| 1 | The Insurance Committee recommends the following: |
| 2 |
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| 3 | Council/Committee Substitute |
| 4 | Remove the entire bill and insert: |
| 5 | A bill to be entitled |
| 6 | An act relating to long-term care coverage; amending s. |
| 7 | 409.905, F.S.; providing conditions for eligibility; |
| 8 | creating s. 409.9102, F.S.; directing the Agency for |
| 9 | Health Care Administration to establish the Long-term Care |
| 10 | Partnership Program; providing purpose and duties; |
| 11 | directing the agency to submit a plan and proposed |
| 12 | legislation to the Legislature; providing a contingent |
| 13 | effective date. |
| 14 |
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| 15 | Be It Enacted by the Legislature of the State of Florida: |
| 16 |
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| 17 | Section 1. Subsection (8) of section 409.905, Florida |
| 18 | Statutes, is amended to read: |
| 19 | 409.905 Mandatory Medicaid services.--The agency may make |
| 20 | payments for the following services, which are required of the |
| 21 | state by Title XIX of the Social Security Act, furnished by |
| 22 | Medicaid providers to recipients who are determined to be |
| 23 | eligible on the dates on which the services were provided. Any |
| 24 | service under this section shall be provided only when medically |
| 25 | necessary and in accordance with state and federal law. |
| 26 | Mandatory services rendered by providers in mobile units to |
| 27 | Medicaid recipients may be restricted by the agency. Nothing in |
| 28 | this section shall be construed to prevent or limit the agency |
| 29 | from adjusting fees, reimbursement rates, lengths of stay, |
| 30 | number of visits, number of services, or any other adjustments |
| 31 | necessary to comply with the availability of moneys and any |
| 32 | limitations or directions provided for in the General |
| 33 | Appropriations Act or chapter 216. |
| 34 | (8) NURSING FACILITY SERVICES.--The agency shall pay for |
| 35 | 24-hour-a-day nursing and rehabilitative services for a |
| 36 | recipient in a nursing facility licensed under part II of |
| 37 | chapter 400 or in a rural hospital, as defined in s. 395.602, or |
| 38 | in a Medicare certified skilled nursing facility operated by a |
| 39 | hospital, as defined by s. 395.002(11), that is licensed under |
| 40 | part I of chapter 395, and in accordance with provisions set |
| 41 | forth in s. 409.908(2)(a), which services are ordered by and |
| 42 | provided under the direction of a licensed physician. However, |
| 43 | if a nursing facility has been destroyed or otherwise made |
| 44 | uninhabitable by natural disaster or other emergency and another |
| 45 | nursing facility is not available, the agency must pay for |
| 46 | similar services temporarily in a hospital licensed under part I |
| 47 | of chapter 395 provided federal funding is approved and |
| 48 | available. The agency shall pay only for bed-hold days if the |
| 49 | facility has an occupancy rate of 95 percent or greater. When |
| 50 | determining eligibility for nursing and rehabilitative services, |
| 51 | if the individual is a beneficiary of an approved long-term care |
| 52 | partnership program policy and has exhausted the benefits of the |
| 53 | policy, the total countable assets of the individual shall be |
| 54 | reduced by $1 for each $1 of benefits paid out under the |
| 55 | individual's approved long-term care partnership program policy. |
| 56 | The agency is authorized to seek any federal waivers to |
| 57 | implement this policy. |
| 58 | Section 2. Section 409.9102, Florida Statutes, is created |
| 59 | to read: |
| 60 | 409.9102 Florida Long-term Care Partnership Program.-- The |
| 61 | Agency for Health Care Administration is directed to establish |
| 62 | the Florida Long-term Care Partnership Program, which shall: |
| 63 | (1) Provide incentives for an individual to obtain |
| 64 | insurance to cover the costs of long-term care. |
| 65 | (2) Establish standards for long-term care insurance |
| 66 | policies for designation as approved long-term care partnership |
| 67 | program policies in consultation with the Office of Insurance |
| 68 | Regulation. |
| 69 | (3) Provide a mechanism to qualify for coverage of the |
| 70 | costs of long-term care under Medicaid without first being |
| 71 | required to substantially exhaust his or her resources, |
| 72 | including reducing the individual's asset valuation by $1 for |
| 73 | each $1 of benefits paid out under the individual's approved |
| 74 | long-term care partnership program policy as a determination of |
| 75 | Medicaid eligibility. |
| 76 | (4) Provide and approve long-term care partnership plan |
| 77 | information distributed to individuals through insurance |
| 78 | companies offering approved partnership policies. |
| 79 | (5) Alleviate the financial burden on the state's medical |
| 80 | assistance program by encouraging the pursuit of private |
| 81 | initiatives. |
| 82 | Section 3. The Agency for Health Care Administration shall |
| 83 | develop a plan for implementation of the Florida Long-term Care |
| 84 | Partnership Program. The agency shall present the plan in the |
| 85 | form of recommended legislation to the President of the Senate |
| 86 | and the Speaker of the House of Representatives prior to the |
| 87 | commencement of the next legislative session. |
| 88 | Section 4. This act shall take effect upon becoming a law, |
| 89 | except that section 409.9102, Florida Statutes, as created by |
| 90 | this act, and the amendment to section 409.905, Florida |
| 91 | Statutes, as provided in this act, shall take effect contingent |
| 92 | upon amendment to section 1917(b)(1)(c) of the Social Security |
| 93 | Act by the United States Congress to delete the "May 14, 1993," |
| 94 | deadline for approval by states of long-term care partnership |
| 95 | plans. |