Act. Each fiscal year, the corporation
16 shall establish a local match policy for the enrollment of
17 non-Title-XXI-eligible children in the Healthy Kids program.
18 By May 1 of each year, the corporation shall provide written
19 notification of the amount to be remitted to the corporation
20 for the following fiscal year under that policy. Local match
21 sources may include, but are not limited to, funds provided by
22 municipalities, counties, school boards, hospitals, health
23 care providers, charitable organizations, special taxing
24 districts, and private organizations. The minimum local match
25 cash contributions required each fiscal year and local match
26 credits shall be determined by the General Appropriations Act.
27 The corporation shall calculate a county's local match rate
28 based upon that county's percentage of the state's total
29 non-Title-XXI expenditures as reported in the corporation's
30 most recently audited financial statement. In awarding the
31 local match credits, the corporation may consider factors
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 including, but not limited to, population density, per-capita
2 income, and existing child-health-related expenditures and
3 services;
4 4. Accept voluntary supplemental local match
5 contributions that comply with the requirements of Title XXI
6 of the Social Security Act for the purpose of providing
7 additional coverage in contributing counties under Title XXI;
8 5.3. Establish the administrative and accounting
9 procedures for the operation of the corporation;
10 6.4. Establish, with consultation from appropriate
11 professional organizations, standards for preventive health
12 services and providers and comprehensive insurance benefits
13 appropriate to children; provided that such standards for
14 rural areas shall not limit primary care providers to
15 board-certified pediatricians;
16 7.5. Establish eligibility criteria which children
17 must meet in order to participate in the program;
18 8.6. Establish procedures under which providers of
19 local match to, applicants to and participants in the program
20 may have grievances reviewed by an impartial body and reported
21 to the board of directors of the corporation;
22 9.7. Establish participation criteria and, if
23 appropriate, contract with an authorized insurer, health
24 maintenance organization, or insurance administrator to
25 provide administrative services to the corporation;
26 10.8. Establish enrollment criteria which shall
27 include penalties or waiting periods of not fewer than 60 days
28 for reinstatement of coverage upon voluntary cancellation for
29 nonpayment of family premiums;
30 11.9. If a space is available, establish a special
31 open enrollment period of 30 days' duration for any child who
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 is enrolled in Medicaid or Medikids if such child loses
2 Medicaid or Medikids eligibility and becomes eligible for the
3 Florida Healthy Kids program;
4 12.10. Contract with authorized insurers or any
5 provider of health care services, meeting standards
6 established by the corporation, for the provision of
7 comprehensive insurance coverage to participants. Such
8 standards shall include criteria under which the corporation
9 may contract with more than one provider of health care
10 services in program sites. Health plans shall be selected
11 through a competitive bid process. The selection of health
12 plans shall be based primarily on quality criteria established
13 by the board. The health plan selection criteria and scoring
14 system, and the scoring results, shall be available upon
15 request for inspection after the bids have been awarded;
16 13. Establish disenrollment criteria in the event
17 local matching funds are insufficient to cover enrollments;
18 14.11. Develop and implement a plan to publicize the
19 Florida Healthy Kids Corporation, the eligibility requirements
20 of the program, and the procedures for enrollment in the
21 program and to maintain public awareness of the corporation
22 and the program;
23 15.12. Secure staff necessary to properly administer
24 the corporation. Staff costs shall be funded from state and
25 local matching funds and such other private or public funds as
26 become available. The board of directors shall determine the
27 number of staff members necessary to administer the
28 corporation;
29 16.13. As appropriate, enter into contracts with local
30 school boards or other agencies to provide onsite information,
31 enrollment, and other services necessary to the operation of
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the corporation;
2 17.14. Provide a report on an annual basis to the
3 Governor, Insurance Commissioner, Commissioner of Education,
4 Senate President, Speaker of the House of Representatives, and
5 Minority Leaders of the Senate and the House of
6 Representatives;
7 18.15. Each fiscal year, establish a maximum number of
8 participants by county, on a statewide basis, who may enroll
9 in the program without the benefit of local matching funds.
10 Thereafter, the corporation may establish local matching
11 requirements for supplemental participation in the program.
12 The corporation may vary local matching requirements and
13 enrollment by county depending on factors which may influence
14 the generation of local match, including, but not limited to,
15 population density, per capita income, existing local tax
16 effort, and other factors. The corporation also may accept
17 in-kind match in lieu of cash for the local match requirement
18 to the extent allowed by Title XXI of the Social Security Act;
19 and
20 19.16. Establish eligibility criteria, premium and
21 cost-sharing requirements, and benefit packages which conform
22 to the provisions of the Florida Kidcare program, as created
23 in ss. 409.810-409.820.
24 (c) Coverage under the corporation's program is
25 secondary to any other available private coverage held by the
26 participant child or family member. The corporation may
27 establish procedures for coordinating benefits under this
28 program with benefits under other public and private coverage.
29 (d) The Florida Healthy Kids Corporation shall be a
30 private corporation not for profit, organized pursuant to
31 chapter 617, and shall have all powers necessary to carry out
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the purposes of this act, including, but not limited to, the
2 power to receive and accept grants, loans, or advances of
3 funds from any public or private agency and to receive and
4 accept from any source contributions of money, property,
5 labor, or any other thing of value, to be held, used, and
6 applied for the purposes of this act.
7 (5) BOARD OF DIRECTORS.--
8 (a) The Florida Healthy Kids Corporation shall operate
9 subject to the supervision and approval of a board of
10 directors chaired by the Insurance Commissioner or her or his
11 designee, and composed of 14 12 other members selected for
12 3-year terms of office as follows:
13 1. One member appointed by the Commissioner of
14 Education from among three persons nominated by the Florida
15 Association of School Administrators;
16 2. One member appointed by the Commissioner of
17 Education from among three persons nominated by the Florida
18 Association of School Boards;
19 3. One member appointed by the Commissioner of
20 Education from the Office of School Health Programs of the
21 Florida Department of Education;
22 4. One member appointed by the Governor from among
23 three members nominated by the Florida Pediatric Society;
24 5. One member, appointed by the Governor, who
25 represents the Children's Medical Services Program;
26 6. One member appointed by the Insurance Commissioner
27 from among three members nominated by the Florida Hospital
28 Association;
29 7. Two members, appointed by the Insurance
30 Commissioner, who are representatives of authorized health
31 care insurers or health maintenance organizations;
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 8. One member, appointed by the Insurance
2 Commissioner, who represents the Institute for Child Health
3 Policy;
4 9. One member, appointed by the Governor, from among
5 three members nominated by the Florida Academy of Family
6 Physicians;
7 10. One member, appointed by the Governor, who
8 represents the Agency for Health Care Administration; and
9 11. The State Health Officer or her or his designee;.
10 12. One member, appointed by the Insurance
11 Commissioner from among three members nominated by the Florida
12 Association of Counties, representing rural counties; and
13 13. One member, appointed by the Governor from among
14 three members nominated by the Florida Association of
15 Counties, representing urban counties.
16 (b) A member of the board of directors may be removed
17 by the official who appointed that member. The board shall
18 appoint an executive director, who is responsible for other
19 staff authorized by the board.
20 (c) Board members are entitled to receive, from funds
21 of the corporation, reimbursement for per diem and travel
22 expenses as provided by s. 112.061.
23 (d) There shall be no liability on the part of, and no
24 cause of action shall arise against, any member of the board
25 of directors, or its employees or agents, for any action they
26 take in the performance of their powers and duties under this
27 act.
28 (6) LICENSING NOT REQUIRED; FISCAL OPERATION.--
29 (a) The corporation shall not be deemed an insurer.
30 The officers, directors, and employees of the corporation
31 shall not be deemed to be agents of an insurer. Neither the
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 corporation nor any officer, director, or employee of the
2 corporation is subject to the licensing requirements of the
3 insurance code or the rules of the Department of Insurance.
4 However, any marketing representative utilized and compensated
5 by the corporation must be appointed as a representative of
6 the insurers or health services providers with which the
7 corporation contracts.
8 (b) The board has complete fiscal control over the
9 corporation and is responsible for all corporate operations.
10 (c) The Department of Insurance shall supervise any
11 liquidation or dissolution of the corporation and shall have,
12 with respect to such liquidation or dissolution, all power
13 granted to it pursuant to the insurance code.
14 (7) ACCESS TO RECORDS; CONFIDENTIALITY;
15 PENALTIES.--Notwithstanding any other laws to the contrary,
16 the Florida Healthy Kids Corporation shall have access to the
17 medical records of a student upon receipt of permission from a
18 parent or guardian of the student. Such medical records may
19 be maintained by state and local agencies. Any identifying
20 information, including medical records and family financial
21 information, obtained by the corporation pursuant to this
22 subsection is confidential and is exempt from the provisions
23 of s. 119.07(1). Neither the corporation nor the staff or
24 agents of the corporation may release, without the written
25 consent of the participant or the parent or guardian of the
26 participant, to any state or federal agency, to any private
27 business or person, or to any other entity, any confidential
28 information received pursuant to this subsection. A violation
29 of this subsection is a misdemeanor of the second degree,
30 punishable as provided in s. 775.082 or s. 775.083.
31 Section 33. Paragraph (a) of subsection (2) of section
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 627.6425, Florida Statutes, is amended to read:
2 627.6425 Renewability of individual coverage.--
3 (2) An insurer may nonrenew or discontinue health
4 insurance coverage of an individual in the individual market
5 based only on one or more of the following:
6 (a) The individual has failed to pay premiums, or
7 contributions, or a required copayment payable to the insurer
8 in accordance with the terms of the health insurance coverage
9 or the insurer has not received timely premium payments. When
10 the copayment is payable to the insurer and exceeds $300, the
11 insurer shall allow the insured up to 90 days after the date
12 of the procedure to pay the required copayment. The insurer
13 shall print in 10-point type on the Declaration of Benefits
14 page notification that the insured could be terminated for
15 failure to make any required copayment to the insurer.
16 Section 34. Subsection (2) of section 766.110, Florida
17 Statutes, is amended to read:
18 766.110 Liability of health care facilities.--
19 (2) Every hospital licensed under chapter 395 may
20 carry liability insurance or adequately insure itself in an
21 amount of not less than $1.5 million per claim, $5 million
22 annual aggregate to cover all medical injuries to patients
23 resulting from negligent acts or omissions on the part of
24 those members of its medical staff who are covered thereby in
25 furtherance of the requirements of ss. 458.320 and 459.0085.
26 Self-insurance coverage extended hereunder to a member of a
27 hospital's medical staff meets the financial responsibility
28 requirements of ss. 458.320 and 459.0085 if the physician's
29 coverage limits are not less than the minimum limits
30 established in ss. 458.320 and 459.0085 and the hospital is a
31 verified trauma center as of July 1, 1990, that has extended
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 self-insurance coverage continuously to members of its medical
2 staff for activities both inside and outside of the hospital
3 since January 1, 1987. Any insurer authorized to write
4 casualty insurance may make available, but shall not be
5 required to write, such coverage. The hospital may assess on
6 an equitable and pro rata basis the following professional
7 health care providers for a portion of the total hospital
8 insurance cost for this coverage: physicians licensed under
9 chapter 458, osteopathic physicians licensed under chapter
10 459, podiatric physicians licensed under chapter 461, dentists
11 licensed under chapter 466, and nurses licensed under part I
12 of chapter 464. The hospital may provide for a deductible
13 amount to be applied against any individual health care
14 provider found liable in a law suit in tort or for breach of
15 contract. The legislative intent in providing for the
16 deductible to be applied to individual health care providers
17 found negligent or in breach of contract is to instill in each
18 individual health care provider the incentive to avoid the
19 risk of injury to the fullest extent and ensure that the
20 citizens of this state receive the highest quality health care
21 obtainable.
22 Section 35. Paragraph (e) of subsection (8) and
23 subsection (28) of section 393.063, Florida Statutes, are
24 amended to read:
25 393.063 Definitions.--For the purposes of this
26 chapter:
27 (8) "Comprehensive transitional education program"
28 means a group of jointly operating centers or units, the
29 collective purpose of which is to provide a sequential series
30 of educational care, training, treatment, habilitation, and
31 rehabilitation services to persons who have developmental
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 disabilities, as defined in subsection (12), and who have
2 severe or moderate maladaptive behaviors. However, nothing in
3 this subsection shall require comprehensive transitional
4 education programs to provide services only to persons with
5 developmental disabilities, as defined in subsection (12).
6 All such services shall be temporary in nature and delivered
7 in a structured residential setting with the primary goal of
8 incorporating the normalization principle to establish
9 permanent residence for persons with maladaptive behaviors in
10 facilities not associated with the comprehensive transitional
11 education program. The staff shall include psychologists and
12 teachers, and such staff personnel shall be available to
13 provide services in each component center or unit of the
14 program. The psychologists shall be individuals who are
15 licensed in this state and certified as behavior analysts in
16 this state, or individuals who meet the professional
17 requirements established by the department for district
18 behavior analysts and are certified as behavior analysts in
19 this state.
20 (e) This subsection shall authorize licensure for
21 comprehensive transitional education programs which by July 1,
22 1989:
23 1. Are in actual operation; or
24 2. Own a fee simple interest in real property for
25 which a county or city government has approved zoning allowing
26 for the placement of the facilities described in this
27 subsection, and have registered an intent with the department
28 to operate a comprehensive transitional education program.
29 However, nothing shall prohibit the assignment by such a
30 registrant to another entity at a different site within the
31 state, so long as there is compliance with all criteria of the
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 comprehensive transitional education program and local zoning
2 requirements and provided that each residential facility
3 within the component centers or units of the program
4 authorized under this subparagraph shall not exceed a capacity
5 of 15 persons.
6 (28) "Intermediate care facility for the
7 developmentally disabled" or "ICF/DD" means a
8 state-owned-and-operated residential facility licensed and
9 certified in accordance with state law, and certified by the
10 Federal Government pursuant to the Social Security Act, as a
11 provider of Medicaid services to persons who are
12 developmentally disabled mentally retarded or who have related
13 conditions. The capacity of such a facility shall not be more
14 than 120 clients.
15 Section 36. Section 400.965, Florida Statutes, is
16 amended to read:
17 400.965 Action by agency against licensee; grounds.--
18 (1) Any of the following conditions constitute grounds
19 for action by the agency against a licensee:
20 (a) A misrepresentation of a material fact in the
21 application;
22 (b) The commission of an intentional or negligent act
23 materially affecting the health or safety of residents of the
24 facility;
25 (c) A violation of any provision of this part or rules
26 adopted under this part; or
27 (d) The commission of any act constituting a ground
28 upon which application for a license may be denied.
29 (2) If the agency has a reasonable belief that any of
30 such conditions exists, it shall:
31 (a) In the case of an applicant for original
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 licensure, deny the application.
2 (b) In the case of an applicant for relicensure or a
3 current licensee, take administrative action as provided in s.
4 400.968 or s. 400.969 or injunctive action as authorized by s.
5 400.963.
6 (c) In the case of a facility operating without a
7 license, take injunctive action as authorized in s. 400.963.
8 Section 37. Subsection (4) of section 400.968, Florida
9 Statutes, is renumbered as section 400.969, Florida Statutes,
10 and amended to read:
11 400.969 Violation of part; penalties.--
12 (1)(4)(a) Except as provided in s. 400.967(3), a
13 violation of any provision of this part section or rules
14 adopted by the agency under this part section is punishable by
15 payment of an administrative or civil penalty not to exceed
16 $5,000.
17 (2)(b) A violation of this part section or of rules
18 adopted under this part section is a misdemeanor of the first
19 degree, punishable as provided in s. 775.082 or s. 775.083.
20 Each day of a continuing violation is a separate offense.
21 Section 38. Paragraph (a) of subsection (1) of section
22 499.012, Florida Statutes, is amended to read:
23 499.012 Wholesale distribution; definitions; permits;
24 general requirements.--
25 (1) As used in this section, the term:
26 (a) "Wholesale distribution" means distribution of
27 prescription drugs to persons other than a consumer or
28 patient, but does not include:
29 1. Any of the following activities, which is not a
30 violation of s. 499.005(21) if such activity is conducted in
31 accordance with s. 499.014:
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 a. The purchase or other acquisition by a hospital or
2 other health care entity that is a member of a group
3 purchasing organization of a prescription drug for its own use
4 from the group purchasing organization or from other hospitals
5 or health care entities that are members of that organization.
6 b. The sale, purchase, or trade of a prescription drug
7 or an offer to sell, purchase, or trade a prescription drug by
8 a charitable organization described in s. 501(c)(3) of the
9 Internal Revenue Code of 1986, as amended and revised, to a
10 nonprofit affiliate of the organization to the extent
11 otherwise permitted by law.
12 c. The sale, purchase, or trade of a prescription drug
13 or an offer to sell, purchase, or trade a prescription drug
14 among hospitals or other health care entities that are under
15 common control. For purposes of this section, "common control"
16 means the power to direct or cause the direction of the
17 management and policies of a person or an organization,
18 whether by ownership of stock, by voting rights, by contract,
19 or otherwise.
20 d. The sale, purchase, trade, or other transfer of a
21 prescription drug from or for any federal, state, or local
22 government agency or any entity eligible to purchase
23 prescription drugs at public health services prices pursuant
24 to Pub. L. No. 102-585, s. 602 to a contract provider or its
25 subcontractor for eligible patients of the agency or entity
26 under the following conditions:
27 (I) The agency or entity must obtain written
28 authorization for the sale, purchase, trade, or other transfer
29 of a prescription drug under this sub-subparagraph from the
30 Secretary of Health or his or her designee.
31 (II) The contract provider or subcontractor must be
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 authorized by law to administer or dispense prescription
2 drugs.
3 (III) In the case of a subcontractor, the agency or
4 entity must be a party to and execute the subcontract.
5 (IV) A contract provider or subcontractor must
6 maintain separate and apart from other prescription drug
7 inventory any prescription drugs of the agency or entity in
8 its possession.
9 (V) The contract provider and subcontractor must
10 maintain and produce immediately for inspection all records of
11 movement or transfer of all the prescription drugs belonging
12 to the agency or entity, including, but not limited to, the
13 records of receipt and disposition of prescription drugs. Each
14 contractor and subcontractor dispensing or administering these
15 drugs must maintain and produce records documenting the
16 dispensing or administration. Records that are required to be
17 maintained include, but are not limited to, a perpetual
18 inventory itemizing drugs received and drugs dispensed by
19 prescription number or administered by patient identifier,
20 which must be submitted to the agency or entity quarterly.
21 (VI) The contract provider or subcontractor may
22 administer or dispense the prescription drugs only to the
23 eligible patients of the agency or entity or must return the
24 prescription drugs for or to the agency or entity. The
25 contract provider or subcontractor must require proof from
26 each person seeking to fill a prescription or obtain treatment
27 that the person is an eligible patient of the agency or entity
28 and must, at a minimum, maintain a copy of this proof as part
29 of the records of the contractor or subcontractor required
30 under sub-sub-subparagraph (V).
31 (VII) The prescription drugs transferred pursuant to
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 this sub-subparagraph may not be billed to Medicaid.
2 (VII)(VIII) In addition to the departmental inspection
3 authority set forth in s. 499.051, the establishment of the
4 contract provider and subcontractor and all records pertaining
5 to prescription drugs subject to this sub-subparagraph shall
6 be subject to inspection by the agency or entity. All records
7 relating to prescription drugs of a manufacturer under this
8 sub-subparagraph shall be subject to audit by the manufacturer
9 of those drugs, without identifying individual patient
10 information.
11 2. Any of the following activities, which is not a
12 violation of s. 499.005(21) if such activity is conducted in
13 accordance with rules established by the department:
14 a. The sale, purchase, or trade of a prescription drug
15 among federal, state, or local government health care entities
16 that are under common control and are authorized to purchase
17 such prescription drug.
18 b. The sale, purchase, or trade of a prescription drug
19 or an offer to sell, purchase, or trade a prescription drug
20 for emergency medical reasons. For purposes of this
21 sub-subparagraph, the term "emergency medical reasons"
22 includes transfers of prescription drugs by a retail pharmacy
23 to another retail pharmacy to alleviate a temporary shortage.
24 c. The transfer of a prescription drug acquired by a
25 medical director on behalf of a licensed emergency medical
26 services provider to that emergency medical services provider
27 and its transport vehicles for use in accordance with the
28 provider's license under chapter 401.
29 d. The revocation of a sale or the return of a
30 prescription drug to the person's prescription drug wholesale
31 supplier.
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 e. The donation of a prescription drug by a health
2 care entity to a charitable organization that has been granted
3 an exemption under s. 501(c)(3) of the Internal Revenue Code
4 of 1986, as amended, and that is authorized to possess
5 prescription drugs.
6 f. The transfer of a prescription drug by a person
7 authorized to purchase or receive prescription drugs to a
8 person licensed or permitted to handle reverse distributions
9 or destruction under the laws of the jurisdiction in which the
10 person handling the reverse distribution or destruction
11 receives the drug.
12 3. The distribution of prescription drug samples by
13 manufacturers' representatives or distributors'
14 representatives conducted in accordance with s. 499.028.
15 4. The sale, purchase, or trade of blood and blood
16 components intended for transfusion. As used in this
17 subparagraph, the term "blood" means whole blood collected
18 from a single donor and processed either for transfusion or
19 further manufacturing, and the term "blood components" means
20 that part of the blood separated by physical or mechanical
21 means.
22 5. The lawful dispensing of a prescription drug in
23 accordance with chapter 465.
24 Section 39. The Legislature finds that the home and
25 community-based services delivery system for persons with
26 developmental disabilities and the availability of
27 appropriated funds are two of the critical elements in making
28 services available. Therefore, it is the intent of the
29 Legislature that the Department of Children and Family
30 Services shall develop and implement a comprehensive redesign
31 of the system. The redesign shall include, at a minimum, all
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 actions necessary to achieve an appropriate rate structure,
2 client choice within a specified service package, appropriate
3 assessment strategies, an efficient billing process that
4 contains reconciliation and monitoring components, a redefined
5 role for support coordinators that avoids potential conflicts
6 of interest, and family/client budgets linked to levels of
7 need. Prior to the release of funds in the lump-sum
8 appropriation, the department shall present a plan to the
9 Executive Office of the Governor, the House Fiscal
10 Responsibility Council, and the Senate Appropriations
11 Committee. The plan must result in a full implementation of
12 the redesigned system no later than July 1, 2003. At a
13 minimum, the plan must provide that the portions related to
14 direct provider enrollment and billing will be operational no
15 later than March 31, 2003. The plan must further provide that
16 a more effective needs assessment instrument will be deployed
17 by January 1, 2003, and that all clients will be assessed with
18 this device by June 30, 2003. In no event may the department
19 select an assessment instrument without appropriate evidence
20 that it will be reliable and valid. Once such evidence has
21 been obtained, however, the department shall determine the
22 feasibility of contracting with an external vendor to apply
23 the new assessment device to all clients receiving services
24 through the Medicaid waiver. In lieu of using an external
25 vendor, the department may use support coordinators for the
26 assessments if it develops sufficient safeguards and training
27 to significantly improve the inter-rater reliability of the
28 support coordinators administering the assessment.
29 Section 40. (1) The Agency for Health Care
30 Administration shall conduct a study of health care services
31 provided to children in the state who are medically fragile or
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 dependent on medical technology and conduct a pilot program in
2 Miami-Dade County to provide subacute pediatric transitional
3 care to a maximum of 30 children at any one time. The purposes
4 of the study and the pilot program are to determine ways to
5 permit children who are medically fragile or dependent on
6 medical technology to successfully make a transition from
7 acute care in a health care institution to live with their
8 families when possible, and to provide cost-effective,
9 subacute transitional care services.
10 (2) The agency, in cooperation with the Children's
11 Medical Services Program in the Department of Health, shall
12 conduct a study to identify the total number of children who
13 are medically fragile or dependent on medical technology, from
14 birth through age 21, in the state. By January 1, 2003, the
15 agency must report to the Legislature regarding the children's
16 ages, the locations where the children are served, the types
17 of services received, itemized costs of the services, and the
18 sources of funding that pay for the services, including the
19 proportional share when more than one funding source pays for
20 a service. The study must include information regarding
21 children who are medically fragile or dependent on medical
22 technology residing in hospitals, nursing homes, and medical
23 foster care, and those who live with their parents. The study
24 must describe children served in prescribed pediatric
25 extended-care centers, including their ages and the services
26 they receive. The report must identify the total services
27 provided for each child and the method for paying for those
28 services. The report must also identify the number of such
29 children who could, if appropriate transitional services were
30 available, return home or move to a less institutional
31 setting.
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Amendment No. ___ (for drafter's use only)
1 (3) Within 30 days after the effective date of this
2 act, the agency shall establish minimum staffing standards and
3 quality requirements for a subacute pediatric transitional
4 care center to be operated as a 2-year pilot program in
5 Miami-Dade County. The pilot program must operate under the
6 license of a hospital licensed under chapter 395, Florida
7 Statutes, or a nursing home licensed under chapter 400,
8 Florida Statutes, and shall use existing beds in the hospital
9 or nursing home. A child's placement in the subacute pediatric
10 transitional care center may not exceed 90 days. The center
11 shall arrange for an alternative placement at the end of a
12 child's stay and a transitional plan for children expected to
13 remain in the facility for the maximum allowed stay.
14 (4) Within 60 days after the effective date of this
15 act, the agency must amend the state Medicaid plan and request
16 any federal waivers necessary to implement and fund the pilot
17 program.
18 (5) The subacute pediatric transitional care center
19 must require level 1 background screening as provided in
20 chapter 435, Florida Statutes, for all employees or
21 prospective employees of the center who are expected to, or
22 whose responsibilities may require them to, provide personal
23 care or services to children, have access to children's living
24 areas, or have access to children's funds or personal
25 property.
26 (6) The subacute pediatric transitional care center
27 must have an advisory board. Membership on the advisory board
28 must include, but need not be limited to:
29 (a) A physician and an advanced registered nurse
30 practitioner who is familiar with services for children who
31 are medically fragile or dependent on medical technology.
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 (b) A registered nurse who has experience in the care
2 of children who are medically fragile or dependent on medical
3 technology.
4 (c) A child development specialist who has experience
5 in the care of children who are medically fragile or dependent
6 on medical technology, and their families.
7 (d) A social worker who has experience in the care of
8 children who are medically fragile or dependent on medical
9 technology, and their families.
10 (e) A consumer representative who is a parent or
11 guardian of a child placed in the center.
12 (7) The advisory board shall:
13 (a) Review the policy and procedure components of the
14 center to assure conformance with applicable standards
15 developed by the agency.
16 (b) Provide consultation with respect to the
17 operational and programmatic components of the center.
18 (8) The subacute pediatric transitional care center
19 must have written policies and procedures governing the
20 admission, transfer, and discharge of children.
21 (9) The admission of each child to the center must be
22 under the supervision of the center nursing administrator or
23 his or her designee and must be in accordance with the
24 center's policies and procedures. Each Medicaid admission must
25 be approved as appropriate for placement in the facility by
26 the Children's Medical Services Multidisciplinary Assessment
27 Team of the Department of Health, in conjunction with the
28 agency.
29 (10) Each child admitted to the center shall be
30 admitted upon prescription of the medical director of the
31 center, licensed pursuant to chapter 458 or chapter 459,
102
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Florida Statutes, and the child shall remain under the care of
2 the medical director and the advanced registered nurse
3 practitioner for the duration of his or her stay in the
4 center.
5 (11) Each child admitted to the center must meet at
6 least the following criteria:
7 (a) The child must be medically fragile or dependent
8 on medical technology.
9 (b) The child may not, prior to admission, present
10 significant risk of infection to other children or personnel.
11 The medical and nursing directors shall review, on a
12 case-by-case basis, the condition of any child who is
13 suspected of having an infectious disease to determine whether
14 admission is appropriate.
15 (c) The child must be medically stabilized and require
16 skilled nursing care or other interventions.
17 (12) If the child meets the criteria specified in
18 paragraphs (11)(a), (b), and (c), the medical director or
19 nursing director of the center shall implement a preadmission
20 plan that delineates services to be provided and appropriate
21 sources for such services.
22 (a) If the child is hospitalized at the time of
23 referral, preadmission planning must include the participation
24 of the child's parent or guardian and relevant medical,
25 nursing, social services, and developmental staff to assure
26 that the hospital's discharge plans will be implemented
27 following the child's placement in the center.
28 (b) A consent form outlining the purpose of the
29 center, family responsibilities, authorized treatment,
30 appropriate release of liability, and emergency disposition
31 plans must be signed by the parent or guardian and witnessed
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 before the child is admitted to the center. The parent or
2 guardian shall be provided a copy of the consent form.
3 (13) By January 1, 2003, the agency shall report to
4 the Legislature concerning the progress of the pilot program.
5 By January 1, 2004, the agency shall submit to the Legislature
6 a report on the success of the pilot program.
7 Section 41. (1) Notwithstanding s. 409.911(3),
8 Florida Statutes, for the state fiscal year 2002-2003 only,
9 the agency shall distribute moneys under the regular
10 disproportionate share program only to hospitals that meet the
11 federal minimum requirements and to public hospitals. Public
12 hospitals are defined as those hospitals identified as
13 government owned or operated in the Financial Hospital Uniform
14 Reporting System (FHURS) data available to the agency as of
15 January 1, 2002. The following methodology shall be used to
16 distribute disproportionate share dollars to hospitals that
17 meet the federal minimum requirements and to the public
18 hospitals:
19 (a) For hospitals that meet the federal minimum
20 requirements and do not qualify as a public hospital, the
21 following formula shall be used:
22
23 DSHP = (HMD/TMSD)*$1 million
24
25 DSHP = disproportionate share hospital payment.
26 HMD = hospital Medicaid days.
27 TSD = total state Medicaid days.
28
29 (b) The following formulas shall be used to pay
30 disproportionate share dollars to public hospitals:
31 1. For state mental health hospitals:
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187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1
2 DSHP = (HMD/TMDMH) * TAAMH
3
4 The total amount available for the state mental
5 health hospitals shall be the difference
6 between the federal cap for Institutions for
7 Mental Diseases and the amounts paid under the
8 mental health disproportionate share program.
9 2. For non-state government owned or operated
10 hospitals with 3,200 or more Medicaid days:
11
12 DSHP = [(.82*HCCD/TCCD) + (.18*HMD/TMD)] *
13 TAAPH
14 TAAPH = TAA - TAAMH
15
16 3. For non-state government owned or operated
17 hospitals with less than 3,200 Medicaid days, a total of
18 $400,000 shall be distributed equally among these hospitals.
19
20 Where:
21
22 TAA = total available appropriation.
23 TAAPH = total amount available for public
24 hospitals.
25 TAAMH = total amount available for mental
26 health hospitals.
27 DSHP = disproportionate share hospital
28 payments.
29 HMD = hospital Medicaid days.
30 TMDMH = total state Medicaid days for mental
31 health days.
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 TMD = total state Medicaid days for public
2 hospitals.
3 HCCD = hospital charity care dollars.
4 TCCD = total state charity care dollars for
5 public non-state hospitals.
6
7 In computing the above amounts for public hospitals and
8 hospitals that qualify under the federal minimum requirements,
9 the agency shall use the 1997 audited data. In the event there
10 is no complete 1997 audited data for a hospital, the agency
11 shall use the 1994 audited data.
12 (2) Notwithstanding s. 409.9112, Florida Statutes, for
13 state fiscal year 2002-2003, only disproportionate share
14 payments to regional perinatal intensive care centers shall be
15 distributed in the same proportion as the disproportionate
16 share payments made to the regional perinatal intensive care
17 centers in the state fiscal year 2001-2002.
18 (3) Notwithstanding s. 409.9117, Florida Statutes, for
19 state fiscal year 2002-2003 only, disproportionate share
20 payments to hospitals that qualify for primary care
21 disproportionate share payments shall be distributed in the
22 same proportion as the primary care disproportionate share
23 payments made to those hospitals in the state fiscal year
24 2001-2002.
25 (4) For state fiscal year 2002-2003 only, no
26 disproportionate share payments shall be made to hospitals
27 under the provisions of s. 409.9119, Florida Statutes. If the
28 Centers for Medicare and Medicaid Services does not approve
29 Florida's inpatient hospital plan amendment for the public
30 disproportionate share program by November 1, 2002, the agency
31 may make payments to the two children's hospitals in the
106
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 amount of $3,682,293, distributed in the same proportion as
2 the children's disproportionate share payments in state fiscal
3 year 2001-2002.
4 (5) In the event the Centers for Medicare and Medicaid
5 Services does not approve Florida's inpatient hospital state
6 plan amendment for the public disproportionate share program
7 by November 1, 2002, the agency may make payments to hospitals
8 under the regular disproportionate share program, regional
9 perinatal intensive care centers disproportionate share
10 program, the children's hospital disproportionate share
11 program, and the primary care disproportionate share program
12 using the same methodologies used in state fiscal year
13 2001-2002.
14 (6) This section is repealed on July 1, 2003.
15 Section 42. The Agency for Health Care Administration
16 may conduct a 2-year pilot project to authorize overnight
17 stays in one ambulatory surgical center located in Acute Care
18 Subdistrict 9-1. An overnight stay shall be permitted only to
19 perform plastic and reconstructive surgeries defined by
20 current procedural terminology code numbers 13000-19999. The
21 total time a patient is at the ambulatory surgical center
22 shall not exceed 23 hours and 59 minutes, including the
23 surgery time, and the maximum planned duration of all surgical
24 procedures combined shall not exceed 8 hours. Prior to
25 implementation of the pilot project, the agency shall
26 establish minimum requirements for protecting the health,
27 safety, and welfare of patients receiving overnight care.
28 These shall include, at a minimum, compliance with all
29 statutes and rules applicable to ambulatory surgical centers
30 and the requirements set forth in Rule 64B8-9.009, Florida
31 Administrative Code, relating to Level II and Level III
107
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 procedures. If the agency implements the pilot project, it
2 shall, within 6 months after its completion, submit a report
3 to the Legislature on whether to expand the pilot project to
4 include all ambulatory surgical centers. The recommendation
5 shall be based on consideration of the efficacy and impact to
6 patient safety and quality of patient care of providing
7 plastic and reconstructive surgeries in the ambulatory
8 surgical center setting. The agency is authorized to obtain
9 such data as necessary to implement this section.
10 Section 43. The Office of Program Policy Analysis and
11 Government Accountability, assisted by the Agency for Health
12 Care Administration, and the Florida Association of Counties,
13 shall perform a study to determine the fair share of the
14 counties' contribution to Medicaid nursing home costs. The
15 Office of Program Policy Analysis and Government
16 Accountability shall submit a report on the study to the
17 President of the Senate and the Speaker of the House of
18 Representatives by January 1, 2003. The report shall set out
19 no less than two options and shall make a recommendation as to
20 what would be a fair share of the costs for the counties'
21 contribution for fiscal year 2003-2004. The report shall also
22 set out options and make a recommendation to be considered to
23 ensure that the counties pay their fair share in subsequent
24 years. No recommendation shall be less than the counties'
25 current share of 1.5 percent. Each option shall include a
26 detailed explanation of the analysis that led to the
27 conclusion.
28 Section 44. (1) Effective July 1, 2002, all powers,
29 duties, functions, records, personnel, property, and
30 unexpended balances of appropriations, allocations, and other
31 funds of the Agency for Health Care Administration that relate
108
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 to consumer complaint services, investigations, and
2 prosecutorial services currently provided by the Agency for
3 Health Care Administration under a contract with the
4 Department of Health are transferred to the Department of
5 Health by a type two transfer, as defined in s. 20.06, Florida
6 Statutes. This transfer of funds shall include all advance
7 payments made from the Medical Quality Assurance Trust Fund to
8 the Agency for Health Care Administration.
9 (2) Effective July 1, 2002, 259 full-time equivalent
10 positions are eliminated from the Agency for Health Care
11 Administration's total number of authorized positions and
12 added to the Department of Health's total number of authorized
13 positions. However, should the General Appropriations Act for
14 fiscal year 2002-2003 reduce the number of positions from the
15 agency's practitioner regulation component, that provision
16 shall be construed to reduce the same number of full-time
17 equivalent positions from the practitioner regulation
18 component which are hereby transferred to the department.
19 (3) The interagency agreement between the Department
20 of Health and the Agency for Health Care Administration shall
21 terminate on June 30, 2002.
22 (4) The Department of Health may contract with the
23 Department of Legal Affairs for the investigative and
24 prosecutorial services transferred to the department.
25 Section 45. Paragraph (g) of subsection (3) of section
26 20.43, Florida Statutes, is amended to read:
27 20.43 Department of Health.--There is created a
28 Department of Health.
29 (3) The following divisions of the Department of
30 Health are established:
31 (g) Division of Medical Quality Assurance, which is
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 responsible for the following boards and professions
2 established within the division:
3 1. The Board of Acupuncture, created under chapter
4 457.
5 2. The Board of Medicine, created under chapter 458.
6 3. The Board of Osteopathic Medicine, created under
7 chapter 459.
8 4. The Board of Chiropractic Medicine, created under
9 chapter 460.
10 5. The Board of Podiatric Medicine, created under
11 chapter 461.
12 6. Naturopathy, as provided under chapter 462.
13 7. The Board of Optometry, created under chapter 463.
14 8. The Board of Nursing, created under part I of
15 chapter 464.
16 9. Nursing assistants, as provided under part II of
17 chapter 464.
18 10. The Board of Pharmacy, created under chapter 465.
19 11. The Board of Dentistry, created under chapter 466.
20 12. Midwifery, as provided under chapter 467.
21 13. The Board of Speech-Language Pathology and
22 Audiology, created under part I of chapter 468.
23 14. The Board of Nursing Home Administrators, created
24 under part II of chapter 468.
25 15. The Board of Occupational Therapy, created under
26 part III of chapter 468.
27 16. Respiratory therapy, as provided under part V of
28 chapter 468.
29 17. Dietetics and nutrition practice, as provided
30 under part X of chapter 468.
31 18. The Board of Athletic Training, created under part
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 XIII of chapter 468.
2 19. The Board of Orthotists and Prosthetists, created
3 under part XIV of chapter 468.
4 20. Electrolysis, as provided under chapter 478.
5 21. The Board of Massage Therapy, created under
6 chapter 480.
7 22. The Board of Clinical Laboratory Personnel,
8 created under part III of chapter 483.
9 23. Medical physicists, as provided under part IV of
10 chapter 483.
11 24. The Board of Opticianry, created under part I of
12 chapter 484.
13 25. The Board of Hearing Aid Specialists, created
14 under part II of chapter 484.
15 26. The Board of Physical Therapy Practice, created
16 under chapter 486.
17 27. The Board of Psychology, created under chapter
18 490.
19 28. School psychologists, as provided under chapter
20 490.
21 29. The Board of Clinical Social Work, Marriage and
22 Family Therapy, and Mental Health Counseling, created under
23 chapter 491.
24
25 The department may contract with the Agency for Health Care
26 Administration who shall provide consumer complaint,
27 investigative, and prosecutorial services required by the
28 Division of Medical Quality Assurance, councils, or boards, as
29 appropriate.
30 Section 46. Effective July 1, 2002, section 456.047,
31 Florida Statutes, is repealed.
111
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 Section 47. Subsection (5) of section 414.41, Florida
2 Statutes, is repealed.
3 Section 48. If any provision of this act or its
4 application to any person or circumstance is held invalid, the
5 invalidity shall not affect other provisions or applications
6 of the act which can be given effect without the invalid
7 provision or application, and to this end the provisions of
8 this act are declared severable.
9 Section 49. If any law amended by this act was also
10 amended by a law enacted during the 2002 Regular Session of
11 the Legislature, such laws shall be construed to have been
12 enacted during the same session of the Legislature and full
13 effect shall be given to each if possible.
14 Section 50. Except as otherwise provided herein, this
15 act shall take effect upon becoming a law.
16
17
18 ================ T I T L E A M E N D M E N T ===============
19 And the title is amended as follows:
20 remove: the entire title
21
22 and insert:
23 A bill to be entitled
24 An act relating to health care; amending s.
25 16.59, F.S.; specifying additional requirements
26 for the Medicaid Fraud Control Unit of the
27 Department of Legal Affairs and the Medicaid
28 program integrity program; amending s.
29 240.4075, F.S.; revising priority of awards
30 under the Nursing Student Loan Forgiveness
31 Program; amending s. 395.002, F.S.; redefining
112
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 "premises" for purposes of hospital licensing
2 and regulation; amending s. 395.003, F.S.;
3 revising provisions relating to such licensing,
4 including licensing of teaching hospitals;
5 amending s. 112.3187, F.S.; revising procedures
6 and requirements relating to whistle-blower
7 protection for reporting Medicaid fraud or
8 abuse; amending s. 400.141, F.S.; requiring
9 licensed nursing home facilities to maintain
10 general and professional liability insurance
11 coverage; requiring facilities to submit
12 information to the Agency for Health Care
13 Administration which shall provide reports
14 regarding facilities' litigation, complaints,
15 and deficiencies; amending s. 400.147, F.S.;
16 revising reporting requirements under facility
17 internal risk management and quality assurance
18 programs; providing for funding to expedite the
19 availability of nursing home liability
20 insurance; amending s. 400.179, F.S.; providing
21 an alternative to certain bond requirements for
22 protection against nursing home Medicaid
23 overpayments; providing for review and
24 rulemaking authority of the Agency for Health
25 Care Administration; providing for future
26 repeal; requiring a study and report; amending
27 s. 400.925, F.S.; eliminating the regulation of
28 certain home medical equipment by the Agency
29 for Health Care Administration; creating s.
30 408.831, F.S.; allowing the Agency for Health
31 Care Administration to take action against a
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 licensee in certain circumstances; reenacting
2 s. 409.8132(4), F.S., to incorporate amendments
3 to ss. 409.902, 409.907, 409.908, and 409.913,
4 F.S., in references thereto; amending s.
5 409.8177, F.S.; requiring the agency to
6 contract for evaluation of the Florida Kidcare
7 program; amending s. 409.902, F.S.; requiring
8 consent for release of medical records to the
9 agency and the Medicaid Fraud Control Unit as a
10 condition of Medicaid eligibility; amending s.
11 409.904, F.S.; revising eligibility standards
12 for certain Medicaid optional medical
13 assistance; amending s. 409.905, F.S.;
14 providing additional criteria for the agency to
15 adjust a hospital's inpatient per diem rate for
16 Medicaid; amending s. 409.906, F.S.;
17 authorizing the agency to make payments for
18 specified services which are optional under
19 Title XIX of the Social Security Act; amending
20 s. 409.9065, F.S.; providing a program name;
21 revising standards for pharmaceutical expense
22 assistance; amending s. 409.907, F.S.;
23 prescribing additional requirements with
24 respect to provider enrollment; requiring that
25 the Agency for Health Care Administration deny
26 a provider's application under certain
27 circumstances; amending s. 409.908, F.S.;
28 requiring retroactive calculation of cost
29 report if requirements for cost reporting are
30 not met; revising provisions relating to rate
31 adjustments to offset the cost of general and
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 professional liability insurance for nursing
2 homes; extending authorization for special
3 Medicaid payments to qualified providers;
4 providing for intergovernmental transfer of
5 payments; amending s. 409.911, F.S.; expanding
6 application of definitions; amending s.
7 409.9116, F.S.; revising the disproportionate
8 share/financial assistance program for rural
9 hospitals; amending s. 409.91195, F.S.;
10 granting interested parties opportunity to
11 present public testimony before the Medicaid
12 Pharmaceutical and Therapeutics Committee;
13 amending s. 409.912, F.S.; providing
14 requirements for contracts for Medicaid
15 behavioral health care services; revising
16 provisions governing the purchase of goods and
17 services for Medicaid recipients; providing for
18 quarterly reports to the Governor and presiding
19 officers of the Legislature; amending s.
20 409.9122, F.S.; revising procedures relating to
21 assignment of a Medicaid recipient to a managed
22 care plan or MediPass provider; granting agency
23 discretion to renew contracts; amending s.
24 409.913, F.S.; requiring that the agency and
25 Medicaid Fraud Control Unit annually submit a
26 report to the Legislature; defining
27 "complaint"; specifying additional requirements
28 for the Medicaid program integrity program and
29 the Medicaid Fraud Control Unit of the
30 Department of Legal Affairs; requiring
31 imposition of sanctions or disincentives,
115
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 except under certain circumstances; providing
2 additional sanctions and disincentives;
3 providing additional grounds under which the
4 agency may terminate a provider's participation
5 in the Medicaid program; providing additional
6 requirements for administrative hearings;
7 providing additional grounds for withholding
8 payments to a provider; authorizing the agency
9 and the Medicaid Fraud Control Unit to review
10 certain records; requiring review by the
11 Attorney General of certain settlements;
12 requiring review by the Auditor General of
13 certain cost reports; amending s. 409.920,
14 F.S.; providing additional duties of the
15 Medicaid Fraud Control Unit; amending s.
16 624.91, F.S.; revising duties of the Florida
17 Healthy Kids Corporation with respect to annual
18 determination of participation in the Healthy
19 Kids program; prescribing duties of the
20 corporation in establishing local match
21 requirements; revising composition of the board
22 of directors; amending s. 627.6425, F.S.;
23 revising requirements for nonrenewal or
24 discontinuance of individual health insurance
25 coverage; amending s. 766.110, F.S.; removing
26 certain restrictions on the authority of
27 licensed hospitals to provide self-insurance
28 coverage for hospital medical staff; amending
29 s. 393.063, F.S.; authorizing licensure of
30 certain comprehensive transitional education
31 programs for persons with developmental
116
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 disabilities; revising definition of
2 "intermediate care facility for the
3 developmentally disabled"; amending ss. 400.965
4 and 400.968, F.S.; providing penalties for
5 violation of pt. XI of ch. 400, F.S., relating
6 to intermediate care facilities for
7 developmentally disabled persons; amending s.
8 499.012, F.S.; redefining "wholesale
9 distribution" with respect to regulation of
10 distribution of prescription drugs; requiring
11 the Department of Children and Family Services
12 to develop and implement a comprehensive
13 redesign of the home and community-based
14 services delivery system for persons with
15 developmental disabilities; restricting certain
16 release of funds; providing an implementation
17 schedule; requiring the Agency for Health Care
18 Administration to conduct a study of health
19 care services provided to children who are
20 medically fragile or dependent on medical
21 technology; requiring the Agency for Health
22 Care Administration to conduct a pilot program
23 for a subacute pediatric transitional care
24 center; requiring background screening of
25 center personnel; requiring the agency to amend
26 the Medicaid state plan and seek federal
27 waivers as necessary; requiring the center to
28 have an advisory board; providing for
29 membership on the advisory board; providing
30 requirements for the admission, transfer, and
31 discharge of a child to the center; requiring
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 the agency to submit certain reports to the
2 Legislature; providing guidelines for the
3 agency regarding distribution of
4 disproportionate share funds during the
5 2002-2003 fiscal year; authorizing the Agency
6 for Health Care Administration to conduct a
7 pilot project on overnight stays in an
8 ambulatory surgical center; directing the
9 Office of Program Policy Analysis and
10 Government Accountability to perform a study of
11 county contributions to Medicaid nursing home
12 costs; requiring a report and recommendations;
13 transferring to the Department of Health the
14 powers, duties, functions, and assets that
15 relate to the consumer complaint services,
16 investigations, and prosecutorial services
17 performed by the Agency for Health Care
18 Administration under contract with the
19 department; transferring full-time equivalent
20 positions and the practitioner regulation
21 component from the agency to the department;
22 terminating an interagency agreement;
23 authorizing the department to contract with the
24 Department of Legal Affairs; amending s. 20.43,
25 F.S.; deleting the provision authorizing the
26 department to enter into such contract with the
27 agency, to conform; repealing s. 456.047, F.S.,
28 relating to standardized credentialing for
29 health care practitioners; repealing s.
30 414.41(5), F.S., relating to interest imposed
31 upon the recovery amount of medical assistance
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CONFERENCE COMMITTEE AMENDMENT
187-994AXA-08 Bill No. HB 59-E, 1st Eng.
Amendment No. ___ (for drafter's use only)
1 overpayments; providing severability; providing
2 for construction of laws enacted at the 2002
3 Regular Session in relation to this act;
4 providing effective dates.
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