HB 0887

1	A bill to be entitled
2	An act relating to services for the elderly; amending s.
3	400.441, F.S.; requiring facilities to conduct resident
4	elopement drills; amending s. 409.912, F.S.; allowing
5	contracting for certain CARES program functions; requiring
6	assessment and review of certain nursing home placements;
7	requiring a database to track individuals assessed under
8	the CARES program and diverted from nursing home care;
9	requiring an annual study on individuals diverted from
10	nursing home placement; requiring a report on modifying
11	level of care criteria; amending s. 430.205, F.S.;
12	requiring development of a managed care delivery system
13	for Medicaid services; providing for submission to the
14	Governor and Legislature of a plan to include Medicare in
15	an integrated long-term-care system; providing for
16	integration of Medicare and Medicaid services; creating s.
17	430.2071, F.S.; requiring integration of certain home and
18	community-based Medicaid waiver programs; requiring a
19	specific funding level after integration; requiring the
20	agency to seek waivers or amendments to waivers as
21	necessary; providing that the agency may reimburse
22	providers; requiring rules; requiring the department and
23	agency to study and develop a plan to integrate certain
24	databases; requiring that such plan be submitted to the
25	Governor and Legislature; requiring evaluations of the
26	plan and certain services; amending s. 430.041, F.S.;
27	revising duties to the Office of Long-Term-Care Policy;
28	removing the advisory council of the Office of Long-Term-
29	Care Policy; providing for an interagency coordinating
30	team; revising requirements for reports; amending s.
31	430.203, F.S.; revising requirements for the community
32	care service system; revising requirements for competitive
33	bidding exemptions; requiring all services to be delivered
34	directly by or through lead agencies; amending s.
35	430.7031, F.S.; requiring CARES program staff to review a
36	percentage of case files; creating s. 430.2053, F.S.;
37	requiring pilot projects for aging resource centers;
38	requiring an implementation plan; requiring that area
39	agencies on aging submit proposals for transition to aging
40	resource centers; requiring a review of the department's
41	process for determining readiness; specifying purposes and
42	duties of an aging resource center; requiring integration
43	of certain functions of other state agencies; specifying
44	criteria for selection of entities to become aging
45	resource centers; specifying the duties and
46	responsibilities of community-care-for-the-elderly
47	providers in an area served by an aging resource center;
48	specifying programs administered by an aging resource
49	center; requiring rules; allowing capitated payments;
50	requiring reports; amending s. 430.703, F.S.; revising
51	requirements for other qualified providers; amending s.
52	430.705, F.S.; providing additional requirements for long-
53	term-care community diversion pilot projects; providing
54	legislative findings; requiring a demonstration project;
55	requiring rules; requiring integration of certain managed
56	care programs; amending s. 430.502, F.S.; designating a
57	Memory Disorder Clinic; amending s. 1004.445, F.S.;
58	providing for appointments to the board of the Alzheimer's
59	Center; requiring a report; making contingent on an
60	appropriation; providing an effective date.
61
62	Be It Enacted by the Legislature of the State of Florida:
63
64	Section 1.  Paragraph (l) is added to subsection (1) of
65	section 400.441, Florida Statutes, to read:
66	400.441  Rules establishing standards.--
67	(1)  It is the intent of the Legislature that rules
68	published and enforced pursuant to this section shall include
69	criteria by which a reasonable and consistent quality of
70	resident care and quality of life may be ensured and the results
71	of such resident care may be demonstrated. Such rules shall also
72	ensure a safe and sanitary environment that is residential and
73	noninstitutional in design or nature. It is further intended
74	that reasonable efforts be made to accommodate the needs and
75	preferences of residents to enhance the quality of life in a
76	facility. In order to provide safe and sanitary facilities and
77	the highest quality of resident care accommodating the needs and
78	preferences of residents, the department, in consultation with
79	the agency, the Department of Children and Family Services, and
80	the Department of Health, shall adopt rules, policies, and
81	procedures to administer this part, which must include
82	reasonable and fair minimum standards in relation to:
83	(l)  The establishment of specific policies and procedures
84	on resident elopement. Facilities shall conduct a minimum of two
85	resident elopement drills per year. All administrators and
86	direct care staff shall participate in the drills. Facilities
87	shall document the drills.
88	Section 2.  Paragraph (h) of subsection (4) and subsection
89	(15) of section 409.912, Florida Statutes, are amended to read:
90	409.912  Cost-effective purchasing of health care.--The
91	agency shall purchase goods and services for Medicaid recipients
92	in the most cost-effective manner consistent with the delivery
93	of quality medical care. The agency shall maximize the use of
94	prepaid per capita and prepaid aggregate fixed-sum basis
95	services when appropriate and other alternative service delivery
96	and reimbursement methodologies, including competitive bidding
97	pursuant to s. 287.057, designed to facilitate the cost-
98	effective purchase of a case-managed continuum of care. The
99	agency shall also require providers to minimize the exposure of
100	recipients to the need for acute inpatient, custodial, and other
101	institutional care and the inappropriate or unnecessary use of
102	high-cost services. The agency may establish prior authorization
103	requirements for certain populations of Medicaid beneficiaries,
104	certain drug classes, or particular drugs to prevent fraud,
105	abuse, overuse, and possible dangerous drug interactions. The
106	Pharmaceutical and Therapeutics Committee shall make
107	recommendations to the agency on drugs for which prior
108	authorization is required. The agency shall inform the
109	Pharmaceutical and Therapeutics Committee of its decisions
110	regarding drugs subject to prior authorization.
111	(4)  The agency may contract with:
112	(h)  An entity authorized in s. 430.705(10) 430.205 to
113	contract with the agency and the Department of Elderly Affairs
114	to provide health care and social services on a prepaid or
115	fixed-sum basis to elderly recipients. Such prepaid health care
116	services entities are exempt from the provisions of part I of
117	chapter 641 for the first 3 years of operation. An entity
118	recognized under this paragraph that demonstrates to the
119	satisfaction of the Office of Insurance Regulation that it is
120	backed by the full faith and credit of one or more counties in
121	which it operates may be exempted from s. 641.225.
122	(15)(a)  The agency shall operate the Comprehensive
123	Assessment and Review and Evaluation for Long-Term Care Services
124	(CARES) nursing facility preadmission screening program to
125	ensure that Medicaid payment for nursing facility care is made
126	only for individuals whose conditions require such care and to
127	ensure that long-term care services are provided in the setting
128	most appropriate to the needs of the person and in the most
129	economical manner possible. The CARES program shall also ensure
130	that individuals participating in Medicaid home and community-
131	based waiver programs meet criteria for those programs,
132	consistent with approved federal waivers.
133	(b)  The agency shall operate the CARES program through an
134	interagency agreement with the Department of Elderly Affairs.
135	The agency, with agreement from the Department of Elderly
136	Affairs, may contract for any function or activity of the CARES
137	program, including any function or activity required by 42
138	C.F.R. part 483.20, relating to preadmission screening and
139	resident review, if the agency and the department can
140	demonstrate that contracting for such a function will result in
141	a savings to the state and increased efficiency and
142	accountability.
143	(c)  Prior to making payment for nursing facility services
144	for a Medicaid recipient, the agency must verify that the
145	nursing facility preadmission screening program has determined
146	that the individual requires nursing facility care and that the
147	individual cannot be safely served in community-based programs.
148	The nursing facility preadmission screening program shall refer
149	a Medicaid recipient to a community-based program if the
150	individual could be safely served at a lower cost and the
151	recipient chooses to participate in such program.
152	(d)  For the purpose of initiating immediate prescreening
153	and diversion assistance for individuals residing in nursing
154	homes and in order to make families aware of alternative long-
155	term-care resources so that they may choose a more cost-
156	effective setting for long-term placement, within existing
157	appropriated staffing, CARES staff shall conduct an assessment
158	and review of a sample of individuals whose nursing home stay is
159	expected to exceed 20 days, regardless of the initial funding
160	source for the nursing home placement. CARES staff shall provide
161	counseling and referral services to these individuals regarding
162	choosing a facility. This paragraph does not apply to continuing
163	care facilities licensed under chapter 651 or to retirement
164	communities that provide a combination of nursing home,
165	independent living, and other long-term-care services.
166	(e)(d)  By January 15 1 of each year, the agency shall
167	submit a report to the President of the Senate, the Speaker of
168	the House of Representatives, Legislature and the Office of
169	Long-Term-Care Policy describing the operations of the CARES
170	program. The report must describe:
171	1.  Rate of diversion to community alternative programs;
172	2.  CARES program staffing needs to achieve additional
173	diversions;
174	3.  Reasons the program is unable to place individuals in
175	less restrictive settings when such individuals desired such
176	services and could have been served in such settings;
177	4.  Barriers to appropriate placement, including barriers
178	due to policies or operations of other agencies or state-funded
179	programs; and
180	5.  Statutory changes necessary to ensure that individuals
181	in need of long-term care services receive care in the least
182	restrictive environment.
183	(f)  Subject to available appropriations, the Department of
184	Elderly Affairs shall develop a database to track individuals
185	over time who are assessed under the CARES program and who are
186	diverted from nursing home placement. By January 15 of each
187	year, the department shall submit to the President of the
188	Senate, the Speaker of the House of Representatives, and the
189	Office of Long-Term-Care Policy a longitudinal study of the
190	individuals who are diverted from nursing home placement. The
191	study must include:
192	1.  The demographic characteristics of the individuals
193	assessed and diverted from nursing home placement, including,
194	but not limited to, age, race, gender, frailty, caregiver
195	status, living arrangements, and geographic location.
196	2.  A summary of community services provided to individuals
197	for 1 year after assessment and diversion.
198	3.  A summary of inpatient hospital admissions for
199	individuals who have been diverted.
200	4.  A summary of the length of time between diversion and
201	subsequent entry into a nursing home or death.
202	(g)  By July 1, 2005, the department and the Agency for
203	Health Care Administration shall report to the President of the
204	Senate and the Speaker of the House of Representatives regarding
205	the impact to the state of modifying level of care criteria to
206	eliminate the Intermediate II level of care.
207	Section 3.  Subsection (6) of section 430.205, Florida
208	Statutes, is amended to read:
209	430.205  Community care service system.--
210	(6)  Notwithstanding other requirements of this chapter,
211	the department of Elderly Affairs and the Agency for Health Care
212	Administration shall develop a model system to transition all
213	Medicaid state-funded services for elderly individuals in
214	portions of one or more of the department's planning and service
215	areas, including both rural and urban areas, to a managed,
216	integrated long-term-care delivery system under the direction of
217	a single entity.
218	(a)  The duties of each managed care organization, or other
219	qualified provider as defined in s. 430.703, contracted to
220	operate the managed the model system shall include organizing
221	and administering service delivery for the elderly, obtaining
222	contracts for services with providers in the area, monitoring
223	the quality of services provided, determining levels of need and
224	disability for payment purposes, and other activities determined
225	by the department and the agency in order to operate the managed
226	model system.
227	(b)  The agency and the department shall integrate all
228	funding for Medicaid services to individuals over the age of 60
229	65 in the managed system model planning and service areas into a
230	single per-person per-month payment rate, except that funds for
231	Medicaid behavioral health care services are exempt from this
232	section. The funds to be integrated shall include:
233	1.  Community-care-for-the-elderly funds;
234	2.  Home-care-for-the-elderly funds;
235	3.  Local services program funds;
236	4.  Contracted services funds;
237	5.  Alzheimer's disease initiative funds;
238	1.6.  Medicaid home and community-based waiver services
239	funds;
240	2.7.  Funds for all Medicaid services authorized in ss.
241	409.905 and 409.906, including Medicaid nursing home services;
242	and
243	3.8.  Funds paid for Medicare premiums, coinsurance and
244	deductibles for persons dually eligible for Medicaid and
245	Medicare as prescribed in s. 409.908(13).
246
247	The department and the agency shall not make Medicaid payments
248	for services for people age 60 or older in the areas in which
249	the managed system operates 65 and older except through the
250	managed model delivery system.
251	(c)  The entities entity selected to administer the managed
252	model system shall develop a comprehensive health and long-term-
253	care service delivery system through contracts with providers of
254	medical, social, and long-term-care services sufficient to meet
255	the needs of the population age 60 or older 65 and older. The
256	entity selected to administer the model system shall not
257	directly provide services other than intake, assessment, and
258	referral services.
259	(d)  The department and the agency shall contract through
260	competitive procurement with no less than two and no more than
261	three managed care organizations, or other qualified providers
262	as defined in s. 430.703, to administer the project determine
263	which of the department's planning and services areas is to be
264	designated as a model area by means of a request for proposals.
265	The department shall select an area to be designated as a model
266	area and the entity to administer the model system based on
267	demonstration of capacity of each provider the entity to:
268	1.  Develop contracts with providers currently under
269	contract with the department, area agencies on aging, or
270	community-care-for-the-elderly lead agencies.;
271	2.  Provide a comprehensive system of appropriate medical
272	and long-term-care services that provides high-quality medical
273	and social services to assist older individuals in remaining in
274	the least restrictive setting.;
275	3.  Demonstrate a quality assurance and quality improvement
276	system satisfactory to the department and the agency.;
277	4.  Develop a system to identify participants who have
278	special health care needs such as polypharmacy, mental health
279	and substance abuse problems, falls, chronic pain, nutritional
280	deficits, and cognitive deficits, in order to respond to and
281	meet these needs.;
282	5.  Use a multidisciplinary team approach to participant
283	management which ensures that information is shared among
284	providers responsible for delivering care to a participant.;
285	6.  Ensure medical oversight of care plans and service
286	delivery, regular medical evaluation of care plans, and the
287	availability of medical consultation for case managers and
288	service coordinators.;
289	7.  Develop, monitor, and enforce quality-of-care
290	requirements.;
291	(e)8.  The selected entities shall secure subcontracts with
292	providers of medical, nursing home, and community-based long-
293	term-care services sufficient to ensure assure access to and
294	choice of providers by project participants. In the absence of a
295	separate contractual relationship between a nursing home
296	provider and a managed care organization, the nursing home shall
297	cooperate with the managed care organization's efforts to
298	determine if a project participant would be more appropriately
299	served in a community setting, and payments shall be made in
300	accordance with Medicaid nursing home rates as calculated in the
301	state plan.;
302	(f)  To ensure that the contracted providers meet a high
303	quality of care standard, the entity selected to administer the
304	managed care system shall:
305	1.  Develop and use a service provider qualification system
306	which describes the quality-of-care standards that a nursing
307	home must meet in order to obtain a contract with the managing
308	entity.
309	2.  Contract with all qualified nursing homes located in
310	the area that is served by the project, including those
311	designated as Gold Seal.
312	3.  Ensure that as an area is transitioned to managed care,
313	individuals who are residents of nursing homes in the project
314	area prior to plan implementation and who do not choose to move
315	to another setting are allowed to remain in the facility in
316	which they are receiving care.
317	(g)9.  The selected entities shall:
318	1.  Ensure a system of case management and service
319	coordination which includes educational and training standards
320	for case managers and service coordinators.;
321	2.10.  Develop a business plan that considers the ability
322	of the applicant to organize and operate a risk-bearing entity.;
323	3.11.  Furnish evidence of adequate liability insurance
324	coverage or an adequate plan of self-insurance that is
325	determined adequate by the Department of Financial Services to
326	respond to claims for injuries arising out of the furnishing of
327	health care.; and
328	4.12.  Provide, through contract or otherwise, for periodic
329	review of its medical facilities as required by the department
330	and the agency.
331	5.  Furnish in a timely manner, in a form determined by the
332	department, requested financial data that has been determined by
333	the department and the agency to be necessary to develop and
334	annually recertify appropriate capitation rates for the project.
335	6.  Provide enrollees the ability, to the extent possible,
336	to choose care providers, including nursing home and assisted
337	living service providers affiliated with an individual's
338	religious faith or denomination and nursing home and ALF
339	providers that are part of a retirement community in which an
340	enrollee resides as provided for in s. 641.31(25).
341
342	The department shall give preference in selecting an area to be
343	designated as a model area to that in which the administering
344	entity is an existing area agency on aging or community-care-
345	for-the-elderly lead agency demonstrating the ability to perform
346	the functions described in this paragraph.
347	(e)  The department in consultation with the selected
348	entity shall develop a statewide proposal regarding the long-
349	term use and structure of a program that addresses a risk pool
350	to reduce financial risk.
351	(h)(f)  The department and the agency shall develop
352	capitation rates based on the historical cost experience of the
353	state in providing acute and long-term-care services to the
354	population over 60 65 years of age in the area served. The
355	agency, in consultation with the department, shall contract for
356	an independent entity to study the historical cost experience,
357	adjusted to reflect changes in regulatory requirements, of the
358	state in providing services listed in paragraph (b) to the
359	population age 60 and older residing within the model area and
360	to develop and certify a per-person, per-month capitation rate
361	for the managed system. The agency, in consultation with the
362	department, shall reevaluate and recertify the capitation rate
363	annually. The agency and the department shall give preference in
364	contracting for the managed system to those entities whose
365	proposals create innovative, functional partnerships with
366	existing community-care-for-the-elderly lead agencies.
367	1.  Payment rates in the first 2 years of operation shall
368	be set at no more than 100 percent of the costs to the state of
369	providing equivalent services to the population of the model
370	area for the year prior to the year in which the model system is
371	implemented, adjusted forward to account for inflation and
372	population growth. In subsequent years, the rate shall be
373	negotiated based on the cost experience of the model system in
374	providing contracted services, but may not exceed 95 percent of
375	the amount that would have been paid by the state in the model
376	planning and service area absent the model integrated service
377	delivery system.
378	2.  The agency and the department may develop innovative
379	risk-sharing agreements that limit the level of custodial
380	nursing home risk that the administering entity assumes,
381	consistent with the intent of the Legislature to reduce the use
382	and cost of nursing home care. Under risk-sharing arrangements,
383	the agency and the department may reimburse the administering
384	entity for the cost of providing nursing home care for Medicaid-
385	eligible participants who have been permanently placed and
386	remain in nursing home care for more than 1 year.
387	(i)(g)  The department and the Agency for Health Care
388	Administration shall seek federal waivers, or amendments to
389	existing waivers, necessary to implement the requirements of
390	this section.
391	(h)  The Department of Children and Family Services shall
392	develop a streamlined and simplified eligibility system and
393	shall outstation a sufficient number and quality of eligibility-
394	determination staff with the administering entity to assure
395	determination of Medicaid eligibility for the integrated service
396	delivery system in the model planning and service area within 10
397	days after receipt of a complete application.
398	(j)(i)  The agency, in consultation with the department,
399	shall begin discussions with the federal Centers for Medicare
400	and Medicaid Services regarding the inclusion of Medicare in an
401	integrated long-term-care system. By December 31, 2006, the
402	agency shall provide to the Governor, the President of the
403	Senate, and the Speaker of the House of Representatives a plan
404	for including Medicare in an integrated long-term-care system
405	The Department of Elderly Affairs shall make arrangements to
406	outstation a sufficient number of nursing home preadmission
407	screening staff with the administering entity to assure timely
408	assessment of level of need for long-term-care services in the
409	model area.
410	(k)(j)  The Department of Elderly Affairs shall conduct or
411	contract for an evaluation of the managed system pilot project.
412	The department shall submit the evaluation to the Governor and
413	the Legislature by January 1, 2006 2005. The evaluation must
414	address the effects of the managed system in pilot project on
415	the effectiveness of the entity providing a comprehensive system
416	of appropriate and high-quality medical and long-term-care
417	services to elders in the least restrictive setting, provide a
418	comparison of average monthly rate incurred by diverted
419	individuals to those of nursing home residents in a similar
420	geographic area, and make recommendations on a phased-in
421	implementation expansion for the rest of the state. In addition,
422	the department, in consultation with the agency, shall consider
423	whether providers operating in the managed system should be
424	placed at risk for the state-funded community care for the
425	elderly, home care for the elderly, and Alzheimer's disease
426	initiative programs.
427	(l)  The agency shall ensure that, to the extent possible,
428	Medicare and Medicaid services are integrated. Where possible,
429	individuals served in the managed system who are eligible for
430	Medicare shall be enrolled in a Medicare managed health care
431	plan operated by the same entity which is placed at risk for
432	long-term care services.
433	Section 4.  Section 430.2071, Florida Statutes, is created
434	to read:
435	430.2071  Home and community-based waiver services.--
436	(1)  The agency, in consultation with the department, shall
437	integrate the assisted living for the elderly Medicaid waiver
438	program into the aged and disabled adult Medicaid waiver program
439	and each program's funds into one fee-for-service Medicaid
440	waiver program serving the aged and disabled.
441	(a)  After the programs are integrated, funding to provide
442	care in assisted-living facilities under the new waiver may not
443	be less than the amount appropriated in the 2003-2004 fiscal
444	year for the assisted living for the elderly Medicaid waiver.
445	(b)  The agency shall seek federal waivers, or amendments
446	to existing waivers, necessary to integrate these waiver
447	programs.
448	(c)  The agency and the department may reimburse providers
449	for case management services on a capitated basis and shall
450	develop uniform standards for case management in this fee-for-
451	service Medicaid waiver program.
452	(d)  The agency and the department shall adopt any rules
453	necessary to comply with or administer these requirements,
454	effect and implement interagency agreements between the
455	department and the agency, and comply with federal requirements.
456	(2)  The department, in consultation with the agency, shall
457	study the integration of the database systems for the
458	Comprehensive Assessment Review and Evaluation for Long-Term
459	Care Services (CARES) program and the Client Information and
460	Referral Tracking System (CIRTS) and develop a plan for database
461	integration.
462	(3)  The department, in consultation with the agency,
463	subject to an appropriation, shall develop a plan to evaluate
464	the newly integrated program over time, from the beginning of
465	the implementation process forward. The department shall
466	contract with a research entity through competitive procurement
467	to help develop the evaluation plan and conduct the evaluation.
468	The evaluation shall be ongoing and shall determine whether the
469	newly integrated program is achieving its goals and evaluate the
470	effects the changes have had on consumers. The evaluation plan
471	must include baseline measures for evaluating cost-
472	effectiveness, the quality of care, and consumer satisfaction of
473	the program. The department shall submit the plan to the
474	Governor, the President of the Senate, and the Speaker of the
475	House of Representatives by December 31, 2004.
476	(4)  The department, in consultation with the agency and
477	the Department of Children and Family Services, shall develop a
478	plan to improve the interaction among the department's newly
479	integrated assessment database, the Florida Medicaid Management
480	Information System, and the FLORIDA system in order to
481	facilitate enrollment of individuals in capitated and fee-for-
482	service programs, as well as to monitor eligibility
483	requirements.
484	(5)  Consistent with federal requirements, the agency, in
485	consultation with the department, shall evaluate the Alzheimer's
486	disease waiver program and the adult day health care waiver
487	program to assess whether providing limited intensive services
488	through these waiver programs produces better outcomes for
489	individuals than providing those services through the fee-for-
490	service or capitated programs that provide a larger array of
491	services.
492	Section 5.  Section 430.041, Florida Statutes, is amended
493	to read:
494	430.041  Office of Long-Term-Care Policy.--
495	(1)  There is established in the Department of Elderly
496	Affairs the Office of Long-Term-Care Policy to evaluate the
497	state's long-term-care service delivery system and make
498	recommendations to increase the efficiency and effectiveness of
499	government-funded long-term-care programs for availability and
500	the use of noninstitutional settings to provide care to the
501	elderly and to ensure coordination among the agencies
502	responsible for setting policies for funding and for
503	administering the long-term-care programs for the elderly
504	continuum.
505	(2)  The purpose of the Office of Long-Term-Care Policy is
506	to:
507	(a)  Ensure close communication and coordination among
508	state agencies involved in developing and administering a more
509	efficient and coordinated long-term-care service delivery system
510	in this state;
511	(b)  Identify duplication and unnecessary service provision
512	in the long-term-care system and make recommendations to
513	decrease inappropriate service provision;
514	(b)(c)  Review current programs providing long-term-care
515	services to determine whether the programs are cost effective,
516	of high quality, and operating efficiently and make
517	recommendations to increase consistency and effectiveness in the
518	state's long-term-care programs;
519	(c)(d)  Develop strategies for promoting and implementing
520	cost-effective home and community-based services as an
521	alternative to institutional care which coordinate and integrate
522	the continuum of care needs of the elderly; and
523	(d)  Recommend roles for state agencies that are
524	responsible for administering long-term-care programs for the
525	elderly and an organization framework for the planning,
526	coordination, implementation, and evaluation of long-term-care
527	programs for the elderly.
528	(e)  Assist the Office of Long-Term-Care Policy Advisory
529	Council as necessary to help implement this section.
530	(3)  The Director of the Office of Long-Term-Care Policy
531	shall be appointed by, and serve at the pleasure of, the
532	Governor. The director shall report to, and be under the general
533	supervision of, the Secretary of Elderly Affairs and shall not
534	be subject to supervision by any other employee of the
535	department.
536	(4)  The Office of Long-Term-Care Policy shall have an
537	advisory council. The purposes of the advisory council are to
538	provide assistance and direction to the office and to ensure
539	that the appropriate state agencies are properly implementing
540	recommendations from the office.
541	(a)  The advisory council shall consist of:
542	1.  A member of the Senate, appointed by the President of
543	the Senate;
544	2.  A member of the House of Representatives, appointed by
545	the Speaker of the House of Representatives;
546	3.  The Secretary of Health Care Administration;
547	4.  The Secretary of Elderly Affairs;
548	5.  The Secretary of Children and Family Services;
549	6.  The Secretary of Health;
550	7.  The Executive Director of the Department of Veterans'
551	Affairs;
552	8.  Three people with broad knowledge and experience in the
553	delivery of long-term-care services, appointed by the Governor
554	from groups representing elderly persons; and
555	9.  Two representatives of people using long-term-care
556	services, appointed by the Governor from groups representing
557	elderly persons.
558	(b)  The council shall elect a chair from among its
559	membership to serve for a 1-year term. A chair may not serve
560	more than two consecutive terms.
561	(c)  Members shall serve without compensation, but are
562	entitled to receive reimbursement for travel and per diem as
563	provided in s. 112.061.
564	(d)  The advisory council shall meet at the call of its
565	chair or at the request of a majority of its members. During its
566	first year of existence, the advisory council shall meet at
567	least monthly.
568	(e)  Members of the advisory council appointed by the
569	Governor shall serve at the pleasure of the Governor and shall
570	be appointed to 4-year staggered terms in accordance with s.
571	20.052.
572	(4)(5)(a)  The Department of Elderly Affairs shall provide
573	administrative support and services to the Office of Long-Term-
574	Care Policy.
575	(b)  The office shall call upon appropriate agencies of
576	state government, including the centers on aging in the State
577	University System, for assistance needed in discharging its
578	duties.
579	(c)  Each state agency represented on the Office of Long-
580	Term-Care Policy Advisory Council shall make at least one
581	employee available to work with the Office of Long-Term-Care
582	Policy. All state agencies and universities shall assist the
583	office in carrying out its responsibilities prescribed by this
584	section.
585	(d)  The Secretary of Health Care Administration, the
586	Secretary of Elderly Affairs, the Secretary of Children and
587	Family Services, the Secretary of Health, and the executive
588	director of the Department of Veterans' Affairs shall each
589	appoint at least one high-level employee with the authority to
590	recommend and implement agency policy and with experience in the
591	area of long-term-care service delivery and financing to work
592	with the Office of Long-Term-Care Policy as part of an
593	interagency coordinating team. The interagency coordinating team
594	shall meet monthly with the director of the Office of Long-Term-
595	Care Policy to implement the purposes of the office.
596	(e)(d)  Each state agency shall pay from its own funds any
597	expenses related to its support of the Office of Long-Term-Care
598	Policy and its participation on the advisory council. The
599	Department of Elderly Affairs shall be responsible for expenses
600	related to participation on the advisory council by members
601	appointed by the Governor.
602	(5)(6)(a)  By December 31 of each year 1, 2002, the office
603	shall submit to the Governor, the President of the Senate, and
604	the Speaker of the House of Representatives a advisory council a
605	preliminary report of its activities and the progress made in
606	findings and recommendations on improving the long-term-care
607	continuum in this state and make recommendations accordingly.
608	The report shall contain the activities completed by the office
609	during the calendar year, recommendations and implementation
610	proposals for policy changes, and as well as legislative and
611	funding recommendations that will make the system more effective
612	and efficient. The report shall contain a specific
613	implementation strategies, with timelines, plan for
614	accomplishing the recommendations and proposals set out in the
615	report. Thereafter, the office shall revise and update the
616	report annually and resubmit it to the advisory council for
617	review and comments by November 1 of each year.
618	(b)  The advisory council shall review and recommend any
619	suggested changes to the preliminary report, and each subsequent
620	annual update of the report, within 30 days after the receipt of
621	the preliminary report. Suggested revisions, additions, or
622	deletions shall be made to the Director of the Office of Long-
623	Term-Care Policy.
624	(c)  The office shall submit its final report, and each
625	subsequent annual update of the report, to the Governor and the
626	Legislature within 30 days after the receipt of any revisions,
627	additions, or deletions suggested by the advisory council, or
628	after the time such comments are due to the office.
629	Section 6.  Subsection (3) and paragraph (c) of subsection
630	(9) of section 430.203, Florida Statutes, are amended to read:
631	430.203  Community care for the elderly; definitions.--As
632	used in ss. 430.201-430.207, the term:
633	(3)  "Community care service system" means a service
634	network comprising a variety of home-delivered services, day
635	care services, and other basic services, hereinafter referred to
636	as "core services," for functionally impaired elderly persons
637	which are provided by or through several agencies under the
638	direction of a single lead agency. Its purpose is to provide a
639	continuum of care encompassing a full range of preventive,
640	maintenance, and restorative services for functionally impaired
641	elderly persons.
642	(9)  "Lead agency" means an agency designated at least once
643	every 3 years by an area agency on aging as the result of a
644	request for proposal process to be in place no later than the
645	state fiscal year 1996-1997.
646	(c)  In each community care service system the lead agency
647	must be given the authority and responsibility to coordinate
648	some or all of the services, either directly or through
649	subcontracts, for functionally impaired elderly persons. These
650	services must include case management. Other services, such as
651	and may include homemaker and chore services, respite care,
652	adult day care, personal care services, home-delivered meals,
653	counseling, information and referral, and emergency home repair
654	services, may be included subject to competitive bidding. The
655	lead agency must compile community care statistics and monitor,
656	when applicable, subcontracts with agencies providing core
657	services.
658	Section 7.  Subsection (2) of section 430.7031, Florida
659	Statutes, is amended to read:
660	430.7031  Nursing home transition program.--The department
661	and the Agency for Health Care Administration:
662	(2)  Shall collaboratively work to identify Medicaid long-
663	stay nursing home residents who are able to move to community
664	placements, and to provide case management and supportive
665	services to such individuals while they are in nursing homes to
666	assist such individuals in moving to less expensive and less
667	restrictive settings. CARES program staff shall annually review
668	at least 20 percent of the case files for nursing home residents
669	who are Medicaid recipients to determine which nursing home
670	residents are able to move to community placements.
671	Section 8.  Section 430.2053, Florida Statutes, is created
672	to read:
673	430.2053  Aging resource centers.--
674	(1)  The department, in consultation with the Agency for
675	Health Care Administration and the Department of Children and
676	Family Services, shall develop pilot projects for aging resource
677	centers. By October 31, 2004, the department, in consultation
678	with the agency and the Department of Children and Family
679	Services, shall develop an implementation plan for aging
680	resource centers and submit the plan to the Governor, the
681	President of the Senate, and the Speaker of the House of
682	Representatives. The plan must include qualifications for
683	designation as a center, the functions to be performed by each
684	center, and a process for determining that a current area agency
685	on aging is ready to assume the functions of an aging resource
686	center.
687	(2)  Each area agency on aging shall develop, in
688	consultation with the existing community care for the elderly
689	lead agencies within their planning and service areas, a
690	proposal that describes the process the area agency on aging
691	intends to undertake to transition to an aging resource center
692	prior to July 1, 2005, and that describes the area agency's
693	compliance with the requirements of this section. The proposals
694	must be submitted to the department prior to December 31, 2004.
695	The department shall evaluate all proposals for readiness and,
696	prior to March 1, 2005, shall select three area agencies on
697	aging which meet the requirements of this section to begin the
698	transition to aging resource centers. Those area agencies on
699	aging which are not selected to begin the transition to aging
700	resource centers shall, in consultation with the department and
701	the existing community care for the elderly lead agencies within
702	their planning and service areas, amend their proposals as
703	necessary and resubmit them to the department prior to July 1,
704	2005. The department may transition additional area agencies to
705	aging resource centers as it determines that area agencies are
706	in compliance with the requirements of this section.
707	(3)  The Auditor General and the Office of Program Policy
708	Analysis and Government Accountability (OPPAGA) shall jointly
709	review and assess the department's process for determining an
710	area agency's readiness to transition to an aging resource
711	center.
712	(a)  The review must, at a minimum, address the
713	appropriateness of the department's criteria for selection of an
714	area agency to transition to an aging resource center, the
715	instruments applied, the degree to which the department
716	accurately determined each area agency's compliance with the
717	readiness criteria, the quality of the technical assistance
718	provided by the department to an area agency in correcting any
719	weaknesses identified in the readiness assessment, and the
720	degree to which each area agency overcame any identified
721	weaknesses.
722	(b)  Reports of these reviews must be submitted to the
723	appropriate substantive and appropriations committees in the
724	Senate and the House of Representatives on March 1 and September
725	1 of each year until full transition to aging resource centers
726	has been accomplished statewide, except that the first report
727	must be submitted by February 1, 2005, and must address all
728	readiness activities undertaken through December 31, 2004. The
729	perspectives of all participants in this review process must be
730	included in each report.
731	(4)  The purposes of an aging resource center shall be:
732	(a)  To provide Florida's elders and their families with a
733	locally focused, coordinated approach to integrating information
734	and referral for all available services for elders with the
735	eligibility determination entities for state and federally
736	funded long-term-care services.
737	(b)  To provide for easier access to long-term-care
738	services by Florida's elders and their families by creating
739	multiple access points to the long-term-care network that flow
740	through one established entity with wide community recognition.
741	(5)  The duties of an aging resource center are to:
742	(a)  Develop referral agreements with local community
743	service organizations, such as senior centers, existing elder
744	service providers, volunteer associations, and other similar
745	organizations, to better assist clients who do not need or do
746	not wish to enroll in programs funded by the department or the
747	agency. The referral agreements must also include a protocol,
748	developed and approved by the department, which provides
749	specific actions that an aging resource center and local
750	community service organizations must take when an elder or an
751	elder's representative seeking information on long-term-care
752	services contacts a local community service organization prior
753	to contacting the aging resource center. The protocol shall be
754	designed to ensure that elders and their families are able to
755	access information and services in the most efficient and least
756	cumbersome manner possible.
757	(b)  Provide an initial screening of all clients who
758	request long-term care services to determine whether the person
759	would be most appropriately served through any combination of
760	federally funded programs, state-funded programs, locally funded
761	or community volunteer programs, or private funding for
762	services.
763	(c)  Determine eligibility for the programs and services
764	listed in subsection (11) for persons residing within the
765	geographic area served by the aging resource center and
766	determine a priority ranking for services which is based upon
767	the potential recipient's frailty level and likelihood of
768	institutional placement without such services.
769	(d)  Manage the availability of financial resources for the
770	programs and services listed in subsection (11) for persons
771	residing within the geographic area served by the aging resource
772	center.
773	(e)  When financial resources become available, refer a
774	client to the most appropriate entity to begin receiving
775	services. The aging resource center shall make referrals to lead
776	agencies for service provision that ensure that individuals who
777	are vulnerable adults in need of services pursuant to s.
778	415.104(3)(b), or who are victims of abuse, neglect, or
779	exploitation in need of immediate services to prevent further
780	harm and are referred by the adult protective services program,
781	are given primary consideration for receiving community-care-
782	for-the-elderly services in compliance with the requirements of
783	s. 430.205(5)(a) and that other referrals for services are in
784	compliance with s. 430.205(5)(b).
785	(f)  Convene a work group to advise in the planning,
786	implementation, and evaluation of the aging resource center. The
787	work group shall be comprised of representatives of local
788	service providers, Alzheimer's Association chapters, housing
789	authorities, social service organizations, advocacy groups,
790	representatives of clients receiving services through the aging
791	resource center, and any other persons or groups as determined
792	by the department. The aging resource center, in consultation
793	with the work group, must develop annual program improvement
794	plans that shall be submitted to the department for
795	consideration. The department shall review each annual
796	improvement plan and make recommendations on how to implement
797	the components of the plan.
798	(g)  Enhance the existing area agency on aging in each
799	planning and service area by integrating, either physically or
800	virtually, the staff and services of the area agency on aging
801	with the staff of the department's local CARES Medicaid nursing
802	home preadmission screening unit and a sufficient number of
803	staff from the Department of Children and Family Services'
804	Economic Self Sufficiency Unit necessary to determine the
805	financial eligibility for all persons age 60 and older residing
806	within the area served by the aging resource center that are
807	seeking Medicaid services, Supplemental Security Income, and
808	food stamps.
809	(6)  The department shall select the entities to become
810	aging resource centers based on each entity's readiness and
811	ability to perform the duties listed in subsection (5) and the
812	entity's:
813	(a)  Expertise in the needs of each target population the
814	center proposes to serve and a thorough knowledge of the
815	providers that serve these populations.
816	(b)  Strong connections to service providers, volunteer
817	agencies, and community institutions.
818	(c)  Expertise in information and referral activities.
819	(d)  Knowledge of long-term-care resources, including
820	resources designed to provide services in the least restrictive
821	setting.
822	(e)  Financial solvency and stability.
823	(f)  Ability to collect, monitor, and analyze data in a
824	timely and accurate manner, along with systems that meet the
825	department's standards.
826	(g)  Commitment to adequate staffing by qualified personnel
827	to effectively perform all functions.
828	(h)  Ability to meet all performance standards established
829	by the department.
830	(7)  The aging resource center shall have a governing body
831	which shall be the same entity described in s. 20.41(7), and an
832	executive director who may be the same person as described in s.
833	20.41(8). The governing body shall annually evaluate the
834	performance of the executive director.
835	(8)  The aging resource center may not be a provider of
836	direct services other than information and referral services and
837	screening.
838	(9)  The aging resource center must agree to allow the
839	department to review any financial information the department
840	determines is necessary for monitoring or reporting purposes,
841	including financial relationships.
842	(10)  The duties and responsibilities of the community care
843	for the elderly lead agencies within each area served by an
844	aging resource center shall be to:
845	(a)  Develop strong community partnerships to maximize the
846	use of community resources for the purpose of assisting elders
847	to remain in their community settings for as long as it is
848	safely possible.
849	(b)  Conduct comprehensive assessments of clients that have
850	been determined eligible and develop a care plan consistent with
851	established protocols that ensures that the unique needs of each
852	client are met.
853	(11)  The services to be administered through the aging
854	resource center shall include those funded by the following
855	programs:
856	(a)  Community care for the elderly.
857	(b)  Home care for the elderly.
858	(c)  Contracted services.
859	(d)  Alzheimer's disease initiative.
860	(e)  Aged and disabled adult Medicaid waiver.
861	(f)  Assisted living for the frail elderly Medicaid waiver.
862	(g)  Older Americans Act.
863	(12)  The department shall, prior to designation of an
864	aging resource center, develop by rule operational and quality
865	assurance standards and outcome measures to ensure that clients
866	receiving services through all long-term-care programs
867	administered through an aging resource center are receiving the
868	appropriate care they require and that contractors and
869	subcontractors are adhering to the terms of their contracts and
870	are acting in the best interests of the clients they are
871	serving, consistent with the intent of the Legislature to reduce
872	the use of and cost of nursing home care. The department shall
873	by rule provide operating procedures for aging resource centers,
874	which shall include:
875	(a)  Minimum standards for financial operation, including
876	audit procedures.
877	(b)  Procedures for monitoring and sanctioning of service
878	providers.
879	(c)  Minimum standards for technology utilized by the aging
880	resource center.
881	(d)  Minimum staff requirements which shall ensure that the
882	aging resource center employs sufficient quality and quantity of
883	staff to adequately meet the needs of the elders residing within
884	the area served by the aging resource center.
885	(e)  Minimum accessibility standards, including hours of
886	operation.
887	(f)  Minimum oversight standards for the governing body of
888	the aging resource center to ensure its continuous involvement
889	in, and accountability for, all matters related to the
890	development, implementation, staffing, administration, and
891	operations of the aging resource center.
892	(g)  Minimum education and experience requirements for
893	executive directors and other executive staff positions of aging
894	resource centers.
895	(h)  Minimum requirements regarding any executive staff
896	positions that the aging resource center must employ and minimum
897	requirements that a candidate must meet in order to be eligible
898	for appointment to such positions.
899	(13)  In an area in which the department has designated an
900	area agency on aging as an aging resource center, the department
901	and the agency shall not make payments for the services listed
902	in subsection (11) and the Long-Term Care Community Diversion
903	Project for such persons who were not screened and enrolled
904	through the aging resource center.
905	(14)  Each aging resource center shall enter into a
906	memorandum of understanding with the department for
907	collaboration with the CARES unit staff. The memorandum of
908	understanding shall outline the staff person responsible for
909	each function and shall provide the staffing levels necessary to
910	carry out the functions of the aging resource center.
911	(15)  Each aging resource center shall enter into a
912	memorandum of understanding with the Department of Children and
913	Family Services for collaboration with the Economic Self-
914	Sufficiency Unit staff. The memorandum of understanding shall
915	outline which staff persons are responsible for which functions
916	and shall provide the staffing levels necessary to carry out the
917	functions of the aging resource center.
918	(16)  If any of the state activities described in this
919	section are outsourced, either in part or in whole, the contract
920	executing the outsourcing shall mandate that the contractor or
921	its subcontractors shall, either physically or virtually,
922	execute the provisions of the memorandum of understanding
923	instead of the state entity whose function the contractor or
924	subcontractor now performs.
925	(17)  In order to be eligible to begin transitioning to an
926	aging resource center, an area agency on aging board must ensure
927	that the area agency on aging which it oversees meets all of the
928	minimum requirements set by law and in rule.
929	(18)  The department shall monitor the three initial
930	projects for aging resource centers and report on the progress
931	of those projects to the Governor, the President of the Senate,
932	and the Speaker of the House of Representatives by June 30,
933	2005. The report must include an evaluation of the
934	implementation process.
935	(19)(a)  Once an aging resource center is operational, the
936	department, in consultation with the agency, may develop
937	capitation rates for any of the programs administered through
938	the aging resource center. Capitation rates for programs shall
939	be based on the historical cost experience of the state in
940	providing those same services to the population age 60 or older
941	residing within each area served by an aging resource center.
942	Each capitated rate may vary by geographic area as determined by
943	the department.
944	(b)  The department and the agency may determine for each
945	area served by an aging resource center whether it is
946	appropriate, consistent with federal and state laws and
947	regulations, to develop and pay separate capitated rates for
948	each program administered through the aging resource center or
949	to develop and pay capitated rates for service packages which
950	include more than one program or service administered through
951	the aging resource center.
952	(c)  Once capitation rates have been developed and
953	certified as actuarially sound, the department and the agency
954	may pay service providers the capitated rates for services when
955	appropriate.
956	(d)  The department, in consultation with the agency, shall
957	annually reevaluate and recertify the capitation rates,
958	adjusting forward to account for inflation, programmatic
959	changes.
960	(20)  The department, in consultation with the agency,
961	shall submit to the Governor, the President of the Senate, and
962	the Speaker of the House of Representatives, by December 1,
963	2006, a report addressing the feasibility of administering the
964	following services through aging resource centers beginning July
965	1, 2007:
966	(a)  Medicaid nursing home services.
967	(b)  Medicaid transportation services.
968	(c)  Medicaid hospice care services.
969	(d)  Medicaid intermediate care services.
970	(e)  Medicaid prescribed drug services.
971	(f)  Medicaid assistive care services.
972	(g)  Any other long-term-care program or Medicaid service.
973	(21)  This section shall not be construed to allow an aging
974	resource center to restrict, manage or impede the local fund-
975	raising activities of service providers.
976	Section 9.  Subsection (7) of section 430.703, Florida
977	Statutes, is amended to read:
978	430.703  Definitions.--As used in this act, the term:
979	(7)  "Other qualified provider" means an entity licensed
980	under chapter 400 that demonstrates a long-term care continuum,
981	meets the requirements of s. 430.705(2), and meets posts a
982	$500,000 performance bond, and meets all the financial and
983	quality assurance requirements for a provider service network as
984	specified in s. 409.912 and all requirements pursuant to an
985	interagency agreement between the agency and the department.
986	Section 10.  Section 430.705, Florida Statutes, is amended
987	to read:
988	430.705  Implementation of the long-term care community
989	diversion pilot projects.--
990	(1)  In designing and implementing the community diversion
991	pilot projects, the department shall work in consultation with
992	the agency.
993	(2)  The department shall select projects whose design and
994	providers demonstrate capacity to maximize the placement of
995	participants in the least restrictive appropriate care setting.
996	The department shall select providers that have a plan
997	administrator who is dedicated to the diversion pilot project
998	and project staff who perform the necessary project
999	administrative functions, including data collection, reporting,
1000	and analysis. The department shall select providers that:
1001	(a)  Are determined by the Department of Financial Services
1002	to:
1003	1.  Meet surplus requirements specified in s. 641.225.
1004	2.  Demonstrate the ability to comply with the standards
1005	for financial solvency specified in s. 641.285.
1006	3.  Demonstrate the ability to provide for the prompt
1007	payment of claims as specified in s. 641.3155.
1008	4.  Demonstrate the ability to provide technology with the
1009	capability for data collection which meets the security
1010	requirements of the federal Health Insurance Portability and
1011	Accountability Act of 1996, 42 C.F.R. ss. 160 and 164.
1012	(b)  Demonstrate the ability to contract with multiple
1013	providers that provide the same type of service.
1014	(3)  Pursuant to 42 C.F.R. s. 438.6(c), the agency, in
1015	consultation with the department, shall annually reevaluate and
1016	recertify the capitation rates for the diversion pilot projects.
1017	The agency, in consultation with the department, shall secure
1018	the utilization and cost data for Medicaid and Medicare
1019	beneficiaries served by the program which shall be used in
1020	developing rates for the diversion pilot projects.
1021	(4)  In order to achieve rapid enrollment into the program
1022	and efficient diversion of applicants from nursing home care,
1023	the department and the agency shall allow enrollment of Medicaid
1024	beneficiaries on the date that eligibility for the community
1025	diversion pilot project is approved. The provider shall receive
1026	a prorated capitated rate for those enrollees who are enrolled
1027	after the first of each month.
1028	(5)(3)  The department shall provide to prospective
1029	participants a choice of participating in a community diversion
1030	pilot project or any other appropriate placement available. To
1031	the extent possible, individuals shall be allowed to choose
1032	their care providers, including long-term care service providers
1033	affiliated with an individual's religious faith or denomination.
1034	(6)(4)  The department shall enroll participants. Providers
1035	shall not directly enroll participants in community diversion
1036	pilot projects.
1037	(7)(5)  In selecting the pilot project area, the department
1038	shall consider the following factors in the area:
1039	(a)  The nursing home occupancy level.
1040	(b)  The number of certificates of need awarded for nursing
1041	home beds for which renovation, expansion, or construction has
1042	not begun.
1043	(c)  The annual number of additional nursing home beds.
1044	(d)  The annual number of nursing home admissions.
1045	(e)  The adequacy of community-based long-term care service
1046	providers.
1047	(8)(6)  The department may require participants to
1048	contribute to their cost of care in an amount not to exceed the
1049	cost-sharing required of Medicaid-eligible nursing home
1050	residents.
1051	(9)(7)  Community diversion pilot projects must:
1052	(a)  Provide services for participants that are of
1053	sufficient quality, quantity, type, and duration to prevent or
1054	delay nursing facility placement.
1055	(b)  Integrate acute and long-term care services, and the
1056	funding sources for such services, as feasible.
1057	(c)  Encourage individuals, families, and communities to
1058	plan for their long-term care needs.
1059	(d)  Provide skilled and intermediate nursing facility care
1060	for participants who cannot be adequately cared for in
1061	noninstitutional settings.
1062	(10)  The Legislature finds that preservation of the
1063	historic aging network of lead agencies is essential to the
1064	well-being of Florida's elderly population. The Legislature
1065	finds that the Florida aging network constitutes a system of
1066	essential community providers which should be nurtured and
1067	assisted to develop systems of operations which allow the
1068	gradual assumption of responsibility and financial risk for
1069	managing a client through the entire continuum of long-term-care
1070	services within the area the lead agency is currently serving
1071	and which allow lead agency providers to develop managed systems
1072	of service delivery. The department and the agency shall
1073	therefore:
1074	(a)  Develop a demonstration system in which existing
1075	community care for the elderly lead agencies are assisted in
1076	transitioning their business model and the service delivery
1077	system within their current community care service area to
1078	enable assumption, over a period of time, of full risk as a
1079	diversion pilot project contractor providing long-term-care
1080	services in their areas of operation. The department, in
1081	consultation with the Agency for Health Care Administration and
1082	the Department of Children and Family Services, shall develop an
1083	implementation plan for three lead agencies by October 31, 2004.
1084	The department may postpone the bidding specified in s.
1085	430.203(9)(c) until such time as the project areas have been
1086	designated.
1087	(b)  In each demonstration system, a community care for the
1088	elderly lead agency shall be initially reimbursed on a prepaid
1089	or fixed-sum basis for services provided under the Aged and
1090	Disabled Adult Medicaid Waiver Program and the Assisted Living
1091	for the Elderly Medicaid Waiver Program. By the end of the third
1092	year of operation, the demonstration shall include services
1093	under the long-term-care community diversion pilot project.
1094	(c)  During the first year of operation, the department and
1095	the agency may place providers at risk to provide the nursing
1096	home services for the enrolled individuals who are participating
1097	in the demonstration project. During the 3-year development
1098	period, the agency and the department may limit the level of
1099	custodial nursing home risk that the administering entities
1100	assume, consistent with the intent of the Legislature to reduce
1101	the use and cost of nursing home care. Under risk-sharing
1102	arrangements, during the first 3 years of operation, the agency
1103	and the department may reimburse the administering entities for
1104	the cost of providing nursing home care for Medicaid-eligible
1105	participants who have been permanently placed and remain in
1106	nursing home care for more than 1 year, or may disenroll such
1107	participants from the demonstration projects.
1108	(d)  The agency and the department shall develop
1109	reimbursement rates based on the historical cost experience of
1110	the state in providing long-term care and nursing home services
1111	under Medicaid waiver programs and providing state-funded long-
1112	term care services to the population 60 years of age and older
1113	in the area served by the pilot project.
1114	(e)  The agency, in consultation with the department, shall
1115	ensure that the entity or entities receiving prepaid or fixed-
1116	sum reimbursement are assisted in developing internal management
1117	and financial control systems necessary to manage the risk
1118	associated with providing services under a prepaid or fixed-sum
1119	rate system.
1120	(f)  If the agency and the department share risk of
1121	custodial nursing home placement, payment rates during the first
1122	3 years of operation shall be set at not more than 100 percent
1123	of the costs to the agency and the department of providing
1124	equivalent services to the population within the area of the
1125	pilot project for the year prior to the year in which the pilot
1126	project is implemented, adjusted forward to account for
1127	inflation and policy changes of the Medicaid program. In
1128	subsequent years, the rate shall be negotiated, based on the
1129	cost experience of the entity in providing contracted services,
1130	but may not exceed 95 percent of the amount that would have been
1131	paid in the area of the pilot project absent the prepaid or
1132	fixed sum reimbursement methodology.
1133	(g)  Community care for the elderly lead agencies which
1134	have operated for a period of at least 20 years, which operate a
1135	Medicare-certified home health agency, and which have developed
1136	a system of service provision by health care volunteers shall be
1137	given priority in the selection of pilot projects if they meet
1138	the minimum requirements specified in the competitive
1139	procurement.
1140	(h)  In order to facilitate the development of the
1141	demonstration project, the agency, subject to appropriations
1142	included in the General Appropriation Act, shall advance
1143	$500,000, if requested by the lead agency, for the purpose of
1144	funding development costs for each demonstration project
1145	provider. The terms of repayment may not extend beyond 6 years
1146	from the date of funding.
1147	(i)  The agency and the department shall adopt any rules
1148	necessary to comply with or administer these requirements,
1149	effect and implement interagency agreements between the agency
1150	and the department, and comply with federal requirements.
1151	(j)  The department and the agency shall seek federal
1152	waivers necessary to implement the requirements of this section,
1153	including waivers available from the federal Assistant Secretary
1154	on Aging necessary to include Older Americans Act services in
1155	the demonstration project.
1156	(k)  The Department of Elderly Affairs shall conduct or
1157	contract for an evaluation of the demonstration project. The
1158	department shall submit the evaluation to the Governor, the
1159	President of the Senate, and the Speaker of the House of
1160	Representatives by January 1, 2006. The evaluation must address
1161	the effects of the demonstration pilot project on the
1162	effectiveness of the project in providing a comprehensive system
1163	of appropriate and high-quality long-term-care services to
1164	elders in the least restrictive setting and make recommendations
1165	on implementation expansion for other parts of the state.
1166	(11)  The agency, in consultation with the department,
1167	shall evaluate the feasibility of integrating the frail elder
1168	option into the nursing home diversion pilot project and the
1169	feasibility of integrating each program's funds into one
1170	capitated program serving the aged.
1171	(12)  The agency shall seek federal waivers necessary to
1172	place a cap on the number of Nursing Home Diversion providers in
1173	each geographic area. The agency may seek federal approval in
1174	advance of approval of its formal waiver application to limit
1175	the diversion provider network by freezing enrollment of
1176	providers at current levels when an area already has three or
1177	more providers or, in an expansion area, when enrollment reaches
1178	a level of three providers. This subsection does not prevent the
1179	department from approving a provider to expand service to
1180	additional counties within a planning and service area for which
1181	the provider is already approved to serve.
1182	(13)  The agency and the department shall adopt any rules
1183	necessary to comply with or administer these requirements,
1184	effect and implement interagency agreements between the
1185	department and the agency, and comply with federal requirements.
1186	Section 11.  Paragraphs (j) and (k) of subsection (1) of
1187	section 430.502, Florida Statutes, are amended, and paragraph
1188	(l) is added to said subsection, to read:
1189	430.502  Alzheimer's disease; memory disorder clinics and
1190	day care and respite care programs.--
1191	(1)  There is established:
1192	(j)  A memory disorder clinic at Lee Memorial Hospital
1193	created by chapter 63-1552, Laws of Florida, as amended; and
1194	(k)  A memory disorder clinic at Sarasota Memorial Hospital
1195	in Sarasota County; and,
1196	(l)  A memory disorder clinic at Morton Plant Hospital,
1197	Clearwater, in Pinellas County,
1198
1199	for the purpose of conducting research and training in a
1200	diagnostic and therapeutic setting for persons suffering from
1201	Alzheimer's disease and related memory disorders. However,
1202	memory disorder clinics funded as of June 30, 1995, shall not
1203	receive decreased funding due solely to subsequent additions of
1204	memory disorder clinics in this subsection.
1205	Section 12.  Paragraph (b) of subsection (2) of section
1206	1000.445, Florida Statutes, as amended by chapter 2004-2, Laws
1207	of Florida, is amended to read:
1208	1004.445  Johnnie B. Byrd, Sr., Alzheimer's Center and
1209	Research Institute.--
1210	(2)
1211	(b)1.  The affairs of the not-for-profit corporation shall
1212	be managed by a board of directors who shall serve without
1213	compensation. The board of directors shall consist of the
1214	President of the University of South Florida and the chair of
1215	the State Board of Education, or their designees, 5
1216	representatives of the state universities, and no fewer than 9
1217	nor more than 14 representatives of the public who are neither
1218	medical doctors nor state employees. Each director who is a
1219	representative of a state university or of the public shall be
1220	appointed to serve a term of 3 years. The chair of the board of
1221	directors shall be selected by a majority vote of the directors.
1222	Each director shall have only one vote.
1223	2.  The initial board of directors shall consist of the
1224	President of the University of South Florida and the chair of
1225	the State Board of Education, or their designees; the five
1226	university representatives, of whom one shall be appointed by
1227	the Governor, two by the President of the Senate, and two by the
1228	Speaker of the House of Representatives; and nine public
1229	representatives, of whom three shall be appointed by the
1230	Governor, three by the President of the Senate, and three by the
1231	Speaker of the House of Representatives.
1232	3.  Upon the expiration of the terms of the initial
1233	appointed directors, all directors subject to 3-year terms of
1234	office under this paragraph shall be appointed by a majority
1235	vote of the directors. and
1236	4.  The board may be expanded to include additional public
1237	representative directors up to the maximum number allowed.
1238	Additional members shall be added by a majority vote of the
1239	directors.
1240	5.  Any vacancy in office shall be filled for the remainder
1241	of the term by majority vote of the directors. Any director may
1242	be reappointed.
1243	Section 13.  By January 1 of each year, the Department of
1244	Elderly Affairs shall submit to the Governor, the President of
1245	the Senate, and the Speaker of the House of Representatives, a
1246	summary of the results of the departmental monitoring of the
1247	activities of area agencies on aging. The report shall include
1248	information about area agency compliance with state and federal
1249	rules pertaining to all programs administered by the area
1250	agency, information about each area agency's financial
1251	management of state and federally-funded programs, information
1252	about each agency's compliance with the terms of its contracts
1253	with the department, and a summary of corrective action required
1254	by the department.
1255	Section 14.  This act is subject to a specific
1256	appropriation in the General Appropriations Act for fiscal year
1257	2004-2005.
1258	Section 15.  This act shall take effect upon becoming a
1259	law.

CODING: Words stricken are deletions; words underlined are additions.