SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
CHAMBER ACTION
Senate House
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11 Senator Saunders moved the following amendment:
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13 Senate Amendment
14 On page 14, line 23, through
15 page 21, line 26, delete those lines
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17 and insert:
18 (b) During the 2004-2005 state fiscal year:
19 1. The agency, in consultation with the department,
20 shall develop an implementation plan to integrate the Frail
21 Elder Option into the Nursing Home Diversion pilot project and
22 each program's funds into one capitated program serving the
23 aged. Beginning July 1, 2004, the agency may not enroll
24 additional individuals in the Frail Elder Option.
25 2. The agency, in consultation with the department,
26 shall integrate the Aged and Disabled Adult Medicaid waiver
27 program and the Assisted Living for the Elderly Medicaid
28 waiver program and each program's funds into one
29 fee-for-service Medicaid waiver program serving the aged and
30 disabled. Once the programs are integrated, funding to provide
31 care in assisted-living facilities under the new waiver may
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SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
1 not be less than the amount appropriated in the 2003-2004
2 fiscal year for the Assisted Living for the Elderly Medicaid
3 waiver.
4 a. The agency shall seek federal waivers necessary to
5 integrate these waiver programs.
6 b. The agency and the department shall reimburse
7 providers for case management services on a capitated basis
8 and develop uniform standards for case management in this
9 fee-for-service Medicaid waiver program. The coordination of
10 acute and chronic medical services for individuals shall be
11 included in the capitated rate for case management services.
12 c. The agency and the department shall adopt any rules
13 necessary to comply with or administer these requirements,
14 effect and implement interagency agreements between the
15 department and the agency, and comply with federal
16 requirements.
17 3. The Legislature finds that preservation of the
18 historic aging network of lead agencies is essential to the
19 well-being of Florida's elderly population. The Legislature
20 finds that the Florida aging network constitutes a system of
21 essential community providers which should be nurtured and
22 assisted to develop systems of operations which allow the
23 gradual assumption of responsibility and financial risk for
24 managing a client through the entire continuum of long-term
25 care services within the area the lead agency is currently
26 serving, and which allow lead agency providers to develop
27 managed systems of service delivery. The department, in
28 consultation with the agency, shall therefore:
29 a. Develop a demonstration project in which existing
30 community care for the elderly lead agencies are assisted in
31 transferring their business model and the service delivery
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SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
1 system within their current community care service area, to
2 enable assumption over a period of time, of full risk as a
3 community diversion pilot project contractor providing
4 long-term care services in the areas of operation. The
5 department, in consultation with the agency and the Department
6 of Children and Family Services, shall develop an
7 implementation plan for no more than three lead agencies by
8 October 31, 2004.
9 b. In the demonstration area, a community care for the
10 elderly lead agency shall be initially reimbursed on a prepaid
11 or fixed-sum basis for services provided under the newly
12 integrated fee-for-service Medicaid waiver. By the end of the
13 third year of operation, the demonstration shall include all
14 services under the long-term care community diversion pilot
15 project.
16 c. During the first year of operation, the department,
17 in consultation with the agency may place providers at risk to
18 provide nursing home services for the enrolled individuals who
19 are participating in the demonstration project. During the
20 3-year development period, the agency and the department may
21 limit the level of custodial nursing home risk that the
22 administering entities assume. Under risk-sharing
23 arrangements, during the first 3 years of operation, the
24 department, in consultation with the agency, may reimburse the
25 administering entity for the cost of providing nursing home
26 care for Medicaid-eligible participants who have been
27 permanently placed and remain in a nursing home for more than
28 1 year, or may disenroll such participants from the
29 demonstration project.
30 d. The agency, in consultation with the department,
31 shall develop reimbursement rates based on the historical cost
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SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
1 experience of the state in providing long-term care and
2 nursing home services under Medicaid waiver programs to the
3 population 65 years of age and older in the area served by the
4 pilot project.
5 e. The department, in consultation with the agency,
6 shall ensure that the entity or entities receiving prepaid or
7 fixed-sum reimbursement are assisted in developing internal
8 management and financial control systems necessary to manage
9 the risk associated with providing services under a prepaid or
10 fixed-sum rate system.
11 f. If the department and the agency share risk of
12 custodial nursing home placement, payment rates during the
13 first 3 years of operation shall be set at not more than 100
14 percent of the costs to the agency and the department of
15 providing equivalent services to the population within the
16 area of the pilot project for the year prior to the year in
17 which the pilot project is implemented, adjusted forward to
18 account for inflation and policy changes in the Medicaid
19 program. In subsequent years, the rate shall be negotiated,
20 based on the cost experience of the entity in providing
21 contracted services, but may not exceed 95 percent of the
22 amount that would have been paid in the pilot project area
23 absent the prepaid or fixed sum reimbursement methodology.
24 g. Community care for the elderly lead agencies that
25 have operated for a period of at least 20 years, which provide
26 Medicare-certified services to elders, and which have
27 developed a system of service provision by health care
28 volunteers shall be given priority in the selection of the
29 pilot project if they meet the minimum requirements specified
30 in the competitive procurement.
31 h. The agency and the department shall adopt rules
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SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
1 necessary to comply with or administer these requirements,
2 effect and implement interagency agreements between the agency
3 and the department, and comply with federal requirements.
4 i. The department and the agency shall seek federal
5 waivers necessary to implement the requirements of this
6 section.
7 j. The Department of Elderly Affairs shall conduct or
8 contract for an evaluation of the demonstration project. The
9 department shall submit the evaluation to the Governor and the
10 Legislature by January 1, 2007. The evaluation must address
11 the effectiveness of the pilot project in providing a
12 comprehensive system of appropriate and high-quality long-term
13 care services to elders in the least restrictive setting and
14 make recommendations on expanding the project to other parts
15 of the state.
16 4. The department, in consultation with the agency,
17 shall study the integration of the database systems for the
18 Comprehensive Assessment and Review of Long-Term Care (CARES)
19 program and the Client Information and Referral Tracking
20 System (CIRTS) and develop a plan for database integration.
21 The department shall submit the plan to the Governor, the
22 President of the Senate, and the Speaker of the House of
23 Representatives by December 31, 2004.
24 5. The department, in consultation with the agency and
25 the Department of Children and Family Services, shall develop
26 two pilot projects to transition area agencies on aging into
27 resource centers on aging. By December 31, 2004, the
28 department, in consultation with the agency and the Department
29 of Children and Family Services, shall develop an
30 implementation plan for transitioning area agencies on aging
31 into resource centers on aging and submit the plan to the
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SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
1 Governor, the President of the Senate, and the Speaker of the
2 House of Representatives. The plan must include qualifications
3 for designation as a center and the functions to be performed
4 by each center. The department shall determine the entities to
5 be designated as resource centers on aging by means of
6 competitive procurement. The department shall select the area
7 agencies on aging based on each agency's demonstration of:
8 a. Expertise in the needs of each target population
9 the center proposes to serve and a thorough knowledge of the
10 providers that serve these populations;
11 b. Strong connections to service providers, volunteer
12 agencies, and community institutions;
13 c. Expertise in information and referral activities;
14 d. Knowledge of long-term care resources, including
15 resources designed to provide services in the least
16 restrictive setting;
17 e. Financial solvency and stability;
18 f. The ability to collect, monitor, and analyze data
19 in a timely and accurate manner, along with systems that meet
20 the department's standards;
21 g. A commitment to adequate staffing by qualified
22 personnel to effectively perform all functions; and
23 h. The ability to meet all performance standards
24 established by the department.
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26 The department shall select two area agencies on aging as
27 pilot projects for resource centers on aging by June 30, 2005.
28 6. The department, in consultation with the agency,
29 shall develop a plan to evaluate the newly integrated
30 fee-for-service program and the managed pilot project over
31 time, from the beginning of the implementation process
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SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
1 forward. The department shall contract with a research entity
2 through competitive procurement to help develop the evaluation
3 plan and conduct the evaluation. The evaluation shall be
4 ongoing and shall determine whether the newly integrated
5 program and the managed pilot project are achieving the goals
6 of the programs and evaluate the effects the changes in the
7 system have had on consumers. The evaluation plan must include
8 baseline measures for evaluating the fee-for-service program
9 and the managed pilot project, with a focus on cost
10 effectiveness, the quality of care, and consumer satisfaction.
11 The department shall submit the plan to the Governor, the
12 President of the Senate, and the Speaker of the House of
13 Representatives by December 31, 2004.
14 7. The agency, in consultation with the department,
15 shall work with the fiscal agent for the Medicaid program to
16 develop a service utilization reporting system that operates
17 through the fiscal agent for the capitated plans.
18 (c) During the 2005-2006 state fiscal year:
19 1. The agency, in consultation with the department,
20 shall monitor the newly integrated fee-for-service program and
21 the managed pilot project and report on the progress of those
22 programs to the Governor, the President of the Senate, and the
23 Speaker of the House of Representatives by June 30, 2006. The
24 report must include an initial evaluation of the programs in
25 their early stages following the evaluation plan developed by
26 the department, in consultation with the agency and the
27 selected contractor.
28 2. The department shall monitor the pilot projects for
29 resource centers on aging and report on the progress of those
30 projects to the Governor, the President of the Senate, and the
31 Speaker of the House of Representatives by June 30, 2006. The
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SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
1 report must include an evaluation of the implementation
2 process in its early stages.
3 3. The department, in consultation with the agency,
4 shall integrate the database systems for the Comprehensive
5 Assessment and Review of Long-Term Care (CARES) program and
6 the Client Information and Referral Tracking System (CIRTS)
7 into a single operating assessment information system by June
8 30, 2006.
9 4. The agency, in consultation with the department
10 shall integrate the Frail Elder Option into the Nursing Home
11 Diversion pilot project and each program's funds into one
12 capitated program serving the aged.
13 a. The department, in consultation with the agency,
14 shall develop uniform standards for case management in this
15 newly integrated capitated system.
16 b. The agency shall seek federal waivers necessary to
17 integrate these programs.
18 c. The department, in consultation with the agency,
19 shall adopt any rules necessary to comply with or administer
20 these requirements, effect and implement interagency
21 agreements between the department and the agency, and comply
22 with federal requirements.
23 (d) During the 2006-2007 state fiscal year:
24 1. The agency, in consultation with the department,
25 shall evaluate the Alzheimer's Disease waiver program and the
26 Adult Day Health Care waiver program to assess whether
27 providing limited intensive services through these waiver
28 programs produce better outcomes for individuals than
29 providing those services through the fee-for-service or
30 capitated programs that provide a larger array of services.
31 2. The agency, in consultation with the department,
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SENATE AMENDMENT
Bill No. CS for SB 1226
Amendment No. ___ Barcode 423446
1 shall begin discussions with the federal Centers for Medicare
2 and Medicaid Services regarding the inclusion of Medicare into
3 the integrated long-term care system. By December 31, 2006,
4 the agency shall provide to the Governor, the President of the
5 Senate, and the Speaker of the House of Representatives a plan
6 for including Medicare in the integrated long-term care
7 system.
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