HB 1465

CS

CHAMBER ACTION

1	The Elder & Long-Term Care Committee recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to Medicaid reimbursement to nursing
7	homes; amending s. 409.908, F.S.; requiring the Agency for
8	Health Care Administration to establish a Nursing Home
9	Voluntary Competitive Bid Pilot Program for certain
10	nursing homes in two counties for a specified period;
11	permitting licensed nursing homes to bid on rates for
12	Medicaid certified beds under certain circumstances;
13	requiring the agency to provide a list of approved bidders
14	to social service providers; requiring the agency to
15	evaluate the pilot program by a specified time; requiring
16	a report to the Governor and Legislature; providing an
17	effective date.
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19	Be It Enacted by the Legislature of the State of Florida:
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21	Section 1.  Paragraph (a) of subsection (2) of section
22	409.908, Florida Statutes, is amended to read:
23	409.908  Reimbursement of Medicaid providers.--Subject to
24	specific appropriations, the agency shall reimburse Medicaid
25	providers, in accordance with state and federal law, according
26	to methodologies set forth in the rules of the agency and in
27	policy manuals and handbooks incorporated by reference therein.
28	These methodologies may include fee schedules, reimbursement
29	methods based on cost reporting, negotiated fees, competitive
30	bidding pursuant to s. 287.057, and other mechanisms the agency
31	considers efficient and effective for purchasing services or
32	goods on behalf of recipients. If a provider is reimbursed based
33	on cost reporting and submits a cost report late and that cost
34	report would have been used to set a lower reimbursement rate
35	for a rate semester, then the provider's rate for that semester
36	shall be retroactively calculated using the new cost report, and
37	full payment at the recalculated rate shall be effected
38	retroactively. Medicare-granted extensions for filing cost
39	reports, if applicable, shall also apply to Medicaid cost
40	reports. Payment for Medicaid compensable services made on
41	behalf of Medicaid eligible persons is subject to the
42	availability of moneys and any limitations or directions
43	provided for in the General Appropriations Act or chapter 216.
44	Further, nothing in this section shall be construed to prevent
45	or limit the agency from adjusting fees, reimbursement rates,
46	lengths of stay, number of visits, or number of services, or
47	making any other adjustments necessary to comply with the
48	availability of moneys and any limitations or directions
49	provided for in the General Appropriations Act, provided the
50	adjustment is consistent with legislative intent.
51	(2)(a)1.  Reimbursement to nursing homes licensed under
52	part II of chapter 400 and state-owned-and-operated intermediate
53	care facilities for the developmentally disabled licensed under
54	chapter 393 must be made prospectively.
55	2.  Unless otherwise limited or directed in the General
56	Appropriations Act, reimbursement to hospitals licensed under
57	part I of chapter 395 for the provision of swing-bed nursing
58	home services must be made on the basis of the average statewide
59	nursing home payment, and reimbursement to a hospital licensed
60	under part I of chapter 395 for the provision of skilled nursing
61	services must be made on the basis of the average nursing home
62	payment for those services in the county in which the hospital
63	is located. When a hospital is located in a county that does not
64	have any community nursing homes, reimbursement must be
65	determined by averaging the nursing home payments, in counties
66	that surround the county in which the hospital is located.
67	Reimbursement to hospitals, including Medicaid payment of
68	Medicare copayments, for skilled nursing services shall be
69	limited to 30 days, unless a prior authorization has been
70	obtained from the agency. Medicaid reimbursement may be extended
71	by the agency beyond 30 days, and approval must be based upon
72	verification by the patient's physician that the patient
73	requires short-term rehabilitative and recuperative services
74	only, in which case an extension of no more than 15 days may be
75	approved. Reimbursement to a hospital licensed under part I of
76	chapter 395 for the temporary provision of skilled nursing
77	services to nursing home residents who have been displaced as
78	the result of a natural disaster or other emergency may not
79	exceed the average county nursing home payment for those
80	services in the county in which the hospital is located and is
81	limited to the period of time which the agency considers
82	necessary for continued placement of the nursing home residents
83	in the hospital.
84	3.  The agency shall establish a Nursing Home Voluntary
85	Competitive Bid Pilot Program in two counties for a 12-month
86	period for nursing homes licensed under chapter 400 with empty
87	Medicaid certified beds. Opening bids must be at a rate below
88	existing Medicaid reimbursement rates within the catchment area.
89	All nursing homes with a standard license in the pilot area can
90	voluntarily participate in the program. A nursing home may not
91	participate in the pilot program while it has a conditional
92	license. No rules shall prohibit Medicaid beneficiaries or their
93	families from choosing among those facilities that are Medicaid
94	certified. The agency shall update and provide a list of
95	approved bidders within the pilot areas to all social service
96	providers in that area, including hospitals, assisted living
97	facilities, and any entity that makes referrals to nursing
98	homes.
99	4.  The agency shall evaluate the pilot program after the
100	12-month period is completed, including an evaluation of the
101	effectiveness of the program, the impact, if any, on quality of
102	care, and the amount of savings to the state and submit a report
103	to the Governor, the Speaker of the House of Representatives,
104	and the President of the Senate no later than 90 days after the
105	completion of the pilot program.
106	Section 2.  This act shall take effect July 1, 2005.

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