Senate Bill sb1208

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2005                                  SB 1208

    By Senator Peaden





    2-1101-05                                           See HB 371

  1                      A bill to be entitled

  2         An act relating to long-term care coverage;

  3         amending s. 409.902, F.S.; directing the Agency

  4         for Health Care Administration to establish the

  5         Long-term Care Partnership Program; providing

  6         purpose and duties; amending s. 409.905, F.S.;

  7         providing conditions for eligibility; directing

  8         the agency to submit a plan and proposed

  9         legislation to the Legislature; providing a

10         contingent effective date.

11  

12  Be It Enacted by the Legislature of the State of Florida:

13  

14         Section 1.  Section 409.902, Florida Statutes, is

15  amended to read:

16         409.902  Designated single state agency; payment

17  requirements; program title; release of medical records;

18  Florida Long-term Care Partnership Program.--

19         (1)  The Agency for Health Care Administration is

20  designated as the single state agency authorized to make

21  payments for medical assistance and related services under

22  Title XIX of the Social Security Act. These payments shall be

23  made, subject to any limitations or directions provided for in

24  the General Appropriations Act, only for services included in

25  the program, shall be made only on behalf of eligible

26  individuals, and shall be made only to qualified providers in

27  accordance with federal requirements for Title XIX of the

28  Social Security Act and the provisions of state law. This

29  program of medical assistance is designated the "Medicaid

30  program." The Department of Children and Family Services is

31  responsible for Medicaid eligibility determinations,

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    Florida Senate - 2005                                  SB 1208
    2-1101-05                                           See HB 371




 1  including, but not limited to, policy, rules, and the

 2  agreement with the Social Security Administration for Medicaid

 3  eligibility determinations for Supplemental Security Income

 4  recipients, as well as the actual determination of

 5  eligibility. As a condition of Medicaid eligibility, subject

 6  to federal approval, the Agency for Health Care Administration

 7  and the Department of Children and Family Services shall

 8  ensure that each recipient of Medicaid consents to the release

 9  of her or his medical records to the Agency for Health Care

10  Administration and the Medicaid Fraud Control Unit of the

11  Department of Legal Affairs.

12         (2)  The Agency for Health Care Administration is

13  directed to establish the Florida Long-term Care Partnership

14  Program, which shall:

15         (a)  Provide incentives for an individual to obtain

16  insurance to cover the costs of long-term care.

17         (b)  Review and approve, in consultation with the

18  Office of Insurance Regulation, long-term care insurance

19  policies for designation as approved long-term care

20  partnership program policies.

21         (c)  Provide a mechanism to qualify for coverage of the

22  costs of long-term care needs under Medicaid without first

23  being required to substantially exhaust his or her resources,

24  including a reduction of the individual's asset valuation by

25  $1 for each $1 of benefits paid out under the individual's

26  approved long-term care partnership program policy as a

27  determination of Medicaid eligibility.

28         (d)  Provide counseling services to assist an

29  individual in planning for long-term care needs.

30  

31  

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    Florida Senate - 2005                                  SB 1208
    2-1101-05                                           See HB 371




 1         (e)  Alleviate the financial burden on the state's

 2  medical assistance program by encouraging the pursuit of

 3  private initiatives.

 4         Section 2.  Subsection (8) of section 409.905, Florida

 5  Statutes, is amended to read:

 6         409.905  Mandatory Medicaid services.--The agency may

 7  make payments for the following services, which are required

 8  of the state by Title XIX of the Social Security Act,

 9  furnished by Medicaid providers to recipients who are

10  determined to be eligible on the dates on which the services

11  were provided. Any service under this section shall be

12  provided only when medically necessary and in accordance with

13  state and federal law. Mandatory services rendered by

14  providers in mobile units to Medicaid recipients may be

15  restricted by the agency. Nothing in this section shall be

16  construed to prevent or limit the agency from adjusting fees,

17  reimbursement rates, lengths of stay, number of visits, number

18  of services, or any other adjustments necessary to comply with

19  the availability of moneys and any limitations or directions

20  provided for in the General Appropriations Act or chapter 216.

21         (8)  NURSING FACILITY SERVICES.--The agency shall pay

22  for 24-hour-a-day nursing and rehabilitative services for a

23  recipient in a nursing facility licensed under part II of

24  chapter 400 or in a rural hospital, as defined in s. 395.602,

25  or in a Medicare certified skilled nursing facility operated

26  by a hospital, as defined by s. 395.002(11), that is licensed

27  under part I of chapter 395, and in accordance with provisions

28  set forth in s. 409.908(2)(a), which services are ordered by

29  and provided under the direction of a licensed physician.

30  However, if a nursing facility has been destroyed or otherwise

31  made uninhabitable by natural disaster or other emergency and

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    Florida Senate - 2005                                  SB 1208
    2-1101-05                                           See HB 371




 1  another nursing facility is not available, the agency must pay

 2  for similar services temporarily in a hospital licensed under

 3  part I of chapter 395 provided federal funding is approved and

 4  available. The agency shall pay only for bed-hold days if the

 5  facility has an occupancy rate of 95 percent or greater. When

 6  determining eligibility for nursing and rehabilitative

 7  services, if the individual is a beneficiary of an approved

 8  long-term care partnership program policy and has exhausted

 9  the benefits of the policy, the total countable assets of the

10  individual shall be reduced by $1 for each $1 of benefits paid

11  out under the individual's approved long-term care partnership

12  program policy. The agency is authorized to seek any federal

13  waivers to implement this policy.

14         Section 3.  The Agency for Health Care Administration

15  shall develop a plan for implementation of the Florida

16  Long-term Care Partnership Program. The agency shall present

17  the plan in the form of recommended legislation to the

18  President of the Senate and the Speaker of House of

19  Representatives prior to the commencement of the next

20  legislative session.

21         Section 4.  This act shall take effect upon becoming a

22  law, except that the amendments to sections 409.902 and

23  409.905, Florida Statutes, provided in this act shall take

24  effect contingent upon amendment to section 1917(b)(1)(c) of

25  the Social Security Act by the United States Congress to

26  delete the "May 14, 1993," deadline for approval by states of

27  long-term care partnership plans.

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29  

30  

31  

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