HOUSE AMENDMENT |
Bill No. SB 22A |
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CHAMBER ACTION |
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Representative Green offered the following: |
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Amendment (with title amendment) |
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Remove everything after the enacting clause, and insert: |
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Section 1. Effective upon this act becoming a law, |
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paragraph (d) of subsection (5) of section 400.179, Florida |
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Statutes, is amended to read: |
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400.179 Sale or transfer of ownership of a nursing |
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facility; liability for Medicaid underpayments and |
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overpayments.-- |
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(5) Because any transfer of a nursing facility may expose |
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the fact that Medicaid may have underpaid or overpaid the |
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transferor, and because in most instances, any such underpayment |
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or overpayment can only be determined following a formal field |
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audit, the liabilities for any such underpayments or |
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overpayments shall be as follows: |
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(d) Where the transfer involves a facility that has been |
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leased by the transferor: |
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1. The transferee shall, as a condition to being issued a |
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license by the agency, acquire, maintain, and provide proof to |
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the agency of a bond with a term of 30 months, renewable |
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annually, in an amount not less than the total of 3 months |
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Medicaid payments to the facility computed on the basis of the |
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preceding 12-month average Medicaid payments to the facility. |
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2. A leasehold licensee may meet the requirements of |
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subparagraph 1. by payment of a nonrefundable fee, paid at |
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initial licensure, paid at the time of any subsequent change of |
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ownership, and paid at the time of any subsequent annual license |
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renewal, in the amount of 2 percent of the total of 3 months' |
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Medicaid payments to the facility computed on the basis of the |
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preceding 12-month average Medicaid payments to the facility. If |
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a preceding 12-month average is not available, projected |
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Medicaid payments may be used. The fee shall be deposited into |
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the Health Care Trust Fund and shall be accounted for separately |
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as a Medicaid nursing home overpayment account. These fees shall |
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be used at the sole discretion of the agency to repay nursing |
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home Medicaid overpayments. Payment of this fee shall not |
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release the licensee from any liability for any Medicaid |
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overpayments, nor shall payment bar the agency from seeking to |
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recoup overpayments from the licensee and any other liable |
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party. As a condition of exercising this lease bond alternative, |
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licensees paying this fee must maintain an existing lease bond |
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through the end of the 30-month term period of that bond. The |
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agency is herein granted specific authority to promulgate all |
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rules pertaining to the administration and management of this |
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account, including withdrawals from the account, subject to |
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federal review and approval. This subparagraph is repealed on |
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June 30, 2003.This provision shall take effect upon becoming |
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law and shall apply to any leasehold license application. |
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a. The financial viability of the Medicaid nursing home |
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overpayment account shall be determined by the agency through |
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annual review of the account balance and the amount of total |
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outstanding, unpaid Medicaid overpayments owing from leasehold |
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licensees to the agency as determined by final agency audits. |
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b. The agency, in consultation with the Florida Health |
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Care Association and the Florida Association of Homes for the |
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Aging, shall study and make recommendations on the minimum |
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amount to be held in reserve to protect against Medicaid |
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overpayments to leasehold licensees and on the issue of |
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successor liability for Medicaid overpayments upon sale or |
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transfer of ownership of a nursing facility. The agency shall |
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submit the findings and recommendations of the study to the |
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Governor, the President of the Senate, and the Speaker of the |
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House of Representatives by January 1, 2003. |
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3. The leasehold licensee may meet the bond requirement |
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through other arrangements acceptable to the agency. The agency |
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is herein granted specific authority to promulgate rules |
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pertaining to lease bond arrangements. |
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4. All existing nursing facility licensees, operating the |
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facility as a leasehold, shall acquire, maintain, and provide |
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proof to the agency of the 30-month bond required in |
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subparagraph 1., above, on and after July 1, 1993, for each |
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license renewal. |
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5. It shall be the responsibility of all nursing facility |
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operators, operating the facility as a leasehold, to renew the |
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30-month bond and to provide proof of such renewal to the agency |
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annually at the time of application for license renewal. |
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6. Any failure of the nursing facility operator to |
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acquire, maintain, renew annually, or provide proof to the |
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agency shall be grounds for the agency to deny, cancel, revoke, |
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or suspend the facility license to operate such facility and to |
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take any further action, including, but not limited to, |
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enjoining the facility, asserting a moratorium, or applying for |
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a receiver, deemed necessary to ensure compliance with this |
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section and to safeguard and protect the health, safety, and |
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welfare of the facility's residents. A lease agreement required |
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as a condition of bond financing or refinancing under s. 154.213 |
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by a health facilities authority or required under s. 159.30 by |
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a county or municipality is not a leasehold for purposes of this |
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paragraph and is not subject to the bond requirement of this |
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paragraph. |
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Section 2. Subsections (17), (18), (19), (20), (21), (22), |
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(23), (24), (25), (26), and (27) of section 409.811, Florida |
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Statutes, are renumbered as subsections (18), (19), (20), (21), |
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(22), (23), (24), (25), (26), (27), and (28), respectively, and |
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a new subsection (17) is added to said section to read: |
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409.811 Definitions relating to Florida Kidcare Act.--As |
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used in ss. 409.810-409.820, the term: |
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(17) "Managed care plan" means a health maintenance |
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organization authorized pursuant to chapter 641 or a prepaid |
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health plan authorized pursuant to s. 409.912. |
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Section 3. Subsection (7) of section 409.8132, Florida |
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Statutes, is amended to read: |
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409.8132 Medikids program component.-- |
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(7) ENROLLMENT.--Enrollment in the Medikids program |
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component may only occur during periodic open enrollment periods |
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as specified by the agency. An applicant may apply for |
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enrollment in the Medikids program component and proceed through |
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the eligibility determination process at any time throughout the |
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year. However, enrollment in Medikids shall not begin until the |
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next open enrollment period; and a child may not receive |
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services under the Medikids program until the child is enrolled |
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in a managed care plan as defined in s. 409.811 or inMediPass. |
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In addition, once determined eligible, an applicant may receive |
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choice counseling and select a managed care plan or MediPass. |
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The agency may initiate mandatory assignment for a Medikids |
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applicant who has not chosen a managed care plan or MediPass |
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provider after the applicant's voluntary choice period ends. An |
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applicant may select MediPass under the Medikids program |
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component only in counties that have fewer than two managed care |
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plans available to serve Medicaid recipients and only if the |
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federal Health Care Financing Administration determines that |
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MediPass constitutes "health insurance coverage" as defined in |
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Title XXI of the Social Security Act. |
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Section 4. Subsection (25) of section 409.901, Florida |
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Statutes, is amended to read: |
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409.901 Definitions; ss. 409.901-409.920.--As used in ss. |
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409.901-409.920, except as otherwise specifically provided, the |
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term: |
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(25) "Third party" means an individual, entity, or |
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program, excluding Medicaid, that is, may be, could be, should |
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be, or has been liable for all or part of the cost of medical |
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services related to any medical assistance providedcovered by |
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Medicaid. Third party includes a third-party administrator or |
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TPA and a pharmacy benefits manager or PBM. |
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Section 5. Subsection (2) of section 409.904, Florida |
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Statutes, as amended by section 1 of chapter 2003-9, Laws of |
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Florida, is amended to read: |
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409.904 Optional payments for eligible persons.--The |
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agency may make payments for medical assistance and related |
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services on behalf of the following persons who are determined |
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to be eligible subject to the income, assets, and categorical |
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eligibility tests set forth in federal and state law. Payment on |
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behalf of these Medicaid eligible persons is subject to the |
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availability of moneys and any limitations established by the |
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General Appropriations Act or chapter 216. |
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(2) A caretaker relative or parent, a pregnant woman, a |
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child under age 19 who would otherwise qualify for Florida |
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Kidcare Medicaid, a child up to age 21 who would otherwise |
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qualify under s. 409.903(1), a person age 65 or over, or a blind |
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or disabled person, who would otherwise be eligible for Florida |
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Medicaid, except that the income or assets of such family or |
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person exceed established limitations. For a family or person in |
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one of these coverage groups, medical expenses are deductible |
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from income in accordance with federal requirements in order to |
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make a determination of eligibility. Expenses used to meet |
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spend-down liability are not reimbursable by Medicaid. Effective |
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July 1, 2003, when determining the eligibility of a pregnant |
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woman, a child, or an aged, blind, or disabled individual, $270 |
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shall be deducted from the countable income of the filing unit. |
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When determining the eligibility of the parent or caretaker |
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relative as defined by Title XIX of the Social Security Act, the |
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additional income disregard of $270 does not apply.A family or |
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person eligible under the coverage known as the "medically |
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needy," is eligible to receive the same services as other |
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Medicaid recipients, with the exception of services in skilled |
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nursing facilities and intermediate care facilities for the |
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developmentally disabled. |
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Section 6. Subsections (1), (12), and (23) of section |
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409.906, Florida Statutes, are amended to read: |
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409.906 Optional Medicaid services.--Subject to specific |
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appropriations, the agency may make payments for services which |
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are optional to the state under Title XIX of the Social Security |
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Act and are furnished by Medicaid providers to recipients who |
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are determined to be eligible on the dates on which the services |
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were provided. Any optional service that is provided shall be |
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provided only when medically necessary and in accordance with |
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state and federal law. Optional services rendered by providers |
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in mobile units to Medicaid recipients may be restricted or |
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prohibited by the agency. Nothing in this section shall be |
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construed to prevent or limit the agency from adjusting fees, |
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reimbursement rates, lengths of stay, number of visits, or |
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number of services, or making any other adjustments necessary to |
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comply with the availability of moneys and any limitations or |
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directions provided for in the General Appropriations Act or |
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chapter 216. If necessary to safeguard the state's systems of |
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providing services to elderly and disabled persons and subject |
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to the notice and review provisions of s. 216.177, the Governor |
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may direct the Agency for Health Care Administration to amend |
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the Medicaid state plan to delete the optional Medicaid service |
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known as "Intermediate Care Facilities for the Developmentally |
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Disabled." Optional services may include: |
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(1) ADULT DENTAL SERVICES.--The agency may pay for |
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dentures, the procedures required to seat dentures, the repair |
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and reline of dentures, emergency dental procedures necessary to |
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alleviate pain or infection, and basic dental preventive |
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procedures provided by or under the direction of a licensed |
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dentist for a recipient who is age 65 or oldermedically |
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necessary, emergency dental procedures to alleviate pain or |
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infection. Emergency dental care shall be limited to emergency |
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oral examinations, necessary radiographs, extractions, and |
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incision and drainage of abscess, for a recipient who is age 21 |
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or older. However, Medicaid will not provide reimbursement for |
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dental services provided in a mobile dental unit, except for a |
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mobile dental unit: |
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(a) Owned by, operated by, or having a contractual |
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agreement with the Department of Health and complying with |
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Medicaid's county health department clinic services program |
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specifications as a county health department clinic services |
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provider. |
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(b) Owned by, operated by, or having a contractual |
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arrangement with a federally qualified health center and |
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complying with Medicaid's federally qualified health center |
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specifications as a federally qualified health center provider. |
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(c) Rendering dental services to Medicaid recipients, 21 |
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years of age and older, at nursing facilities. |
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(d) Owned by, operated by, or having a contractual |
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agreement with a state-approved dental educational institution. |
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(12) CHILDREN'SHEARING SERVICES.--The agency may pay for |
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hearing and related services, including hearing evaluations, |
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hearing aid devices, dispensing of the hearing aid, and related |
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repairs, if provided to a recipient younger than 21 years of age |
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by a licensed hearing aid specialist, otolaryngologist, |
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otologist, audiologist, or physician. |
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(23) CHILDREN'SVISUAL SERVICES.--The agency may pay for |
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visual examinations, eyeglasses, and eyeglass repairs for a |
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recipient younger than 21 years of age, if they are prescribed |
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by a licensed physician specializing in diseases of the eye or |
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by a licensed optometrist. |
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Section 7. Paragraphs (c) and (d) are added to subsection |
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(1) of section 409.9081, Florida Statutes, to read: |
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409.9081 Copayments.-- |
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(1) The agency shall require, subject to federal |
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regulations and limitations, each Medicaid recipient to pay at |
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the time of service a nominal copayment for the following |
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Medicaid services: |
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(c) Prescription drugs: a coinsurance equal to 5 percent |
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of the Medicaid cost of the prescription drug at the time of |
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purchase. The maximum coinsurance shall be $15 per prescription |
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drug purchased.
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(d) Hospital outpatient services, emergency department: up |
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to $15 for each hospital outpatient emergency department |
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encounter that is for nonemergency purposes. |
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Section 8. Section 409.911, Florida Statutes, is amended |
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to read: |
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409.911 Disproportionate share program.--Subject to |
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specific allocations established within the General |
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Appropriations Act and any limitations established pursuant to |
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chapter 216, the agency shall distribute, pursuant to this |
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section, moneys to hospitals providing a disproportionate share |
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of Medicaid or charity care services by making quarterly |
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Medicaid payments as required. Notwithstanding the provisions of |
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s. 409.915, counties are exempt from contributing toward the |
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cost of this special reimbursement for hospitals serving a |
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disproportionate share of low-income patients. |
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(1) Definitions.--As used in this section, s. 409.9112, |
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and the Florida Hospital Uniform Reporting System manual: |
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(a) "Adjusted patient days" means the sum of acute care |
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patient days and intensive care patient days as reported to the |
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Agency for Health Care Administration, divided by the ratio of |
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inpatient revenues generated from acute, intensive, ambulatory, |
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and ancillary patient services to gross revenues. |
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(b) "Actual audited data" or "actual audited experience" |
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means data reported to the Agency for Health Care Administration |
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which has been audited in accordance with generally accepted |
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auditing standards by the agency or representatives under |
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contract with the agency. |
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(c) "Base Medicaid per diem" means the hospital's Medicaid |
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per diem rate initially established by the Agency for Health |
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Care Administration on January 1, 1999. The base Medicaid per |
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diem rate shall not include any additional per diem increases |
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received as a result of the disproportionate share distribution.
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(c)(d)"Charity care" or "uncompensated charity care" |
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means that portion of hospital charges reported to the Agency |
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for Health Care Administration for which there is no |
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compensation, other than restricted or unrestricted revenues |
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provided to a hospital by local governments or tax districts |
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regardless of the method of payment, for care provided to a |
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patient whose family income for the 12 months preceding the |
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determination is less than or equal to 200 percent of the |
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federal poverty level, unless the amount of hospital charges due |
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from the patient exceeds 25 percent of the annual family income. |
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However, in no case shall the hospital charges for a patient |
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whose family income exceeds four times the federal poverty level |
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for a family of four be considered charity. |
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(d)(e)"Charity care days" means the sum of the deductions |
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from revenues for charity care minus 50 percent of restricted |
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and unrestricted revenues provided to a hospital by local |
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governments or tax districts, divided by gross revenues per |
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adjusted patient day. |
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(f) "Disproportionate share percentage" means a rate of |
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increase in the Medicaid per diem rate as calculated under this |
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section.
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(e)(g)"Hospital" means a health care institution licensed |
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as a hospital pursuant to chapter 395, but does not include |
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ambulatory surgical centers. |
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(f)(h)"Medicaid days" means the number of actual days |
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attributable to Medicaid patients as determined by the Agency |
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for Health Care Administration. |
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(2) The Agency for Health Care Administration shall |
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utilize the following actual audited datacriteria to determine |
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the Medicaid days and charity care to be used in the calculation |
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of theif a hospital qualifies for adisproportionate share |
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payment: |
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(a) The Agency for Health Care Administration shall use |
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the average of the 1997, 1998, and 1999 audited data to |
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determine each hospital's Medicaid days and charity careA |
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hospital's total Medicaid days when combined with its total |
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charity care days must equal or exceed 7 percent of its total |
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adjusted patient days. |
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(b) In the event the Agency for Health Care Administration |
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does not have the prescribed 3 years of audited disproportionate |
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share data for a hospital, the Agency for Health Care |
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Administration shall use the average of the audited |
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disproportionate share data for the years availableA hospital's |
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total charity care days weighted by a factor of 4.5, plus its |
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total Medicaid days weighted by a factor of 1, shall be equal to |
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or greater than 10 percent of its total adjusted patient days. |
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(c) Additionally, In accordance with s. 1923(b) of the |
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Social Security Actthe seventh federal Omnibus Budget |
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Reconciliation Act, a hospital with a Medicaid inpatient |
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utilization rate greater than one standard deviation above the |
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statewide mean or a hospital with a low-income utilization rate |
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of 25 percent or greater shall qualify for reimbursement. |
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(3) In computing the disproportionate share rate:
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(a) Per diem increases earned from disproportionate share |
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shall be applied to each hospital's base Medicaid per diem rate |
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and shall be capped at 170 percent.
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(b) The agency shall use 1994 audited financial data for |
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the calculation of disproportionate share payments under this |
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section.
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(c) If the total amount earned by all hospitals under this |
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section exceeds the amount appropriated, each hospital's share |
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shall be reduced on a pro rata basis so that the total dollars |
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distributed from the trust fund do not exceed the total amount |
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appropriated.
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(d) The total amount calculated to be distributed under |
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this section shall be made in quarterly payments subsequent to |
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each quarter during the fiscal year.
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(3)(4)Hospitals that qualify for a disproportionate share |
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payment solely under paragraph (2)(c) shall have their payment |
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calculated in accordance with the following formulas: |
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DSHP = (HMD/TSMD) x $1 million
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TAA = TA x (1/5.5)
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DSHP = (HMD/TSMD) x TAA
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Where: |
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TAA = total amount available.
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TA = total appropriation.
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DSHP = disproportionate share hospital payment. |
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HMD = hospital Medicaid days. |
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TSMD = total state Medicaid days. |
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(4) The following formulas shall be used to pay |
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disproportionate share dollars to public hospitals:
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(a) For state mental health hospitals:
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DSHP = (HMD/TMDMH) x TAAMH
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The total amount available for the state mental health hospitals |
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shall be the difference between the federal cap for Institutions |
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for Mental Diseases and the amounts paid under the mental health |
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disproportionate share program.
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Where:
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DSHP = disproportionate share hospital payment.
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HMD = hospital Medicaid days.
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TMDMH = total Medicaid days for state mental health |
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hospitals.
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TAAMH = total amount available for mental health hospitals.
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(b) For nonstate government owned or operated hospitals |
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with 3,200 or more Medicaid days:
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DSHP = [(.82 x HCCD/TCCD) + (.18 x HMD/TMD)] x TAAPH
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TAAPH = TAA – TAAMH – 1,400,000
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Where:
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DSHP = disproportionate share hospital payments.
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HCCD = hospital charity care dollars.
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TCCD = total charity care dollars for public nonstate |
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hospitals.
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HMD = hospital Medicaid days.
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TMD = total Medicaid days for public nonstate hospitals.
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TAAPH = total amount available for public hospitals.
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TAA = total available appropriation.
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TAAMH = total amount available for mental health hospitals.
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(c) For nonstate government owned or operated hospitals |
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with less than 3,200 Medicaid days, a total of $400,000 shall be |
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distributed equally among these hospitals.
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(5) The following formula shall be utilized by the agency |
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to determine the maximum disproportionate share rate to be used |
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to increase the Medicaid per diem rate for hospitals that |
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qualify pursuant to paragraphs (2)(a) and (b):
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| ((---------) | x 4.5) + | (---------) |
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@_@2@_@
|
411
|
Where:
|
412
|
APD = adjusted patient days.
|
413
|
CCD = charity care days.
|
414
|
DSR = disproportionate share rate.
|
415
|
MD = Medicaid days.
|
416
|
|
417
|
(6)(a) To calculate the total amount earned by all |
418
|
hospitals under this section, hospitals with a disproportionate |
419
|
share rate less than 50 percent shall divide their Medicaid days |
420
|
by four, and hospitals with a disproportionate share rate |
421
|
greater than or equal to 50 percent and with greater than 40,000 |
422
|
Medicaid days shall multiply their Medicaid days by 1.5, and the |
423
|
following formula shall be used by the agency to calculate the |
424
|
total amount earned by all hospitals under this section:
|
425
|
|
426
|
TAE = BMPD x MD x DSP
|
427
|
|
428
|
Where:
|
429
|
TAE = total amount earned.
|
430
|
BMPD = base Medicaid per diem.
|
431
|
MD = Medicaid days.
|
432
|
DSP = disproportionate share percentage.
|
433
|
|
434
|
(5)(b)In no case shall total payments to a hospital under |
435
|
this section, with the exception of public nonstate facilities |
436
|
orstate facilities, exceed the total amount of uncompensated |
437
|
charity care of the hospital, as determined by the agency |
438
|
according to the most recent calendar year audited data |
439
|
available at the beginning of each state fiscal year. |
440
|
(7) The following criteria shall be used in determining |
441
|
the disproportionate share percentage:
|
442
|
(a) If the disproportionate share rate is less than 10 |
443
|
percent, the disproportionate share percentage is zero and there |
444
|
is no additional payment.
|
445
|
(b) If the disproportionate share rate is greater than or |
446
|
equal to 10 percent, but less than 20 percent, then the |
447
|
disproportionate share percentage is 1.8478498.
|
448
|
(c) If the disproportionate share rate is greater than or |
449
|
equal to 20 percent, but less than 30 percent, then the |
450
|
disproportionate share percentage is 3.4145488.
|
451
|
(d) If the disproportionate share rate is greater than or |
452
|
equal to 30 percent, but less than 40 percent, then the |
453
|
disproportionate share percentage is 6.3095734.
|
454
|
(e) If the disproportionate share rate is greater than or |
455
|
equal to 40 percent, but less than 50 percent, then the |
456
|
disproportionate share percentage is 11.6591440.
|
457
|
(f) If the disproportionate share rate is greater than or |
458
|
equal to 50 percent, but less than 60 percent, then the |
459
|
disproportionate share percentage is 73.5642254.
|
460
|
(g) If the disproportionate share rate is greater than or |
461
|
equal to 60 percent but less than 72.5 percent, then the |
462
|
disproportionate share percentage is 135.9356391.
|
463
|
(h) If the disproportionate share rate is greater than or |
464
|
equal to 72.5 percent, then the disproportionate share |
465
|
percentage is 170.
|
466
|
(8) The following formula shall be used by the agency to |
467
|
calculate the total amount earned by all hospitals under this |
468
|
section:
|
469
|
|
470
|
TAE = BMPD x MD x DSP
|
471
|
|
472
|
Where:
|
473
|
TAE = total amount earned.
|
474
|
BMPD = base Medicaid per diem.
|
475
|
MD = Medicaid days.
|
476
|
DSP = disproportionate share percentage.
|
477
|
|
478
|
(6)(9)The agency is authorized to receive funds from |
479
|
local governments and other local political subdivisions for the |
480
|
purpose of making payments, including federal matching funds, |
481
|
through the Medicaid disproportionate share program. Funds |
482
|
received from local governments for this purpose shall be |
483
|
separately accounted for and shall not be commingled with other |
484
|
state or local funds in any manner. |
485
|
(7)(10)Payments made by the agency to hospitals eligible |
486
|
to participate in this program shall be made in accordance with |
487
|
federal rules and regulations. |
488
|
(a) If the Federal Government prohibits, restricts, or |
489
|
changes in any manner the methods by which funds are distributed |
490
|
for this program, the agency shall not distribute any additional |
491
|
funds and shall return all funds to the local government from |
492
|
which the funds were received, except as provided in paragraph |
493
|
(b). |
494
|
(b) If the Federal Government imposes a restriction that |
495
|
still permits a partial or different distribution, the agency |
496
|
may continue to disburse funds to hospitals participating in the |
497
|
disproportionate share program in a federally approved manner, |
498
|
provided: |
499
|
1. Each local government which contributes to the |
500
|
disproportionate share program agrees to the new manner of |
501
|
distribution as shown by a written document signed by the |
502
|
governing authority of each local government; and |
503
|
2. The Executive Office of the Governor, the Office of |
504
|
Planning and Budgeting, the House of Representatives, and the |
505
|
Senate are provided at least 7 days' prior notice of the |
506
|
proposed change in the distribution, and do not disapprove such |
507
|
change. |
508
|
(c) No distribution shall be made under the alternative |
509
|
method specified in paragraph (b) unless all parties agree or |
510
|
unless all funds of those parties that disagree which are not |
511
|
yet disbursed have been returned to those parties. |
512
|
(8)(11)Notwithstanding the provisions of chapter 216, the |
513
|
Executive Office of the Governor is hereby authorized to |
514
|
establish sufficient trust fund authority to implement the |
515
|
disproportionate share program. |
516
|
Section 9. Subsections (1) and (2) of section 409.9112, |
517
|
Florida Statutes, are amended to read: |
518
|
409.9112 Disproportionate share program for regional |
519
|
perinatal intensive care centers.--In addition to the payments |
520
|
made under s. 409.911, the Agency for Health Care Administration |
521
|
shall design and implement a system of making disproportionate |
522
|
share payments to those hospitals that participate in the |
523
|
regional perinatal intensive care center program established |
524
|
pursuant to chapter 383. This system of payments shall conform |
525
|
with federal requirements and shall distribute funds in each |
526
|
fiscal year for which an appropriation is made by making |
527
|
quarterly Medicaid payments. Notwithstanding the provisions of |
528
|
s. 409.915, counties are exempt from contributing toward the |
529
|
cost of this special reimbursement for hospitals serving a |
530
|
disproportionate share of low-income patients. |
531
|
(1) The following formula shall be used by the agency to |
532
|
calculate the total amount earned for hospitals that participate |
533
|
in the regional perinatal intensive care center program: |
534
|
|
535
|
TAE = HDSP/THDSP
|
536
|
|
537
|
Where:
|
538
|
TAE = total amount earned by a regional perinatal intensive |
539
|
care center.
|
540
|
HDSP = the prior state fiscal year regional perinatal |
541
|
intensive care center disproportionate share payment to the |
542
|
individual hospital.
|
543
|
THDSP = the prior state fiscal year total regional |
544
|
perinatal intensive care center disproportionate share payments |
545
|
to all hospitals.
|
546
|
(2) The total additional payment for hospitals that |
547
|
participate in the regional perinatal intensive care center |
548
|
program shall be calculated by the agency as follows:
|
549
|
|
550
|
TAP = TAE x TA
|
551
|
|
552
|
Where:
|
553
|
TAP = total additional payment for a regional perinatal |
554
|
intensive care center.
|
555
|
TAE = total amount earned by a regional perinatal intensive |
556
|
care center.
|
557
|
TA = total appropriation for the regional perinatal |
558
|
intensive care center disproportionate share program.
|
559
|
|
560
|
TAE = DSR x BMPD x MD
|
561
|
|
562
|
Where:
|
563
|
TAE = total amount earned by a regional perinatal intensive |
564
|
care center.
|
565
|
DSR = disproportionate share rate.
|
566
|
BMPD = base Medicaid per diem.
|
567
|
MD = Medicaid days.
|
568
|
|
569
|
(2) The total additional payment for hospitals that |
570
|
participate in the regional perinatal intensive care center |
571
|
program shall be calculated by the agency as follows:
|
572
|
|
573
|
|
574
|
@_@5@_@
|
575
|
Where:
|
576
|
TAP = total additional payment for a regional perinatal |
577
|
intensive care center.
|
578
|
TAE = total amount earned by a regional perinatal intensive |
579
|
care center.
|
580
|
STAE = sum of total amount earned by each hospital that |
581
|
participates in the regional perinatal intensive care center |
582
|
program.
|
583
|
TA = total appropriation for the regional perinatal |
584
|
intensive care disproportionate share program.
|
585
|
Section 10. Section 409.9117, Florida Statutes, is amended |
586
|
to read: |
587
|
409.9117 Primary care disproportionate share program.-- |
588
|
(1) If federal funds are available for disproportionate |
589
|
share programs in addition to those otherwise provided by law, |
590
|
there shall be created a primary care disproportionate share |
591
|
program. |
592
|
(2) The following formula shall be used by the agency to |
593
|
calculate the total amount earned for hospitals that participate |
594
|
in the primary care disproportionate share program:
|
595
|
|
596
|
TAE = HDSP/THDSP
|
597
|
|
598
|
Where:
|
599
|
TAE = total amount earned by a hospital participating in |
600
|
the primary care disproportionate share program.
|
601
|
HDSP = the prior state fiscal year primary care |
602
|
disproportionate share payment to the individual hospital.
|
603
|
THDSP = the prior state fiscal year to primary care |
604
|
disproportionate share payments to all hospitals.
|
605
|
(3) The total additional payment for hospitals that |
606
|
participate in the primary care disproportionate share program |
607
|
shall be calculated by the agency as follows:
|
608
|
|
609
|
TAP = TAE x TA
|
610
|
|
611
|
Where:
|
612
|
TAP = total additional payment for a primary care hospital.
|
613
|
TAE = total amount earned by a primary care hospital.
|
614
|
TA = total appropriation for the primary care |
615
|
disproportionate share program.
|
616
|
(4)(2)In the establishment and funding of this program, |
617
|
the agency shall use the following criteria in addition to those |
618
|
specified in s. 409.911.,Payments may not be made to a hospital |
619
|
unless the hospital agrees to: |
620
|
(a) Cooperate with a Medicaid prepaid health plan, if one |
621
|
exists in the community. |
622
|
(b) Ensure the availability of primary and specialty care |
623
|
physicians to Medicaid recipients who are not enrolled in a |
624
|
prepaid capitated arrangement and who are in need of access to |
625
|
such physicians. |
626
|
(c) Coordinate and provide primary care services free of |
627
|
charge, except copayments, to all persons with incomes up to 100 |
628
|
percent of the federal poverty level who are not otherwise |
629
|
covered by Medicaid or another program administered by a |
630
|
governmental entity, and to provide such services based on a |
631
|
sliding fee scale to all persons with incomes up to 200 percent |
632
|
of the federal poverty level who are not otherwise covered by |
633
|
Medicaid or another program administered by a governmental |
634
|
entity, except that eligibility may be limited to persons who |
635
|
reside within a more limited area, as agreed to by the agency |
636
|
and the hospital. |
637
|
(d) Contract with any federally qualified health center, |
638
|
if one exists within the agreed geopolitical boundaries, |
639
|
concerning the provision of primary care services, in order to |
640
|
guarantee delivery of services in a nonduplicative fashion, and |
641
|
to provide for referral arrangements, privileges, and |
642
|
admissions, as appropriate. The hospital shall agree to provide |
643
|
at an onsite or offsite facility primary care services within 24 |
644
|
hours to which all Medicaid recipients and persons eligible |
645
|
under this paragraph who do not require emergency room services |
646
|
are referred during normal daylight hours. |
647
|
(e) Cooperate with the agency, the county, and other |
648
|
entities to ensure the provision of certain public health |
649
|
services, case management, referral and acceptance of patients, |
650
|
and sharing of epidemiological data, as the agency and the |
651
|
hospital find mutually necessary and desirable to promote and |
652
|
protect the public health within the agreed geopolitical |
653
|
boundaries. |
654
|
(f) In cooperation with the county in which the hospital |
655
|
resides, develop a low-cost, outpatient, prepaid health care |
656
|
program to persons who are not eligible for the Medicaid |
657
|
program, and who reside within the area. |
658
|
(g) Provide inpatient services to residents within the |
659
|
area who are not eligible for Medicaid or Medicare, and who do |
660
|
not have private health insurance, regardless of ability to pay, |
661
|
on the basis of available space, except that nothing shall |
662
|
prevent the hospital from establishing bill collection programs |
663
|
based on ability to pay. |
664
|
(h) Work with the Florida Healthy Kids Corporation, the |
665
|
Florida Health Care Purchasing Cooperative,and business health |
666
|
coalitions, as appropriate, to develop a feasibility study and |
667
|
plan to provide a low-cost comprehensive health insurance plan |
668
|
to persons who reside within the area and who do not have access |
669
|
to such a plan. |
670
|
(i) Work with public health officials and other experts to |
671
|
provide community health education and prevention activities |
672
|
designed to promote healthy lifestyles and appropriate use of |
673
|
health services. |
674
|
(j) Work with the local health council to develop a plan |
675
|
for promoting access to affordable health care services for all |
676
|
persons who reside within the area, including, but not limited |
677
|
to, public health services, primary care services, inpatient |
678
|
services, and affordable health insurance generally. |
679
|
|
680
|
Any hospital that fails to comply with any of the provisions of |
681
|
this subsection, or any other contractual condition, may not |
682
|
receive payments under this section until full compliance is |
683
|
achieved. |
684
|
Section 11. Section 409.9119, Florida Statutes, is amended |
685
|
to read: |
686
|
409.9119 Disproportionate share program for specialty |
687
|
hospitals for children.--In addition to the payments made under |
688
|
s. 409.911, the Agency for Health Care Administration shall |
689
|
develop and implement a system under which disproportionate |
690
|
share payments are made to those hospitals that are licensed by |
691
|
the state as specialty hospitals for children and were licensed |
692
|
on January 1, 2000, as specialty hospitals for children. This |
693
|
system of payments must conform to federal requirements and must |
694
|
distribute funds in each fiscal year for which an appropriation |
695
|
is made by making quarterly Medicaid payments. Notwithstanding |
696
|
s. 409.915, counties are exempt from contributing toward the |
697
|
cost of this special reimbursement for hospitals that serve a |
698
|
disproportionate share of low-income patients. Payments are |
699
|
subject to specific appropriations in the General Appropriations |
700
|
Act. |
701
|
(1) The agency shall use the following formula to |
702
|
calculate the total amount earned for hospitals that participate |
703
|
in the specialty hospital for children disproportionate share |
704
|
program: |
705
|
|
706
|
TAE = DSR x BMPD x MD |
707
|
|
708
|
Where: |
709
|
TAE = total amount earned by a specialty hospital for |
710
|
children. |
711
|
DSR = disproportionate share rate. |
712
|
BMPD = base Medicaid per diem. |
713
|
MD = Medicaid days. |
714
|
(2) The agency shall calculate the total additional |
715
|
payment for hospitals that participate in the specialty hospital |
716
|
for children disproportionate share program as follows: |
717
|
|
718
|
|
719
|
|
720
|
Where: |
721
|
TAP = total additional payment for a specialty hospital for |
722
|
children. |
723
|
TAE = total amount earned by a specialty hospital for |
724
|
children. |
725
|
TA = total appropriation for the specialty hospital for |
726
|
children disproportionate share program. |
727
|
STAE = sum of total amount earned by each hospital that |
728
|
participates in the specialty hospital for children |
729
|
disproportionate share program. |
730
|
|
731
|
(3) A hospital may not receive any payments under this |
732
|
section until it achieves full compliance with the applicable |
733
|
rules of the agency. A hospital that is not in compliance for |
734
|
two or more consecutive quarters may not receive its share of |
735
|
the funds. Any forfeited funds must be distributed to the |
736
|
remaining participating specialty hospitals for children that |
737
|
are in compliance. |
738
|
Section 12. Paragraph (d) of subsection (3) of section |
739
|
409.912, Florida Statutes, is amended, and subsection (41) is |
740
|
added to said section, to read: |
741
|
409.912 Cost-effective purchasing of health care.--The |
742
|
agency shall purchase goods and services for Medicaid recipients |
743
|
in the most cost-effective manner consistent with the delivery |
744
|
of quality medical care. The agency shall maximize the use of |
745
|
prepaid per capita and prepaid aggregate fixed-sum basis |
746
|
services when appropriate and other alternative service delivery |
747
|
and reimbursement methodologies, including competitive bidding |
748
|
pursuant to s. 287.057, designed to facilitate the cost- |
749
|
effective purchase of a case-managed continuum of care. The |
750
|
agency shall also require providers to minimize the exposure of |
751
|
recipients to the need for acute inpatient, custodial, and other |
752
|
institutional care and the inappropriate or unnecessary use of |
753
|
high-cost services. The agency may establish prior authorization |
754
|
requirements for certain populations of Medicaid beneficiaries, |
755
|
certain drug classes, or particular drugs to prevent fraud, |
756
|
abuse, overuse, and possible dangerous drug interactions. The |
757
|
Pharmaceutical and Therapeutics Committee shall make |
758
|
recommendations to the agency on drugs for which prior |
759
|
authorization is required. The agency shall inform the |
760
|
Pharmaceutical and Therapeutics Committee of its decisions |
761
|
regarding drugs subject to prior authorization. |
762
|
(3) The agency may contract with: |
763
|
(d) A provider networkNo more than four provider service |
764
|
networks for demonstration projects to test Medicaid direct |
765
|
contracting. The demonstration projectsmay be reimbursed on a |
766
|
fee-for-service or prepaid basis. A provider service network |
767
|
which is reimbursed by the agency on a prepaid basis shall be |
768
|
exempt from parts I and III of chapter 641, but must meet |
769
|
appropriate financial reserve, quality assurance, and patient |
770
|
rights requirements as established by the agency. The agency |
771
|
shall award contracts on a competitive bid basis and shall |
772
|
select bidders based upon price and quality of care. Medicaid |
773
|
recipients assigned to a demonstration project shall be chosen |
774
|
equally from those who would otherwise have been assigned to |
775
|
prepaid plans and MediPass.The agency is authorized to seek |
776
|
federal Medicaid waivers as necessary to implement the |
777
|
provisions of this section. A demonstration project awarded |
778
|
pursuant to this paragraph shall be for 4 years from the date of |
779
|
implementation.
|
780
|
(41) The agency may contract on a prepaid or fixed-sum |
781
|
basis with an appropriately licensed prepaid dental health plan |
782
|
to provide Medicaid covered dental services to child or adult |
783
|
Medicaid recipients.
|
784
|
Section 13. Paragraphs (f) and (k) of subsection (2) of |
785
|
section 409.9122, Florida Statutes, are amended to read: |
786
|
409.9122 Mandatory Medicaid managed care enrollment; |
787
|
programs and procedures.-- |
788
|
(2) |
789
|
(f) When a Medicaid recipient does not choose a managed |
790
|
care plan or MediPass provider, the agency shall assign the |
791
|
Medicaid recipient to a managed care plan or MediPass provider. |
792
|
Medicaid recipients who are subject to mandatory assignment but |
793
|
who fail to make a choice shall be assigned to managed care |
794
|
plans until an enrollment of 4045 percent in MediPass and 6055 |
795
|
percent in managed care plans is achieved. Once this enrollment |
796
|
is achieved, the assignments shall be divided in order to |
797
|
maintain an enrollment in MediPass and managed care plans which |
798
|
is in a 4045 percent and 6055percent proportion, |
799
|
respectively. Thereafter, assignment of Medicaid recipients who |
800
|
fail to make a choice shall be based proportionally on the |
801
|
preferences of recipients who have made a choice in the previous |
802
|
period. Such proportions shall be revised at least quarterly to |
803
|
reflect an update of the preferences of Medicaid recipients. The |
804
|
agency shall disproportionately assign Medicaid-eligible |
805
|
recipients who are required to but have failed to make a choice |
806
|
of managed care plan or MediPass, including children, and who |
807
|
are to be assigned to the MediPass program to children's |
808
|
networks as described in s. 409.912(3)(g), Children's Medical |
809
|
Services network as defined in s. 391.021, exclusive provider |
810
|
organizations, provider service networks, minority physician |
811
|
networks, and pediatric emergency department diversion programs |
812
|
authorized by this chapter or the General Appropriations Act, in |
813
|
such manner as the agency deems appropriate, until the agency |
814
|
has determined that the networks and programs have sufficient |
815
|
numbers to be economically operated. For purposes of this |
816
|
paragraph, when referring to assignment, the term "managed care |
817
|
plans" includes health maintenance organizations, exclusive |
818
|
provider organizations, provider service networks, minority |
819
|
physician networks, Children's Medical Services network, and |
820
|
pediatric emergency department diversion programs authorized by |
821
|
this chapter or the General Appropriations Act. Beginning July |
822
|
1, 2002, the agency shall assign all children in families who |
823
|
have not made a choice of a managed care plan or MediPass in the |
824
|
required timeframe to a pediatric emergency room diversion |
825
|
program described in s. 409.912(3)(g) that, as of July 1, 2002, |
826
|
has executed a contract with the agency, until such network or |
827
|
program has reached an enrollment of 15,000 children. Once that |
828
|
minimum enrollment level has been reached, the agency shall |
829
|
assign children who have not chosen a managed care plan or |
830
|
MediPass to the network or program in a manner that maintains |
831
|
the minimum enrollment in the network or program at not less |
832
|
than 15,000 children. To the extent practicable, the agency |
833
|
shall also assign all eligible children in the same family to |
834
|
such network or program. When making assignments, the agency |
835
|
shall take into account the following criteria: |
836
|
1. A managed care plan has sufficient network capacity to |
837
|
meet the need of members. |
838
|
2. The managed care plan or MediPass has previously |
839
|
enrolled the recipient as a member, or one of the managed care |
840
|
plan's primary care providers or MediPass providers has |
841
|
previously provided health care to the recipient. |
842
|
3. The agency has knowledge that the member has previously |
843
|
expressed a preference for a particular managed care plan or |
844
|
MediPass provider as indicated by Medicaid fee-for-service |
845
|
claims data, but has failed to make a choice. |
846
|
4. The managed care plan's or MediPass primary care |
847
|
providers are geographically accessible to the recipient's |
848
|
residence. |
849
|
5. The agency has authority to make mandatory assignments |
850
|
based on quality of service and performance of managed care |
851
|
plans.
|
852
|
(k) When a Medicaid recipient does not choose a managed |
853
|
care plan or MediPass provider, the agency shall assign the |
854
|
Medicaid recipient to a managed care plan, except in those |
855
|
counties in which there are fewer than two managed care plans |
856
|
accepting Medicaid enrollees, in which case assignment shall be |
857
|
to a managed care plan or a MediPass provider. Medicaid |
858
|
recipients in counties with fewer than two managed care plans |
859
|
accepting Medicaid enrollees who are subject to mandatory |
860
|
assignment but who fail to make a choice shall be assigned to |
861
|
managed care plans until an enrollment of 4045percent in |
862
|
MediPass and 6055percent in managed care plans is achieved. |
863
|
Once that enrollment is achieved, the assignments shall be |
864
|
divided in order to maintain an enrollment in MediPass and |
865
|
managed care plans which is in a 4045 percent and 6055percent |
866
|
proportion, respectively. In geographic areas where the agency |
867
|
is contracting for the provision of comprehensive behavioral |
868
|
health services through a capitated prepaid arrangement, |
869
|
recipients who fail to make a choice shall be assigned equally |
870
|
to MediPass or a managed care plan. For purposes of this |
871
|
paragraph, when referring to assignment, the term "managed care |
872
|
plans" includes exclusive provider organizations, provider |
873
|
service networks, Children's Medical Services network, minority |
874
|
physician networks, and pediatric emergency department diversion |
875
|
programs authorized by this chapter or the General |
876
|
Appropriations Act. When making assignments, the agency shall |
877
|
take into account the following criteria: |
878
|
1. A managed care plan has sufficient network capacity to |
879
|
meet the need of members. |
880
|
2. The managed care plan or MediPass has previously |
881
|
enrolled the recipient as a member, or one of the managed care |
882
|
plan's primary care providers or MediPass providers has |
883
|
previously provided health care to the recipient. |
884
|
3. The agency has knowledge that the member has previously |
885
|
expressed a preference for a particular managed care plan or |
886
|
MediPass provider as indicated by Medicaid fee-for-service |
887
|
claims data, but has failed to make a choice. |
888
|
4. The managed care plan's or MediPass primary care |
889
|
providers are geographically accessible to the recipient's |
890
|
residence. |
891
|
5. The agency has authority to make mandatory assignments |
892
|
based on quality of service and performance of managed care |
893
|
plans. |
894
|
Section 14. Subsections (8) and (28) of section 409.913, |
895
|
Florida Statutes, are amended to read: |
896
|
409.913 Oversight of the integrity of the Medicaid |
897
|
program.--The agency shall operate a program to oversee the |
898
|
activities of Florida Medicaid recipients, and providers and |
899
|
their representatives, to ensure that fraudulent and abusive |
900
|
behavior and neglect of recipients occur to the minimum extent |
901
|
possible, and to recover overpayments and impose sanctions as |
902
|
appropriate. Beginning January 1, 2003, and each year |
903
|
thereafter, the agency and the Medicaid Fraud Control Unit of |
904
|
the Department of Legal Affairs shall submit a joint report to |
905
|
the Legislature documenting the effectiveness of the state's |
906
|
efforts to control Medicaid fraud and abuse and to recover |
907
|
Medicaid overpayments during the previous fiscal year. The |
908
|
report must describe the number of cases opened and investigated |
909
|
each year; the sources of the cases opened; the disposition of |
910
|
the cases closed each year; the amount of overpayments alleged |
911
|
in preliminary and final audit letters; the number and amount of |
912
|
fines or penalties imposed; any reductions in overpayment |
913
|
amounts negotiated in settlement agreements or by other means; |
914
|
the amount of final agency determinations of overpayments; the |
915
|
amount deducted from federal claiming as a result of |
916
|
overpayments; the amount of overpayments recovered each year; |
917
|
the amount of cost of investigation recovered each year; the |
918
|
average length of time to collect from the time the case was |
919
|
opened until the overpayment is paid in full; the amount |
920
|
determined as uncollectible and the portion of the uncollectible |
921
|
amount subsequently reclaimed from the Federal Government; the |
922
|
number of providers, by type, that are terminated from |
923
|
participation in the Medicaid program as a result of fraud and |
924
|
abuse; and all costs associated with discovering and prosecuting |
925
|
cases of Medicaid overpayments and making recoveries in such |
926
|
cases. The report must also document actions taken to prevent |
927
|
overpayments and the number of providers prevented from |
928
|
enrolling in or reenrolling in the Medicaid program as a result |
929
|
of documented Medicaid fraud and abuse and must recommend |
930
|
changes necessary to prevent or recover overpayments. For the |
931
|
2001-2002 fiscal year, the agency shall prepare a report that |
932
|
contains as much of this information as is available to it. |
933
|
(8) A Medicaid provider shall retain medical, |
934
|
professional, financial, and business records pertaining to |
935
|
services and goods furnished to a Medicaid recipient and billed |
936
|
to Medicaid for a period of 5 years after the date of furnishing |
937
|
such services or goods. The agency and its duly authorized |
938
|
agentsmay investigate, review, or analyze such records, which |
939
|
must be made available during normal business hours. However, |
940
|
24-hour notice must be provided if patient treatment would be |
941
|
disrupted. The provider is responsible for furnishing to the |
942
|
agency and its duly authorized agents, and keeping the agency |
943
|
and its duly authorized agentsinformed of the location of, the |
944
|
provider's Medicaid-related records. The authority of the agency |
945
|
and its duly authorized agentsto obtain Medicaid-related |
946
|
records from a provider is neither curtailed nor limited during |
947
|
a period of litigation between the agency and the provider. |
948
|
(28) Notwithstanding other provisions of law, the agency |
949
|
and its duly authorized agentsand the Medicaid Fraud Control |
950
|
Unit of the Department of Legal Affairs may review a provider's |
951
|
Medicaid-related records in order to determine the total output |
952
|
of a provider's practice to reconcile quantities of goods or |
953
|
services billed to Medicaid against quantities of goods or |
954
|
services used in the provider's total practice. |
955
|
Section 15. Subsections (7), (8), and (9) are added to |
956
|
section 430.502, Florida Statutes, to read: |
957
|
430.502 Alzheimer's disease; memory disorder clinics and |
958
|
day care and respite care programs.-- |
959
|
(7) The Agency for Health Care Administration and the |
960
|
department shall seek a federal waiver to implement a Medicaid |
961
|
home and community-based waiver targeted to persons with |
962
|
Alzheimer's disease to test the effectiveness of Alzheimer's |
963
|
specific interventions to delay or to avoid institutional |
964
|
placement.
|
965
|
(8) The department shall implement the waiver program |
966
|
specified in subsection (7). The agency and the department shall |
967
|
ensure that providers are selected that have a history of |
968
|
successfully serving persons with Alzheimer's disease. The |
969
|
department and the agency shall develop specialized standards |
970
|
for providers and services tailored to persons in the early, |
971
|
middle, and late stages of Alzheimer's disease and designate a |
972
|
level of care determination process and standard that is most |
973
|
appropriate to this population. The department and the agency |
974
|
shall include in the waiver services designed to assist the |
975
|
caregiver in continuing to provide in-home care. The department |
976
|
shall implement this waiver program subject to a specific |
977
|
appropriation or as provided in the General Appropriations Act. |
978
|
The department and the agency shall submit their program design |
979
|
to the President of the Senate and the Speaker of the House of |
980
|
Representatives for consultation during the development process.
|
981
|
(9) Authority to continue the waiver program specified in |
982
|
subsection (7) shall be automatically eliminated at the close of |
983
|
the 2008 Regular Session of the Legislature unless further |
984
|
legislative action is taken to continue it prior to such time.
|
985
|
Section 16. Paragraph (b) of subsection (4) and paragraph |
986
|
(a) of subsection (5) of section 624.91, Florida Statutes, are |
987
|
amended to read: |
988
|
624.91 The Florida Healthy Kids Corporation Act.-- |
989
|
(4) CORPORATION AUTHORIZATION, DUTIES, POWERS.-- |
990
|
(b) The Florida Healthy Kids Corporation shall: |
991
|
1. Organize school children groups to facilitate the |
992
|
provision of comprehensive health insurance coverage to |
993
|
children.; |
994
|
2. Arrange for the collection of any family, local |
995
|
contributions, or employer payment or premium, in an amount to |
996
|
be determined by the board of directors, to provide for payment |
997
|
of premiums for comprehensive insurance coverage and for the |
998
|
actual or estimated administrative expenses.; |
999
|
3. Arrange for the collection of any voluntary |
1000
|
contributions to provide for payment of premiums for children |
1001
|
who are not eligible for medical assistance under Title XXI of |
1002
|
the Social Security Act. Each fiscal year, the corporation shall |
1003
|
establish a local match policy for the enrollment of non-Title- |
1004
|
XXI-eligible children in the Healthy Kids program. By May 1 of |
1005
|
each year, the corporation shall provide written notification of |
1006
|
the amount to be remitted to the corporation for the following |
1007
|
fiscal year under that policy. Local match sources may include, |
1008
|
but are not limited to, funds provided by municipalities, |
1009
|
counties, school boards, hospitals, health care providers, |
1010
|
charitable organizations, special taxing districts, and private |
1011
|
organizations. The minimum local match cash contributions |
1012
|
required each fiscal year and local match credits shall be |
1013
|
determined by the General Appropriations Act. The corporation |
1014
|
shall calculate a county's local match rate based upon that |
1015
|
county's percentage of the state's total non-Title-XXI |
1016
|
expenditures as reported in the corporation's most recently |
1017
|
audited financial statement. In awarding the local match |
1018
|
credits, the corporation may consider factors including, but not |
1019
|
limited to, population density, per capita income, and existing |
1020
|
child-health-related expenditures and services.; |
1021
|
4. Accept voluntary supplemental local match contributions |
1022
|
that comply with the requirements of Title XXI of the Social |
1023
|
Security Act for the purpose of providing additional coverage in |
1024
|
contributing counties under Title XXI.; |
1025
|
5. Establish the administrative and accounting procedures |
1026
|
for the operation of the corporation.; |
1027
|
6. Establish, with consultation from appropriate |
1028
|
professional organizations, standards for preventive health |
1029
|
services and providers and comprehensive insurance benefits |
1030
|
appropriate to children; provided that such standards for rural |
1031
|
areas shall not limit primary care providers to board-certified |
1032
|
pediatricians.; |
1033
|
7. Establish eligibility criteria which children must meet |
1034
|
in order to participate in the program.; |
1035
|
8. Establish procedures under which providers of local |
1036
|
match to, applicants to and participants in the program may have |
1037
|
grievances reviewed by an impartial body and reported to the |
1038
|
board of directors of the corporation.; |
1039
|
9. Establish participation criteria and, if appropriate, |
1040
|
contract with an authorized insurer, health maintenance |
1041
|
organization, or insurance administrator to provide |
1042
|
administrative services to the corporation.; |
1043
|
10. Establish enrollment criteria which shall include |
1044
|
penalties or waiting periods of not fewer than 60 days for |
1045
|
reinstatement of coverage upon voluntary cancellation for |
1046
|
nonpayment of family premiums.; |
1047
|
11. If a space is available, establish a special open |
1048
|
enrollment period of 30 days' duration for any child who is |
1049
|
enrolled in Medicaid or Medikids if such child loses Medicaid or |
1050
|
Medikids eligibility and becomes eligible for the Florida |
1051
|
Healthy Kids program.; |
1052
|
12. Contract with authorized insurers or any provider of |
1053
|
health care services, meeting standards established by the |
1054
|
corporation, for the provision of comprehensive insurance |
1055
|
coverage to participants. |
1056
|
a.Such standards shall include criteria under which the |
1057
|
corporation may contract with more than one provider of health |
1058
|
care services in program sites. Health plans shall be selected |
1059
|
through a competitive bid process that utilizes as the maximum |
1060
|
payable rate the current Medicaid reimbursement being paid by |
1061
|
the Agency for Health Care Administration to its managed care |
1062
|
plans for the same age population, risk-adjusted for the Healthy |
1063
|
Kids population and adjusted for enrollee demographics, services |
1064
|
covered by the proposed rate, utilization, and inflation. |
1065
|
Healthy Kids shall neither enter a contract nor renew a contract |
1066
|
that has administrative costs greater than 15 percent. |
1067
|
b. Enrollees shall be enrolled with the selected health |
1068
|
plan or plans in their county. If no qualified bidder submits a |
1069
|
proposal utilizing the rate, then enrollees in the Healthy Kids |
1070
|
program may receive services through the Medikids program. If |
1071
|
the corporation delivers services through the Medikids option, |
1072
|
the corporation shall establish an appropriate level of reserves |
1073
|
in which to pay claims. The amount of the reserves shall be |
1074
|
appropriate for the number of enrollees accessing services |
1075
|
through this option and will be actuarially reviewed for |
1076
|
soundness and approved by the Department of Financial Services. |
1077
|
c. Implementation of the process described in sub- |
1078
|
subparagraphs a. and b. shall begin on July 1, 2003, or at |
1079
|
renewal of each insurer's current contract, but shall be |
1080
|
completed statewide no later than September 30, 2004. The term |
1081
|
"renewal" includes contract options and option years. |
1082
|
d. Dental services shall be provided to Healthy Kids |
1083
|
enrollees using the administrative structure and provider |
1084
|
network of the Medicaid programThe selection of health plans |
1085
|
shall be based primarily on quality criteria established by the |
1086
|
board. |
1087
|
|
1088
|
The health plan selection criteria and scoring system, and the |
1089
|
scoring results, shall be available upon request for inspection |
1090
|
after the bids have been awarded.;
|
1091
|
13. Establish disenrollment criteria in the event local |
1092
|
matching funds are insufficient to cover enrollments.; |
1093
|
14. Develop and implement a plan to publicize the Florida |
1094
|
Healthy Kids Corporation, the eligibility requirements of the |
1095
|
program, and the procedures for enrollment in the program and to |
1096
|
maintain public awareness of the corporation and the program.; |
1097
|
15. Secure staff necessary to properly administer the |
1098
|
corporation. Staff costs shall be funded from state and local |
1099
|
matching funds and such other private or public funds as become |
1100
|
available. The board of directors shall determine the number of |
1101
|
staff members necessary to administer the corporation.; |
1102
|
16. As appropriate, enter into contracts with local school |
1103
|
boards or other agencies to provide onsite information, |
1104
|
enrollment, and other services necessary to the operation of the |
1105
|
corporation.; |
1106
|
17. Provide a report annually to the Governor, Chief |
1107
|
Financial Officer, Commissioner of Education, Senate President, |
1108
|
Speaker of the House of Representatives, and Minority Leaders of |
1109
|
the Senate and the House of Representatives.; |
1110
|
18. Each fiscal year, establish a maximum number of |
1111
|
participants, on a statewide basis, who may enroll in the |
1112
|
program.; and
|
1113
|
19. Establish eligibility criteria, premium and cost- |
1114
|
sharing requirements, and benefit packages which conform to the |
1115
|
provisions of the Florida Kidcare program, as created in ss. |
1116
|
409.810-409.820. |
1117
|
(5) BOARD OF DIRECTORS.-- |
1118
|
(a) The Florida Healthy Kids Corporation shall operate |
1119
|
subject to the supervision and approval of a board of directors |
1120
|
chaired by the Chief Financial Officer or her or his designee, |
1121
|
and composed of 614other members selected for 3-year terms of |
1122
|
office as follows: |
1123
|
1. One member, appointed by the Chief Financial Officer, |
1124
|
who represents the Office of Insurance Regulation.Commissioner |
1125
|
of Education from among three persons nominated by the Florida |
1126
|
Association of School Administrators;
|
1127
|
2. One member appointed by the Commissioner of Education |
1128
|
from among three persons nominated by the Florida Association of |
1129
|
School Boards;
|
1130
|
3. One member appointed by the Commissioner of Education |
1131
|
from the Office of School Health Programs of the Florida |
1132
|
Department of Education;
|
1133
|
4. One member appointed by the Governor from among three |
1134
|
members nominated by the Florida Pediatric Society;
|
1135
|
2.5.One member, appointed by the Governor, who represents |
1136
|
the Children's Medical Services Program and the Department of |
1137
|
Health.; |
1138
|
6. One member appointed by the Chief Financial Officer |
1139
|
from among three members nominated by the Florida Hospital |
1140
|
Association;
|
1141
|
7. Two members, appointed by the Chief Financial Officer, |
1142
|
who are representatives of authorized health care insurers or |
1143
|
health maintenance organizations;
|
1144
|
3.8.One member, appointed by the Chief Financial Officer, |
1145
|
who represents the Institute for Child Health Policy.; |
1146
|
9. One member, appointed by the Governor, from among three |
1147
|
members nominated by the Florida Academy of Family Physicians;
|
1148
|
4.10.One member, appointed by the Governor, who |
1149
|
represents the Agency for Health Care Administration.; |
1150
|
5.11.One member, appointed by the Chief Financial |
1151
|
Officer, from among three members nominated by the Florida |
1152
|
Association of Counties, representing rural counties.;
|
1153
|
6.12.One member, appointed by the Governor, from among |
1154
|
three members nominated by the Florida Association of Counties, |
1155
|
representing urban counties.; and |
1156
|
13. The State Health Officer or her or his designee.
|
1157
|
Section 17. The provisions of this act which would require |
1158
|
changes to the contracts in existence on June 30, 2003, between |
1159
|
the Florida Healthy Kids Corporation and its contracted |
1160
|
providers shall be applied to such contracts upon the renewal of |
1161
|
the contracts, but no later than September 30, 2004. The term |
1162
|
"renewal" includes contract options and option years. |
1163
|
Section 18. Section 57 of chapter 98-288, Laws of Florida, |
1164
|
is repealed. |
1165
|
Section 19. If any law amended by this act was also |
1166
|
amended by a law enacted at the 2003 Regular Session of the |
1167
|
Legislature, such laws shall be construed as if they had been |
1168
|
enacted at the same session of the Legislature, and full effect |
1169
|
shall be given to each if possible. |
1170
|
Section 20. Except as otherwise provided herein, this act |
1171
|
shall take effect July 1, 2003. |
1172
|
|
1173
|
================= T I T L E A M E N D M E N T ================= |
1174
|
Remove the entire title, and insert: |
1175
|
A bill to be entitled |
1176
|
An act relating to health care; amending s. 400.179, F.S.; |
1177
|
retaining a fee against leasehold licensees to meet |
1178
|
bonding requirements to cover Medicaid underpayments and |
1179
|
overpayments; amending s. 409.811, F.S.; defining "managed |
1180
|
care plan" for purposes of the Florida Kidcare Act; |
1181
|
amending s. 409.8132, F.S.; providing a cross reference; |
1182
|
amending s. 409.901, F.S.; revising the definition of |
1183
|
"third party"; amending s. 409.904, F.S.; revising |
1184
|
eligibility requirements for certain optional payments for |
1185
|
medical assistance and related services; amending s. |
1186
|
409.906, F.S.; revising requirements for payment of |
1187
|
optional Medicaid services; limiting provision of dental, |
1188
|
hearing, and visual services; amending s. 409.9081, F.S.; |
1189
|
providing coinsurance requirements for prescription drugs; |
1190
|
providing copayment requirements for hospital outpatient |
1191
|
emergency department services; amending s. 409.911, F.S.; |
1192
|
revising formulas for payment under the disproportionate |
1193
|
share program; revising definitions; providing for use of |
1194
|
audited data; amending s. 409.9112, F.S.; revising |
1195
|
formulas for payment under the disproportionate share |
1196
|
program for regional perinatal intensive care centers; |
1197
|
amending s. 409.9117, F.S.; revising formulas for payment |
1198
|
under the primary care disproportionate share program; |
1199
|
revising criteria for such payments; amending s. 409.9119, |
1200
|
F.S.; revising criteria for payment under the |
1201
|
disproportionate share program for specialty hospitals for |
1202
|
children; amending s. 409.912, F.S.; providing for the |
1203
|
Agency for Health Care Administration to contract with a |
1204
|
service network; deleting provisions for service network |
1205
|
demonstration projects; providing for contracting to |
1206
|
provide Medicaid covered dental services; amending s. |
1207
|
409.9122, F.S.; revising provisions for assignment to a |
1208
|
managed care plan by the agency; amending s. 409.913, |
1209
|
F.S.; providing for oversight of Medicaid by authorized |
1210
|
agents of the Agency for Health Care Administration; |
1211
|
amending s. 430.502, F.S.; requiring the Agency for Health |
1212
|
Care Administration and the Department of Elderly Affairs |
1213
|
to seek and implement a Medicaid home and community-based |
1214
|
waiver for persons with Alzheimer's disease; requiring the |
1215
|
development of waiver program standards; providing for |
1216
|
consultation with the presiding officers of the |
1217
|
Legislature; providing for a contingent future repeal of |
1218
|
such waiver program; amending s. 624.91, F.S.; revising |
1219
|
duties of the Florida Healthy Kids Corporation; revising |
1220
|
membership of the board of directors of the corporation; |
1221
|
providing for application of the act to existing contracts |
1222
|
between the Florida Healthy Kids Corporation and its |
1223
|
contracted providers; repealing s. 57, ch. 98-288, Laws of |
1224
|
Florida, relating to future review and repeal of the |
1225
|
"Florida Kidcare Act" based on specified changes in |
1226
|
federal policy; providing for construction of the act in |
1227
|
pari materia with laws enacted during the Regular Session |
1228
|
of the Legislature; providing effective dates. |