Amendment
Bill No. 1893

Amendment No. 430313

CHAMBER ACTION
Senate		House
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1	Representative(s) Homan offered the following:
2
3	Amendment (with directory and title amendments)
4	Remove lines 176-701 and insert:
5	to methodologies set forth in the rules of the agency and in
6	policy manuals and handbooks incorporated by reference therein.
7	These methodologies may include fee schedules, reimbursement
8	methods based on cost reporting, negotiated fees, competitive
9	bidding pursuant to s. 287.057, and other mechanisms the agency
10	considers efficient and effective for purchasing services or
11	goods on behalf of recipients. If a provider is reimbursed based
12	on cost reporting and submits a cost report late and that cost
13	report would have been used to set a lower reimbursement rate
14	for a rate semester, then the provider's rate for that semester
15	shall be retroactively calculated using the new cost report, and
16	full payment at the recalculated rate shall be effected
17	retroactively. Medicare-granted extensions for filing cost
18	reports, if applicable, shall also apply to Medicaid cost
19	reports. Payment for Medicaid compensable services made on
20	behalf of Medicaid eligible persons is subject to the
21	availability of moneys and any limitations or directions
22	provided for in the General Appropriations Act or chapter 216.
23	Further, nothing in this section shall be construed to prevent
24	or limit the agency from adjusting fees, reimbursement rates,
25	lengths of stay, number of visits, or number of services, or
26	making any other adjustments necessary to comply with the
27	availability of moneys and any limitations or directions
28	provided for in the General Appropriations Act, provided the
29	adjustment is consistent with legislative intent.
30	(2)
31	(b)  Subject to any limitations or directions provided for
32	in the General Appropriations Act, the agency shall establish
33	and implement a Florida Title XIX Long-Term Care Reimbursement
34	Plan (Medicaid) for nursing home care in order to provide care
35	and services in conformance with the applicable state and
36	federal laws, rules, regulations, and quality and safety
37	standards and to ensure that individuals eligible for medical
38	assistance have reasonable geographic access to such care.
39	1.  Changes of ownership or of licensed operator do not
40	qualify for increases in reimbursement rates associated with the
41	change of ownership or of licensed operator. The agency shall
42	amend the Title XIX Long Term Care Reimbursement Plan to provide
43	that the initial nursing home reimbursement rates, for the
44	operating, patient care, and MAR components, associated with
45	related and unrelated party changes of ownership or licensed
46	operator filed on or after September 1, 2001, are equivalent to
47	the previous owner's reimbursement rate.
48	2.  The agency shall amend the long-term care reimbursement
49	plan and cost reporting system to create direct care and
50	indirect care subcomponents of the patient care component of the
51	per diem rate. These two subcomponents together shall equal the
52	patient care component of the per diem rate. Separate cost-based
53	ceilings shall be calculated for each patient care subcomponent.
54	The direct care and indirect care subcomponents subcomponent of
55	the per diem rate shall be limited by the cost-based class
56	ceiling, and the indirect care subcomponent shall be limited by
57	the lower of a the cost-based class ceiling, a by the target
58	rate class ceiling, or an by the individual provider target for
59	each subcomponent. The agency shall adjust the patient care
60	component effective January 1, 2002. The cost to adjust the
61	direct care subcomponent shall be the net of the total funds
62	previously allocated for the case mix add-on. The agency shall
63	make the required changes to the nursing home cost reporting
64	forms to implement this requirement effective January 1, 2002.
65	3.  The direct care subcomponent shall include salaries and
66	benefits of direct care staff providing nursing services
67	including registered nurses, licensed practical nurses, and
68	certified nursing assistants who deliver care directly to
69	residents in the nursing home facility. This excludes nursing
70	administration, MDS, and care plan coordinators, staff
71	development, and staffing coordinator.
72	4.  All other patient care costs shall be included in the
73	indirect care cost subcomponent of the patient care per diem
74	rate. There shall be no costs directly or indirectly allocated
75	to the direct care subcomponent from a home office or management
76	company.
77	5.  On July 1 of each year, the agency shall report to the
78	Legislature direct and indirect care costs, including average
79	direct and indirect care costs per resident per facility and
80	direct care and indirect care salaries and benefits per category
81	of staff member per facility.
82	6.  In order to offset the cost of general and professional
83	liability insurance, the agency shall amend the plan to allow
84	for interim rate adjustments to reflect increases in the cost of
85	general or professional liability insurance for nursing homes.
86	This provision shall be implemented to the extent existing
87	appropriations are available.
88
89	It is the intent of the Legislature that the reimbursement plan
90	achieve the goal of providing access to health care for nursing
91	home residents who require large amounts of care while
92	encouraging diversion services as an alternative to nursing home
93	care for residents who can be served within the community. The
94	agency shall base the establishment of any maximum rate of
95	payment, whether overall or component, on the available moneys
96	as provided for in the General Appropriations Act. The agency
97	may base the maximum rate of payment on the results of
98	scientifically valid analysis and conclusions derived from
99	objective statistical data pertinent to the particular maximum
100	rate of payment.
101	(14)  A provider of prescribed drugs shall be reimbursed
102	the least of the amount billed by the provider, the provider's
103	usual and customary charge, or the Medicaid maximum allowable
104	fee established by the agency, plus a dispensing fee.
105	(a)  For pharmacies with less than $75,000 in average
106	aggregate monthly payments, the Medicaid maximum allowable fee
107	for ingredient cost will be based on the lower of: average
108	wholesale price (AWP) minus 15.4 percent, wholesaler acquisition
109	cost (WAC) plus 5.75 percent, the federal upper limit (FUL), the
110	state maximum allowable cost (SMAC), or the usual and customary
111	(UAC) charge billed by the provider.
112	(b)  For pharmacies with $75,000 or more in average
113	aggregate monthly payments, the Medicaid maximum allowable fee
114	for ingredient cost will be based on the lower of: average
115	wholesale price (AWP) minus 17 percent, wholesaler acquisition
116	cost (WAC) plus 3.5 percent, the federal upper limit (FUL), the
117	state maximum allowable cost (SMAC), or the usual and customary
118	(UAC) charge billed by the provider.
119	(c)  Medicaid providers are required to dispense generic
120	drugs if available at lower cost and the agency has not
121	determined that the branded product is more cost-effective,
122	unless the prescriber has requested and received approval to
123	require the branded product. The agency is directed to implement
124	a variable dispensing fee for payments for prescribed medicines
125	while ensuring continued access for Medicaid recipients. The
126	variable dispensing fee may be based upon, but not limited to,
127	either or both the volume of prescriptions dispensed by a
128	specific pharmacy provider, the volume of prescriptions
129	dispensed to an individual recipient, and dispensing of
130	preferred-drug-list products. The agency may increase the
131	pharmacy dispensing fee authorized by statute and in the annual
132	General Appropriations Act by $0.50 for the dispensing of a
133	Medicaid preferred-drug-list product and reduce the pharmacy
134	dispensing fee by $0.50 for the dispensing of a Medicaid product
135	that is not included on the preferred drug list. The agency may
136	establish a supplemental pharmaceutical dispensing fee to be
137	paid to providers returning unused unit-dose packaged
138	medications to stock and crediting the Medicaid program for the
139	ingredient cost of those medications if the ingredient costs to
140	be credited exceed the value of the supplemental dispensing fee.
141	The agency is authorized to limit reimbursement for prescribed
142	medicine in order to comply with any limitations or directions
143	provided for in the General Appropriations Act, which may
144	include implementing a prospective or concurrent utilization
145	review program.
146
147	=========== D I R E C T O R Y  A M E N D M E N T ==========
148	Remove line 171 and insert:
149	Section 6.  Paragraph (b) of subsection (2) and subsection
150	(14) of section 409.908, Florida Statutes, are amended
151
152	================ T I T L E  A M E N D M E N T =============
153	Remove lines 14 and 15 and insert:
154	F.S.; revising provisions

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