Senate Bill sb2364c1

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2005                           CS for SB 2364

    By the Committee on Health Care; and Senator Fasano





    587-2017-05

  1                      A bill to be entitled

  2         An act relating to elderly affairs; amending s.

  3         430.205, F.S.; deleting the requirement for the

  4         Agency for Health Care Administration to

  5         develop a plan to integrate a plan for frail

  6         elderly persons into a diversion pilot program;

  7         deleting the agency's requirement to integrate

  8         two separate Medicaid waiver programs into one

  9         waiver program; deleting the requirement to

10         seek federal waivers for these waiver programs;

11         requiring the agency and the Department of

12         Elderly Affairs to reimburse providers and

13         develop standards for case management within a

14         certain Medicaid waiver program; authorizing

15         the coordinating of certain medical services to

16         be included in the capitated rate for case

17         management services; deleting the agency's

18         requirements to implement interagency

19         agreements; providing reimbursement for an

20         elderly lead agency on a prepaid or fixed-sum

21         basis for certain services under a particular

22         diversion pilot project; clarifying that the

23         lead agency be reimbursed for all services by

24         the third year of operation; revising the basis

25         under which the agency is required to develop

26         reimbursement rates; deleting the method of

27         rate of payment for custodial nursing home

28         placement beyond the first 3 years; deleting

29         the department's requirements to study and

30         develop a plan for the integration of certain

31         database systems and submit the plan to the

                                  1

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1         Legislature; amending s. 430.7031, F.S.;

 2         deleting the requirement for certain program

 3         staff to annually review a certain number of

 4         case files to find certain nursing home

 5         residents who are eligible for possible

 6         community placement; amending s. 430.705, F.S.;

 7         revising eligibility requirements relating to

 8         financial solvency for entities that provide

 9         services under the long-term care community

10         diversion pilot projects; authorizing the

11         department to adopt rules; amending s. 430.707,

12         F.S.; requiring project providers to report

13         quarterly to the department regarding

14         compliance with financial requirements;

15         repealing s. 430.041, F.S., relating to the

16         Office of Long-Term-Care Policy; providing an

17         effective date.

18  

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

20  

21         Section 1.  Paragraphs (b) and (c) of subsection (6) of

22  section 430.205, Florida Statutes, are amended to read:

23         430.205  Community care service system.--

24         (6)  Notwithstanding other requirements of this

25  chapter, the Department of Elderly Affairs and the Agency for

26  Health Care Administration shall develop an integrated

27  long-term-care delivery system.

28         (b)  During the 2004-2005 state fiscal year:

29         1.  The agency, in consultation with the department,

30  shall develop an implementation plan to integrate the Frail

31  Elder Option into the Nursing Home Diversion pilot project and

                                  2

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1  each program's funds into one capitated program serving the

 2  aged. Beginning July 1, 2004, the agency may not enroll

 3  additional individuals in the Frail Elder Option.

 4         2.  The agency, in consultation with the department,

 5  shall integrate the Aged and Disabled Adult Medicaid waiver

 6  program and the Assisted Living for the Elderly Medicaid

 7  waiver program and each program's funds into one

 8  fee-for-service Medicaid waiver program serving the aged and

 9  disabled. Once the programs are integrated, funding to provide

10  care in assisted-living facilities under the new waiver may

11  not be less than the amount appropriated in the 2003-2004

12  fiscal year for the Assisted Living for the Elderly Medicaid

13  waiver.

14         a.  The agency shall seek federal waivers necessary to

15  integrate these waiver programs.

16         1.b.  The agency and the department shall reimburse

17  providers for case management services on a capitated basis

18  and develop uniform standards for case management within the

19  Aged and Disabled Adult in this fee-for-service Medicaid

20  waiver program. The coordination of acute and chronic medical

21  services for individuals may shall be included in the

22  capitated rate for case management services.

23         c.  The agency, in consultation with and the

24  department, shall adopt any rules necessary to comply with or

25  administer these requirements, effect and implement

26  interagency agreements between the department and the agency,

27  and comply with federal requirements.

28         2.3.  The Legislature finds that preservation of the

29  historic aging network of lead agencies is essential to the

30  well-being of Florida's elderly population. The Legislature

31  finds that the Florida aging network constitutes a system of

                                  3

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1  essential community providers which should be nurtured and

 2  assisted to develop systems of operations which allow the

 3  gradual assumption of responsibility and financial risk for

 4  managing a client through the entire continuum of long-term

 5  care services within the area the lead agency is currently

 6  serving, and which allow lead agency providers to develop

 7  managed systems of service delivery. The department, in

 8  consultation with the agency, shall therefore:

 9         a.  Develop a demonstration project in which existing

10  community care for the elderly lead agencies are assisted in

11  transferring their business model and the service delivery

12  system within their current community care service area to

13  enable assumption, over a period of time, of full risk as a

14  community diversion pilot project contractor providing

15  long-term care services in the areas of operation. The

16  department, in consultation with the agency and the Department

17  of Children and Family Services, shall develop an

18  implementation plan for no more than three lead agencies by

19  October 31, 2004.

20         b.  In the demonstration area, a community care for the

21  elderly lead agency shall be initially reimbursed on a prepaid

22  or fixed-sum basis for all home and community-based services

23  provided under the long-term care community diversion pilot

24  project newly integrated fee-for-service Medicaid waiver. By

25  the end of the third year of operation, the lead agency shall

26  be reimbursed on a prepaid or fixed-sum basis for

27  demonstration project shall include all services provided

28  under the long-term care community diversion pilot project.

29         c.  During the first year of operation, the department,

30  in consultation with the agency, may place providers at risk

31  to provide nursing home services for the enrolled individuals

                                  4

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1  who are participating in the demonstration project. During the

 2  3-year development period, the agency and the department may

 3  limit the level of custodial nursing home risk that the

 4  administering entities assume. Under risk-sharing

 5  arrangements, during the first 3 years of operation, the

 6  department, in consultation with the agency, may reimburse the

 7  administering entity for the cost of providing nursing home

 8  care for Medicaid-eligible participants who have been

 9  permanently placed and remain in a nursing home for more than

10  1 year, or may disenroll such participants from the

11  demonstration project.

12         d.  The agency, in consultation with the department,

13  shall develop reimbursement rates based on the federally

14  approved, actuarially certified rate methodology for the

15  long-term care community diversion pilot project historical

16  cost experience of the state in providing long-term care and

17  nursing home services under Medicaid waiver programs to the

18  population 65 years of age and older in the area served by the

19  pilot project.

20         e.  The department, in consultation with the agency,

21  shall ensure that the entity or entities receiving prepaid or

22  fixed-sum reimbursement are assisted in developing internal

23  management and financial control systems necessary to manage

24  the risk associated with providing services under a prepaid or

25  fixed-sum rate system.

26         f.  If the department and the agency share risk of

27  custodial nursing home placement, payment rates during the

28  first 3 years of operation shall be set at not more than 100

29  percent of the costs to the agency and the department of

30  providing equivalent services to the population within the

31  area of the pilot project for the year prior to the year in

                                  5

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1  which the pilot project is implemented, adjusted forward to

 2  account for inflation and policy changes in the Medicaid

 3  program. In subsequent years, the rate shall be negotiated,

 4  based on the cost experience of the entity in providing

 5  contracted services, but may not exceed 95 percent of the

 6  amount that would have been paid in the pilot project area

 7  absent the prepaid or fixed sum reimbursement methodology.

 8         g.  Community care for the elderly lead agencies that

 9  have operated for a period of at least 20 years, which provide

10  Medicare-certified services to elders, and which have

11  developed a system of service provision by health care

12  volunteers shall be given priority in the selection of the

13  pilot project if they meet the minimum requirements specified

14  in the competitive procurement.

15         h.  The agency and the department shall adopt rules

16  necessary to comply with or administer these requirements,

17  effect and implement interagency agreements between the agency

18  and the department, and comply with federal requirements.

19         i.  The department and the agency shall seek federal

20  waivers necessary to implement the requirements of this

21  section.

22         j.  The Department of Elderly Affairs shall conduct or

23  contract for an evaluation of the demonstration project. The

24  department shall submit the evaluation to the Governor and the

25  Legislature by January 1, 2007. The evaluation must address

26  the effectiveness of the pilot project in providing a

27  comprehensive system of appropriate and high-quality,

28  long-term care services to elders in the least restrictive

29  setting and make recommendations on expanding the project to

30  other parts of the state. This sub-subparagraph is subject to

31  an appropriation by the Legislature.

                                  6

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1         4.  The department, in consultation with the agency,

 2  shall study the integration of the database systems for the

 3  Comprehensive Assessment and Review of Long-Term Care (CARES)

 4  program and the Client Information and Referral Tracking

 5  System (CIRTS) and develop a plan for database integration.

 6  The department shall submit the plan to the Governor, the

 7  President of the Senate, and the Speaker of the House of

 8  Representatives by December 31, 2004.

 9         3.5.  The agency, in consultation with the department,

10  shall work with the fiscal agent for the Medicaid program to

11  develop a service utilization reporting system that operates

12  through the fiscal agent for the capitated plans.

13         (c)  During the 2005-2006 state fiscal year:

14         1.  The agency, in consultation with the department,

15  shall monitor the newly integrated programs and report on the

16  progress of those programs to the Governor, the President of

17  the Senate, and the Speaker of the House of Representatives by

18  June 30, 2006. The report must include an initial evaluation

19  of the programs in their early stages following the evaluation

20  plan developed by the department, in consultation with the

21  agency and the selected contractor.

22         2.  The department shall monitor the pilot projects for

23  resource centers on aging and report on the progress of those

24  projects to the Governor, the President of the Senate, and the

25  Speaker of the House of Representatives by June 30, 2006. The

26  report must include an evaluation of the implementation

27  process in its early stages.

28         3.  The department, in consultation with the agency,

29  shall integrate the database systems for the Comprehensive

30  Assessment and Review for of Long-Term Care Services (CARES)

31  program and the Client Information and Referral Tracking

                                  7

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1  System (CIRTS) into a single operating assessment information

 2  system by June 30, 2006.

 3         4.  The agency, in consultation with the department,

 4  shall integrate the Frail Elder Option into the Nursing Home

 5  Diversion pilot project and each program's funds into one

 6  capitated program serving the aged.

 7         a.  The department, in consultation with the agency,

 8  shall develop uniform standards for case management in this

 9  newly integrated capitated system.

10         b.  The agency shall seek federal waivers necessary to

11  integrate these programs.

12         c.  The department, in consultation with the agency,

13  shall adopt any rules necessary to comply with or administer

14  these requirements, effect and implement interagency

15  agreements between the department and the agency, and comply

16  with federal requirements.

17         Section 2.  Subsection (2) of section 430.7031, Florida

18  Statutes, is amended to read:

19         430.7031  Nursing home transition program.--The

20  department and the Agency for Health Care Administration:

21         (2)  Shall collaboratively work to identify nursing

22  home residents who are able to move to community placements,

23  and to provide case management and supportive services to such

24  individuals while they are in nursing homes to assist such

25  individuals to move in moving to less expensive and less

26  restrictive settings. CARES program staff shall annually

27  review at least 20 percent of the case files for nursing home

28  residents who are Medicaid recipients to determine which

29  nursing home residents are able to move to community

30  placements.

31  

                                  8

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1         Section 3.  Subsection (2) of section 430.705, Florida

 2  Statutes, is amended, and subsection (10) is added to that

 3  section, to read:

 4         430.705  Implementation of the long-term care community

 5  diversion pilot projects.--

 6         (2)(a)  The department shall select projects whose

 7  design and providers demonstrate capacity to maximize the

 8  placement of participants in the least restrictive appropriate

 9  care setting.

10         (b)  The department shall select providers that meet

11  all of the following criteria. Providers shall:

12         1.  Have a plan administrator who is dedicated to the

13  diversion pilot project and project staff who perform the

14  necessary project administrative functions, including data

15  collection, reporting, and analysis.

16         2.  Demonstrate the ability to provide program

17  enrollees with a choice of care provider by contracting with

18  multiple providers that provide the same type of service.

19         3.  Demonstrate through performance or other documented

20  means the capacity for prompt payment of claims as specified

21  under s. 641.3155.

22         4.  Maintain an insolvency protection account in a bank

23  or savings and loan association located in this state with a

24  balance of at least $100,000 into which monthly deposits equal

25  to at least 5 percent of premiums received under the project

26  are made until the balance equals 2 percent of the total

27  contract amount. The account shall be established with such

28  terms as to ensure that funds may be withdrawn only with the

29  signature approval of designated department representatives.

30         5.  Maintain a surplus of at least $1.5 million as

31  determined by the department. Each applicant and each provider

                                  9

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1  shall furnish to the department initial and annual unqualified

 2  audited financial statements prepared by a certified public

 3  accountant that expressly confirm that the applicant or

 4  provider satisfies this surplus requirement. The department

 5  may approve a waiver of compliance with the surplus

 6  requirement for an existing diversion provider. The

 7  department's approval of this waiver must be contingent on the

 8  provider demonstrating proof to the department that the entity

 9  has posted and maintains a $1.5 million performance bond that

10  is written by an insurer licensed to transact insurance in

11  this state, in lieu of meeting the surplus requirement. The

12  department may not approve a waiver of compliance with the

13  surplus requirement that extends beyond June 30, 2006. As used

14  in this subparagraph, the term:

15         a.  "Existing diversion provider" means an entity that

16  is approved by the department, on or before June 30, 2005, to

17  provide services to consumers through any long-term care

18  community diversion pilot project authorized under ss.

19  430.701-430.709.

20         b.  "Surplus" has the same meaning as in s. 641.19(19).

21         (c)  The requirements of paragraph (b) do not apply to

22  entities selected to provide services in the pilot projects

23  authorized under s. 430.205(6)(b)2. The department, in

24  consultation with the agency, shall develop by rule minimum

25  financial solvency and reporting standards for these providers

26  which are reflective of the amount of risk the provider will

27  assume under the pilot project. The standards adopted by rule

28  shall ensure safety for the pilot project enrollees and

29  financial protection for the state in the event of a

30  provider's inability to continue providing services under the

31  project. The department shall select providers that:

                                  10

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1         (a)  Are determined by the Department of Financial

 2  Services to:

 3         1.  Meet surplus requirements specified in s. 641.225;

 4         2.  Demonstrate the ability to comply with the

 5  standards for financial solvency specified in s. 641.285;

 6         3.  Demonstrate the ability to provide for the prompt

 7  payment of claims as specified in s. 641.3155; and

 8         4.  Demonstrate the ability to provide technology with

 9  the capability for data collection that meets the security

10  requirements of the federal Health Insurance Portability and

11  Accountability Act of 1996, 42 C.F.R. ss. 160 and 164.

12         (b)  Demonstrate the ability to contract with multiple

13  providers that provide the same type of service.

14         (10)  The department, in consultation with the agency,

15  may adopt any rules necessary to administer the long-term care

16  community diversion pilot projects authorized under ss.

17  430.701-430.709.

18         Section 4.  Subsection (1) of section 430.707, Florida

19  Statutes, is amended to read:

20         430.707  Contracts.--

21         (1)  The department, in consultation with the agency,

22  shall select and contract with managed care organizations and,

23  on a prepaid basis, with other qualified providers as defined

24  in s. 430.703(7) to provide long-term care within community

25  diversion pilot project areas. All providers shall The agency

26  shall evaluate and report quarterly to the department

27  regarding the entity's the compliance by other qualified

28  providers with all the financial and quality assurance

29  requirements of the contract.

30         Section 5.  Section 430.041, Florida Statutes, is

31  repealed.

                                  11

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






    Florida Senate - 2005                           CS for SB 2364
    587-2017-05




 1         Section 6.  This act shall take effect upon becoming a

 2  law.

 3  

 4          STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
                       COMMITTEE SUBSTITUTE FOR
 5                         Senate Bill 2364

 6                                 

 7  The committee substitute modifies financial solvency
    requirements for "other qualified providers" within the
 8  long-term care community diversion pilot projects (Nursing
    Home Diversion and PACE programs) under the Department of
 9  Elderly Affairs. The standards are rewritten in such a way as
    to ensure that the state can approve the financial viability
10  of these other qualified providers, and allow them to remain
    diversion program providers for up to 1-year, or until they
11  meet the solvency requirements. Within this 1-year period,
    these providers may post a performance bond in lieu of meeting
12  the surplus requirement. The committee substitute provides
    rule authority to the department, in consultation with AHCA,
13  and requires quarterly financial reporting by providers to
    ensure that the providers not only met those standards upon
14  signing the contract, but maintain those standards throughout
    the contract period. The committee substitute also repeals the
15  Office of Long-Term-Care Policy in the Department of Elderly
    Affairs.
16  

17  

18  

19  

20  

21  

22  

23  

24  

25  

26  

27  

28  

29  

30  

31  

                                  12

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