CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
CHAMBER ACTION
Senate House
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11 The Conference Committee on SB 22-A, 1st Eng. recommended the
12 following amendment:
13
14 Conference Committee Amendment (with title amendment)
15 Delete everything after the enacting clause
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17 and insert:
18 Section 1. Effective upon this act becoming a law,
19 paragraph (d) of subsection (5) of section 400.179, Florida
20 Statutes, is amended to read:
21 400.179 Sale or transfer of ownership of a nursing
22 facility; liability for Medicaid underpayments and
23 overpayments.--
24 (5) Because any transfer of a nursing facility may
25 expose the fact that Medicaid may have underpaid or overpaid
26 the transferor, and because in most instances, any such
27 underpayment or overpayment can only be determined following a
28 formal field audit, the liabilities for any such underpayments
29 or overpayments shall be as follows:
30 (d) Where the transfer involves a facility that has
31 been leased by the transferor:
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 1. The transferee shall, as a condition to being
2 issued a license by the agency, acquire, maintain, and provide
3 proof to the agency of a bond with a term of 30 months,
4 renewable annually, in an amount not less than the total of 3
5 months Medicaid payments to the facility computed on the basis
6 of the preceding 12-month average Medicaid payments to the
7 facility.
8 2. A leasehold licensee may meet the requirements of
9 subparagraph 1. by payment of a nonrefundable fee, paid at
10 initial licensure, paid at the time of any subsequent change
11 of ownership, and paid at the time of any subsequent annual
12 license renewal, in the amount of 2 percent of the total of 3
13 months' Medicaid payments to the facility computed on the
14 basis of the preceding 12-month average Medicaid payments to
15 the facility. If a preceding 12-month average is not
16 available, projected Medicaid payments may be used. The fee
17 shall be deposited into the Health Care Trust Fund and shall
18 be accounted for separately as a Medicaid nursing home
19 overpayment account. These fees shall be used at the sole
20 discretion of the agency to repay nursing home Medicaid
21 overpayments. Payment of this fee shall not release the
22 licensee from any liability for any Medicaid overpayments, nor
23 shall payment bar the agency from seeking to recoup
24 overpayments from the licensee and any other liable party. As
25 a condition of exercising this lease bond alternative,
26 licensees paying this fee must maintain an existing lease bond
27 through the end of the 30-month term period of that bond. The
28 agency is herein granted specific authority to promulgate all
29 rules pertaining to the administration and management of this
30 account, including withdrawals from the account, subject to
31 federal review and approval. This subparagraph is repealed on
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 June 30, 2003. This provision shall take effect upon becoming
2 law and shall apply to any leasehold license application.
3 a. The financial viability of the Medicaid nursing
4 home overpayment account shall be determined by the agency
5 through annual review of the account balance and the amount of
6 total outstanding, unpaid Medicaid overpayments owing from
7 leasehold licensees to the agency as determined by final
8 agency audits.
9 b. The agency, in consultation with the Florida Health
10 Care Association and the Florida Association of Homes for the
11 Aging, shall study and make recommendations on the minimum
12 amount to be held in reserve to protect against Medicaid
13 overpayments to leasehold licensees and on the issue of
14 successor liability for Medicaid overpayments upon sale or
15 transfer of ownership of a nursing facility. The agency shall
16 submit the findings and recommendations of the study to the
17 Governor, the President of the Senate, and the Speaker of the
18 House of Representatives by January 1, 2003.
19 3. The leasehold licensee may meet the bond
20 requirement through other arrangements acceptable to the
21 agency. The agency is herein granted specific authority to
22 promulgate rules pertaining to lease bond arrangements.
23 4. All existing nursing facility licensees, operating
24 the facility as a leasehold, shall acquire, maintain, and
25 provide proof to the agency of the 30-month bond required in
26 subparagraph 1., above, on and after July 1, 1993, for each
27 license renewal.
28 5. It shall be the responsibility of all nursing
29 facility operators, operating the facility as a leasehold, to
30 renew the 30-month bond and to provide proof of such renewal
31 to the agency annually at the time of application for license
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 renewal.
2 6. Any failure of the nursing facility operator to
3 acquire, maintain, renew annually, or provide proof to the
4 agency shall be grounds for the agency to deny, cancel,
5 revoke, or suspend the facility license to operate such
6 facility and to take any further action, including, but not
7 limited to, enjoining the facility, asserting a moratorium, or
8 applying for a receiver, deemed necessary to ensure compliance
9 with this section and to safeguard and protect the health,
10 safety, and welfare of the facility's residents. A lease
11 agreement required as a condition of bond financing or
12 refinancing under s. 154.213 by a health facilities authority
13 or required under s. 159.30 by a county or municipality is not
14 a leasehold for purposes of this paragraph and is not subject
15 to the bond requirement of this paragraph.
16 Section 2. Paragraph (a) of subsection (3) of section
17 400.23, Florida Statutes, as amended by chapter 2003-1, Laws
18 of Florida, is amended to read:
19 400.23 Rules; evaluation and deficiencies; licensure
20 status.--
21 (3)(a) The agency shall adopt rules providing for the
22 minimum staffing requirements for nursing homes. These
23 requirements shall include, for each nursing home facility, a
24 minimum certified nursing assistant staffing of 2.3 hours of
25 direct care per resident per day beginning January 1, 2002,
26 increasing to 2.6 hours of direct care per resident per day
27 beginning January 1, 2003, and increasing to 2.9 hours of
28 direct care per resident per day beginning May January 1,
29 2004. Beginning January 1, 2002, no facility shall staff below
30 one certified nursing assistant per 20 residents, and a
31 minimum licensed nursing staffing of 1.0 hour of direct
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 resident care per resident per day but never below one
2 licensed nurse per 40 residents. Nursing assistants employed
3 under s. 400.211(2) may be included in computing the staffing
4 ratio for certified nursing assistants only if they provide
5 nursing assistance services to residents on a full-time basis.
6 Each nursing home must document compliance with staffing
7 standards as required under this paragraph and post daily the
8 names of staff on duty for the benefit of facility residents
9 and the public. The agency shall recognize the use of licensed
10 nurses for compliance with minimum staffing requirements for
11 certified nursing assistants, provided that the facility
12 otherwise meets the minimum staffing requirements for licensed
13 nurses and that the licensed nurses so recognized are
14 performing the duties of a certified nursing assistant. Unless
15 otherwise approved by the agency, licensed nurses counted
16 towards the minimum staffing requirements for certified
17 nursing assistants must exclusively perform the duties of a
18 certified nursing assistant for the entire shift and shall not
19 also be counted towards the minimum staffing requirements for
20 licensed nurses. If the agency approved a facility's request
21 to use a licensed nurse to perform both licensed nursing and
22 certified nursing assistant duties, the facility must allocate
23 the amount of staff time specifically spent on certified
24 nursing assistant duties for the purpose of documenting
25 compliance with minimum staffing requirements for certified
26 and licensed nursing staff. In no event may the hours of a
27 licensed nurse with dual job responsibilities be counted
28 twice.
29 Section 3. Section 400.452, Florida Statutes, is
30 amended to read:
31 400.452 Staff training and educational programs; core
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 educational requirement.--
2 (1) The department shall provide, or cause to be
3 provided, training and educational programs for the
4 Administrators and other assisted living facility staff must
5 meet minimum training and education requirements established
6 by the Department of Elderly Affairs by rule. This training
7 and education is intended to assist facilities to better
8 enable them to appropriately respond to the needs of
9 residents, to maintain resident care and facility standards,
10 and to meet licensure requirements.
11 (2) The department shall also establish a competency
12 test and a minimum required score to indicate successful
13 completion of the training and core educational requirements
14 requirement to be used in these programs. The competency test
15 must be developed by the department in conjunction with the
16 agency and providers. Successful completion of the core
17 educational requirement must include successful completion of
18 a competency test. Programs must be provided by the department
19 or by a provider approved by the department at least
20 quarterly. The required training and education core
21 educational requirement must cover at least the following
22 topics:
23 (a) State law and rules relating to assisted living
24 facilities.
25 (b) Resident rights and identifying and reporting
26 abuse, neglect, and exploitation.
27 (c) Special needs of elderly persons, persons with
28 mental illness, and persons with developmental disabilities
29 and how to meet those needs.
30 (d) Nutrition and food service, including acceptable
31 sanitation practices for preparing, storing, and serving food.
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 (e) Medication management, recordkeeping, and proper
2 techniques for assisting residents with self-administered
3 medication.
4 (f) Firesafety requirements, including fire evacuation
5 drill procedures and other emergency procedures.
6 (g) Care of persons with Alzheimer's disease and
7 related disorders.
8 (3) Effective January 1, 2004, Such a program must be
9 available at least quarterly in each planning and service area
10 of the department. The competency test must be developed by
11 the department in conjunction with the agency and providers. a
12 new facility administrator must complete the required training
13 and education, core educational requirement including the
14 competency test, within a reasonable time 3 months after being
15 employed as an administrator, as determined by the department.
16 Failure to do so complete a core educational requirement
17 specified in this subsection is a violation of this part and
18 subjects the violator to an administrative fine as prescribed
19 in s. 400.419. Administrators licensed in accordance with
20 chapter 468, part II, are exempt from this requirement. Other
21 licensed professionals may be exempted, as determined by the
22 department by rule.
23 (4) Administrators are required to participate in
24 continuing education for a minimum of 12 contact hours every 2
25 years.
26 (5) Staff involved with the management of medications
27 and assisting with the self-administration of medications
28 under s. 400.4256 must complete a minimum of 4 additional
29 hours of training pursuant to a curriculum developed by the
30 department and provided by a registered nurse, licensed
31 pharmacist, or department staff. The department shall
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 establish by rule the minimum requirements of this additional
2 training.
3 (6) Other facility staff shall participate in training
4 relevant to their job duties as specified by rule of the
5 department.
6 (7) A facility that does not have any residents who
7 receive monthly optional supplementation payments must pay a
8 reasonable fee for such training and education programs. A
9 facility that has one or more such residents shall pay a
10 reduced fee that is proportional to the percentage of such
11 residents in the facility. Any facility more than 90 percent
12 of whose residents receive monthly optional state
13 supplementation payments is not required to pay for the
14 training and continuing education programs required under this
15 section.
16 (7)(8) If the department or the agency determines that
17 there are problems in a facility that could be reduced through
18 specific staff training or education beyond that already
19 required under this section, the department or the agency may
20 require, and provide, or cause to be provided, the training or
21 education of any personal care staff in the facility.
22 (8)(9) The department shall adopt rules related to
23 these establish training programs, standards and curriculum
24 for training, staff training requirements, the competency
25 test, necessary procedures for approving training programs,
26 and competency test training fees.
27 Section 4. Section 400.6211, Florida Statutes, is
28 amended to read:
29 400.6211 Training and education programs.--
30 (1) Each adult family-care home provider shall
31 complete The department must provide training and education
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 programs for all adult family-care home providers.
2 (2) Training and education programs must include
3 information relating to:
4 (a) State law and rules governing adult family-care
5 homes, with emphasis on appropriateness of placement of
6 residents in an adult family-care home.
7 (b) Identifying and reporting abuse, neglect, and
8 exploitation.
9 (c) Identifying and meeting the special needs of
10 disabled adults and frail elders.
11 (d) Monitoring the health of residents, including
12 guidelines for prevention and care of pressure ulcers.
13 (3) Effective January 1, 2004, providers must complete
14 the training and education program within a reasonable time
15 determined by the department. Failure to complete the training
16 and education program within the time set by the department is
17 a violation of this part and subjects the provider to
18 revocation of the license.
19 (4) If the Department of Children and Family Services,
20 the agency, or the department determines that there are
21 problems in an adult family-care home which could be reduced
22 through specific training or education beyond that required
23 under this section, the agency may require the provider or
24 staff to complete such training or education.
25 (5) The department may adopt rules shall specify by
26 rule training and education programs, training requirements
27 and the assignment of training responsibilities for staff,
28 training procedures, and training fees as necessary to
29 administer this section.
30 Section 5. Paragraph (e) of subsection (2) and
31 subsection (10) of section 408.909, Florida Statutes, are
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 amended to read:
2 408.909 Health flex plans.--
3 (2) DEFINITIONS.--As used in this section, the term:
4 (e) "Health flex plan" means a health plan approved
5 under subsection (3) which guarantees payment for specified
6 health care coverage provided to the enrollee who purchases
7 coverage directly from the plan or through a small business
8 purchasing arrangement sponsored by a local government.
9 (10) EXPIRATION.--This section expires July 1, 2008
10 2004.
11 Section 6. Paragraph (q) of subsection (2) of section
12 409.815, Florida Statutes, as amended by chapter 2003-1, Laws
13 of Florida, is amended to read:
14 409.815 Health benefits coverage; limitations.--
15 (2) BENCHMARK BENEFITS.--In order for health benefits
16 coverage to qualify for premium assistance payments for an
17 eligible child under ss. 409.810-409.820, the health benefits
18 coverage, except for coverage under Medicaid and Medikids,
19 must include the following minimum benefits, as medically
20 necessary.
21 (q) Dental services.--Subject to a specific
22 appropriation for this benefit, Covered services include those
23 dental services provided to children by the Florida Medicaid
24 program under s. 409.906(5), up to a maximum benefit of $750
25 per enrollee per year.
26 Section 7. Subsection (25) of section 409.901, Florida
27 Statutes, is amended to read:
28 409.901 Definitions; ss. 409.901-409.920.--As used in
29 ss. 409.901-409.920, except as otherwise specifically
30 provided, the term:
31 (25) "Third party" means an individual, entity, or
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 program, excluding Medicaid, that is, may be, could be, should
2 be, or has been liable for all or part of the cost of medical
3 services related to any medical assistance covered by
4 Medicaid. A third party includes a third-party administrator
5 or a pharmacy benefits manager.
6 Section 8. Subsection (2) of section 409.904, Florida
7 Statutes, as amended by section 1 of chapter 2003-9, Laws of
8 Florida, is amended to read:
9 409.904 Optional payments for eligible persons.--The
10 agency may make payments for medical assistance and related
11 services on behalf of the following persons who are determined
12 to be eligible subject to the income, assets, and categorical
13 eligibility tests set forth in federal and state law. Payment
14 on behalf of these Medicaid eligible persons is subject to the
15 availability of moneys and any limitations established by the
16 General Appropriations Act or chapter 216.
17 (2) A family caretaker relative or parent, a pregnant
18 woman, a child under age 21 19 who would otherwise qualify for
19 Florida Kidcare Medicaid, a child up to age 21 who would
20 otherwise qualify under s. 409.903(1), a person age 65 or
21 over, or a blind or disabled person, who would otherwise be
22 eligible under any group listed in s. 409.903(1), (2), or (3)
23 for Florida Medicaid, except that the income or assets of such
24 family or person exceed established limitations. For a family
25 or person in one of these coverage groups, medical expenses
26 are deductible from income in accordance with federal
27 requirements in order to make a determination of eligibility.
28 Expenses used to meet spend-down liability are not
29 reimbursable by Medicaid. Effective July 1, 2003, when
30 determining the eligibility of a pregnant woman, a child, or
31 an aged, blind, or disabled individual, $270 shall be deducted
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 from the countable income of the filing unit. When determining
2 the eligibility of the parent or caretaker relative as defined
3 by Title XIX of the Social Security Act, the additional income
4 disregard of $270 does not apply. A family or person eligible
5 under the coverage known as the "medically needy," is eligible
6 to receive the same services as other Medicaid recipients,
7 with the exception of services in skilled nursing facilities
8 and intermediate care facilities for the developmentally
9 disabled.
10 Section 9. Subsections (12) and (23) of section
11 409.906, Florida Statutes, are amended to read:
12 409.906 Optional Medicaid services.--Subject to
13 specific appropriations, the agency may make payments for
14 services which are optional to the state under Title XIX of
15 the Social Security Act and are furnished by Medicaid
16 providers to recipients who are determined to be eligible on
17 the dates on which the services were provided. Any optional
18 service that is provided shall be provided only when medically
19 necessary and in accordance with state and federal law.
20 Optional services rendered by providers in mobile units to
21 Medicaid recipients may be restricted or prohibited by the
22 agency. Nothing in this section shall be construed to prevent
23 or limit the agency from adjusting fees, reimbursement rates,
24 lengths of stay, number of visits, or number of services, or
25 making any other adjustments necessary to comply with the
26 availability of moneys and any limitations or directions
27 provided for in the General Appropriations Act or chapter 216.
28 If necessary to safeguard the state's systems of providing
29 services to elderly and disabled persons and subject to the
30 notice and review provisions of s. 216.177, the Governor may
31 direct the Agency for Health Care Administration to amend the
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 Medicaid state plan to delete the optional Medicaid service
2 known as "Intermediate Care Facilities for the Developmentally
3 Disabled." Optional services may include:
4 (12) CHILDREN'S HEARING SERVICES.--The agency may pay
5 for hearing and related services, including hearing
6 evaluations, hearing aid devices, dispensing of the hearing
7 aid, and related repairs, if provided to a recipient younger
8 than 21 years of age by a licensed hearing aid specialist,
9 otolaryngologist, otologist, audiologist, or physician.
10 (23) CHILDREN'S VISUAL SERVICES.--The agency may pay
11 for visual examinations, eyeglasses, and eyeglass repairs for
12 a recipient younger than 21 years of age, if they are
13 prescribed by a licensed physician specializing in diseases of
14 the eye or by a licensed optometrist.
15 Section 10. Section 409.9065, Florida Statutes, is
16 amended to read:
17 409.9065 Pharmaceutical expense assistance.--
18 (1) PROGRAM ESTABLISHED.--There is established a
19 program to provide pharmaceutical expense assistance to
20 eligible certain low-income elderly individuals, which shall
21 be known as the "Ron Silver Senior Drug Program" and may be
22 referred to as the "Lifesaver Rx Program."
23 (2) ELIGIBILITY.--Eligibility for the program is
24 limited to those individuals who qualify for limited
25 assistance under the Florida Medicaid program as a result of
26 being dually eligible for both Medicare and Medicaid, but
27 whose limited assistance or Medicare coverage does not include
28 any pharmacy benefit. To the extent funds are appropriated,
29 specifically eligible individuals are individuals who:
30 (a) Are Florida residents age 65 and over;
31 (b) Have an income equal to or less than 200 percent
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Bill No. SB 22-A, 1st Eng.
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1 of the federal poverty level;:
2 1. Between 88 and 120 percent of the federal poverty
3 level;
4 2. Between 88 and 150 percent of the federal poverty
5 level if the Federal Government increases the federal Medicaid
6 match for persons between 100 and 150 percent of the federal
7 poverty level; or
8 3. Between 88 percent of the federal poverty level and
9 a level that can be supported with funds provided in the
10 General Appropriations Act for the program offered under this
11 section along with federal matching funds approved by the
12 Federal Government under a s. 1115 waiver. The agency is
13 authorized to submit and implement a federal waiver pursuant
14 to this subparagraph. The agency shall design a pharmacy
15 benefit that includes annual per-member benefit limits and
16 cost-sharing provisions and limits enrollment to available
17 appropriations and matching federal funds. Prior to
18 implementing this program, the agency must submit a budget
19 amendment pursuant to chapter 216;
20 (c) Are eligible for both Medicare and Medicaid;
21 (d) Have exhausted pharmacy benefits under Medicare,
22 Medicaid, or any other insurance plan Are not enrolled in a
23 Medicare health maintenance organization that provides a
24 pharmacy benefit; and
25 (e) Request to be enrolled in the program.
26 (3) BENEFITS.--Eligible individuals shall receive a
27 discount for prescription drugs Medications covered under the
28 pharmaceutical expense assistance program are those covered
29 under the Medicaid program in s. 409.906(20)(19). Monthly
30 benefit payments shall be limited to $80 per program
31 participant. Participants are required to make a 10-percent
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 coinsurance payment for each prescription purchased through
2 this program.
3 (a) Eligible individuals with incomes equal to or less
4 than 120 percent of the federal poverty level shall receive a
5 discount of 100 percent for the first $160 worth of
6 prescription drugs they receive each month, subject to
7 copayments that the agency requires on these benefits. For all
8 other prescription drugs received each month, eligible
9 individuals shall receive a discount of 50 percent.
10 (b) Eligible individuals with incomes of more than 120
11 percent but not more than 150 percent of the federal poverty
12 level shall receive a discount of 50 percent.
13 (c) Eligible individuals with incomes of more than 150
14 percent but not more than 175 percent of the federal poverty
15 level shall receive a discount of 41 percent.
16 (d) Eligible individuals with incomes of more than 175
17 percent but not more than 200 percent of the federal poverty
18 level shall receive a discount of 37 percent.
19 (4) ADMINISTRATION.--The pharmaceutical expense
20 assistance program shall be administered by the agency for
21 Health Care Administration, in collaboration consultation with
22 the Department of Elderly Affairs and the Department of
23 Children and Family Services.
24 (a) The Agency for Health Care Administration and the
25 Department of Elderly Affairs shall develop a single-page
26 application for the pharmaceutical expense assistance program.
27 (a)(b) The agency for Health Care Administration
28 shall, by rule, establish for the pharmaceutical expense
29 assistance program eligibility requirements;, limits on
30 participation;, benefit limitations, including copayments; a
31 requirement for generic drug substitution;, and other program
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Bill No. SB 22-A, 1st Eng.
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1 parameters comparable to those of the Medicaid program.
2 Individuals eligible to participate in this program are not
3 subject to the limit of four brand name drugs per month per
4 recipient as specified in s. 409.912(38)(a). There shall be no
5 monetary limit on prescription drugs purchased with discounts
6 of less than 51 percent unless the agency determines there is
7 a risk of a funding shortfall in the program. If the agency
8 determines there is a risk of a funding shortfall, the agency
9 may establish monetary limits on prescription drugs which
10 shall not be less than $160 worth of prescription drugs per
11 month.
12 (b)(c) By January 1 of each year, the agency for
13 Health Care Administration shall report to the Legislature on
14 the operation of the program. The report shall include
15 information on the number of individuals served, use rates,
16 and expenditures under the program. The report shall also
17 address the impact of the program on reducing unmet
18 pharmaceutical drug needs among the elderly and recommend
19 programmatic changes.
20 (5) NONENTITLEMENT.--The pharmaceutical expense
21 assistance program established by this section is not an
22 entitlement. Enrollment levels are limited to those authorized
23 by the Legislature in the annual General Appropriations Act.
24 If, after establishing monetary limits as required by
25 paragraph (4)(a), funds are insufficient to serve all eligible
26 individuals eligible under subsection (2) and seeking
27 coverage, the agency may develop a waiting list based on
28 application dates to use in enrolling individuals in unfilled
29 enrollment slots.
30 (6) PHARMACEUTICAL MANUFACTURER PARTICIPATION.--In
31 order for a drug product to be covered under Medicaid or this
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1 program, the product's manufacturer shall:
2 (a) Provide a rebate to the state equal to the rebate
3 required by the Medicaid program; and
4 (b) Make the drug product available to the program for
5 the best price that the manufacturer makes the drug product
6 available in the Medicaid program.
7 (7) REIMBURSEMENT.--Total reimbursements to pharmacies
8 participating in the pharmaceutical expense assistance program
9 established under this section shall be equivalent to
10 reimbursements under the Medicaid program.
11 (8) FEDERAL APPROVAL.--The benefits provided in this
12 section are limited to those approved by the Federal
13 Government pursuant to a Medicaid waiver or an amendment to
14 the state Medicaid plan.
15 Section 11. Subsection (14) of section 409.908,
16 Florida Statutes, is amended to read:
17 409.908 Reimbursement of Medicaid providers.--Subject
18 to specific appropriations, the agency shall reimburse
19 Medicaid providers, in accordance with state and federal law,
20 according to methodologies set forth in the rules of the
21 agency and in policy manuals and handbooks incorporated by
22 reference therein. These methodologies may include fee
23 schedules, reimbursement methods based on cost reporting,
24 negotiated fees, competitive bidding pursuant to s. 287.057,
25 and other mechanisms the agency considers efficient and
26 effective for purchasing services or goods on behalf of
27 recipients. If a provider is reimbursed based on cost
28 reporting and submits a cost report late and that cost report
29 would have been used to set a lower reimbursement rate for a
30 rate semester, then the provider's rate for that semester
31 shall be retroactively calculated using the new cost report,
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1 and full payment at the recalculated rate shall be affected
2 retroactively. Medicare-granted extensions for filing cost
3 reports, if applicable, shall also apply to Medicaid cost
4 reports. Payment for Medicaid compensable services made on
5 behalf of Medicaid eligible persons is subject to the
6 availability of moneys and any limitations or directions
7 provided for in the General Appropriations Act or chapter 216.
8 Further, nothing in this section shall be construed to prevent
9 or limit the agency from adjusting fees, reimbursement rates,
10 lengths of stay, number of visits, or number of services, or
11 making any other adjustments necessary to comply with the
12 availability of moneys and any limitations or directions
13 provided for in the General Appropriations Act, provided the
14 adjustment is consistent with legislative intent.
15 (14) A provider of prescribed drugs shall be
16 reimbursed the least of the amount billed by the provider, the
17 provider's usual and customary charge, or the Medicaid maximum
18 allowable fee established by the agency, plus a dispensing
19 fee. The agency is directed to implement a variable dispensing
20 fee for payments for prescribed medicines while ensuring
21 continued access for Medicaid recipients. The variable
22 dispensing fee may be based upon, but not limited to, either
23 or both the volume of prescriptions dispensed by a specific
24 pharmacy provider, the volume of prescriptions dispensed to an
25 individual recipient, and dispensing of preferred-drug-list
26 products. The agency may shall increase the pharmacy
27 dispensing fee authorized by statute and in the annual General
28 Appropriations Act by $0.50 for the dispensing of a Medicaid
29 preferred-drug-list product and reduce the pharmacy dispensing
30 fee by $0.50 for the dispensing of a Medicaid product that is
31 not included on the preferred-drug list. The agency may
18
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 establish a supplemental pharmaceutical dispensing fee to be
2 paid to providers returning unused unit-dose packaged
3 medications to stock and crediting the Medicaid program for
4 the ingredient cost of those medications if the ingredient
5 costs to be credited exceed the value of the supplemental
6 dispensing fee. The agency is authorized to limit
7 reimbursement for prescribed medicine in order to comply with
8 any limitations or directions provided for in the General
9 Appropriations Act, which may include implementing a
10 prospective or concurrent utilization review program.
11 Section 12. Subsection (1) of section 409.9081,
12 Florida Statutes, is amended to read:
13 409.9081 Copayments.--
14 (1) The agency shall require, subject to federal
15 regulations and limitations, each Medicaid recipient to pay at
16 the time of service a nominal copayment for the following
17 Medicaid services:
18 (a) Hospital outpatient services: up to $3 for each
19 hospital outpatient visit.
20 (b) Physician services: up to $2 copayment for each
21 visit with a physician licensed under chapter 458, chapter
22 459, chapter 460, chapter 461, or chapter 463.
23 (c) Hospital emergency department visits for
24 nonemergency care: $15 for each emergency department visit.
25 (d) Prescription drugs: a coinsurance equal to 2.5
26 percent of the Medicaid cost of the prescription drug at the
27 time of purchase. The maximum coinsurance shall be $7.50 per
28 prescription drug purchased.
29 Section 13. Section 409.911, Florida Statutes, is
30 amended to read:
31 409.911 Disproportionate share program.--Subject to
19
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 specific allocations established within the General
2 Appropriations Act and any limitations established pursuant to
3 chapter 216, the agency shall distribute, pursuant to this
4 section, moneys to hospitals providing a disproportionate
5 share of Medicaid or charity care services by making quarterly
6 Medicaid payments as required. Notwithstanding the provisions
7 of s. 409.915, counties are exempt from contributing toward
8 the cost of this special reimbursement for hospitals serving a
9 disproportionate share of low-income patients.
10 (1) Definitions.--As used in this section, s.
11 409.9112, and the Florida Hospital Uniform Reporting System
12 manual:
13 (a) "Adjusted patient days" means the sum of acute
14 care patient days and intensive care patient days as reported
15 to the Agency for Health Care Administration, divided by the
16 ratio of inpatient revenues generated from acute, intensive,
17 ambulatory, and ancillary patient services to gross revenues.
18 (b) "Actual audited data" or "actual audited
19 experience" means data reported to the Agency for Health Care
20 Administration which has been audited in accordance with
21 generally accepted auditing standards by the agency or
22 representatives under contract with the agency.
23 (c) "Base Medicaid per diem" means the hospital's
24 Medicaid per diem rate initially established by the Agency for
25 Health Care Administration on January 1, 1999. The base
26 Medicaid per diem rate shall not include any additional per
27 diem increases received as a result of the disproportionate
28 share distribution.
29 (c)(d) "Charity care" or "uncompensated charity care"
30 means that portion of hospital charges reported to the Agency
31 for Health Care Administration for which there is no
20
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 compensation, other than restricted or unrestricted revenues
2 provided to a hospital by local governments or tax districts
3 regardless of the method of payment, for care provided to a
4 patient whose family income for the 12 months preceding the
5 determination is less than or equal to 200 percent of the
6 federal poverty level, unless the amount of hospital charges
7 due from the patient exceeds 25 percent of the annual family
8 income. However, in no case shall the hospital charges for a
9 patient whose family income exceeds four times the federal
10 poverty level for a family of four be considered charity.
11 (d)(e) "Charity care days" means the sum of the
12 deductions from revenues for charity care minus 50 percent of
13 restricted and unrestricted revenues provided to a hospital by
14 local governments or tax districts, divided by gross revenues
15 per adjusted patient day.
16 (f) "Disproportionate share percentage" means a rate
17 of increase in the Medicaid per diem rate as calculated under
18 this section.
19 (e)(g) "Hospital" means a health care institution
20 licensed as a hospital pursuant to chapter 395, but does not
21 include ambulatory surgical centers.
22 (f)(h) "Medicaid days" means the number of actual days
23 attributable to Medicaid patients as determined by the Agency
24 for Health Care Administration.
25 (2) The Agency for Health Care Administration shall
26 use utilize the following actual audited data criteria to
27 determine the Medicaid days and charity care to be used in
28 calculating the if a hospital qualifies for a disproportionate
29 share payment:
30 (a) The average of the 1997, 1998, and 1999 audited
31 data to determine each hospital's Medicaid days and charity
21
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 care.
2 (b) The average of the audited disproportionate share
3 data for the years available if the Agency for Health Care
4 Administration does not have the prescribed 3 years of audited
5 disproportionate share data for a hospital.
6 (a) A hospital's total Medicaid days when combined
7 with its total charity care days must equal or exceed 7
8 percent of its total adjusted patient days.
9 (b) A hospital's total charity care days weighted by a
10 factor of 4.5, plus its total Medicaid days weighted by a
11 factor of 1, shall be equal to or greater than 10 percent of
12 its total adjusted patient days.
13 (c) Additionally, In accordance with s. 1923(b) of the
14 Social Security Act the seventh federal Omnibus Budget
15 Reconciliation Act, a hospital with a Medicaid inpatient
16 utilization rate greater than one standard deviation above the
17 statewide mean or a hospital with a low-income utilization
18 rate of 25 percent or greater shall qualify for reimbursement.
19 (3) In computing the disproportionate share rate:
20 (a) Per diem increases earned from disproportionate
21 share shall be applied to each hospital's base Medicaid per
22 diem rate and shall be capped at 170 percent.
23 (b) The agency shall use 1994 audited financial data
24 for the calculation of disproportionate share payments under
25 this section.
26 (c) If the total amount earned by all hospitals under
27 this section exceeds the amount appropriated, each hospital's
28 share shall be reduced on a pro rata basis so that the total
29 dollars distributed from the trust fund do not exceed the
30 total amount appropriated.
31 (d) The total amount calculated to be distributed
22
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 under this section shall be made in quarterly payments
2 subsequent to each quarter during the fiscal year.
3 (3)(4) Hospitals that qualify for a disproportionate
4 share payment solely under paragraph (2)(c) shall have their
5 payment calculated in accordance with the following formulas:
6 DSHP = (HMD/TMSD)*$1 million
7
8 Where:
9
10 DSHP = disproportionate share hospital payment.
11 HMD = hospital Medicaid days.
12 TSD = total state Medicaid days.
13
14
15 TAA = TA x (1/5.5)
16 DSHP = (HMD/TSMD) x TAA
17
18 Where:
19 TAA = total amount available.
20 TA = total appropriation.
21 DSHP = disproportionate share hospital payment.
22 HMD = hospital Medicaid days.
23 TSMD = total state Medicaid days.
24
25 (4) The following formulas shall be used to pay
26 disproportionate share dollars to public hospitals:
27 (a) For state mental health hospitals:
28
29 DSHP = (HMD/TMDMH) * TAAMH
30
31 shall be the difference between the federal cap
23
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 for Institutions for Mental Diseases and the
2 amounts paid under the mental health
3 disproportionate share program.
4
5 Where:
6
7 DSHP = disproportionate share hospital payment.
8 HMD = hospital Medicaid days.
9 TMDHH = total Medicaid days for state mental health
10 hospitals.
11 TAAMH = total amount available for mental health
12 hospitals.
13
14 (b) For non-state government owned or operated
15 hospitals with 3,300 or more Medicaid days:
16
17 DSHP = [(.82*HCCD/TCCD) + (.18*HMD/TMD)] * TAAPH
18 TAAPH = TAA - TAAMH
19
20 Where:
21
22 TAA = total available appropriation.
23 TAAPH = total amount available for public hospitals.
24 DSHP = disproportionate share hospital payments.
25 HMD = hospital Medicaid days.
26 TMD = total state Medicaid days for public hospitals.
27 HCCD = hospital charity care dollars.
28 TCCD = total state charity care dollars for public
29 non-state hospitals.
30
31 (c) For non-state government owned or operated
24
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 hospitals with less than 3,300 Medicaid days, a total of
2 $400,000 shall be distributed equally among these hospitals.
3 (5) The following formula shall be utilized by the
4 agency to determine the maximum disproportionate share rate to
5 be used to increase the Medicaid per diem rate for hospitals
6 that qualify pursuant to paragraphs (2)(a) and (b):al>
7
8 CCD MD
9 DSR = ( (........) x 4.5) + (........)
10 APD APD
11 Where:
12 APD = adjusted patient days.
13 CCD = charity care days.
14 DSR = disproportionate share rate.
15 MD = Medicaid days.
16
17 (6)(a) To calculate the total amount earned by all
18 hospitals under this section, hospitals with a
19 disproportionate share rate less than 50 percent shall divide
20 their Medicaid days by four, and hospitals with a
21 disproportionate share rate greater than or equal to 50
22 percent and with greater than 40,000 Medicaid days shall
23 multiply their Medicaid days by 1.5, and the following formula
24 shall be used by the agency to calculate the total amount
25 earned by all hospitals under this section:
26
27 TAE = BMPD x MD x DSP
28
29 Where:
30 TAE = total amount earned.
31 BMPD = base Medicaid per diem.
25
11:10 PM 05/23/03 c0022Ac-0c
CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 MD = Medicaid days.
2 DSP = disproportionate share percentage.
3
4 (5)(b) In no case shall total payments to a hospital
5 under this section, with the exception of public non-state
6 facilities or state facilities, exceed the total amount of
7 uncompensated charity care of the hospital, as determined by
8 the agency according to the most recent calendar year audited
9 data available at the beginning of each state fiscal year.
10 (7) The following criteria shall be used in
11 determining the disproportionate share percentage:
12 (a) If the disproportionate share rate is less than 10
13 percent, the disproportionate share percentage is zero and
14 there is no additional payment.
15 (b) If the disproportionate share rate is greater than
16 or equal to 10 percent, but less than 20 percent, then the
17 disproportionate share percentage is 1.8478498.
18 (c) If the disproportionate share rate is greater than
19 or equal to 20 percent, but less than 30 percent, then the
20 disproportionate share percentage is 3.4145488.
21 (d) If the disproportionate share rate is greater than
22 or equal to 30 percent, but less than 40 percent, then the
23 disproportionate share percentage is 6.3095734.
24 (e) If the disproportionate share rate is greater than
25 or equal to 40 percent, but less than 50 percent, then the
26 disproportionate share percentage is 11.6591440.
27 (f) If the disproportionate share rate is greater than
28 or equal to 50 percent, but less than 60 percent, then the
29 disproportionate share percentage is 73.5642254.
30 (g) If the disproportionate share rate is greater than
31 or equal to 60 percent but less than 72.5 percent, then the
26
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 disproportionate share percentage is 135.9356391.
2 (h) If the disproportionate share rate is greater than
3 or equal to 72.5 percent, then the disproportionate share
4 percentage is 170.
5 (8) The following formula shall be used by the agency
6 to calculate the total amount earned by all hospitals under
7 this section:
8
9 TAE = BMPD x MD x DSP
10
11 Where:
12 TAE = total amount earned.
13 BMPD = base Medicaid per diem.
14 MD = Medicaid days.
15 DSP = disproportionate share percentage.
16
17 (6)(9) The agency is authorized to receive funds from
18 local governments and other local political subdivisions for
19 the purpose of making payments, including federal matching
20 funds, through the Medicaid disproportionate share program.
21 Funds received from local governments for this purpose shall
22 be separately accounted for and shall not be commingled with
23 other state or local funds in any manner.
24 (7)(10) Payments made by the agency to hospitals
25 eligible to participate in this program shall be made in
26 accordance with federal rules and regulations.
27 (a) If the Federal Government prohibits, restricts, or
28 changes in any manner the methods by which funds are
29 distributed for this program, the agency shall not distribute
30 any additional funds and shall return all funds to the local
31 government from which the funds were received, except as
27
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 provided in paragraph (b).
2 (b) If the Federal Government imposes a restriction
3 that still permits a partial or different distribution, the
4 agency may continue to disburse funds to hospitals
5 participating in the disproportionate share program in a
6 federally approved manner, provided:
7 1. Each local government which contributes to the
8 disproportionate share program agrees to the new manner of
9 distribution as shown by a written document signed by the
10 governing authority of each local government; and
11 2. The Executive Office of the Governor, the Office of
12 Planning and Budgeting, the House of Representatives, and the
13 Senate are provided at least 7 days' prior notice of the
14 proposed change in the distribution, and do not disapprove
15 such change.
16 (c) No distribution shall be made under the
17 alternative method specified in paragraph (b) unless all
18 parties agree or unless all funds of those parties that
19 disagree which are not yet disbursed have been returned to
20 those parties.
21 (8)(11) Notwithstanding the provisions of chapter 216,
22 the Executive Office of the Governor is hereby authorized to
23 establish sufficient trust fund authority to implement the
24 disproportionate share program.
25 Section 14. Section 409.9112, Florida Statutes, is
26 amended to read:
27 409.9112 Disproportionate share program for regional
28 perinatal intensive care centers.--In addition to the payments
29 made under s. 409.911, the Agency for Health Care
30 Administration shall design and implement a system of making
31 disproportionate share payments to those hospitals that
28
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 participate in the regional perinatal intensive care center
2 program established pursuant to chapter 383. This system of
3 payments shall conform with federal requirements and shall
4 distribute funds in each fiscal year for which an
5 appropriation is made by making quarterly Medicaid payments.
6 Notwithstanding the provisions of s. 409.915, counties are
7 exempt from contributing toward the cost of this special
8 reimbursement for hospitals serving a disproportionate share
9 of low-income patients.
10 (1) The following formula shall be used by the agency
11 to calculate the total amount earned for hospitals that
12 participate in the regional perinatal intensive care center
13 program:
14
15 TAE = HDSP/THDSP
16
17 Where:
18
19 TAE = total amount earned by a regional perinatal
20 intensive care center.
21 HDSP = the prior state fiscal year regional perinatal
22 intensive care center disproportionate share payment to the
23 individual hospital.
24 THDSP = the prior state fiscal year total regional
25 perinatal intensive care center disproportionate share
26 payments to all hospitals.
27
28 (2) The total additional payment for hospitals that
29 participate in the regional perinatal intensive care center
30 program shall be calculated by the agency as follows:
31
29
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 TAP = TAE * TA
2
3 Where:
4
5 TAP = total additional payment for a regional perinatal
6 intensive care center.
7 TAE = total amount earned by a regional perinatal
8 intensive care center.
9 TA = total appropriation for the regional perinatal
10 intensive care center disproportionate share program.
11
12 TAE = DSR x BMPD x MD
13
14 Where:
15 TAE = total amount earned by a regional perinatal
16 intensive care center.
17 DSR = disproportionate share rate.
18 BMPD = base Medicaid per diem.
19 MD = Medicaid days.
20
21 (2) The total additional payment for hospitals that
22 participate in the regional perinatal intensive care center
23 program shall be calculated by the agency as follows:
24
25
26 TAE x TA
27 TAP = (............)
28 STAE
29
30 Where:
31 TAP = total additional payment for a regional perinatal
30
11:10 PM 05/23/03 c0022Ac-0c
CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 intensive care center.
2 TAE = total amount earned by a regional perinatal
3 intensive care center.
4 STAE = sum of total amount earned by each hospital that
5 participates in the regional perinatal intensive care center
6 program.
7 TA = total appropriation for the regional perinatal
8 intensive care disproportionate share program.
9
10 (3) In order to receive payments under this section, a
11 hospital must be participating in the regional perinatal
12 intensive care center program pursuant to chapter 383 and must
13 meet the following additional requirements:
14 (a) Agree to conform to all departmental and agency
15 requirements to ensure high quality in the provision of
16 services, including criteria adopted by departmental and
17 agency rule concerning staffing ratios, medical records,
18 standards of care, equipment, space, and such other standards
19 and criteria as the department and agency deem appropriate as
20 specified by rule.
21 (b) Agree to provide information to the department and
22 agency, in a form and manner to be prescribed by rule of the
23 department and agency, concerning the care provided to all
24 patients in neonatal intensive care centers and high-risk
25 maternity care.
26 (c) Agree to accept all patients for neonatal
27 intensive care and high-risk maternity care, regardless of
28 ability to pay, on a functional space-available basis.
29 (d) Agree to develop arrangements with other maternity
30 and neonatal care providers in the hospital's region for the
31 appropriate receipt and transfer of patients in need of
31
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 specialized maternity and neonatal intensive care services.
2 (e) Agree to establish and provide a developmental
3 evaluation and services program for certain high-risk
4 neonates, as prescribed and defined by rule of the department.
5 (f) Agree to sponsor a program of continuing education
6 in perinatal care for health care professionals within the
7 region of the hospital, as specified by rule.
8 (g) Agree to provide backup and referral services to
9 the department's county health departments and other
10 low-income perinatal providers within the hospital's region,
11 including the development of written agreements between these
12 organizations and the hospital.
13 (h) Agree to arrange for transportation for high-risk
14 obstetrical patients and neonates in need of transfer from the
15 community to the hospital or from the hospital to another more
16 appropriate facility.
17 (4) Hospitals which fail to comply with any of the
18 conditions in subsection (3) or the applicable rules of the
19 department and agency shall not receive any payments under
20 this section until full compliance is achieved. A hospital
21 which is not in compliance in two or more consecutive quarters
22 shall not receive its share of the funds. Any forfeited funds
23 shall be distributed by the remaining participating regional
24 perinatal intensive care center program hospitals.
25 Section 15. Subsection (1) of section 409.9116,
26 Florida Statutes, is amended to read:
27 409.9116 Disproportionate share/financial assistance
28 program for rural hospitals.--In addition to the payments made
29 under s. 409.911, the Agency for Health Care Administration
30 shall administer a federally matched disproportionate share
31 program and a state-funded financial assistance program for
32
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 statutory rural hospitals. The agency shall make
2 disproportionate share payments to statutory rural hospitals
3 that qualify for such payments and financial assistance
4 payments to statutory rural hospitals that do not qualify for
5 disproportionate share payments. The disproportionate share
6 program payments shall be limited by and conform with federal
7 requirements. Funds shall be distributed quarterly in each
8 fiscal year for which an appropriation is made.
9 Notwithstanding the provisions of s. 409.915, counties are
10 exempt from contributing toward the cost of this special
11 reimbursement for hospitals serving a disproportionate share
12 of low-income patients.
13 (1) The following formula shall be used by the agency
14 to calculate the total amount earned for hospitals that
15 participate in the rural hospital disproportionate share
16 program or the financial assistance program:
17
18 TAERH = (CCD + MDD)/TPD
19
20 Where:
21 CCD = total charity care-other, plus charity
22 care-Hill-Burton, minus 50 percent of unrestricted tax revenue
23 from local governments, and restricted funds for indigent
24 care, divided by gross revenue per adjusted patient day;
25 however, if CCD is less than zero, then zero shall be used for
26 CCD.
27 MDD = Medicaid inpatient days plus Medicaid HMO
28 inpatient days.
29 TPD = total inpatient days.
30 TAERH = total amount earned by each rural hospital.
31
33
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 In computing the total amount earned by each rural hospital,
2 the agency must use the average of the 3 most recent years of
3 actual data reported in accordance with s. 408.061(4)(a). The
4 agency shall provide a preliminary estimate of the payments
5 under the rural disproportionate share and financial
6 assistance programs to the rural hospitals by August 31 of
7 each state fiscal year for review. Each rural hospital shall
8 have 30 days to review the preliminary estimates of payments
9 and report any errors to the agency. The agency shall make any
10 corrections deemed necessary and compute the rural
11 disproportionate share and financial assistance program
12 payments.
13 Section 16. Section 409.9117, Florida Statutes, is
14 amended to read:
15 409.9117 Primary care disproportionate share
16 program.--
17 (1) If federal funds are available for
18 disproportionate share programs in addition to those otherwise
19 provided by law, there shall be created a primary care
20 disproportionate share program.
21 (2) The following formula shall be used by the agency
22 to calculate the total amount earned for hospitals that
23 participate in the primary care disproportionate share
24 program:
25
26 TAE = HDSP/THDSP
27
28 Where:
29
30 TAE = total amount earned by a hospital participating
31 in the primary care disproportionate share program.
34
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 HDSP = the prior state fiscal year primary care
2 disproportionate share payment to the individual hospital.
3 THDSP = the prior state fiscal year total primary care
4 disproportionate share payments to all hospitals.
5
6 (3) The total additional payment for hospitals that
7 participate in the primary care disproportionate share program
8 shall be calculated by the agency as follows:
9
10 TAP = TAE * TA
11
12 Where:
13
14 TAP = total additional payment for a primary care
15 hospital.
16 TAE = total amount earned by a primary care hospital.
17 TA = total appropriation for the primary care
18 disproportionate share program.
19 (4)(2) In the establishment and funding of this
20 program, the agency shall use the following criteria in
21 addition to those specified in s. 409.911, payments may not be
22 made to a hospital unless the hospital agrees to:
23 (a) Cooperate with a Medicaid prepaid health plan, if
24 one exists in the community.
25 (b) Ensure the availability of primary and specialty
26 care physicians to Medicaid recipients who are not enrolled in
27 a prepaid capitated arrangement and who are in need of access
28 to such physicians.
29 (c) Coordinate and provide primary care services free
30 of charge, except copayments, to all persons with incomes up
31 to 100 percent of the federal poverty level who are not
35
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 otherwise covered by Medicaid or another program administered
2 by a governmental entity, and to provide such services based
3 on a sliding fee scale to all persons with incomes up to 200
4 percent of the federal poverty level who are not otherwise
5 covered by Medicaid or another program administered by a
6 governmental entity, except that eligibility may be limited to
7 persons who reside within a more limited area, as agreed to by
8 the agency and the hospital.
9 (d) Contract with any federally qualified health
10 center, if one exists within the agreed geopolitical
11 boundaries, concerning the provision of primary care services,
12 in order to guarantee delivery of services in a nonduplicative
13 fashion, and to provide for referral arrangements, privileges,
14 and admissions, as appropriate. The hospital shall agree to
15 provide at an onsite or offsite facility primary care services
16 within 24 hours to which all Medicaid recipients and persons
17 eligible under this paragraph who do not require emergency
18 room services are referred during normal daylight hours.
19 (e) Cooperate with the agency, the county, and other
20 entities to ensure the provision of certain public health
21 services, case management, referral and acceptance of
22 patients, and sharing of epidemiological data, as the agency
23 and the hospital find mutually necessary and desirable to
24 promote and protect the public health within the agreed
25 geopolitical boundaries.
26 (f) In cooperation with the county in which the
27 hospital resides, develop a low-cost, outpatient, prepaid
28 health care program to persons who are not eligible for the
29 Medicaid program, and who reside within the area.
30 (g) Provide inpatient services to residents within the
31 area who are not eligible for Medicaid or Medicare, and who do
36
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 not have private health insurance, regardless of ability to
2 pay, on the basis of available space, except that nothing
3 shall prevent the hospital from establishing bill collection
4 programs based on ability to pay.
5 (h) Work with the Florida Healthy Kids Corporation,
6 the Florida Health Care Purchasing Cooperative, and business
7 health coalitions, as appropriate, to develop a feasibility
8 study and plan to provide a low-cost comprehensive health
9 insurance plan to persons who reside within the area and who
10 do not have access to such a plan.
11 (i) Work with public health officials and other
12 experts to provide community health education and prevention
13 activities designed to promote healthy lifestyles and
14 appropriate use of health services.
15 (j) Work with the local health council to develop a
16 plan for promoting access to affordable health care services
17 for all persons who reside within the area, including, but not
18 limited to, public health services, primary care services,
19 inpatient services, and affordable health insurance generally.
20
21 Any hospital that fails to comply with any of the provisions
22 of this subsection, or any other contractual condition, may
23 not receive payments under this section until full compliance
24 is achieved.
25 Section 17. Section 409.9119, Florida Statutes, is
26 amended to read:
27 409.9119 Disproportionate share program for specialty
28 hospitals for children.--In addition to the payments made
29 under s. 409.911, the Agency for Health Care Administration
30 shall develop and implement a system under which
31 disproportionate share payments are made to those hospitals
37
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CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 that are licensed by the state as specialty hospitals for
2 children and were licensed on January 1, 2000, as specialty
3 hospitals for children. This system of payments must conform
4 to federal requirements and must distribute funds in each
5 fiscal year for which an appropriation is made by making
6 quarterly Medicaid payments. Notwithstanding s. 409.915,
7 counties are exempt from contributing toward the cost of this
8 special reimbursement for hospitals that serve a
9 disproportionate share of low-income patients. Payments are
10 subject to specific appropriations in the General
11 Appropriations Act.
12 (1) The agency shall use the following formula to
13 calculate the total amount earned for hospitals that
14 participate in the specialty hospital for children
15 disproportionate share program:
16
17 TAE = DSR x BMPD x MD
18
19 Where:
20 TAE = total amount earned by a specialty hospital for
21 children.
22 DSR = disproportionate share rate.
23 BMPD = base Medicaid per diem.
24 MD = Medicaid days.
25 (2) The agency shall calculate the total additional
26 payment for hospitals that participate in the specialty
27 hospital for children disproportionate share program as
28 follows:
29
30
31 TAE x TA
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 TAP = (............)
2 STAE
3 Where:
4 TAP = total additional payment for a specialty hospital
5 for children.
6 TAE = total amount earned by a specialty hospital for
7 children.
8 TA = total appropriation for the specialty hospital for
9 children disproportionate share program.
10 STAE = sum of total amount earned by each hospital that
11 participates in the specialty hospital for children
12 disproportionate share program.
13
14 (3) A hospital may not receive any payments under this
15 section until it achieves full compliance with the applicable
16 rules of the agency. A hospital that is not in compliance for
17 two or more consecutive quarters may not receive its share of
18 the funds. Any forfeited funds must be distributed to the
19 remaining participating specialty hospitals for children that
20 are in compliance.
21 Section 18. Paragraph (d) of subsection (3) of section
22 409.912, Florida Statutes, as amended by chapter 2003-1, Laws
23 of Florida, is amended, and subsections (41) and (42) are
24 added to that section, to read:
25 409.912 Cost-effective purchasing of health care.--The
26 agency shall purchase goods and services for Medicaid
27 recipients in the most cost-effective manner consistent with
28 the delivery of quality medical care. The agency shall
29 maximize the use of prepaid per capita and prepaid aggregate
30 fixed-sum basis services when appropriate and other
31 alternative service delivery and reimbursement methodologies,
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 including competitive bidding pursuant to s. 287.057, designed
2 to facilitate the cost-effective purchase of a case-managed
3 continuum of care. The agency shall also require providers to
4 minimize the exposure of recipients to the need for acute
5 inpatient, custodial, and other institutional care and the
6 inappropriate or unnecessary use of high-cost services. The
7 agency may establish prior authorization requirements for
8 certain populations of Medicaid beneficiaries, certain drug
9 classes, or particular drugs to prevent fraud, abuse, overuse,
10 and possible dangerous drug interactions. The Pharmaceutical
11 and Therapeutics Committee shall make recommendations to the
12 agency on drugs for which prior authorization is required. The
13 agency shall inform the Pharmaceutical and Therapeutics
14 Committee of its decisions regarding drugs subject to prior
15 authorization.
16 (3) The agency may contract with:
17 (d) A provider service network No more than four
18 provider service networks for demonstration projects to test
19 Medicaid direct contracting. The demonstration projects may be
20 reimbursed on a fee-for-service or prepaid basis. A provider
21 service network which is reimbursed by the agency on a prepaid
22 basis shall be exempt from parts I and III of chapter 641, but
23 must meet appropriate financial reserve, quality assurance,
24 and patient rights requirements as established by the agency.
25 The agency shall award contracts on a competitive bid basis
26 and shall select bidders based upon price and quality of care.
27 Medicaid recipients assigned to a demonstration project shall
28 be chosen equally from those who would otherwise have been
29 assigned to prepaid plans and MediPass. The agency is
30 authorized to seek federal Medicaid waivers as necessary to
31 implement the provisions of this section. A demonstration
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 project awarded pursuant to this paragraph shall be for 4
2 years from the date of implementation.
3 (41) The agency shall develop and implement a
4 utilization management program for Medicaid-eligible
5 recipients for the management of occupational, physical,
6 respiratory, and speech therapies. The agency shall establish
7 a utilization program that may require prior authorization in
8 order to ensure medically necessary and cost-effective
9 treatments. The program shall be operated in accordance with a
10 federally approved waiver program or state plan amendment. The
11 agency may seek a federal waiver or state plan amendment to
12 implement this program. The agency may also competitively
13 procure these services from an outside vendor on a regional or
14 statewide basis.
15 (42) The agency may contract on a prepaid or fixed-sum
16 basis with appropriately licensed prepaid dental health plans
17 to provide dental services.
18 Section 19. Paragraphs (f) and (k) of subsection (2)
19 of section 409.9122, Florida Statutes, are amended, and
20 subsection (13) is added to that section, to read:
21 409.9122 Mandatory Medicaid managed care enrollment;
22 programs and procedures.--
23 (2)
24 (f) When a Medicaid recipient does not choose a
25 managed care plan or MediPass provider, the agency shall
26 assign the Medicaid recipient to a managed care plan or
27 MediPass provider. Medicaid recipients who are subject to
28 mandatory assignment but who fail to make a choice shall be
29 assigned to managed care plans until an enrollment of 40 45
30 percent in MediPass and 60 55 percent in managed care plans is
31 achieved. Once this enrollment is achieved, the assignments
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 shall be divided in order to maintain an enrollment in
2 MediPass and managed care plans which is in a 40 45 percent
3 and 60 55 percent proportion, respectively. Thereafter,
4 assignment of Medicaid recipients who fail to make a choice
5 shall be based proportionally on the preferences of recipients
6 who have made a choice in the previous period. Such
7 proportions shall be revised at least quarterly to reflect an
8 update of the preferences of Medicaid recipients. The agency
9 shall disproportionately assign Medicaid-eligible recipients
10 who are required to but have failed to make a choice of
11 managed care plan or MediPass, including children, and who are
12 to be assigned to the MediPass program to children's networks
13 as described in s. 409.912(3)(g), Children's Medical Services
14 network as defined in s. 391.021, exclusive provider
15 organizations, provider service networks, minority physician
16 networks, and pediatric emergency department diversion
17 programs authorized by this chapter or the General
18 Appropriations Act, in such manner as the agency deems
19 appropriate, until the agency has determined that the networks
20 and programs have sufficient numbers to be economically
21 operated. For purposes of this paragraph, when referring to
22 assignment, the term "managed care plans" includes health
23 maintenance organizations, exclusive provider organizations,
24 provider service networks, minority physician networks,
25 Children's Medical Services network, and pediatric emergency
26 department diversion programs authorized by this chapter or
27 the General Appropriations Act.
28 1. Beginning July 1, 2002, the agency shall assign all
29 children in families who have not made a choice of a managed
30 care plan or MediPass in the required timeframe to a pediatric
31 emergency room diversion program described in s. 409.912(3)(g)
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 that, as of July 1, 2002, has executed a contract with the
2 agency, until such network or program has reached an
3 enrollment of 15,000 children. Once that minimum enrollment
4 level has been reached, the agency shall assign children who
5 have not chosen a managed care plan or MediPass to the network
6 or program in a manner that maintains the minimum enrollment
7 in the network or program at not less than 15,000 children. To
8 the extent practicable, the agency shall also assign all
9 eligible children in the same family to such network or
10 program. This subparagraph expires January 1, 2004.
11 2. When making assignments, the agency shall take into
12 account the following criteria:
13 a.1. A managed care plan has sufficient network
14 capacity to meet the need of members.
15 b.2. The managed care plan or MediPass has previously
16 enrolled the recipient as a member, or one of the managed care
17 plan's primary care providers or MediPass providers has
18 previously provided health care to the recipient.
19 c.3. The agency has knowledge that the member has
20 previously expressed a preference for a particular managed
21 care plan or MediPass provider as indicated by Medicaid
22 fee-for-service claims data, but has failed to make a choice.
23 d.4. The managed care plan's or MediPass primary care
24 providers are geographically accessible to the recipient's
25 residence.
26 (k) When a Medicaid recipient does not choose a
27 managed care plan or MediPass provider, the agency shall
28 assign the Medicaid recipient to a managed care plan, except
29 in those counties in which there are fewer than two managed
30 care plans accepting Medicaid enrollees, in which case
31 assignment shall be to a managed care plan or a MediPass
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 provider. Medicaid recipients in counties with fewer than two
2 managed care plans accepting Medicaid enrollees who are
3 subject to mandatory assignment but who fail to make a choice
4 shall be assigned to managed care plans until an enrollment of
5 40 45 percent in MediPass and 60 55 percent in managed care
6 plans is achieved. Once that enrollment is achieved, the
7 assignments shall be divided in order to maintain an
8 enrollment in MediPass and managed care plans which is in a 40
9 45 percent and 60 55 percent proportion, respectively. In
10 geographic areas where the agency is contracting for the
11 provision of comprehensive behavioral health services through
12 a capitated prepaid arrangement, recipients who fail to make a
13 choice shall be assigned equally to MediPass or a managed care
14 plan. For purposes of this paragraph, when referring to
15 assignment, the term "managed care plans" includes exclusive
16 provider organizations, provider service networks, Children's
17 Medical Services network, minority physician networks, and
18 pediatric emergency department diversion programs authorized
19 by this chapter or the General Appropriations Act. When making
20 assignments, the agency shall take into account the following
21 criteria:
22 1. A managed care plan has sufficient network capacity
23 to meet the need of members.
24 2. The managed care plan or MediPass has previously
25 enrolled the recipient as a member, or one of the managed care
26 plan's primary care providers or MediPass providers has
27 previously provided health care to the recipient.
28 3. The agency has knowledge that the member has
29 previously expressed a preference for a particular managed
30 care plan or MediPass provider as indicated by Medicaid
31 fee-for-service claims data, but has failed to make a choice.
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 4. The managed care plan's or MediPass primary care
2 providers are geographically accessible to the recipient's
3 residence.
4 5. The agency has authority to make mandatory
5 assignments based on quality of service and performance of
6 managed care plans.
7 (13) Effective July 1, 2003, the agency shall adjust
8 the enrollee assignment process of Medicaid managed prepaid
9 health plans for those Medicaid managed prepaid plans
10 operating in Miami-Dade County which have executed a contract
11 with the agency for a minimum of 8 consecutive years in order
12 for the Medicaid managed prepaid plan to maintain a minimum
13 enrollment level of 15,000 members per month.
14 Section 20. Section 430.83, Florida Statutes, is
15 created to read:
16 430.83 Sunshine for Seniors Program.--
17 (1) POPULAR NAME.--This section shall be known by the
18 popular name "The Sunshine for Seniors Act."
19 (2) DEFINITIONS.--As used in this section, the term:
20 (a) "Application assistance organization" means any
21 private organization that assists individuals with obtaining
22 prescription drugs through manufacturers' pharmaceutical
23 assistance programs.
24 (b) "Eligible individual" means any individual who is
25 60 years of age or older who lacks adequate pharmaceutical
26 insurance coverage.
27 (c) "Manufacturers' pharmaceutical assistance program"
28 means any program offered by a pharmaceutical manufacturer
29 which provides low-income individuals with prescription drugs
30 free or at reduced prices, including, but not limited to,
31 senior discount card programs and patient assistance programs.
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 (3) LEGISLATIVE FINDINGS AND INTENT.--The Legislature
2 finds that the pharmaceutical manufacturers, seeing a need,
3 have created charitable programs to aid low-income seniors
4 with the cost of prescription drugs. The Legislature also
5 finds that many low-income seniors are unaware of such
6 programs or either do not know how to apply for or need
7 assistance in completing the applications for such programs.
8 Therefore, it is the intent of the Legislature that the
9 Department of Elderly Affairs, in consultation with the Agency
10 for Health Care Administration, implement and oversee the
11 Sunshine for Seniors Program to help seniors in accessing
12 manufacturers' pharmaceutical assistance programs.
13 (4) SUNSHINE FOR SENIORS PROGRAM.--There is
14 established a program to assist low-income seniors with
15 obtaining prescription drugs from manufacturers'
16 pharmaceutical assistance programs, which shall be known as
17 the "Sunshine for Seniors Program." Implementation of the
18 program is subject to the availability of funding and any
19 limitations or directions provided for by the General
20 Appropriations Act or chapter 216.
21 (5) IMPLEMENTATION AND OVERSIGHT DUTIES.--In
22 implementing and overseeing the Sunshine for Seniors Program,
23 the Department of Elderly Affairs:
24 (a) Shall promote the availability of manufacturers'
25 pharmaceutical assistance programs to eligible individuals
26 with various outreach initiatives.
27 (b) Shall, working cooperatively with pharmaceutical
28 manufacturers and consumer advocates, develop a uniform
29 application form to be completed by seniors who wish to
30 participate in the Sunshine for Seniors Program.
31 (c) May request proposals from application assistance
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 organizations to assist eligible individuals with obtaining
2 prescription drugs through manufacturers' pharmaceutical
3 assistance programs.
4 (d) Shall train volunteers to help eligible
5 individuals fill out applications for the manufacturers'
6 pharmaceutical assistance programs.
7 (e) Shall train volunteers to determine when
8 applicants may be eligible for other state programs and refer
9 them to the proper entity for eligibility determination for
10 such programs.
11 (f) Shall seek federal funds to help fund the Sunshine
12 for Seniors Program.
13 (g) May seek federal waivers to help fund the Sunshine
14 for Seniors Program.
15 (6) COMMUNITY PARTNERSHIPS.--The Department of Elderly
16 Affairs may build private-sector and public-sector
17 partnerships with corporations, hospitals, physicians,
18 pharmacists, foundations, volunteers, state agencies,
19 community groups, area agencies on aging, and any other
20 entities that will further the intent of this section. These
21 community partnerships may also be used to facilitate other
22 pro bono benefits for eligible individuals, including, but not
23 limited to, medical, dental, and prescription services.
24 (7) CONTRACTS.--The Department of Elderly Affairs may
25 select and contract with application assistance organizations
26 to assist eligible individuals in obtaining their prescription
27 drugs through the manufacturers' pharmaceutical assistance
28 programs. If the department contracts with an application
29 assistance organization, the department shall evaluate
30 quarterly the performance of the application assistance
31 organization to ensure compliance with the contract and the
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 quality of service provided to eligible individuals.
2 (8) REPORTS AND EVALUATIONS.--By January 1 of each
3 year, while the Sunshine for Seniors Program is operating, the
4 Department of Elderly Affairs shall report to the Legislature
5 regarding the implementation and operation of the Sunshine for
6 Seniors Program.
7 (9) NONENTITLEMENT.--The Sunshine for Seniors Program
8 established by this section is not an entitlement. If funds
9 are insufficient to assist all eligible individuals, the
10 Department of Elderly Affairs may develop a waiting list
11 prioritized by application date.
12 Section 21. Paragraph (b) of subsection (2), paragraph
13 (b) of subsection (4), and paragraph (a) of subsection (5) of
14 section 624.91, Florida Statutes, are amended to read:
15 624.91 The Florida Healthy Kids Corporation Act.--
16 (2) LEGISLATIVE INTENT.--
17 (b) It is the intent of the Legislature that the
18 Florida Healthy Kids Corporation serve as one of several
19 providers of services to children eligible for medical
20 assistance under Title XXI of the Social Security Act.
21 Although the corporation may serve other children, the
22 Legislature intends the primary recipients of services
23 provided through the corporation be school-age children with a
24 family income below 200 percent of the federal poverty level,
25 who do not qualify for Medicaid. It is also the intent of the
26 Legislature that state and local government Florida Healthy
27 Kids funds be used to continue and expand coverage, subject to
28 specific within available appropriations in the General
29 Appropriations Act, to children not eligible for federal
30 matching funds under Title XXI.
31 (4) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 (b) The Florida Healthy Kids Corporation shall:
2 1. Organize school children groups to facilitate the
3 provision of comprehensive health insurance coverage to
4 children;
5 1.2. Arrange for the collection of any family, local
6 contributions, or employer payment or premium, in an amount to
7 be determined by the board of directors, to provide for
8 payment of premiums for comprehensive insurance coverage and
9 for the actual or estimated administrative expenses;
10 2.3. Arrange for the collection of any voluntary
11 contributions to provide for payment of premiums for children
12 who are not eligible for medical assistance under Title XXI of
13 the Social Security Act. Each fiscal year, the corporation
14 shall establish a local match policy for the enrollment of
15 non-Title-XXI-eligible children in the Healthy Kids program.
16 By May 1 of each year, the corporation shall provide written
17 notification of the amount to be remitted to the corporation
18 for the following fiscal year under that policy. Local match
19 sources may include, but are not limited to, funds provided by
20 municipalities, counties, school boards, hospitals, health
21 care providers, charitable organizations, special taxing
22 districts, and private organizations. The minimum local match
23 cash contributions required each fiscal year and local match
24 credits shall be determined by the General Appropriations Act.
25 The corporation shall calculate a county's local match rate
26 based upon that county's percentage of the state's total
27 non-Title-XXI expenditures as reported in the corporation's
28 most recently audited financial statement. In awarding the
29 local match credits, the corporation may consider factors
30 including, but not limited to, population density, per capita
31 income, and existing child-health-related expenditures and
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 services;
2 3.4. Accept voluntary supplemental local match
3 contributions that comply with the requirements of Title XXI
4 of the Social Security Act for the purpose of providing
5 additional coverage in contributing counties under Title XXI;
6 4.5. Establish the administrative and accounting
7 procedures for the operation of the corporation;
8 5.6. Establish, with consultation from appropriate
9 professional organizations, standards for preventive health
10 services and providers and comprehensive insurance benefits
11 appropriate to children; provided that such standards for
12 rural areas shall not limit primary care providers to
13 board-certified pediatricians;
14 6.7. Establish eligibility criteria which children
15 must meet in order to participate in the program;
16 7.8. Establish procedures under which providers of
17 local match to, applicants to and participants in the program
18 may have grievances reviewed by an impartial body and reported
19 to the board of directors of the corporation;
20 8.9. Establish participation criteria and, if
21 appropriate, contract with an authorized insurer, health
22 maintenance organization, or insurance administrator to
23 provide administrative services to the corporation;
24 9.10. Establish enrollment criteria which shall
25 include penalties or waiting periods of not fewer than 60 days
26 for reinstatement of coverage upon voluntary cancellation for
27 nonpayment of family premiums;
28 10.11. If a space is available, establish a special
29 open enrollment period of 30 days' duration for any child who
30 is enrolled in Medicaid or Medikids if such child loses
31 Medicaid or Medikids eligibility and becomes eligible for the
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 Florida Healthy Kids program;
2 11.12. Contract with authorized insurers or any
3 provider of health care services, meeting standards
4 established by the corporation, for the provision of
5 comprehensive insurance coverage to participants. Such
6 standards shall include criteria under which the corporation
7 may contract with more than one provider of health care
8 services in program sites. Health plans shall be selected
9 through a competitive bid process. The maximum administrative
10 cost for a Florida Healthy Kids Corporation contract shall be
11 15 percent. The minimum medical loss ratio for a Florida
12 Healthy Kids Corporation contract shall be 85 percent. The
13 selection of health plans shall be based primarily on quality
14 criteria established by the board. The health plan selection
15 criteria and scoring system, and the scoring results, shall be
16 available upon request for inspection after the bids have been
17 awarded;
18 12.13. Establish disenrollment criteria in the event
19 local matching funds are insufficient to cover enrollments;
20 13.14. Develop and implement a plan to publicize the
21 Florida Healthy Kids Corporation, the eligibility requirements
22 of the program, and the procedures for enrollment in the
23 program and to maintain public awareness of the corporation
24 and the program;
25 14.15. Secure staff necessary to properly administer
26 the corporation. Staff costs shall be funded from state and
27 local matching funds and such other private or public funds as
28 become available. The board of directors shall determine the
29 number of staff members necessary to administer the
30 corporation;
31 15.16. As appropriate, enter into contracts with local
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 school boards or other agencies to provide onsite information,
2 enrollment, and other services necessary to the operation of
3 the corporation;
4 16.17. Provide a report annually to the Governor,
5 Chief Financial Officer, Commissioner of Education, Senate
6 President, Speaker of the House of Representatives, and
7 Minority Leaders of the Senate and the House of
8 Representatives;
9 17.18. Each fiscal year, establish a maximum number of
10 participants, on a statewide basis, who may enroll in the
11 program; and
12 18.19. Establish eligibility criteria, premium and
13 cost-sharing requirements, and benefit packages which conform
14 to the provisions of the Florida Kidcare program, as created
15 in ss. 409.810-409.820.
16 (5) BOARD OF DIRECTORS.--
17 (a) The Florida Healthy Kids Corporation shall operate
18 subject to the supervision and approval of a board of
19 directors chaired by the Chief Financial Officer or her or his
20 designee, and composed of 10 14 other members selected for
21 3-year terms of office as follows:
22 1. The Secretary of Health Care Administration, or his
23 or her designee;
24 1. One member appointed by the Commissioner of
25 Education from among three persons nominated by the Florida
26 Association of School Administrators;
27 2. One member appointed by the Commissioner of
28 Education from among three persons nominated by the Florida
29 Association of School Boards;
30 2.3. One member appointed by the Commissioner of
31 Education from the Office of School Health Programs of the
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 Florida Department of Education;
2 3.4. One member appointed by the Chief Financial
3 Officer Governor from among three members nominated by the
4 Florida Pediatric Society;
5 4.5. One member, appointed by the Governor, who
6 represents the Children's Medical Services Program;
7 5.6. One member appointed by the Chief Financial
8 Officer from among three members nominated by the Florida
9 Hospital Association;
10 7. Two members, appointed by the Chief Financial
11 Officer, who are representatives of authorized health care
12 insurers or health maintenance organizations;
13 6.8. One member, appointed by the Governor Chief
14 Financial Officer, who is an expert on represents the
15 Institute for child health policy;
16 7.9. One member, appointed by the Chief Financial
17 Officer Governor, from among three members nominated by the
18 Florida Academy of Family Physicians;
19 8.10. One member, appointed by the Governor, who
20 represents the state Medicaid program Agency for Health Care
21 Administration;
22 11. One member, appointed by the Chief Financial
23 Officer, from among three members nominated by the Florida
24 Association of Counties, representing rural counties;
25 9.12. One member, appointed by the Chief Financial
26 Officer Governor, from among three members nominated by the
27 Florida Association of Counties, representing urban counties;
28 and
29 10.13. The State Health Officer or her or his
30 designee.
31 Section 22. Section 57 of chapter 98-288, Laws of
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 Florida, is repealed.
2 Section 23. Effective upon this act becoming a law,
3 for the 2002-2003 state fiscal year, the Agency for Health
4 Care Administration may make additional payment of up to
5 $7,561,104 from the Grants and Donations Trust Fund and
6 $10,849,182 from the Medical Care Trust Fund to hospitals as
7 special Medicaid payments in order to use the full amount of
8 the upper payment limit available in the public hospital
9 category.
10 (1) These funds shall be distributed as follows:
11 (a) Statutory teaching hospitals - $1,355,991.
12 (b) Family practice teaching hospitals - $181,291.
13 (c) Primary care hospitals - $1,355,991.
14 (d) Trauma hospitals - $1,290,000.
15 (e) Rural hospitals - $931,500.
16 (f) Hospitals receiving specific special Medicaid
17 payments not included in a payment under paragraphs (a)-(e),
18 $4,359,417.
19 (g) Hospitals providing enhanced services to
20 low-income individuals - $8,884,298.
21 (2) The payments shall be distributed proportionately
22 to each hospital in the specific payment category based on the
23 hospital's actual payments for the 2002-2003 state fiscal
24 year. These payment amounts shall be adjusted downward in a
25 proportionate manner as to not exceed the available upper
26 payment limit in the public hospital category. Payment of
27 these amounts are contingent on the state share being provided
28 through grants and donations from state, county, or other
29 local funds and approval by the Centers of Medicare and
30 Medicaid Services.
31 Section 24. If any law that is amended by this act was
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 also amended by a law enacted at the 2003 Regular Session of
2 the Legislature, such laws shall be construed as if they had
3 been enacted during the same session of the Legislature, and
4 full effect should be given to each if that is possible.
5 Section 25. Except as otherwise expressly provided in
6 this act, this act shall take effect July 1, 2003.
7
8
9 ================ T I T L E A M E N D M E N T ===============
10 And the title is amended as follows:
11 Delete everything before the enacting clause
12
13 and insert:
14 A bill to be entitled
15 An act relating to health care; amending s.
16 400.179, F.S.; deleting a repeal of provisions
17 requiring payment of certain fees upon the
18 transfer of the leasehold license for a nursing
19 facility; amending s. 400.23, F.S.; delaying
20 the effective date of certain requirements
21 concerning hours of direct care per resident
22 for nursing home facilities; amending ss.
23 400.452 and 400.6211, F.S.; revising training
24 requirements for administrators and staff of
25 assisted living facilities and adult
26 family-care home providers; requiring a
27 competency test; providing rulemaking
28 authority; amending s. 408.909, F.S., relating
29 to health flex plans; revising eligibility for
30 the plan; extending the expiration date of the
31 program; amending s. 409.815, F.S., relating to
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Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 benefits coverage under the Medicaid program;
2 specifying a maximum annual benefit for
3 children's dental services; amending s.
4 409.901, F.S.; defining the term "third party"
5 to include a third-party administrator or
6 pharmacy benefits manager; amending s. 409.904,
7 F.S.; revising provisions governing the payment
8 of optional medical benefits for certain
9 Medicaid-eligible persons; amending s. 409.906,
10 F.S.; revising requirements for hearing and
11 visual services to limit such services to
12 persons younger than 21 years of age; amending
13 s. 409.9065, F.S.; revising the pharmaceutical
14 expense assistance program for low-income
15 elderly individuals; adding eligibility groups;
16 providing benefits; requiring the Agency for
17 Health Care Administration, in administering
18 the program, to collaborate with both the
19 Department of Elderly Affairs and the
20 Department of Children and Family Services;
21 requiring federal approval of benefits;
22 amending s. 409.908, F.S., relating to
23 reimbursement of Medicaid providers; providing
24 for a fee to be paid to providers returning
25 unused medications and credited to the Medicaid
26 program; amending s. 409.9081, F.S.; providing
27 a copayment under the Medicaid program for
28 certain nonemergency hospital visits; providing
29 coinsurance of a specified amount for the
30 Medicaid cost of prescription drugs; amending
31 ss. 409.911, 409.9112, 409.9116, and 409.9117,
56
11:10 PM 05/23/03 c0022Ac-0c
CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 F.S.; revising the disproportionate share
2 program; deleting definitions; requiring the
3 Agency for Health Care Administration to use
4 actual audited data to determine the Medicaid
5 days and charity care to be used to calculate
6 the disproportionate share payment; revising
7 formulas for calculating payments; revising the
8 formula for calculating payments under the
9 disproportionate share program for regional
10 perinatal intensive care centers; providing for
11 estimates of the payments under the rural
12 disproportionate share and financial assistance
13 programs; providing a formula for calculating
14 payments under the primary care
15 disproportionate share program; amending s.
16 409.9119, F.S., relating to disproportionate
17 share program for specialty hospitals for
18 children; providing that payments are subject
19 to appropriations; amending s. 409.912, F.S.;
20 providing for reimbursement of provider service
21 networks; authorizing the agency to implement a
22 utilization management program for certain
23 services and contract for certain dental
24 services; amending s. 409.9122, F.S.; revising
25 the percentage of Medicaid recipients required
26 to be enrolled in managed care; revising
27 requirements for the enrollment process;
28 creating s. 430.83, F.S.; providing a popular
29 name; providing definitions; providing
30 legislative findings and intent; creating the
31 Sunshine for Seniors Program to assist
57
11:10 PM 05/23/03 c0022Ac-0c
CONFERENCE COMMITTEE AMENDMENT
Bill No. SB 22-A, 1st Eng.
Amendment No. __ Barcode 501270
1 low-income seniors with obtaining prescription
2 drugs from manufacturers' pharmaceutical
3 assistance programs; providing implementation
4 and oversight duties of the Department of
5 Elderly Affairs; providing for community
6 partnerships; providing for contracts;
7 requiring annual evaluation reports on the
8 program; specifying that the program is not an
9 entitlement; amending s. 624.91, F.S., relating
10 to the Florida Healthy Kids Corporation Act;
11 providing for funding to be subject to specific
12 appropriations; providing contract
13 requirements; revising membership of the board
14 of directors of the corporation; repealing s.
15 57 of chapter 98-288, Laws of Florida;
16 abrogating a repeal of the Florida Kidcare Act;
17 authorizing the Agency for Health Care
18 Administration to make additional payments to
19 certain hospitals; specifying the amounts and
20 providing for adjustments; providing for
21 construction of the act in pari materia with
22 laws enacted during the Regular Session of the
23 Legislature; providing an effective date.
24
25
26
27
28
29
30
31
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