| 1 | A bill to be entitled |
| 2 | An act relating to Medicaid eligibility; amending s. |
| 3 | 409.902, F.S.; providing asset transfer limitations for |
| 4 | determination of eligibility for nursing facility services |
| 5 | under the Medicaid program; authorizing the Department of |
| 6 | Children and Family Services to adopt rules; providing a |
| 7 | contingent effective date. |
| 8 |
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| 9 | Be It Enacted by the Legislature of the State of Florida: |
| 10 |
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| 11 | Section 1. Section 409.902, Florida Statutes, is amended |
| 12 | to read: |
| 13 | 409.902 Designated single state agency; payment |
| 14 | requirements; program title; release of medical records; |
| 15 | eligibility requirements.-- |
| 16 | (1) The Agency for Health Care Administration is |
| 17 | designated as the single state agency authorized to make |
| 18 | payments for medical assistance and related services under Title |
| 19 | XIX of the Social Security Act. These payments shall be made, |
| 20 | subject to any limitations or directions provided for in the |
| 21 | General Appropriations Act, only for services included in the |
| 22 | program, shall be made only on behalf of eligible individuals, |
| 23 | and shall be made only to qualified providers in accordance with |
| 24 | federal requirements for Title XIX of the Social Security Act |
| 25 | and the provisions of state law. This program of medical |
| 26 | assistance is designated the "Medicaid program." The Department |
| 27 | of Children and Family Services is responsible for Medicaid |
| 28 | eligibility determinations, including, but not limited to, |
| 29 | policy, rules, and the agreement with the Social Security |
| 30 | Administration for Medicaid eligibility determinations for |
| 31 | Supplemental Security Income recipients, as well as the actual |
| 32 | determination of eligibility. As a condition of Medicaid |
| 33 | eligibility, subject to federal approval, the Agency for Health |
| 34 | Care Administration and the Department of Children and Family |
| 35 | Services shall ensure that each recipient of Medicaid consents |
| 36 | to the release of her or his medical records to the Agency for |
| 37 | Health Care Administration and the Medicaid Fraud Control Unit |
| 38 | of the Department of Legal Affairs. |
| 39 | (2)(a) In determining eligibility for nursing facility |
| 40 | services under the Medicaid program, the Department of Children |
| 41 | and Family Services shall apply the following asset transfer |
| 42 | limitations effective for transfers made after October 1, 2005: |
| 43 | 1. All transfers of assets for less than fair market value |
| 44 | are prohibited. |
| 45 | 2. All transfers of assets for less than fair market |
| 46 | value, including transfers of assets to trusts, are subject to a |
| 47 | 72-month look-back period. |
| 48 | 3. The penalty period associated with all transfers of |
| 49 | assets for less than fair market value begins on the first day |
| 50 | of the month in which an individual applies for medical |
| 51 | assistance and is otherwise eligible. For recipients of medical |
| 52 | assistance, the penalty period begins on the first day of the |
| 53 | month in which the Department of Children and Family Services or |
| 54 | the Agency for Health Care Administration becomes aware of the |
| 55 | transfer or on the first day of the month following a period of |
| 56 | ineligibility that existed when the transfer was made. |
| 57 | 4. Transfers of the eligible individual's interest in a |
| 58 | homestead for less than fair market value are prohibited even to |
| 59 | those relatives specified under federal law; however, the |
| 60 | homestead retains its excluded status so long as the specified |
| 61 | relative continues to reside in the household. |
| 62 | 5. Transfers of assets to community spouses for less than |
| 63 | fair market value after medical assistance eligibility is |
| 64 | established are permitted only up to the amount of the asset |
| 65 | threshold for spousal impoverishment. |
| 66 | 6. Payments for care or personal services provided by a |
| 67 | relative are prohibited, unless the compensation was stipulated |
| 68 | in a notarized written agreement that was in existence when the |
| 69 | service was performed; the care or services directly benefited |
| 70 | the person, are reasonably related to the person's health |
| 71 | condition, and do not duplicate services otherwise provided by |
| 72 | Medicaid; and the payments made represent reasonable |
| 73 | compensation for the care or services provided. A notarized |
| 74 | written agreement is not required if payment for the services |
| 75 | was made within 60 days after the care or service was provided. |
| 76 | 7. Transfers of assets are prohibited to any annuity that |
| 77 | exceeds the value of the benefit likely to be returned to the |
| 78 | annuitant or the annuitant's spouse while alive, based on |
| 79 | estimated life expectancy using the life expectancy tables |
| 80 | employed by the Supplemental Security Income program or based on |
| 81 | a shorter life expectancy if the annuitant has a medical |
| 82 | condition that would shorten the annuitant's life expectancy and |
| 83 | that was diagnosed before funds were placed into the annuity. |
| 84 | The department may request and receive a physician's statement |
| 85 | to determine if the annuitant has a diagnosed medical condition |
| 86 | that would shorten the annuitant's life expectancy. If so, the |
| 87 | department shall determine the expected value of the benefits |
| 88 | based upon the physician's statement instead of using a life |
| 89 | expectancy table. This section applies to an annuity described |
| 90 | in this subparagraph that was purchased on or after October 1, |
| 91 | 2005, and that: |
| 92 | a. Is not purchased from an insurance company or financial |
| 93 | institution that is subject to licensing or regulation by the |
| 94 | Office of Insurance Regulation or a similar regulatory agency of |
| 95 | another state; |
| 96 | b. Does not pay out principal and interest in equal |
| 97 | monthly installments; or |
| 98 | c. Does not begin payment at the earliest possible date |
| 99 | after annuitization. |
| 100 | (b) The Department of Children and Family Services may |
| 101 | adopt rules pursuant to ss. 120.536(1) and 120.54 to implement |
| 102 | the requirements of this subsection. |
| 103 | Section 2. This act shall take effect July 1, 2005, except |
| 104 | that if any provision of subsection (2) of section 409.902, |
| 105 | Florida Statutes, as created by this act, is prohibited by |
| 106 | federal law, that provision shall take effect when federal law |
| 107 | is changed to permit its application or when a waiver is |
| 108 | received. If, by October 1, 2005, any provision of subsection |
| 109 | (2) of section 409.902, Florida Statutes, as created by this |
| 110 | act, has not taken effect because of prohibitions in federal |
| 111 | law, the Secretary of Health Care Administration shall apply to |
| 112 | the Federal Government by January 1, 2006, for a waiver of the |
| 113 | prohibitions in federal law or other federal authority, and the |
| 114 | provisions of subsection (2) of section 409.902, Florida |
| 115 | Statutes, as created by this act, shall take effect upon receipt |
| 116 | of a federal waiver or other federal approval, notification to |
| 117 | the Secretary of State, and publication of a notice in the |
| 118 | Florida Administrative Weekly to that effect. |