Senate Bill sb0400c2
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Florida Senate - 2003 CS for CS for SB 400
By the Committees on Appropriations; Health, Aging, and
Long-Term Care; and Senator Peaden
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1 A bill to be entitled
2 An act relating to health programs; amending s.
3 120.80, F.S.; exempting hearings in the Agency
4 for Health Care Administration from the
5 requirement of being conducted by an
6 administrative law judge; amending s. 400.0255,
7 F.S.; providing for certain hearings to be
8 conducted by the agency's Office of Fair
9 Hearings relating to resident transfer or
10 discharge; amending s. 408.15, F.S.; providing
11 authority of the agency to establish and
12 conduct Medicaid fair hearings; amending s.
13 409.91195, F.S.; revising provisions relating
14 to the establishment of the agency's preferred
15 drug list; providing for appeals of preferred
16 drug list decisions through the Office of Fair
17 Hearings; amending s. 400.0239, F.S.; providing
18 for deposit of certain federal nursing home
19 civil penalties into the Quality of Long-Term
20 Care Facility Improvement Trust Fund; providing
21 for expenditures from the fund; amending s.
22 400.071, F.S.; requiring additional information
23 from applicants for licensure to operate health
24 care facilities; amending s. 400.414, F.S.;
25 revising grounds for denial, revocation, or
26 suspension of a license; amending s. 400.419,
27 F.S.; providing for imposition of
28 administrative fines; providing grounds for
29 such fines; amending s. 400.417, F.S.; revising
30 methods of notifying a facility of the
31 necessity of renewing a license; amending s.
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1 400.557, F.S.; revising methods of notifying
2 adult day care centers of the necessity of
3 renewing a license; amending s. 400.619, F.S.;
4 providing for notification of an adult
5 family-care home of the necessity of renewing a
6 license and providing the method therefor;
7 amending s. 400.980, F.S.; deleting obsolete
8 provisions; amending s. 408.061, F.S.; revising
9 requirements for data submission by nursing
10 homes and continuing care facilities; amending
11 s. 408.062, F.S.; revising duties of the agency
12 with respect to evaluating and monitoring data
13 and reporting its findings; amending s.
14 408.831, F.S.; providing conditions on a change
15 of ownership or a change of licensee,
16 registrant, or certificateholder; amending s.
17 409.811, F.S.; defining the term "managed care
18 plan"; amending s. 409.8132, F.S.; creating a
19 cross-reference to such definition; amending s.
20 409.91188, F.S.; authorizing the agency to
21 contract with private or public entities for
22 health care services; amending s. 409.912,
23 F.S.; revising provisions relating to
24 cost-effective purchasing of health care;
25 deleting provisions relating to preenrollments
26 by managed care plans; deleting obsolete
27 provisions; amending s. 409.901, F.S.;
28 redefining the terms "third party" and
29 "third-party benefit"; amending s. 409.905,
30 F.S.; revising standards for authorization for
31 hospital inpatient services; amending s.
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1 409.913, F.S.; deleting a requirement that a
2 hearing be conducted within a specified time;
3 amending s. 409.919, F.S.; authorizing the
4 agency to adopt rules relating to interagency
5 agreements; amending s. 766.314, F.S.;
6 redefining the term "infant delivered";
7 amending s. 400.462, F.S.; redefining the terms
8 "companion" and "sitter"; amending s. 400.464,
9 F.S.; deleting references to regulated entities
10 other than home health agencies; increasing
11 penalties for specified violations and
12 providing penalties for persons operating home
13 health agencies who fail to cease operation
14 when directed to do so; amending s. 400.471,
15 F.S.; requiring additional information from
16 applicants for home health agency licensure;
17 amending s. 400.487, F.S.; revising
18 requirements relating to treatment orders when
19 claims are submitted to managed care
20 organizations; amending s. 400.491, F.S.;
21 deleting a requirement that home health
22 agencies maintain a service provision plan for
23 clients receiving nonskilled services; amending
24 s. 400.512, F.S., relating to screening of home
25 health agency personnel; deleting references to
26 persons employed as companions and homemakers;
27 amending s. 400.515, F.S.; revising provisions
28 relating to injunctive proceedings by the
29 agency; amending s. 415.102, F.S.; redefining
30 the term "vulnerable adult" for purposes of the
31 Adult Protective Services Act; repealing s.
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1 400.509, F.S., relating to registration of
2 service providers exempt from licensure;
3 providing an effective date.
4
5 Be It Enacted by the Legislature of the State of Florida:
6
7 Section 1. Subsection (7) of section 120.80, Florida
8 Statutes, is amended to read:
9 120.80 Exceptions and special requirements;
10 agencies.--
11 (7) DEPARTMENT OF CHILDREN AND FAMILY SERVICES AND
12 AGENCY FOR HEALTH CARE ADMINISTRATION.--Notwithstanding s.
13 120.57(1)(a), hearings conducted within the Department of
14 Children and Family Services and the Agency for Health Care
15 Administration in the execution of those social and economic
16 programs administered by the former Division of Family
17 Services of the former Department of Health and Rehabilitative
18 Services prior to the reorganization effected by chapter
19 75-48, Laws of Florida, need not be conducted by an
20 administrative law judge assigned by the division.
21 Section 2. Subsections (8), (15), and (16) of section
22 400.0255, Florida Statutes, are amended to read:
23 400.0255 Resident transfer or discharge; requirements
24 and procedures; hearings.--
25 (8) The notice required by subsection (7) must be in
26 writing and must contain all information required by state and
27 federal law, rules, or regulations applicable to Medicaid or
28 Medicare cases. The agency shall develop a standard document
29 to be used by all facilities licensed under this part for
30 purposes of notifying residents of a discharge or transfer.
31 Such document must include a means for a resident to request
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1 the local long-term care ombudsman council to review the
2 notice and request information about or assistance with
3 initiating a fair hearing with the agency's department's
4 Office of Fair Appeals Hearings. In addition to any other
5 pertinent information included, the form shall specify the
6 reason allowed under federal or state law that the resident is
7 being discharged or transferred, with an explanation to
8 support this action. Further, the form shall state the
9 effective date of the discharge or transfer and the location
10 to which the resident is being discharged or transferred. The
11 form shall clearly describe the resident's appeal rights and
12 the procedures for filing an appeal, including the right to
13 request the local ombudsman council to review the notice of
14 discharge or transfer. A copy of the notice must be placed in
15 the resident's clinical record, and a copy must be transmitted
16 to the resident's legal guardian or representative and to the
17 local ombudsman council within 5 business days after signature
18 by the resident or resident designee.
19 (15)(a) The agency's department's Office of Fair
20 Appeals Hearings shall conduct hearings under this section.
21 The office shall notify the facility of a resident's request
22 for a hearing.
23 (b) The agency department shall, by rule, establish
24 procedures to be used for fair hearings requested by
25 residents. These procedures shall be equivalent to the
26 procedures used for fair hearings for other Medicaid cases,
27 chapter 65-2 10-2, part VI, Florida Administrative Code. The
28 burden of proof must be clear and convincing evidence. A
29 hearing decision must be rendered within 90 days after receipt
30 of the request for hearing.
31
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1 (c) If the hearing decision is favorable to the
2 resident who has been transferred or discharged, the resident
3 must be readmitted to the facility's first available bed.
4 (d) The decision of the hearing officer shall be
5 final. Any aggrieved party may appeal the decision to the
6 district court of appeal in the appellate district where the
7 facility is located. Review procedures shall be conducted in
8 accordance with the Florida Rules of Appellate Procedure.
9 (16) The agency department may adopt rules necessary
10 to administer this section.
11 Section 3. Subsection (13) is added to section 408.15,
12 Florida Statutes, to read:
13 408.15 Powers of the agency.--In addition to the
14 powers granted to the agency elsewhere in this chapter, the
15 agency is authorized to:
16 (13) Establish and conduct those Medicaid fair
17 hearings that are unrelated to eligibility determinations, in
18 accordance with 42 C.F.R. s. 431.200 and other applicable
19 federal and state laws.
20 Section 4. Subsections (4) and (11) of section
21 409.91195, Florida Statutes, are amended to read:
22 409.91195 Medicaid Pharmaceutical and Therapeutics
23 Committee.--There is created a Medicaid Pharmaceutical and
24 Therapeutics Committee within the Agency for Health Care
25 Administration for the purpose of developing a preferred drug
26 formulary pursuant to 42 U.S.C. s. 1396r-8.
27 (4) Upon recommendation of the Medicaid Pharmaceutical
28 and Therapeutics Committee, the agency shall adopt a preferred
29 drug list. To the extent feasible, the committee shall review
30 the top 75 percent of all drug classes, based on use, included
31 in the formulary at least every 12 months, and all other
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1 therapeutic classes biennially. The committee may recommend
2 additions to and deletions from the formulary, such that the
3 formulary provides for medically appropriate drug therapies
4 for Medicaid patients which achieve cost savings contained in
5 the General Appropriations Act.
6 (11) Medicaid recipients may appeal agency preferred
7 drug list formulary decisions using the Medicaid fair hearing
8 process administered by the agency's Office of Fair Hearings
9 Department of Children and Family Services.
10 Section 5. Subsections (1) and (2) of section
11 400.0239, Florida Statutes, are amended to read:
12 400.0239 Quality of Long-Term Care Facility
13 Improvement Trust Fund.--
14 (1) There is created within the Agency for Health Care
15 Administration a Quality of Long-Term Care Facility
16 Improvement Trust Fund to support activities and programs
17 directly related to improvement of the care of nursing home
18 and assisted living facility residents. The trust fund shall
19 be funded through proceeds generated pursuant to ss. 400.0238
20 and 400.4298, through funds specifically appropriated by the
21 Legislature, and through gifts, endowments, and other
22 charitable contributions allowed under federal and state law,
23 and federal nursing home civil monetary penalties collected by
24 the Centers for Medicare and Medicaid Services and returned to
25 the state. These funds must be used in accordance with federal
26 requirements.
27 (2) Expenditures from the trust fund shall be
28 allowable for direct support of the following:
29 (a) Development and operation of a mentoring program,
30 in consultation with the Department of Health and the
31 Department of Elderly Affairs, for increasing the competence,
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1 professionalism, and career preparation of long-term care
2 facility direct care staff, including nurses, nursing
3 assistants, and social service and dietary personnel.
4 (b) Development and implementation of specialized
5 training programs for long-term care facility personnel who
6 provide direct care for residents with Alzheimer's disease and
7 other dementias, residents at risk of developing pressure
8 sores, and residents with special nutrition and hydration
9 needs.
10 (c) Areas of deficient practice identified through
11 regulation or state monitoring.
12 (d)(c) Provision of economic and other incentives to
13 enhance the stability and career development of the nursing
14 home direct care workforce, including paid sabbaticals for
15 exemplary direct care career staff to visit facilities
16 throughout the state to train and motivate younger workers to
17 commit to careers in long-term care.
18 (e)(d) Promotion and support for the formation and
19 active involvement of resident and family councils in the
20 improvement of nursing home care.
21 (f) Evaluation of special resident needs in long-term
22 care facilities, including challenges in meeting resident
23 needs; appropriateness of placement and setting; and
24 deficiencies cited related to caring for special needs.
25 (g) Other initiatives authorized by the Centers for
26 Medicare and Medicaid Services for the use of federal civil
27 monetary penalties, including projects recommended through the
28 Medicaid Up or Out program pursuant to s. 400.148.
29 Section 6. Subsection (12) is added to section
30 400.071, Florida Statutes, to read:
31 400.071 Application for license.--
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1 (12) The applicant must provide the agency with proof
2 of legal right to occupy the property before a license may be
3 issued. Proof may include, but is not limited to, copies of
4 warranty deeds, lease or rental agreements, contracts for
5 deeds, or quitclaim deeds.
6 Section 7. Section 400.414, Florida Statutes, is
7 amended to read:
8 400.414 Denial, revocation, or suspension of license;
9 imposition of administrative fine; grounds.--
10 (1) The agency may deny, revoke, or suspend any
11 license issued under this part, or impose an administrative
12 fine in the manner provided in chapter 120, for any of the
13 following actions by an assisted living facility, for the
14 actions of any person subject to level 2 background screening
15 under s. 400.4174, or for the actions of any facility
16 employee:
17 (a) An intentional or negligent act seriously
18 affecting the health, safety, or welfare of a resident of the
19 facility.
20 (b) The determination by the agency that the owner
21 lacks the financial ability to provide continuing adequate
22 care to residents.
23 (c) Misappropriation or conversion of the property of
24 a resident of the facility.
25 (d) Failure to follow the criteria and procedures
26 provided under part I of chapter 394 relating to the
27 transportation, voluntary admission, and involuntary
28 examination of a facility resident.
29 (e) A citation of any of the following deficiencies as
30 defined in s. 400.419:
31 1. One or more cited class I deficiencies;
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1 2. Three or more cited class II deficiencies; or
2 3. Five or more cited class III deficiencies that have
3 been cited on a single survey and have not been corrected
4 within the time specified. One or more class I, three or more
5 class II, or five or more repeated or recurring identical or
6 similar class III violations that are similar or identical to
7 violations which were identified by the agency within the last
8 2 years.
9 (f) A determination that a person subject to level 2
10 background screening under s. 400.4174(1) does not meet the
11 screening standards of s. 435.04 or that the facility is
12 retaining an employee subject to level 1 background screening
13 standards under s. 400.4174(2) who does not meet the screening
14 standards of s. 435.03 and for whom exemptions from
15 disqualification have not been provided by the agency.
16 (g) A determination that an employee, volunteer,
17 administrator, or owner, or person who otherwise has access to
18 the residents of a facility does not meet the criteria
19 specified in s. 435.03(2), and the owner or administrator has
20 not taken action to remove the person. Exemptions from
21 disqualification may be granted as set forth in s. 435.07. No
22 administrative action may be taken against the facility if the
23 person is granted an exemption.
24 (h) Violation of a moratorium.
25 (i) Failure of the license applicant, the licensee
26 during relicensure, or a licensee that holds a provisional
27 license to meet the minimum license requirements of this part,
28 or related rules, at the time of license application or
29 renewal.
30 (j) A fraudulent statement or omission of any material
31 fact on an application for a license or any other document
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1 required by the agency, including the submission of a license
2 application that conceals the fact that any board member,
3 officer, or person owning 5 percent or more of the facility
4 may not meet the background screening requirements of s.
5 400.4174, or that the applicant has been excluded, permanently
6 suspended, or terminated from the Medicaid or Medicare
7 programs.
8 (k) An intentional or negligent life-threatening act
9 in violation of the uniform firesafety standards for assisted
10 living facilities or other firesafety standards that threatens
11 the health, safety, or welfare of a resident of a facility, as
12 communicated to the agency by the local authority having
13 jurisdiction or the State Fire Marshal.
14 (l) Exclusion, permanent suspension, or termination
15 from the Medicare or Medicaid programs.
16 (m) Knowingly operating any unlicensed facility or
17 providing without a license any service that must be licensed
18 under this chapter.
19 (n) Any act constituting a ground upon which
20 application for a license may be denied.
21
22 Administrative proceedings challenging agency action under
23 this subsection shall be reviewed on the basis of the facts
24 and conditions that resulted in the agency action.
25 (2) Upon notification by the local authority having
26 jurisdiction or by the State Fire Marshal, the agency may deny
27 or revoke the license of an assisted living facility that
28 fails to correct cited fire code violations that affect or
29 threaten the health, safety, or welfare of a resident of a
30 facility.
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1 (3) The agency may deny a license to any applicant or
2 to any officer or board member of an applicant who is a firm,
3 corporation, partnership, or association or who owns 5 percent
4 or more of the facility, if the applicant, officer, or board
5 member has or had a 25-percent or greater financial or
6 ownership interest in any other facility licensed under this
7 part, or in any entity licensed by this state or another state
8 to provide health or residential care, which facility or
9 entity during the 5 years prior to the application for a
10 license closed due to financial inability to operate; had a
11 receiver appointed or a license denied, suspended, or revoked;
12 was subject to a moratorium on admissions; had an injunctive
13 proceeding initiated against it; or has an outstanding fine
14 assessed under this chapter.
15 (4) The agency shall deny or revoke the license of an
16 assisted living facility that has two or more class I
17 violations that are similar or identical to violations
18 identified by the agency during a survey, inspection,
19 monitoring visit, or complaint investigation occurring within
20 the previous 2 years.
21 (5) An action taken by the agency to suspend, deny, or
22 revoke a facility's license under this part, in which the
23 agency claims that the facility owner or an employee of the
24 facility has threatened the health, safety, or welfare of a
25 resident of the facility be heard by the Division of
26 Administrative Hearings of the Department of Management
27 Services within 120 days after receipt of the facility's
28 request for a hearing, unless that time limitation is waived
29 by both parties. The administrative law judge must render a
30 decision within 30 days after receipt of a proposed
31 recommended order.
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1 (6) The agency shall provide to the Division of Hotels
2 and Restaurants of the Department of Business and Professional
3 Regulation, on a monthly basis, a list of those assisted
4 living facilities that have had their licenses denied,
5 suspended, or revoked or that are involved in an appellate
6 proceeding pursuant to s. 120.60 related to the denial,
7 suspension, or revocation of a license.
8 (7) Agency notification of a license suspension or
9 revocation, or denial of a license renewal, shall be posted
10 and visible to the public at the facility.
11 (8) The agency may issue a temporary license pending
12 final disposition of a proceeding involving the suspension or
13 revocation of an assisted living facility license.
14 Section 8. Section 400.419, Florida Statutes, is
15 amended to read:
16 400.419 Violations; administrative fines; imposition
17 of administrative fines; grounds.--
18 (1) The agency shall impose an administrative fine in
19 the manner provided in chapter 120 for any of the actions or
20 violations as set forth within this section by an assisted
21 living facility, for the actions of any persons subject to
22 level 2 background screening under s. 400.4174, for the
23 actions of any facility employee, or for an intentional or
24 negligent act seriously affecting the health, safety, or
25 welfare of a resident of the facility.
26 (2)(1) Each violation of this part and adopted rules
27 shall be classified according to the nature of the violation
28 and the gravity of its probable effect on facility residents.
29 The agency shall indicate the classification on the written
30 notice of the violation as follows:
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1 (a) Class "I" violations are those conditions or
2 occurrences related to the operation and maintenance of a
3 facility or to the personal care of residents which the agency
4 determines present an imminent danger to the residents or
5 guests of the facility or a substantial probability that death
6 or serious physical or emotional harm would result therefrom.
7 The condition or practice constituting a class I violation
8 shall be abated or eliminated within 24 hours, unless a fixed
9 period, as determined by the agency, is required for
10 correction. The agency shall impose an administrative fine for
11 a cited class I violation is subject to an administrative fine
12 in an amount not less than $5,000 and not exceeding $10,000
13 for each violation. A fine may be levied notwithstanding the
14 correction of the violation.
15 (b) Class "II" violations are those conditions or
16 occurrences related to the operation and maintenance of a
17 facility or to the personal care of residents which the agency
18 determines directly threaten the physical or emotional health,
19 safety, or security of the facility residents, other than
20 class I violations. The agency shall impose an administrative
21 fine for a cited class II violation is subject to an
22 administrative fine in an amount not less than $1,000 and not
23 exceeding $5,000 for each violation. A fine shall be levied
24 notwithstanding the correction of the violation A citation for
25 a class II violation must specify the time within which the
26 violation is required to be corrected.
27 (c) Class "III" violations are those conditions or
28 occurrences related to the operation and maintenance of a
29 facility or to the personal care of residents which the agency
30 determines indirectly or potentially threaten the physical or
31 emotional health, safety, or security of facility residents,
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1 other than class I or class II violations. The agency shall
2 impose an administrative fine for a cited class III violation
3 in an amount is subject to an administrative fine of not less
4 than $500 and not exceeding $1,000 for each violation. A
5 citation for a class III violation must specify the time
6 within which the violation is required to be corrected. If a
7 class III violation is corrected within the time specified, no
8 fine may be imposed, unless it is a repeated offense.
9 (d) Class "IV" violations are those conditions or
10 occurrences related to the operation and maintenance of a
11 building or to required reports, forms, or documents that do
12 not have the potential of negatively affecting residents.
13 These violations are of a type that the agency determines do
14 not threaten the health, safety, or security of residents of
15 the facility. The agency shall impose an administrative fine
16 for a cited class IV violation in an amount A facility that
17 does not correct a class IV violation within the time
18 specified in the agency-approved corrective action plan is
19 subject to an administrative fine of not less than $100 nor
20 more than $200 for each violation. A citation for a class IV
21 violation must specify the time within which the violation is
22 required to be corrected. If a class IV violation is corrected
23 within the time specified, no fine shall be imposed. Any class
24 IV violation that is corrected during the time an agency
25 survey is being conducted will be identified as an agency
26 finding and not as a violation.
27 (3)(2) In determining if a penalty is to be imposed
28 and in fixing the amount of the fine, the agency shall
29 consider the following factors:
30 (a) The gravity of the violation, including the
31 probability that death or serious physical or emotional harm
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1 to a resident will result or has resulted, the severity of the
2 action or potential harm, and the extent to which the
3 provisions of the applicable laws or rules were violated.
4 (b) Actions taken by the owner or administrator to
5 correct violations.
6 (c) Any previous violations.
7 (d) The financial benefit to the facility of
8 committing or continuing the violation.
9 (e) The licensed capacity of the facility.
10 (4)(3) Each day of continuing violation after the date
11 fixed for termination of the violation, as ordered by the
12 agency, constitutes an additional, separate, and distinct
13 violation.
14 (5)(4) Any action taken to correct a violation shall
15 be documented in writing by the owner or administrator of the
16 facility and verified through followup visits by agency
17 personnel. The agency may impose a fine and, in the case of an
18 owner-operated facility, revoke or deny a facility's license
19 when a facility administrator fraudulently misrepresents
20 action taken to correct a violation.
21 (6)(5) For fines that are upheld following
22 administrative or judicial review, the violator shall pay the
23 fine, plus interest at the rate as specified in s. 55.03, for
24 each day beyond the date set by the agency for payment of the
25 fine.
26 (7)(6) Any unlicensed facility that continues to
27 operate after agency notification is subject to a $1,000 fine
28 per day.
29 (8)(7) Any licensed facility whose owner or
30 administrator concurrently operates an unlicensed facility
31 shall be subject to an administrative fine of $5,000 per day.
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1 (9)(8) Any facility whose owner fails to apply for a
2 change-of-ownership license in accordance with s. 400.412 and
3 operates the facility under the new ownership is subject to a
4 fine of $5,000.
5 (10)(9) In addition to any administrative fines
6 imposed, the agency may assess a survey fee, equal to the
7 lesser of one half of the facility's biennial license and bed
8 fee or $500, to cover the cost of conducting initial complaint
9 investigations that result in the finding of a violation that
10 was the subject of the complaint or monitoring visits
11 conducted under s. 400.428(3)(c) to verify the correction of
12 the violations.
13 (11)(10) The agency, as an alternative to or in
14 conjunction with an administrative action against a facility
15 for violations of this part and adopted rules, shall make a
16 reasonable attempt to discuss each violation and recommended
17 corrective action with the owner or administrator of the
18 facility, prior to written notification. The agency, instead
19 of fixing a period within which the facility shall enter into
20 compliance with standards, may request a plan of corrective
21 action from the facility which demonstrates a good faith
22 effort to remedy each violation by a specific date, subject to
23 the approval of the agency.
24 (12)(11) Administrative fines paid by any facility
25 under this section shall be deposited into the Health Care
26 Trust Fund and expended as provided in s. 400.418.
27 (13)(12) The agency shall develop and disseminate an
28 annual list of all facilities sanctioned or fined $5,000 or
29 more for violations of state standards, the number and class
30 of violations involved, the penalties imposed, and the current
31 status of cases. The list shall be disseminated, at no charge,
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1 to the Department of Elderly Affairs, the Department of
2 Health, the Department of Children and Family Services, the
3 area agencies on aging, the Florida Statewide Advocacy
4 Council, and the state and local ombudsman councils. The
5 Department of Children and Family Services shall disseminate
6 the list to service providers under contract to the department
7 who are responsible for referring persons to a facility for
8 residency. The agency may charge a fee commensurate with the
9 cost of printing and postage to other interested parties
10 requesting a copy of this list.
11 Section 9. Subsection (1) of section 400.417, Florida
12 Statutes, is amended to read:
13 400.417 Expiration of license; renewal; conditional
14 license.--
15 (1) Biennial licenses, unless sooner suspended or
16 revoked, shall expire 2 years from the date of issuance.
17 Limited nursing, extended congregate care, and limited mental
18 health licenses shall expire at the same time as the
19 facility's standard license, regardless of when issued. The
20 agency shall notify the facility by certified mail at least
21 120 days prior to expiration that a renewal license is
22 necessary to continue operation. The notification must be
23 provided electronically or by mail delivery. Ninety days prior
24 to the expiration date, an application for renewal shall be
25 submitted to the agency. Fees must be prorated. The failure
26 to file a timely renewal application shall result in a late
27 fee charged to the facility in an amount equal to 50 percent
28 of the current fee.
29 Section 10. Subsection (1) of section 400.557, Florida
30 Statutes, is amended to read:
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1 400.557 Expiration of license; renewal; conditional
2 license or permit.--
3 (1) A license issued for the operation of an adult day
4 care center, unless sooner suspended or revoked, expires 2
5 years after the date of issuance. The agency shall notify a
6 licensee by certified mail, return receipt requested, at least
7 120 days before the expiration date that license renewal is
8 required to continue operation. The notification must be
9 provided electronically or by mail delivery. At least 90 days
10 prior to the expiration date, an application for renewal must
11 be submitted to the agency. A license shall be renewed, upon
12 the filing of an application on forms furnished by the agency,
13 if the applicant has first met the requirements of this part
14 and of the rules adopted under this part. The applicant must
15 file with the application satisfactory proof of financial
16 ability to operate the center in accordance with the
17 requirements of this part and in accordance with the needs of
18 the participants to be served and an affidavit of compliance
19 with the background screening requirements of s. 400.5572.
20 Section 11. Subsection (3) of section 400.619, Florida
21 Statutes, is amended to read:
22 400.619 Licensure application and renewal.--
23 (3) The agency shall notify a licensee at least 120
24 days before the expiration date that license renewal is
25 required to continue operation. The notification must be
26 provided electronically or by mail delivery. Application for a
27 license or annual license renewal must be made on a form
28 provided by the agency, signed under oath, and must be
29 accompanied by a licensing fee of $100 per year.
30 Section 12. Paragraph (h) of subsection (4) of section
31 400.980, Florida Statutes, is repealed.
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1 Section 13. Subsections (4) and (6) of section
2 408.061, Florida Statutes, are amended to read:
3 408.061 Data collection; uniform systems of financial
4 reporting; information relating to physician charges;
5 confidential information; immunity.--
6 (4)(a) Within 120 days after the end of its fiscal
7 year, each health care facility, excluding nursing homes and
8 continuing care facilities as defined in s. 408.07(23) and
9 (36), shall file with the agency, on forms adopted by the
10 agency and based on the uniform system of financial reporting,
11 its actual financial experience for that fiscal year,
12 including expenditures, revenues, and statistical measures.
13 Such data may be based on internal financial reports which are
14 certified to be complete and accurate by the provider.
15 However, hospitals' actual financial experience shall be their
16 audited actual experience. Nursing homes that do not
17 participate in the Medicare or Medicaid programs shall also
18 submit audited actual experience. Every nursing home shall
19 submit to the agency, in a format designated by the agency, a
20 statistical profile of the nursing home residents. The agency,
21 in conjunction with the Department of Elderly Affairs and the
22 Department of Health, shall review these statistical profiles
23 and develop recommendations for the types of residents who
24 might more appropriately be placed in their homes or other
25 noninstitutional settings.
26 (b) Each nursing home shall also submit a schedule of
27 the charges in effect at the beginning of the fiscal year and
28 any changes that were made during the fiscal year. A nursing
29 home which is certified under Title XIX of the Social Security
30 Act and files annual Medicaid cost reports may substitute
31 copies of such reports and any Medicaid audits to the agency
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1 in lieu of a report and audit required under this subsection.
2 For such facilities, the agency may require only information
3 in compliance with this chapter that is not contained in the
4 Medicaid cost report. Facilities that are certified under
5 Title XVIII, but not Title XIX, of the Social Security Act
6 must submit a report as developed by the agency. This report
7 shall be substantially the same as the Medicaid cost report
8 and shall not require any more information than is contained
9 in the Medicare cost report unless that information is
10 required of all nursing homes. The audit under Title XVIII
11 shall satisfy the audit requirement under this subsection.
12 (6) Any nursing home which assesses residents a
13 separate charge for personal laundry services shall submit to
14 the agency data on the monthly charge for such services,
15 excluding drycleaning. For facilities that charge based on
16 the amount of laundry, the most recent schedule of charges and
17 the average monthly charge shall be submitted to the agency.
18 Section 14. Subsection (2) of section 408.062, Florida
19 Statutes, is repealed.
20 Section 15. Present subsection (2) of section 408.831,
21 Florida Statutes, is renumbered as subsection (3), and a new
22 subsection (2) is added to that section, to read:
23 408.831 Denial, suspension, or revocation of a
24 license, registration, certificate, or application.--
25 (2) In reviewing any application requesting a change
26 of ownership or change of the licensee, registrant, or
27 certificateholder, the transferor shall, prior to agency
28 approval of the change, repay or make arrangements to repay
29 any amounts owed to the agency. If the transferor fails to
30 repay or make arrangements to repay the amounts owed to the
31 agency, the issuance of a license, registration, or
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1 certificate to the transferee shall be delayed until repayment
2 or until arrangements for repayment are made.
3 Section 16. Present subsections (17) through (27) of
4 section 409.811, Florida Statutes, are renumbered as
5 subsections (18) through (28), respectively, and a new
6 subsection (17) is added to that section, to read:
7 409.811 Definitions relating to Florida Kidcare
8 Act.--As used in ss. 409.810-409.820, the term:
9 (17) "Managed care plan" means a health maintenance
10 organization authorized pursuant to chapter 641 or a prepaid
11 health plan authorized pursuant to s. 409.912.
12 Section 17. Subsection (7) of section 409.8132,
13 Florida Statutes, is amended to read:
14 409.8132 Medikids program component.--
15 (7) ENROLLMENT.--Enrollment in the Medikids program
16 component may only occur during periodic open enrollment
17 periods as specified by the agency. An applicant may apply for
18 enrollment in the Medikids program component and proceed
19 through the eligibility determination process at any time
20 throughout the year. However, enrollment in Medikids shall not
21 begin until the next open enrollment period; and a child may
22 not receive services under the Medikids program until the
23 child is enrolled in a managed care plan, as defined in s.
24 409.811, or in MediPass. In addition, once determined
25 eligible, an applicant may receive choice counseling and
26 select a managed care plan or MediPass. The agency may
27 initiate mandatory assignment for a Medikids applicant who has
28 not chosen a managed care plan or MediPass provider after the
29 applicant's voluntary choice period ends. An applicant may
30 select MediPass under the Medikids program component only in
31 counties that have fewer than two managed care plans available
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1 to serve Medicaid recipients and only if the federal Health
2 Care Financing Administration determines that MediPass
3 constitutes "health insurance coverage" as defined in Title
4 XXI of the Social Security Act.
5 Section 18. Section 409.91188, Florida Statutes, is
6 amended to read:
7 409.91188 Specialty prepaid health plans for Medicaid
8 recipients with HIV or AIDS.--
9 (1) The Agency for Health Care Administration shall
10 issue a request for proposal or intent to implement a is
11 authorized to contract with specialty prepaid health plans
12 authorized pursuant to subsection (2) of this section and to
13 pay them on a prepaid capitated basis to provide Medicaid
14 benefits to Medicaid-eligible recipients who have human
15 immunodeficiency syndrome (HIV) or acquired immunodeficiency
16 syndrome (AIDS). The agency shall apply for or amend existing
17 applications for and is authorized to implement federal
18 waivers or other necessary federal authorization to implement
19 the prepaid health plans authorized by this section. The
20 agency shall procure the specialty prepaid health plans
21 through a competitive procurement. In awarding a contract to a
22 managed care plan, the agency shall take into account price,
23 quality, accessibility, linkages to community-based
24 organizations, and the comprehensiveness of the benefit
25 package offered by the plan. The agency may bid the HIV/AIDS
26 specialty plans on a county, regional, or statewide basis.
27 Qualified plans must be licensed under chapter 641. The agency
28 shall monitor and evaluate the implementation of this waiver
29 program if it is approved by the Federal Government and shall
30 report on its status to the President of the Senate and the
31 Speaker of the House of Representatives by February 1, 2001.
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1 To improve coordination of medical care delivery and to
2 increase cost efficiency for the Medicaid program in treating
3 HIV disease, the Agency for Health Care Administration shall
4 seek all necessary federal waivers to allow participation in
5 the Medipass HIV disease management program for Medicare
6 beneficiaries who test positive for HIV infection and who also
7 qualify for Medicaid benefits such as prescription medications
8 not covered by Medicare.
9 (2) The agency may contract with any public or private
10 entity authorized by this section on a prepaid or fixed-sum
11 basis for the provision of health care services to recipients.
12 An entity may provide prepaid services to recipients, either
13 directly or through arrangements with other entities. Each
14 entity shall:
15 (a) Be organized primarily for the purpose of
16 providing health care or other services of the type regularly
17 offered to Medicaid recipients in compliance with federal
18 laws.
19 (b) Ensure that services meet the standards set by the
20 agency for quality, appropriateness, and timeliness.
21 (c) Make provisions satisfactory to the agency for
22 insolvency protection and ensure that neither enrolled
23 Medicaid recipients nor the agency is liable for the debts of
24 the entity.
25 (d) Provide to the agency a financial plan that
26 ensures fiscal soundness and that may include provisions
27 pursuant to which the entity and the agency share in the risk
28 of providing health care services. The contractual arrangement
29 between an entity and the agency shall provide for risk
30 sharing. The agency may bear the cost of providing certain
31 services when those costs exceed established risk limits or
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1 arrangements whereby certain services are specifically
2 excluded under the terms of the contract between an entity and
3 the agency.
4 (e) Provide, through contract or otherwise, for
5 periodic review of its medical facilities and services, as
6 required by the agency.
7 (f) Furnish evidence satisfactory to the agency of
8 adequate liability insurance coverage or an adequate plan of
9 self-insurance to respond to claims for injuries arising out
10 of the furnishing of health care.
11 (g) Provides organizational, operational, financial,
12 and other information required by the agency.
13 Section 19. Section 409.912, Florida Statutes, is
14 amended to read:
15 409.912 Cost-effective purchasing of health care.--The
16 agency shall purchase goods and services for Medicaid
17 recipients in the most cost-effective manner consistent with
18 the delivery of quality medical care. The agency shall
19 maximize the use of prepaid per capita and prepaid aggregate
20 fixed-sum basis services when appropriate and other
21 alternative service delivery and reimbursement methodologies,
22 including competitive bidding pursuant to s. 287.057, designed
23 to facilitate the cost-effective purchase of a case-managed
24 continuum of care. The agency shall also require providers to
25 minimize the exposure of recipients to the need for acute
26 inpatient, custodial, and other institutional care and the
27 inappropriate or unnecessary use of high-cost services. The
28 agency may establish prior authorization requirements for
29 certain populations of Medicaid beneficiaries, certain drug
30 classes, or particular drugs to prevent fraud, abuse, overuse,
31 and possible dangerous drug interactions. The Pharmaceutical
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1 and Therapeutics Committee shall make recommendations to the
2 agency on drugs for which prior authorization is required. The
3 agency shall inform the Pharmaceutical and Therapeutics
4 Committee of its decisions regarding drugs subject to prior
5 authorization.
6 (1) The agency may enter into agreements with
7 appropriate agents of other state agencies or of any agency of
8 the Federal Government and accept such duties in respect to
9 social welfare or public aid as may be necessary to implement
10 the provisions of Title XIX of the Social Security Act and ss.
11 409.901-409.920.
12 (2) The agency may contract with health maintenance
13 organizations certified pursuant to part I of chapter 641 for
14 the provision of services to recipients.
15 (3) The agency may contract with:
16 (a) An entity that provides no prepaid health care
17 services other than Medicaid services under contract with the
18 agency and which is owned and operated by a county, county
19 health department, or county-owned and operated hospital to
20 provide health care services on a prepaid or fixed-sum basis
21 to recipients, which entity may provide such prepaid services
22 either directly or through arrangements with other providers.
23 Such prepaid health care services entities must be licensed
24 under parts I and III by January 1, 1998, and until then are
25 exempt from the provisions of part I of chapter 641. An entity
26 recognized under this paragraph which demonstrates to the
27 satisfaction of the Department of Insurance that it is backed
28 by the full faith and credit of the county in which it is
29 located may be exempted from s. 641.225.
30 (b) An entity that is providing comprehensive
31 behavioral health care services to certain Medicaid recipients
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1 through a capitated, prepaid arrangement pursuant to the
2 federal waiver provided for by s. 409.905(5). Such an entity
3 must be licensed under chapter 624, chapter 636, or chapter
4 641 and must possess the clinical systems and operational
5 competence to manage risk and provide comprehensive behavioral
6 health care to Medicaid recipients. As used in this paragraph,
7 the term "comprehensive behavioral health care services" means
8 covered mental health and substance abuse treatment services
9 that are available to Medicaid recipients. The secretary of
10 the Department of Children and Family Services shall approve
11 provisions of procurements related to children in the
12 department's care or custody prior to enrolling such children
13 in a prepaid behavioral health plan. Any contract awarded
14 under this paragraph must be competitively procured. In
15 developing the behavioral health care prepaid plan procurement
16 document, the agency shall ensure that the procurement
17 document requires the contractor to develop and implement a
18 plan to ensure compliance with s. 394.4574 related to services
19 provided to residents of licensed assisted living facilities
20 that hold a limited mental health license. The agency must
21 ensure that Medicaid recipients have available the choice of
22 at least two managed care plans for their behavioral health
23 care services. To ensure unimpaired access to behavioral
24 health care services by Medicaid recipients, all contracts
25 issued pursuant to this paragraph shall require 80 percent of
26 the capitation paid to the managed care plan, including health
27 maintenance organizations, to be expended for the provision of
28 behavioral health care services. In the event the managed care
29 plan expends less than 80 percent of the capitation paid
30 pursuant to this paragraph for the provision of behavioral
31 health care services, the difference shall be returned to the
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1 agency. The agency shall provide the managed care plan with a
2 certification letter indicating the amount of capitation paid
3 during each calendar year for the provision of behavioral
4 health care services pursuant to this section. The agency may
5 reimburse for substance-abuse-treatment services on a
6 fee-for-service basis until the agency finds that adequate
7 funds are available for capitated, prepaid arrangements.
8 1. By January 1, 2001, the agency shall modify the
9 contracts with the entities providing comprehensive inpatient
10 and outpatient mental health care services to Medicaid
11 recipients in Hillsborough, Highlands, Hardee, Manatee, and
12 Polk Counties, to include substance-abuse-treatment services.
13 2. By December 31, 2001, the agency shall contract
14 with entities providing comprehensive behavioral health care
15 services to Medicaid recipients through capitated, prepaid
16 arrangements in Charlotte, Collier, DeSoto, Escambia, Glades,
17 Hendry, Lee, Okaloosa, Pasco, Pinellas, Santa Rosa, Sarasota,
18 and Walton Counties. The agency may contract with entities
19 providing comprehensive behavioral health care services to
20 Medicaid recipients through capitated, prepaid arrangements in
21 Alachua County. The agency may determine if Sarasota County
22 shall be included as a separate catchment area or included in
23 any other agency geographic area.
24 3. Children residing in a Department of Juvenile
25 Justice residential program approved as a Medicaid behavioral
26 health overlay services provider shall not be included in a
27 behavioral health care prepaid health plan pursuant to this
28 paragraph.
29 4. In converting to a prepaid system of delivery, the
30 agency shall in its procurement document require an entity
31 providing comprehensive behavioral health care services to
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1 prevent the displacement of indigent care patients by
2 enrollees in the Medicaid prepaid health plan providing
3 behavioral health care services from facilities receiving
4 state funding to provide indigent behavioral health care, to
5 facilities licensed under chapter 395 which do not receive
6 state funding for indigent behavioral health care, or
7 reimburse the unsubsidized facility for the cost of behavioral
8 health care provided to the displaced indigent care patient.
9 5. Traditional community mental health providers under
10 contract with the Department of Children and Family Services
11 pursuant to part IV of chapter 394 and inpatient mental health
12 providers licensed pursuant to chapter 395 must be offered an
13 opportunity to accept or decline a contract to participate in
14 any provider network for prepaid behavioral health services.
15 (c) A federally qualified health center or an entity
16 owned by one or more federally qualified health centers or an
17 entity owned by other migrant and community health centers
18 receiving non-Medicaid financial support from the Federal
19 Government to provide health care services on a prepaid or
20 fixed-sum basis to recipients. Such prepaid health care
21 services entity must be licensed under parts I and III of
22 chapter 641, but shall be prohibited from serving Medicaid
23 recipients on a prepaid basis, until such licensure has been
24 obtained. However, such an entity is exempt from s. 641.225
25 if the entity meets the requirements specified in subsections
26 (14) and (15).
27 (d) A provider service network No more than four
28 provider service networks for demonstration projects to test
29 Medicaid direct contracting. The demonstration projects may be
30 reimbursed on a fee-for-service or prepaid basis. A provider
31 service network which is reimbursed by the agency on a prepaid
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1 basis shall be exempt from parts I and III of chapter 641, but
2 must meet appropriate financial reserve, quality assurance,
3 and patient rights requirements as established by the agency.
4 The agency shall award contracts on a competitive bid basis
5 and shall select bidders based upon price and quality of care.
6 Medicaid recipients assigned to a demonstration project shall
7 be chosen equally from those who would otherwise have been
8 assigned to prepaid plans and MediPass. The agency is
9 authorized to seek federal Medicaid waivers as necessary to
10 implement the provisions of this section. A demonstration
11 project awarded pursuant to this paragraph shall be for 4
12 years from the date of implementation.
13 (e) An entity that provides comprehensive behavioral
14 health care services to certain Medicaid recipients through an
15 administrative services organization agreement. Such an entity
16 must possess the clinical systems and operational competence
17 to provide comprehensive health care to Medicaid recipients.
18 As used in this paragraph, the term "comprehensive behavioral
19 health care services" means covered mental health and
20 substance abuse treatment services that are available to
21 Medicaid recipients. Any contract awarded under this paragraph
22 must be competitively procured. The agency must ensure that
23 Medicaid recipients have available the choice of at least two
24 managed care plans for their behavioral health care services.
25 (f) An entity that provides in-home physician services
26 to test the cost-effectiveness of enhanced home-based medical
27 care to Medicaid recipients with degenerative neurological
28 diseases and other diseases or disabling conditions associated
29 with high costs to Medicaid. The program shall be designed to
30 serve very disabled persons and to reduce Medicaid reimbursed
31 costs for inpatient, outpatient, and emergency department
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1 services. The agency shall contract with vendors on a
2 risk-sharing basis.
3 (g) Children's or adult's provider networks that
4 provide care coordination and care management for
5 Medicaid-eligible pediatric patients, primary care,
6 authorization of specialty care, and other urgent and
7 emergency care through organized providers designed to service
8 Medicaid eligibles under age 18 and pediatric emergency
9 department departments' diversion programs. The networks shall
10 provide after-hour operations, including evening and weekend
11 hours, to promote, when appropriate, the use of the children's
12 and adult's networks rather than hospital emergency
13 departments.
14 (h) An entity authorized in s. 430.205 to contract
15 with the agency and the Department of Elderly Affairs to
16 provide health care and social services on a prepaid or
17 fixed-sum basis to elderly recipients. Such prepaid health
18 care services entities are exempt from the provisions of part
19 I of chapter 641 for the first 3 years of operation. An entity
20 recognized under this paragraph that demonstrates to the
21 satisfaction of the Department of Insurance that it is backed
22 by the full faith and credit of one or more counties in which
23 it operates may be exempted from s. 641.225.
24 (i) A Children's Medical Services network, as defined
25 in s. 391.021.
26 (4) The agency may contract with any public or private
27 entity otherwise authorized by this section on a prepaid or
28 fixed-sum basis for the provision of health care services to
29 recipients. An entity may provide prepaid services to
30 recipients, either directly or through arrangements with other
31 entities, if each entity involved in providing services:
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1 (a) Is organized primarily for the purpose of
2 providing health care or other services of the type regularly
3 offered to Medicaid recipients;
4 (b) Ensures that services meet the standards set by
5 the agency for quality, appropriateness, and timeliness;
6 (c) Makes provisions satisfactory to the agency for
7 insolvency protection and ensures that neither enrolled
8 Medicaid recipients nor the agency will be liable for the
9 debts of the entity;
10 (d) Submits to the agency, if a private entity, a
11 financial plan that the agency finds to be fiscally sound and
12 that provides for working capital in the form of cash or
13 equivalent liquid assets excluding revenues from Medicaid
14 premium payments equal to at least the first 3 months of
15 operating expenses or $200,000, whichever is greater;
16 (e) Furnishes evidence satisfactory to the agency of
17 adequate liability insurance coverage or an adequate plan of
18 self-insurance to respond to claims for injuries arising out
19 of the furnishing of health care;
20 (f) Provides, through contract or otherwise, for
21 periodic review of its medical facilities and services, as
22 required by the agency; and
23 (g) Provides organizational, operational, financial,
24 and other information required by the agency.
25 (5) The agency may contract on a prepaid or fixed-sum
26 basis with any health insurer that:
27 (a) Pays for health care services provided to enrolled
28 Medicaid recipients in exchange for a premium payment paid by
29 the agency;
30 (b) Assumes the underwriting risk; and
31
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1 (c) Is organized and licensed under applicable
2 provisions of the Florida Insurance Code and is currently in
3 good standing with the Department of Insurance.
4 (6) The agency may contract on a prepaid or fixed-sum
5 basis with an exclusive provider organization to provide
6 health care services to Medicaid recipients provided that the
7 exclusive provider organization meets applicable managed care
8 plan requirements in this section, ss. 409.9122, 409.9123,
9 409.9128, and 627.6472, and other applicable provisions of
10 law.
11 (7) The Agency for Health Care Administration may
12 provide cost-effective purchasing of chiropractic services on
13 a fee-for-service basis to Medicaid recipients through
14 arrangements with a statewide chiropractic preferred provider
15 organization incorporated in this state as a not-for-profit
16 corporation. The agency shall ensure that the benefit limits
17 and prior authorization requirements in the current Medicaid
18 program shall apply to the services provided by the
19 chiropractic preferred provider organization.
20 (8) The agency shall not contract on a prepaid or
21 fixed-sum basis for Medicaid services with an entity which
22 knows or reasonably should know that any officer, director,
23 agent, managing employee, or owner of stock or beneficial
24 interest in excess of 5 percent common or preferred stock, or
25 the entity itself, has been found guilty of, regardless of
26 adjudication, or entered a plea of nolo contendere, or guilty,
27 to:
28 (a) Fraud;
29 (b) Violation of federal or state antitrust statutes,
30 including those proscribing price fixing between competitors
31 and the allocation of customers among competitors;
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1 (c) Commission of a felony involving embezzlement,
2 theft, forgery, income tax evasion, bribery, falsification or
3 destruction of records, making false statements, receiving
4 stolen property, making false claims, or obstruction of
5 justice; or
6 (d) Any crime in any jurisdiction which directly
7 relates to the provision of health services on a prepaid or
8 fixed-sum basis.
9 (9) The agency, after notifying the Legislature, may
10 apply for waivers of applicable federal laws and regulations
11 as necessary to implement more appropriate systems of health
12 care for Medicaid recipients and reduce the cost of the
13 Medicaid program to the state and federal governments and
14 shall implement such programs, after legislative approval,
15 within a reasonable period of time after federal approval.
16 These programs must be designed primarily to reduce the need
17 for inpatient care, custodial care and other long-term or
18 institutional care, and other high-cost services.
19 (a) Prior to seeking legislative approval of such a
20 waiver as authorized by this subsection, the agency shall
21 provide notice and an opportunity for public comment. Notice
22 shall be provided to all persons who have made requests of the
23 agency for advance notice and shall be published in the
24 Florida Administrative Weekly not less than 28 days prior to
25 the intended action.
26 (b) Notwithstanding s. 216.292, funds that are
27 appropriated to the Department of Elderly Affairs for the
28 Assisted Living for the Elderly Medicaid waiver and are not
29 expended shall be transferred to the agency to fund
30 Medicaid-reimbursed nursing home care.
31
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1 (10) The agency shall establish a postpayment
2 utilization control program designed to identify recipients
3 who may inappropriately overuse or underuse Medicaid services
4 and shall provide methods to correct such misuse.
5 (11) The agency shall develop and provide coordinated
6 systems of care for Medicaid recipients and may contract with
7 public or private entities to develop and administer such
8 systems of care among public and private health care providers
9 in a given geographic area.
10 (12) The agency shall operate or contract for the
11 operation of utilization management and incentive systems
12 designed to encourage cost-effective use services.
13 (13)(a) The agency shall operate the Comprehensive
14 Assessment and Review (CARES) nursing facility preadmission
15 screening program to ensure that Medicaid payment for nursing
16 facility care is made only for individuals whose conditions
17 require such care and to ensure that long-term care services
18 are provided in the setting most appropriate to the needs of
19 the person and in the most economical manner possible. The
20 CARES program shall also ensure that individuals participating
21 in Medicaid home and community-based waiver programs meet
22 criteria for those programs, consistent with approved federal
23 waivers.
24 (b) The agency shall operate the CARES program through
25 an interagency agreement with the Department of Elderly
26 Affairs.
27 (c) Prior to making payment for nursing facility
28 services for a Medicaid recipient, the agency must verify that
29 the nursing facility preadmission screening program has
30 determined that the individual requires nursing facility care
31 and that the individual cannot be safely served in
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1 community-based programs. The nursing facility preadmission
2 screening program shall refer a Medicaid recipient to a
3 community-based program if the individual could be safely
4 served at a lower cost and the recipient chooses to
5 participate in such program.
6 (d) By January 1 of each year, the agency shall submit
7 a report to the Legislature and the Office of Long-Term-Care
8 Policy describing the operations of the CARES program. The
9 report must describe:
10 1. Rate of diversion to community alternative
11 programs;
12 2. CARES program staffing needs to achieve additional
13 diversions;
14 3. Reasons the program is unable to place individuals
15 in less restrictive settings when such individuals desired
16 such services and could have been served in such settings;
17 4. Barriers to appropriate placement, including
18 barriers due to policies or operations of other agencies or
19 state-funded programs; and
20 5. Statutory changes necessary to ensure that
21 individuals in need of long-term care services receive care in
22 the least restrictive environment.
23 (14)(a) The agency shall identify health care
24 utilization and price patterns within the Medicaid program
25 which are not cost-effective or medically appropriate and
26 assess the effectiveness of new or alternate methods of
27 providing and monitoring service, and may implement such
28 methods as it considers appropriate. Such methods may include
29 disease management initiatives, an integrated and systematic
30 approach for managing the health care needs of recipients who
31 are at risk of or diagnosed with a specific disease by using
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1 best practices, prevention strategies, clinical-practice
2 improvement, clinical interventions and protocols, outcomes
3 research, information technology, and other tools and
4 resources to reduce overall costs and improve measurable
5 outcomes.
6 (b) The responsibility of the agency under this
7 subsection shall include the development of capabilities to
8 identify actual and optimal practice patterns; patient and
9 provider educational initiatives; methods for determining
10 patient compliance with prescribed treatments; fraud, waste,
11 and abuse prevention and detection programs; and beneficiary
12 case management programs.
13 1. The practice pattern identification program shall
14 evaluate practitioner prescribing patterns based on national
15 and regional practice guidelines, comparing practitioners to
16 their peer groups. The agency and its Drug Utilization Review
17 Board shall consult with a panel of practicing health care
18 professionals consisting of the following: the Speaker of the
19 House of Representatives and the President of the Senate shall
20 each appoint three physicians licensed under chapter 458 or
21 chapter 459; and the Governor shall appoint two pharmacists
22 licensed under chapter 465 and one dentist licensed under
23 chapter 466 who is an oral surgeon. Terms of the panel members
24 shall expire at the discretion of the appointing official. The
25 panel shall begin its work by August 1, 1999, regardless of
26 the number of appointments made by that date. The advisory
27 panel shall be responsible for evaluating treatment guidelines
28 and recommending ways to incorporate their use in the practice
29 pattern identification program. Practitioners who are
30 prescribing inappropriately or inefficiently, as determined by
31
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1 the agency, may have their prescribing of certain drugs
2 subject to prior authorization.
3 2. The agency shall also develop educational
4 interventions designed to promote the proper use of
5 medications by providers and beneficiaries.
6 3. The agency shall implement a pharmacy fraud, waste,
7 and abuse initiative that may include a surety bond or letter
8 of credit requirement for participating pharmacies, enhanced
9 provider auditing practices, the use of additional fraud and
10 abuse software, recipient management programs for
11 beneficiaries inappropriately using their benefits, and other
12 steps that will eliminate provider and recipient fraud, waste,
13 and abuse. The initiative shall address enforcement efforts to
14 reduce the number and use of counterfeit prescriptions.
15 4. By September 30, 2002, the agency shall contract
16 with an entity in the state to implement a wireless handheld
17 clinical pharmacology drug information database for
18 practitioners. The initiative shall be designed to enhance the
19 agency's efforts to reduce fraud, abuse, and errors in the
20 prescription drug benefit program and to otherwise further the
21 intent of this paragraph.
22 5. The agency may apply for any federal waivers needed
23 to implement this paragraph.
24 (15) An entity contracting on a prepaid or fixed-sum
25 basis shall, in addition to meeting any applicable statutory
26 surplus requirements, also maintain at all times in the form
27 of cash, investments that mature in less than 180 days
28 allowable as admitted assets by the Department of Insurance,
29 and restricted funds or deposits controlled by the agency or
30 the Department of Insurance, a surplus amount equal to
31 one-and-one-half times the entity's monthly Medicaid prepaid
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1 revenues. As used in this subsection, the term "surplus" means
2 the entity's total assets minus total liabilities. If an
3 entity's surplus falls below an amount equal to
4 one-and-one-half times the entity's monthly Medicaid prepaid
5 revenues, the agency shall prohibit the entity from engaging
6 in marketing and preenrollment activities, shall cease to
7 process new enrollments, and shall not renew the entity's
8 contract until the required balance is achieved. The
9 requirements of this subsection do not apply:
10 (a) Where a public entity agrees to fund any deficit
11 incurred by the contracting entity; or
12 (b) Where the entity's performance and obligations are
13 guaranteed in writing by a guaranteeing organization which:
14 1. Has been in operation for at least 5 years and has
15 assets in excess of $50 million; or
16 2. Submits a written guarantee acceptable to the
17 agency which is irrevocable during the term of the contracting
18 entity's contract with the agency and, upon termination of the
19 contract, until the agency receives proof of satisfaction of
20 all outstanding obligations incurred under the contract.
21 (16)(a) The agency may require an entity contracting
22 on a prepaid or fixed-sum basis to establish a restricted
23 insolvency protection account with a federally guaranteed
24 financial institution licensed to do business in this state.
25 The entity shall deposit into that account 5 percent of the
26 capitation payments made by the agency each month until a
27 maximum total of 2 percent of the total current contract
28 amount is reached. The restricted insolvency protection
29 account may be drawn upon with the authorized signatures of
30 two persons designated by the entity and two representatives
31 of the agency. If the agency finds that the entity is
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1 insolvent, the agency may draw upon the account solely with
2 the two authorized signatures of representatives of the
3 agency, and the funds may be disbursed to meet financial
4 obligations incurred by the entity under the prepaid contract.
5 If the contract is terminated, expired, or not continued, the
6 account balance must be released by the agency to the entity
7 upon receipt of proof of satisfaction of all outstanding
8 obligations incurred under this contract.
9 (b) The agency may waive the insolvency protection
10 account requirement in writing when evidence is on file with
11 the agency of adequate insolvency insurance and reinsurance
12 that will protect enrollees if the entity becomes unable to
13 meet its obligations.
14 (17) An entity that contracts with the agency on a
15 prepaid or fixed-sum basis for the provision of Medicaid
16 services shall reimburse any hospital or physician that is
17 outside the entity's authorized geographic service area as
18 specified in its contract with the agency, and that provides
19 services authorized by the entity to its members, at a rate
20 negotiated with the hospital or physician for the provision of
21 services or according to the lesser of the following:
22 (a) The usual and customary charges made to the
23 general public by the hospital or physician; or
24 (b) The Florida Medicaid reimbursement rate
25 established for the hospital or physician.
26 (18) When a merger or acquisition of a Medicaid
27 prepaid contractor has been approved by the Department of
28 Insurance pursuant to s. 628.4615, the agency shall approve
29 the assignment or transfer of the appropriate Medicaid prepaid
30 contract upon request of the surviving entity of the merger or
31 acquisition if the contractor and the other entity have been
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1 in good standing with the agency for the most recent 12-month
2 period, unless the agency determines that the assignment or
3 transfer would be detrimental to the Medicaid recipients or
4 the Medicaid program. To be in good standing, an entity must
5 not have failed accreditation or committed any material
6 violation of the requirements of s. 641.52 and must meet the
7 Medicaid contract requirements. For purposes of this section,
8 a merger or acquisition means a change in controlling interest
9 of an entity, including an asset or stock purchase.
10 (19) Any entity contracting with the agency pursuant
11 to this section to provide health care services to Medicaid
12 recipients is prohibited from engaging in any of the following
13 practices or activities:
14 (a) Practices that are discriminatory, including, but
15 not limited to, attempts to discourage participation on the
16 basis of actual or perceived health status.
17 (b) Activities that could mislead or confuse
18 recipients, or misrepresent the organization, its marketing
19 representatives, or the agency. Violations of this paragraph
20 include, but are not limited to:
21 1. False or misleading claims that marketing
22 representatives are employees or representatives of the state
23 or county, or of anyone other than the entity or the
24 organization by whom they are reimbursed.
25 2. False or misleading claims that the entity is
26 recommended or endorsed by any state or county agency, or by
27 any other organization which has not certified its endorsement
28 in writing to the entity.
29 3. False or misleading claims that the state or county
30 recommends that a Medicaid recipient enroll with an entity.
31
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1 4. Claims that a Medicaid recipient will lose benefits
2 under the Medicaid program, or any other health or welfare
3 benefits to which the recipient is legally entitled, if the
4 recipient does not enroll with the entity.
5 (c) Granting or offering of any monetary or other
6 valuable consideration for enrollment, except as authorized by
7 subsection (21).
8 (d) Door-to-door solicitation of recipients who have
9 not contacted the entity or who have not invited the entity to
10 make a presentation.
11 (e) Solicitation of Medicaid recipients by marketing
12 representatives stationed in state offices unless approved and
13 supervised by the agency or its agent and approved by the
14 affected state agency when solicitation occurs in an office of
15 the state agency. The agency shall ensure that marketing
16 representatives stationed in state offices shall market their
17 managed care plans to Medicaid recipients only in designated
18 areas and in such a way as to not interfere with the
19 recipients' activities in the state office.
20 (f) Enrollment of Medicaid recipients.
21 (20) The agency may impose a fine for a violation of
22 this section or the contract with the agency by a person or
23 entity that is under contract with the agency. With respect
24 to any nonwillful violation, such fine shall not exceed $2,500
25 per violation. In no event shall such fine exceed an
26 aggregate amount of $10,000 for all nonwillful violations
27 arising out of the same action. With respect to any knowing
28 and willful violation of this section or the contract with the
29 agency, the agency may impose a fine upon the entity in an
30 amount not to exceed $20,000 for each such violation. In no
31 event shall such fine exceed an aggregate amount of $100,000
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1 for all knowing and willful violations arising out of the same
2 action.
3 (21) A health maintenance organization or a person or
4 entity exempt from chapter 641 that is under contract with the
5 agency for the provision of health care services to Medicaid
6 recipients may not use or distribute marketing materials used
7 to solicit Medicaid recipients, unless such materials have
8 been approved by the agency. The provisions of this subsection
9 do not apply to general advertising and marketing materials
10 used by a health maintenance organization to solicit both
11 non-Medicaid subscribers and Medicaid recipients.
12 (22) Upon approval by the agency, health maintenance
13 organizations and persons or entities exempt from chapter 641
14 that are under contract with the agency for the provision of
15 health care services to Medicaid recipients may be permitted
16 within the capitation rate to provide additional health
17 benefits that the agency has found are of high quality, are
18 practicably available, provide reasonable value to the
19 recipient, and are provided at no additional cost to the
20 state.
21 (23) The agency shall utilize the statewide health
22 maintenance organization complaint hotline for the purpose of
23 investigating and resolving Medicaid and prepaid health plan
24 complaints, maintaining a record of complaints and confirmed
25 problems, and receiving disenrollment requests made by
26 recipients.
27 (24) The agency shall require the publication of the
28 health maintenance organization's and the prepaid health
29 plan's consumer services telephone numbers and the "800"
30 telephone number of the statewide health maintenance
31 organization complaint hotline on each Medicaid identification
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1 card issued by a health maintenance organization or prepaid
2 health plan contracting with the agency to serve Medicaid
3 recipients and on each subscriber handbook issued to a
4 Medicaid recipient.
5 (25) The agency shall establish a health care quality
6 improvement system for those entities contracting with the
7 agency pursuant to this section, incorporating all the
8 standards and guidelines developed by the Medicaid Bureau of
9 the Health Care Financing Administration as a part of the
10 quality assurance reform initiative. The system shall
11 include, but need not be limited to, the following:
12 (a) Guidelines for internal quality assurance
13 programs, including standards for:
14 1. Written quality assurance program descriptions.
15 2. Responsibilities of the governing body for
16 monitoring, evaluating, and making improvements to care.
17 3. An active quality assurance committee.
18 4. Quality assurance program supervision.
19 5. Requiring the program to have adequate resources to
20 effectively carry out its specified activities.
21 6. Provider participation in the quality assurance
22 program.
23 7. Delegation of quality assurance program activities.
24 8. Credentialing and recredentialing.
25 9. Enrollee rights and responsibilities.
26 10. Availability and accessibility to services and
27 care.
28 11. Ambulatory care facilities.
29 12. Accessibility and availability of medical records,
30 as well as proper recordkeeping and process for record review.
31 13. Utilization review.
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1 14. A continuity of care system.
2 15. Quality assurance program documentation.
3 16. Coordination of quality assurance activity with
4 other management activity.
5 17. Delivering care to pregnant women and infants; to
6 elderly and disabled recipients, especially those who are at
7 risk of institutional placement; to persons with developmental
8 disabilities; and to adults who have chronic, high-cost
9 medical conditions.
10 (b) Guidelines which require the entities to conduct
11 quality-of-care studies which:
12 1. Target specific conditions and specific health
13 service delivery issues for focused monitoring and evaluation.
14 2. Use clinical care standards or practice guidelines
15 to objectively evaluate the care the entity delivers or fails
16 to deliver for the targeted clinical conditions and health
17 services delivery issues.
18 3. Use quality indicators derived from the clinical
19 care standards or practice guidelines to screen and monitor
20 care and services delivered.
21 (c) Guidelines for external quality review of each
22 contractor which require: focused studies of patterns of care;
23 individual care review in specific situations; and followup
24 activities on previous pattern-of-care study findings and
25 individual-care-review findings. In designing the external
26 quality review function and determining how it is to operate
27 as part of the state's overall quality improvement system, the
28 agency shall construct its external quality review
29 organization and entity contracts to address each of the
30 following:
31
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1 1. Delineating the role of the external quality review
2 organization.
3 2. Length of the external quality review organization
4 contract with the state.
5 3. Participation of the contracting entities in
6 designing external quality review organization review
7 activities.
8 4. Potential variation in the type of clinical
9 conditions and health services delivery issues to be studied
10 at each plan.
11 5. Determining the number of focused pattern-of-care
12 studies to be conducted for each plan.
13 6. Methods for implementing focused studies.
14 7. Individual care review.
15 8. Followup activities.
16 (26) In order to ensure that children receive health
17 care services for which an entity has already been
18 compensated, an entity contracting with the agency pursuant to
19 this section shall achieve an annual Early and Periodic
20 Screening, Diagnosis, and Treatment (EPSDT) Service screening
21 rate of at least 60 percent for those recipients continuously
22 enrolled for at least 8 months. The agency shall develop a
23 method by which the EPSDT screening rate shall be calculated.
24 For any entity which does not achieve the annual 60 percent
25 rate, the entity must submit a corrective action plan for the
26 agency's approval. If the entity does not meet the standard
27 established in the corrective action plan during the specified
28 timeframe, the agency is authorized to impose appropriate
29 contract sanctions. At least annually, the agency shall
30 publicly release the EPSDT Services screening rates of each
31
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1 entity it has contracted with on a prepaid basis to serve
2 Medicaid recipients.
3 (27) The agency shall perform enrollments and
4 disenrollments for Medicaid recipients who are eligible for
5 MediPass or managed care plans. Notwithstanding the
6 prohibition contained in paragraph (18)(f), managed care plans
7 may perform preenrollments of Medicaid recipients under the
8 supervision of the agency or its agents. For the purposes of
9 this section, "preenrollment" means the provision of marketing
10 and educational materials to a Medicaid recipient and
11 assistance in completing the application forms, but shall not
12 include actual enrollment into a managed care plan. An
13 application for enrollment shall not be deemed complete until
14 the agency or its agent verifies that the recipient made an
15 informed, voluntary choice. The agency, in cooperation with
16 the Department of Children and Family Services, may test new
17 marketing initiatives to inform Medicaid recipients about
18 their managed care options at selected sites. The agency shall
19 report to the Legislature on the effectiveness of such
20 initiatives. The agency may contract with a third party to
21 perform managed care plan and MediPass enrollment and
22 disenrollment services for Medicaid recipients and is
23 authorized to adopt rules to implement such services. The
24 agency may adjust the capitation rate only to cover the costs
25 of a third-party enrollment and disenrollment contract, and
26 for agency supervision and management of the managed care plan
27 enrollment and disenrollment contract.
28 (28) Any lists of providers made available to Medicaid
29 recipients, MediPass enrollees, or managed care plan enrollees
30 shall be arranged alphabetically showing the provider's name
31
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1 and specialty and, separately, by specialty in alphabetical
2 order.
3 (29) The agency shall establish an enhanced managed
4 care quality assurance oversight function, to include at least
5 the following components:
6 (a) At least quarterly analysis and followup,
7 including sanctions as appropriate, of managed care
8 participant utilization of services.
9 (b) At least quarterly analysis and followup,
10 including sanctions as appropriate, of quality findings of the
11 Medicaid peer review organization and other external quality
12 assurance programs.
13 (c) At least quarterly analysis and followup,
14 including sanctions as appropriate, of the fiscal viability of
15 managed care plans.
16 (d) At least quarterly analysis and followup,
17 including sanctions as appropriate, of managed care
18 participant satisfaction and disenrollment surveys.
19 (e) The agency shall conduct regular and ongoing
20 Medicaid recipient satisfaction surveys.
21
22 The analyses and followup activities conducted by the agency
23 under its enhanced managed care quality assurance oversight
24 function shall not duplicate the activities of accreditation
25 reviewers for entities regulated under part III of chapter
26 641, but may include a review of the finding of such
27 reviewers.
28 (30) Each managed care plan that is under contract
29 with the agency to provide health care services to Medicaid
30 recipients shall annually conduct a background check with the
31 Florida Department of Law Enforcement of all persons with
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1 ownership interest of 5 percent or more or executive
2 management responsibility for the managed care plan and shall
3 submit to the agency information concerning any such person
4 who has been found guilty of, regardless of adjudication, or
5 has entered a plea of nolo contendere or guilty to, any of the
6 offenses listed in s. 435.03.
7 (31) The agency shall, by rule, develop a process
8 whereby a Medicaid managed care plan enrollee who wishes to
9 enter hospice care may be disenrolled from the managed care
10 plan within 24 hours after contacting the agency regarding
11 such request. The agency rule shall include a methodology for
12 the agency to recoup managed care plan payments on a pro rata
13 basis if payment has been made for the enrollment month when
14 disenrollment occurs.
15 (32) The agency and entities which contract with the
16 agency to provide health care services to Medicaid recipients
17 under this section or s. 409.9122 must comply with the
18 provisions of s. 641.513 in providing emergency services and
19 care to Medicaid recipients and MediPass recipients.
20 (33) All entities providing health care services to
21 Medicaid recipients shall make available, and encourage all
22 pregnant women and mothers with infants to receive, and
23 provide documentation in the medical records to reflect, the
24 following:
25 (a) Healthy Start prenatal or infant screening.
26 (b) Healthy Start care coordination, when screening or
27 other factors indicate need.
28 (c) Healthy Start enhanced services in accordance with
29 the prenatal or infant screening results.
30 (d) Immunizations in accordance with recommendations
31 of the Advisory Committee on Immunization Practices of the
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1 United States Public Health Service and the American Academy
2 of Pediatrics, as appropriate.
3 (e) Counseling and services for family planning to all
4 women and their partners.
5 (f) A scheduled postpartum visit for the purpose of
6 voluntary family planning, to include discussion of all
7 methods of contraception, as appropriate.
8 (g) Referral to the Special Supplemental Nutrition
9 Program for Women, Infants, and Children (WIC).
10 (34) Any entity that provides Medicaid prepaid health
11 plan services shall ensure the appropriate coordination of
12 health care services with an assisted living facility in cases
13 where a Medicaid recipient is both a member of the entity's
14 prepaid health plan and a resident of the assisted living
15 facility. If the entity is at risk for Medicaid targeted case
16 management and behavioral health services, the entity shall
17 inform the assisted living facility of the procedures to
18 follow should an emergent condition arise.
19 (35) The agency may seek and implement federal waivers
20 necessary to provide for cost-effective purchasing of home
21 health services, private duty nursing services,
22 transportation, independent laboratory services, and durable
23 medical equipment and supplies through competitive bidding
24 pursuant to s. 287.057. The agency may request appropriate
25 waivers from the federal Health Care Financing Administration
26 in order to competitively bid such services. The agency may
27 exclude providers not selected through the bidding process
28 from the Medicaid provider network.
29 (36) The Agency for Health Care Administration is
30 directed to issue a request for proposal or intent to
31 negotiate to implement on a demonstration basis an outpatient
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1 specialty services pilot project in a rural and urban county
2 in the state. As used in this subsection, the term
3 "outpatient specialty services" means clinical laboratory,
4 diagnostic imaging, and specified home medical services to
5 include durable medical equipment, prosthetics and orthotics,
6 and infusion therapy.
7 (a) The entity that is awarded the contract to provide
8 Medicaid managed care outpatient specialty services must, at a
9 minimum, meet the following criteria:
10 1. The entity must be licensed by the Department of
11 Insurance under part II of chapter 641.
12 2. The entity must be experienced in providing
13 outpatient specialty services.
14 3. The entity must demonstrate to the satisfaction of
15 the agency that it provides high-quality services to its
16 patients.
17 4. The entity must demonstrate that it has in place a
18 complaints and grievance process to assist Medicaid recipients
19 enrolled in the pilot managed care program to resolve
20 complaints and grievances.
21 (b) The pilot managed care program shall operate for a
22 period of 3 years. The objective of the pilot program shall
23 be to determine the cost-effectiveness and effects on
24 utilization, access, and quality of providing outpatient
25 specialty services to Medicaid recipients on a prepaid,
26 capitated basis.
27 (c) The agency shall conduct a quality assurance
28 review of the prepaid health clinic each year that the
29 demonstration program is in effect. The prepaid health clinic
30 is responsible for all expenses incurred by the agency in
31 conducting a quality assurance review.
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1 (d) The entity that is awarded the contract to provide
2 outpatient specialty services to Medicaid recipients shall
3 report data required by the agency in a format specified by
4 the agency, for the purpose of conducting the evaluation
5 required in paragraph (e).
6 (e) The agency shall conduct an evaluation of the
7 pilot managed care program and report its findings to the
8 Governor and the Legislature by no later than January 1, 2001.
9 (36)(37) The agency shall enter into agreements with
10 not-for-profit organizations based in this state for the
11 purpose of providing vision screening.
12 (37)(38)(a) The agency shall implement a Medicaid
13 prescribed-drug spending-control program that includes the
14 following components:
15 1. Medicaid prescribed-drug coverage for brand-name
16 drugs for adult Medicaid recipients is limited to the
17 dispensing of four brand-name drugs per month per recipient.
18 Children are exempt from this restriction. Antiretroviral
19 agents are excluded from this limitation. No requirements for
20 prior authorization or other restrictions on medications used
21 to treat mental illnesses such as schizophrenia, severe
22 depression, or bipolar disorder may be imposed on Medicaid
23 recipients. Medications that will be available without
24 restriction for persons with mental illnesses include atypical
25 antipsychotic medications, conventional antipsychotic
26 medications, selective serotonin reuptake inhibitors, and
27 other medications used for the treatment of serious mental
28 illnesses. The agency shall also limit the amount of a
29 prescribed drug dispensed to no more than a 34-day supply. The
30 agency shall continue to provide unlimited generic drugs,
31 contraceptive drugs and items, and diabetic supplies. Although
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1 a drug may be included on the preferred drug formulary, it
2 would not be exempt from the four-brand limit. The agency may
3 authorize exceptions to the brand-name-drug restriction based
4 upon the treatment needs of the patients, only when such
5 exceptions are based on prior consultation provided by the
6 agency or an agency contractor, but the agency must establish
7 procedures to ensure that:
8 a. There will be a response to a request for prior
9 consultation by telephone or other telecommunication device
10 within 24 hours after receipt of a request for prior
11 consultation;
12 b. A 72-hour supply of the drug prescribed will be
13 provided in an emergency or when the agency does not provide a
14 response within 24 hours as required by sub-subparagraph a.;
15 and
16 c. Except for the exception for nursing home residents
17 and other institutionalized adults and except for drugs on the
18 restricted formulary for which prior authorization may be
19 sought by an institutional or community pharmacy, prior
20 authorization for an exception to the brand-name-drug
21 restriction is sought by the prescriber and not by the
22 pharmacy. When prior authorization is granted for a patient in
23 an institutional setting beyond the brand-name-drug
24 restriction, such approval is authorized for 12 months and
25 monthly prior authorization is not required for that patient.
26 2. Reimbursement to pharmacies for Medicaid prescribed
27 drugs shall be set at the average wholesale price less 13.25
28 percent.
29 3. The agency shall develop and implement a process
30 for managing the drug therapies of Medicaid recipients who are
31 using significant numbers of prescribed drugs each month. The
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1 management process may include, but is not limited to,
2 comprehensive, physician-directed medical-record reviews,
3 claims analyses, and case evaluations to determine the medical
4 necessity and appropriateness of a patient's treatment plan
5 and drug therapies. The agency may contract with a private
6 organization to provide drug-program-management services. The
7 Medicaid drug benefit management program shall include
8 initiatives to manage drug therapies for HIV/AIDS patients,
9 patients using 20 or more unique prescriptions in a 180-day
10 period, and the top 1,000 patients in annual spending.
11 4. The agency may limit the size of its pharmacy
12 network based on need, competitive bidding, price
13 negotiations, credentialing, or similar criteria. The agency
14 shall give special consideration to rural areas in determining
15 the size and location of pharmacies included in the Medicaid
16 pharmacy network. A pharmacy credentialing process may include
17 criteria such as a pharmacy's full-service status, location,
18 size, patient educational programs, patient consultation,
19 disease-management services, and other characteristics. The
20 agency may impose a moratorium on Medicaid pharmacy enrollment
21 when it is determined that it has a sufficient number of
22 Medicaid-participating providers.
23 5. The agency shall develop and implement a program
24 that requires Medicaid practitioners who prescribe drugs to
25 use a counterfeit-proof prescription pad for Medicaid
26 prescriptions. The agency shall require the use of
27 standardized counterfeit-proof prescription pads by
28 Medicaid-participating prescribers or prescribers who write
29 prescriptions for Medicaid recipients. The agency may
30 implement the program in targeted geographic areas or
31 statewide.
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1 6. The agency may enter into arrangements that require
2 manufacturers of generic drugs prescribed to Medicaid
3 recipients to provide rebates of at least 15.1 percent of the
4 average manufacturer price for the manufacturer's generic
5 products. These arrangements shall require that if a
6 generic-drug manufacturer pays federal rebates for
7 Medicaid-reimbursed drugs at a level below 15.1 percent, the
8 manufacturer must provide a supplemental rebate to the state
9 in an amount necessary to achieve a 15.1-percent rebate level.
10 7. The agency may establish a preferred drug formulary
11 in accordance with 42 U.S.C. s. 1396r-8, and, pursuant to the
12 establishment of such formulary, it is authorized to negotiate
13 supplemental rebates from manufacturers that are in addition
14 to those required by Title XIX of the Social Security Act and
15 at no less than 10 percent of the average manufacturer price
16 as defined in 42 U.S.C. s. 1936 on the last day of a quarter
17 unless the federal or supplemental rebate, or both, equals or
18 exceeds 25 percent. There is no upper limit on the
19 supplemental rebates the agency may negotiate. The agency may
20 determine that specific products, brand-name or generic, are
21 competitive at lower rebate percentages. Agreement to pay the
22 minimum supplemental rebate percentage will guarantee a
23 manufacturer that the Medicaid Pharmaceutical and Therapeutics
24 Committee will consider a product for inclusion on the
25 preferred drug formulary. However, a pharmaceutical
26 manufacturer is not guaranteed placement on the formulary by
27 simply paying the minimum supplemental rebate. Agency
28 decisions will be made on the clinical efficacy of a drug and
29 recommendations of the Medicaid Pharmaceutical and
30 Therapeutics Committee, as well as the price of competing
31 products minus federal and state rebates. The agency is
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1 authorized to contract with an outside agency or contractor to
2 conduct negotiations for supplemental rebates. For the
3 purposes of this section, the term "supplemental rebates" may
4 include, at the agency's discretion, cash rebates and other
5 program benefits that offset a Medicaid expenditure. Such
6 other program benefits may include, but are not limited to,
7 disease management programs, drug product donation programs,
8 drug utilization control programs, prescriber and beneficiary
9 counseling and education, fraud and abuse initiatives, and
10 other services or administrative investments with guaranteed
11 savings to the Medicaid program in the same year the rebate
12 reduction is included in the General Appropriations Act. The
13 agency is authorized to seek any federal waivers to implement
14 this initiative.
15 8. The agency shall establish an advisory committee
16 for the purposes of studying the feasibility of using a
17 restricted drug formulary for nursing home residents and other
18 institutionalized adults. The committee shall be comprised of
19 seven members appointed by the Secretary of Health Care
20 Administration. The committee members shall include two
21 physicians licensed under chapter 458 or chapter 459; three
22 pharmacists licensed under chapter 465 and appointed from a
23 list of recommendations provided by the Florida Long-Term Care
24 Pharmacy Alliance; and two pharmacists licensed under chapter
25 465.
26 9. The Agency for Health Care Administration shall
27 expand home delivery of pharmacy products. To assist Medicaid
28 patients in securing their prescriptions and reduce program
29 costs, the agency shall expand its current mail-order-pharmacy
30 diabetes-supply program to include all generic and brand-name
31 drugs used by Medicaid patients with diabetes. Medicaid
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1 recipients in the current program may obtain nondiabetes drugs
2 on a voluntary basis. This initiative is limited to the
3 geographic area covered by the current contract. The agency
4 may seek and implement any federal waivers necessary to
5 implement this subparagraph.
6 (b) The agency shall implement this subsection to the
7 extent that funds are appropriated to administer the Medicaid
8 prescribed-drug spending-control program. The agency may
9 contract all or any part of this program to private
10 organizations.
11 (c) The agency shall submit quarterly reports to the
12 Governor, the President of the Senate, and the Speaker of the
13 House of Representatives which must include, but need not be
14 limited to, the progress made in implementing this subsection
15 and its effect on Medicaid prescribed-drug expenditures.
16 (38)(39) Notwithstanding the provisions of chapter
17 287, the agency may, at its discretion, renew a contract or
18 contracts for fiscal intermediary services one or more times
19 for such periods as the agency may decide; however, all such
20 renewals may not combine to exceed a total period longer than
21 the term of the original contract.
22 (39)(40) The agency shall provide for the development
23 of a demonstration project by establishment in Miami-Dade
24 County of a long-term-care facility licensed pursuant to
25 chapter 395 to improve access to health care for a
26 predominantly minority, medically underserved, and medically
27 complex population and to evaluate alternatives to nursing
28 home care and general acute care for such population. Such
29 project is to be located in a health care condominium and
30 colocated with licensed facilities providing a continuum of
31 care. The establishment of this project is not subject to the
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1 provisions of s. 408.036 or s. 408.039. The agency shall
2 report its findings to the Governor, the President of the
3 Senate, and the Speaker of the House of Representatives by
4 January 1, 2003.
5 Section 20. Subsections (25) and (26) of section
6 409.901, Florida Statutes, are amended to read:
7 409.901 Definitions; ss. 409.901-409.920.--As used in
8 ss. 409.901-409.920, except as otherwise specifically
9 provided, the term:
10 (25) "Third party" means an individual, entity, or
11 program, excluding Medicaid, that is, may be, could be, should
12 be, or has been liable for all or part of the cost of medical
13 services related to any medical assistance covered by
14 Medicaid. The term includes third party administrators and
15 pharmacy benefit managers.
16 (26) "Third-party benefit" means any benefit that is
17 or may be available at any time through contract, court award,
18 judgment, settlement, agreement, or any arrangement between a
19 third party and any person or entity, including, without
20 limitation, a Medicaid recipient, a provider, another third
21 party, an insurer, or the agency, for any Medicaid-covered
22 injury, illness, goods, or services, including costs of
23 medical services related thereto, for personal injury or for
24 death of the recipient, but specifically excluding policies of
25 life insurance on the recipient, unless available under terms
26 of the policy to pay medical expenses prior to death. The
27 term includes, without limitation, collateral, as defined in
28 this section, health insurance, any benefit under a health
29 maintenance organization, Neurological Injury Compensation
30 Association funds, preferred provider arrangement, a prepaid
31 health clinic, liability insurance, uninsured motorist
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1 insurance or personal injury protection coverage, medical
2 benefits under workers' compensation, and any obligation under
3 law or equity to provide medical support.
4 Section 21. Paragraph (a) of subsection (5) of section
5 409.905, Florida Statutes, is amended to read:
6 409.905 Mandatory Medicaid services.--The agency may
7 make payments for the following services, which are required
8 of the state by Title XIX of the Social Security Act,
9 furnished by Medicaid providers to recipients who are
10 determined to be eligible on the dates on which the services
11 were provided. Any service under this section shall be
12 provided only when medically necessary and in accordance with
13 state and federal law. Mandatory services rendered by
14 providers in mobile units to Medicaid recipients may be
15 restricted by the agency. Nothing in this section shall be
16 construed to prevent or limit the agency from adjusting fees,
17 reimbursement rates, lengths of stay, number of visits, number
18 of services, or any other adjustments necessary to comply with
19 the availability of moneys and any limitations or directions
20 provided for in the General Appropriations Act or chapter 216.
21 (5) HOSPITAL INPATIENT SERVICES.--The agency shall pay
22 for all covered services provided for the medical care and
23 treatment of a recipient who is admitted as an inpatient by a
24 licensed physician or dentist to a hospital licensed under
25 part I of chapter 395. However, the agency shall limit the
26 payment for inpatient hospital services for a Medicaid
27 recipient 21 years of age or older to 45 days or the number of
28 days necessary to comply with the General Appropriations Act.
29 (a) The agency is authorized to implement
30 reimbursement and utilization management reforms in order to
31 comply with any limitations or directions in the General
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1 Appropriations Act, which may include, but are not limited to:
2 prior authorization for inpatient psychiatric days; prior
3 authorization for nonemergency hospital inpatient admissions
4 for individuals 21 years of age and older; authorization of
5 emergency and urgent-care admissions within 24 hours after
6 admission; enhanced utilization and concurrent review programs
7 for highly utilized services; reduction or elimination of
8 covered days of service; adjusting reimbursement ceilings for
9 variable costs; adjusting reimbursement ceilings for fixed and
10 property costs; and implementing target rates of increase. The
11 agency may limit prior authorization for hospital inpatient
12 services to selected diagnosis-related groups, based on an
13 analysis of the cost and potential for unnecessary
14 hospitalizations represented by certain diagnoses. Admissions
15 for normal delivery and newborns are exempt from requirements
16 for prior authorization. In implementing the provisions of
17 this section related to prior authorization, the agency shall
18 ensure that the process for authorization is accessible 24
19 hours per day, 7 days per week and authorization is
20 automatically granted when not denied within 24 4 hours after
21 the request. Authorization procedures must include steps for
22 review of denials. Upon implementing the prior authorization
23 program for hospital inpatient services, the agency shall
24 discontinue its hospital retrospective review program.
25 Section 22. Subsection (30) of section 409.913,
26 Florida Statutes, is amended to read:
27 409.913 Oversight of the integrity of the Medicaid
28 program.--The agency shall operate a program to oversee the
29 activities of Florida Medicaid recipients, and providers and
30 their representatives, to ensure that fraudulent and abusive
31 behavior and neglect of recipients occur to the minimum extent
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1 possible, and to recover overpayments and impose sanctions as
2 appropriate. Beginning January 1, 2003, and each year
3 thereafter, the agency and the Medicaid Fraud Control Unit of
4 the Department of Legal Affairs shall submit a joint report to
5 the Legislature documenting the effectiveness of the state's
6 efforts to control Medicaid fraud and abuse and to recover
7 Medicaid overpayments during the previous fiscal year. The
8 report must describe the number of cases opened and
9 investigated each year; the sources of the cases opened; the
10 disposition of the cases closed each year; the amount of
11 overpayments alleged in preliminary and final audit letters;
12 the number and amount of fines or penalties imposed; any
13 reductions in overpayment amounts negotiated in settlement
14 agreements or by other means; the amount of final agency
15 determinations of overpayments; the amount deducted from
16 federal claiming as a result of overpayments; the amount of
17 overpayments recovered each year; the amount of cost of
18 investigation recovered each year; the average length of time
19 to collect from the time the case was opened until the
20 overpayment is paid in full; the amount determined as
21 uncollectible and the portion of the uncollectible amount
22 subsequently reclaimed from the Federal Government; the number
23 of providers, by type, that are terminated from participation
24 in the Medicaid program as a result of fraud and abuse; and
25 all costs associated with discovering and prosecuting cases of
26 Medicaid overpayments and making recoveries in such cases. The
27 report must also document actions taken to prevent
28 overpayments and the number of providers prevented from
29 enrolling in or reenrolling in the Medicaid program as a
30 result of documented Medicaid fraud and abuse and must
31 recommend changes necessary to prevent or recover
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1 overpayments. For the 2001-2002 fiscal year, the agency shall
2 prepare a report that contains as much of this information as
3 is available to it.
4 (30) If a provider requests an administrative hearing
5 pursuant to chapter 120, such hearing must be conducted within
6 90 days following assignment of an administrative law judge,
7 absent exceptionally good cause shown as determined by the
8 administrative law judge or hearing officer. Upon issuance of
9 a final order, the outstanding balance of the amount
10 determined to constitute a Medicaid the overpayment shall
11 become due. If a provider fails to make payments in full,
12 fails to enter into a satisfactory repayment plan, or fails to
13 comply with the terms of a repayment plan or settlement
14 agreement, the agency may withhold medical assistance
15 reimbursement payments until the amount due is paid in full.
16 Section 23. Section 409.919, Florida Statutes, is
17 amended to read:
18 409.919 Rules.--The agency shall adopt any rules
19 necessary to comply with or administer ss. 409.901-409.920;
20 those rules necessary to effect and implement interagency
21 agreements between the agency and other departments; and all
22 rules necessary to comply with federal requirements. In
23 addition, the Department of Children and Family Services shall
24 adopt and accept transfer of any rules necessary to carry out
25 its responsibilities for receiving and processing Medicaid
26 applications and determining Medicaid eligibility, and for
27 assuring compliance with and administering ss.
28 409.901-409.906, as they relate to these responsibilities, and
29 any other provisions related to responsibility for the
30 determination of Medicaid eligibility.
31
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1 Section 24. Paragraph (a) of subsection (4) of section
2 766.314, Florida Statutes, is amended to read:
3 766.314 Assessments; plan of operation.--
4 (4) The following persons and entities shall pay into
5 the association an initial assessment in accordance with the
6 plan of operation:
7 (a) On or before October 1, 1988, each hospital
8 licensed under chapter 395 shall pay an initial assessment of
9 $50 per infant delivered in the hospital during the prior
10 calendar year, as reported to the Agency for Health Care
11 Administration; provided, however, that a hospital owned or
12 operated by the state or a county, special taxing district, or
13 other political subdivision of the state shall not be required
14 to pay the initial assessment or any assessment required by
15 subsection (5). The term "infant delivered" includes live
16 births and not stillbirths, but the term does not include
17 infants delivered by employees or agents of the Board of
18 Regents, or those born in a teaching hospital as defined in s.
19 408.07, or those born in a teaching hospital as defined in s.
20 395.806 which had been deemed by the association as being
21 exempt from assessments since fiscal year 1997 to fiscal year
22 2001. The initial assessment and any assessment imposed
23 pursuant to subsection (5) may not include any infant born to
24 a charity patient (as defined by rule of the Agency for Health
25 Care Administration) or born to a patient for whom the
26 hospital receives Medicaid reimbursement, if the sum of the
27 annual charges for charity patients plus the annual Medicaid
28 contractuals of the hospital exceeds 10 percent of the total
29 annual gross operating revenues of the hospital. The hospital
30 is responsible for documenting, to the satisfaction of the
31 association, the exclusion of any birth from the computation
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1 of the assessment. Upon demonstration of financial need by a
2 hospital, the association may provide for installment payments
3 of assessments.
4 Section 25. Subsection (5) of section 400.462, Florida
5 Statutes, is amended to read:
6 400.462 Definitions.--As used in this part, the term:
7 (5) "Companion" or "sitter" means a person who
8 provides companionship to an elderly, handicapped, or
9 convalescent individual; cares for an elderly, handicapped, or
10 convalescent individual and accompanies such individual on
11 trips and outings; and may prepare and serve meals to such
12 individual. A companion may not provide hands-on personal care
13 to a client.
14 Section 26. Subsections (4) and (5) of section
15 400.464, Florida Statutes, are amended to read:
16 400.464 Home health agencies to be licensed;
17 expiration of license; exemptions; unlawful acts; penalties.--
18 (4)(a) An organization may not provide, offer, or
19 advertise home health services to the public unless the
20 organization has a valid license or is specifically exempted
21 under this part. An organization that offers or advertises to
22 the public any service for which licensure or registration is
23 required under this part must include in the advertisement the
24 license number or regulation number issued to the organization
25 by the agency. The agency shall assess a fine of not less
26 than $100 to any licensee or registrant who fails to include
27 the license or registration number when submitting the
28 advertisement for publication, broadcast, or printing. The
29 holder of a license issued under this part may not advertise
30 or indicate to the public that it holds a home health agency
31
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1 or nurse registry license other than the one it has been
2 issued.
3 (b) A person who violates paragraph (a) is subject to
4 an injunctive proceeding under s. 400.515. A violation of
5 paragraph (a) is a deceptive and unfair trade practice and
6 constitutes a violation of the Florida Deceptive and Unfair
7 Trade Practices Act under part II of chapter 501.
8 (c) A person who violates the provisions of paragraph
9 (a) commits a felony misdemeanor of the third second degree,
10 punishable as provided in s. 775.082, or s. 775.083, or s.
11 775.084. Any person who commits a second or subsequent
12 violation commits a felony misdemeanor of the second first
13 degree, punishable as provided in s. 775.082, or s. 775.083,
14 or s. 775.084. Each day of continuing violation constitutes a
15 separate offense.
16 (d) Any person who owns, operates, or maintains an
17 unlicensed home health agency or unlicensed nurse registry and
18 who, within 10 working days after receiving notification from
19 the agency, fails to cease operation and apply for a license
20 under this part commits a felony of the third degree,
21 punishable as provided in s. 775.082, s. 775.083, or s.
22 775.084. Each day of continued operation is a separate
23 offense.
24 (e) Any home health agency, as defined in this part,
25 or nurse registry that fails to cease operation after agency
26 notification may be fined $500 for each day of noncompliance.
27 (5) The following are exempt from the licensure
28 requirements of this part:
29 (a) A home health agency operated by the Federal
30 Government.
31
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1 (b) Home health services provided by a state agency,
2 either directly or through a contractor with:
3 1. The Department of Elderly Affairs.
4 2. The Department of Health, a community health
5 center, or a rural health network that furnishes home visits
6 for the purpose of providing environmental assessments, case
7 management, health education, personal care services, family
8 planning, or followup treatment, or for the purpose of
9 monitoring and tracking disease.
10 3. Services provided to persons who have developmental
11 disabilities, as defined in s. 393.063(12).
12 4. Companion and sitter organizations that were
13 registered under s. 400.509(1) on January 1, 1999, and were
14 authorized to provide personal services under s. 393.063(33)
15 under a developmental services provider certificate on January
16 1, 1999, may continue to provide such services to past,
17 present, and future clients of the organization who need such
18 services, notwithstanding the provisions of this act.
19 5. The Department of Children and Family Services.
20 (c) A health care professional, whether or not
21 incorporated, who is licensed under chapter 457; chapter 458;
22 chapter 459; part I of chapter 464; chapter 467; part I, part
23 III, part V, or part X of chapter 468; chapter 480; chapter
24 486; chapter 490; or chapter 491; and who is acting alone
25 within the scope of his or her professional license to provide
26 care to patients in their homes.
27 (d) A home health aide or certified nursing assistant
28 who is acting in his or her individual capacity, within the
29 definitions and standards of his or her occupation, and who
30 provides hands-on care to patients in their homes.
31
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1 (e) An individual who acts alone, in his or her
2 individual capacity, and who is not employed by or affiliated
3 with a licensed home health agency or registered with a
4 licensed nurse registry. This exemption does not entitle an
5 individual to perform home health services without the
6 required professional license.
7 (f) The delivery of instructional services in home
8 dialysis and home dialysis supplies and equipment.
9 (g) The delivery of nursing home services for which
10 the nursing home is licensed under part II of this chapter, to
11 serve its residents in its facility.
12 (h) The delivery of assisted living facility services
13 for which the assisted living facility is licensed under part
14 III of this chapter, to serve its residents in its facility.
15 (i) The delivery of hospice services for which the
16 hospice is licensed under part VI of this chapter, to serve
17 hospice patients admitted to its service.
18 (j) A hospital that provides services for which it is
19 licensed under chapter 395.
20 (k) The delivery of community residential services for
21 which the community residential home is licensed under chapter
22 419, to serve the residents in its facility.
23 (l) A not-for-profit, community-based agency that
24 provides early intervention services to infants and toddlers.
25 (m) Certified rehabilitation agencies and
26 comprehensive outpatient rehabilitation facilities that are
27 certified under Title 18 of the Social Security Act.
28 (n) The delivery of adult family care home services
29 for which the adult family care home is licensed under part
30 VII of this chapter, to serve the residents in its facility.
31
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1 Section 27. Subsection (2) of section 400.471, Florida
2 Statutes, is amended to read:
3 400.471 Application for license; fee; provisional
4 license; temporary permit.--
5 (2) The applicant must file with the application
6 satisfactory proof that the home health agency is in
7 compliance with this part and applicable rules, including:
8 (a) A listing of services to be provided, either
9 directly by the applicant or through contractual arrangements
10 with existing providers;
11 (b) The number and discipline of professional staff to
12 be employed; and
13 (c) Proof of financial ability to operate; and.
14 (d) Completion of volume data questions on the renewal
15 application.
16 Section 28. Subsection (2) of section 400.487, Florida
17 Statutes, is amended to read:
18 400.487 Home health service agreements; physician's
19 treatment orders; patient assessment; establishment and review
20 of plan of care; provision of services; orders not to
21 resuscitate.--
22 (2) When required by the provisions of chapter 464;
23 part I, part III, or part V of chapter 468; or chapter 486,
24 the attending physician for a patient who is to receive
25 skilled care must establish treatment orders. The treatment
26 orders must be signed by the physician. If the claim is
27 submitted to a managed care organization, the treatment orders
28 shall be signed in the time allowed under the provider
29 agreement. The treatment orders shall within 30 days after the
30 start of care and must be reviewed, as frequently as the
31 patient's illness requires, by the physician in consultation
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1 with the home health agency personnel that provide services to
2 the patient.
3 Section 29. Section 400.491, Florida Statutes, is
4 amended to read:
5 400.491 Clinical records.--
6 (1) The home health agency must maintain for each
7 patient who receives skilled care a clinical record that
8 includes pertinent past and current medical, nursing, social
9 and other therapeutic information, the treatment orders, and
10 other such information as is necessary for the safe and
11 adequate care of the patient. When home health services are
12 terminated, the record must show the date and reason for
13 termination. Such records are considered patient records
14 under s. 456.057, and must be maintained by the home health
15 agency for 5 years following termination of services. If a
16 patient transfers to another home health agency, a copy of his
17 or her record must be provided to the other home health agency
18 upon request.
19 (2) The home health agency must maintain for each
20 client who receives nonskilled care a service provision plan.
21 Such records must be maintained by the home health agency for
22 1 year following termination of services.
23 Section 30. Section 400.512, Florida Statutes, is
24 amended to read:
25 400.512 Screening of home health agency personnel and;
26 nurse registry personnel; and companions and homemakers.--The
27 agency shall require employment or contractor screening as
28 provided in chapter 435, using the level 1 standards for
29 screening set forth in that chapter, for home health agency
30 personnel and; persons referred for employment by nurse
31
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1 registries; and persons employed by companion or homemaker
2 services registered under s. 400.509.
3 (1)(a) The Agency for Health Care Administration may,
4 upon request, grant exemptions from disqualification from
5 employment or contracting under this section as provided in s.
6 435.07, except for health care practitioners licensed by the
7 Department of Health or a regulatory board within that
8 department.
9 (b) The appropriate regulatory board within the
10 Department of Health, or that department itself when there is
11 no board, may, upon request of the licensed health care
12 practitioner, grant exemptions from disqualification from
13 employment or contracting under this section as provided in s.
14 435.07.
15 (2) The administrator of each home health agency and,
16 the managing employee of each nurse registry, and the managing
17 employee of each companion or homemaker service registered
18 under s. 400.509 must sign an affidavit annually, under
19 penalty of perjury, stating that all personnel hired or,
20 contracted with, or registered on or after October 1, 1994,
21 who enter the home of a patient or client in their service
22 capacity have been screened and that its remaining personnel
23 have worked for the home health agency or registrant
24 continuously since before October 1, 1994.
25 (3) As a prerequisite to operating as a home health
26 agency or, nurse registry, or companion or homemaker service
27 under s. 400.509, the administrator or managing employee,
28 respectively, must submit to the agency his or her name and
29 any other information necessary to conduct a complete
30 screening according to this section. The agency shall submit
31 the information to the Department of Law Enforcement for state
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1 processing. The agency shall review the record of the
2 administrator or manager with respect to the offenses
3 specified in this section and shall notify the owner of its
4 findings. If disposition information is missing on a criminal
5 record, the administrator or manager, upon request of the
6 agency, must obtain and supply within 30 days the missing
7 disposition information to the agency. Failure to supply
8 missing information within 30 days or to show reasonable
9 efforts to obtain such information will result in automatic
10 disqualification.
11 (4) Proof of compliance with the screening
12 requirements of chapter 435 shall be accepted in lieu of the
13 requirements of this section if the person has been
14 continuously employed or registered without a breach in
15 service that exceeds 180 days, the proof of compliance is not
16 more than 2 years old, and the person has been screened by the
17 Department of Law Enforcement. A home health agency or, nurse
18 registry, or companion or homemaker service registered under
19 s. 400.509 shall directly provide proof of compliance to
20 another home health agency or, nurse registry, or companion or
21 homemaker service registered under s. 400.509. The recipient
22 home health agency or, nurse registry, or companion or
23 homemaker service registered under s. 400.509 may not accept
24 any proof of compliance directly from the person who requires
25 screening. Proof of compliance with the screening requirements
26 of this section shall be provided upon request to the person
27 screened by the home health agencies or; nurse registries; or
28 companion or homemaker services registered under s. 400.509.
29 (5) There is no monetary liability on the part of, and
30 no cause of action for damages arises against, a licensed home
31 health agency or, licensed nurse registry, or companion or
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1 homemaker service registered under s. 400.509, that, upon
2 notice that the employee or contractor has been found guilty
3 of, regardless of adjudication, or entered a plea of nolo
4 contendere or guilty to, any offense prohibited under s.
5 435.03 or under any similar statute of another jurisdiction,
6 terminates the employee or contractor, whether or not the
7 employee or contractor has filed for an exemption with the
8 agency in accordance with chapter 435 and whether or not the
9 time for filing has expired.
10 (6) The costs of processing the statewide
11 correspondence criminal records checks must be borne by the
12 home health agency or; the nurse registry; or the companion or
13 homemaker service registered under s. 400.509, or by the
14 person being screened, at the discretion of the home health
15 agency or, nurse registry, or s. 400.509 registrant.
16 (7)(a) It is a misdemeanor of the first degree,
17 punishable under s. 775.082 or s. 775.083, for any person
18 willfully, knowingly, or intentionally to:
19 1. Fail, by false statement, misrepresentation,
20 impersonation, or other fraudulent means, to disclose in any
21 application for voluntary or paid employment a material fact
22 used in making a determination as to such person's
23 qualifications to be an employee under this section;
24 2. Operate or attempt to operate an entity licensed or
25 registered under this part with persons who do not meet the
26 minimum standards for good moral character as contained in
27 this section; or
28 3. Use information from the criminal records obtained
29 under this section for any purpose other than screening that
30 person for employment as specified in this section or release
31
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1 such information to any other person for any purpose other
2 than screening for employment under this section.
3 (b) It is a felony of the third degree, punishable
4 under s. 775.082, s. 775.083, or s. 775.084, for any person
5 willfully, knowingly, or intentionally to use information from
6 the juvenile records of a person obtained under this section
7 for any purpose other than screening for employment under this
8 section.
9 Section 31. Section 400.515, Florida Statutes, is
10 amended to read:
11 400.515 Injunction proceedings.--Notwithstanding the
12 existence or pursuit of any other remedy, the agency may
13 maintain an action in the name of the state for injunction or
14 other process to enforce the provisions of this part and rules
15 adopted to implement this part. The Agency for Health Care
16 Administration may institute injunction proceedings in a court
17 of competent jurisdiction when violation of this part or of
18 applicable rules constitutes an emergency affecting the
19 immediate health and safety of a patient or client.
20 Section 32. Subsection (26) of section 415.102,
21 Florida Statutes, is amended to read:
22 415.102 Definitions of terms used in ss.
23 415.101-415.113.--As used in ss. 415.101-415.113, the term:
24 (26) "Vulnerable adult" means a person 18 years of age
25 or older whose ability to perform the normal activities of
26 daily living or to provide for his or her own care or
27 protection is impaired due to a long-term mental, emotional,
28 physical, or developmental disability or dysfunctioning, or
29 brain damage, or the infirmities of aging.
30 Section 33. Section 400.509, Florida Statutes, is
31 repealed.
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1 Section 34. This act shall take effect July 1, 2003.
2
3 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
4 CS for Senate Bill 400
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6 The Committee Substitute clarifies the definition of
"vulnerable adult" include individuals whose disability is
7 long-term.
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CODING: Words stricken are deletions; words underlined are additions.