Senate Bill sb1924

CODING: Words stricken are deletions; words underlined are additions.
    Florida Senate - 2006                                  SB 1924

    By Senator Peaden





    2-1177-06                                               See HB

  1                      A bill to be entitled

  2         An act relating to long-term care coverage;

  3         amending s. 409.905, F.S.; revising conditions

  4         for eligibility for nursing and rehabilitative

  5         services; repealing s. 409.905(8), F.S., as

  6         amended, to delete a conflicting provision

  7         relating to eligibility for nursing and

  8         rehabilitative services that was contingent

  9         upon amendment to the Social Security Act;

10         reenacting and amending s. 409.9102, F.S.;

11         directing the Agency for Health Care

12         Administration to amend the Medicaid state plan

13         that established the Florida Long-term Care

14         Partnership Program for purposes of compliance

15         with provisions of the Social Security Act;

16         revising conditions for qualification for

17         coverage; requiring consultation with the

18         Department of Children and Family Services;

19         amending s. 4, ch. 2005-252, Laws of Florida,

20         to delete a contingency in an effective date;

21         providing an effective date.

22  

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

24  

25         Section 1.  Subsection (8) of section 409.905, Florida

26  Statutes, is amended to read:

27         409.905  Mandatory Medicaid services.--The agency may

28  make payments for the following services, which are required

29  of the state by Title XIX of the Social Security Act,

30  furnished by Medicaid providers to recipients who are

31  determined to be eligible on the dates on which the services

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    Florida Senate - 2006                                  SB 1924
    2-1177-06                                               See HB




 1  were provided. Any service under this section shall be

 2  provided only when medically necessary and in accordance with

 3  state and federal law. Mandatory services rendered by

 4  providers in mobile units to Medicaid recipients may be

 5  restricted by the agency. Nothing in this section shall be

 6  construed to prevent or limit the agency from adjusting fees,

 7  reimbursement rates, lengths of stay, number of visits, number

 8  of services, or any other adjustments necessary to comply with

 9  the availability of moneys and any limitations or directions

10  provided for in the General Appropriations Act or chapter 216.

11         (8)  NURSING FACILITY SERVICES.--The agency shall pay

12  for 24-hour-a-day nursing and rehabilitative services for a

13  recipient in a nursing facility licensed under part II of

14  chapter 400 or in a rural hospital, as defined in s. 395.602,

15  or in a Medicare certified skilled nursing facility operated

16  by a hospital, as defined by s. 395.002(11), that is licensed

17  under part I of chapter 395, and in accordance with provisions

18  set forth in s. 409.908(2)(a), which services are ordered by

19  and provided under the direction of a licensed physician.

20  However, if a nursing facility has been destroyed or otherwise

21  made uninhabitable by natural disaster or other emergency and

22  another nursing facility is not available, the agency must pay

23  for similar services temporarily in a hospital licensed under

24  part I of chapter 395 provided federal funding is approved and

25  available. The agency shall pay only for bed-hold days if the

26  facility has an occupancy rate of 95 percent or greater. The

27  agency is authorized to seek any federal waivers to implement

28  this policy. When determining eligibility for nursing and

29  rehabilitative services, if the individual is a beneficiary of

30  a Florida long-term care partnership program policy and has

31  exhausted the benefits of the policy, the total countable

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    Florida Senate - 2006                                  SB 1924
    2-1177-06                                               See HB




 1  assets of the individual shall be reduced by an amount equal

 2  to the insurance benefit payments that are made to or on

 3  behalf of the individual.

 4         Section 2.  Subsection (8) of section 409.905, Florida

 5  Statutes, as amended by chapter 2005-252, Laws of Florida, is

 6  repealed:

 7         409.905  Mandatory Medicaid services.--The agency may

 8  make payments for the following services, which are required

 9  of the state by Title XIX of the Social Security Act,

10  furnished by Medicaid providers to recipients who are

11  determined to be eligible on the dates on which the services

12  were provided. Any service under this section shall be

13  provided only when medically necessary and in accordance with

14  state and federal law. Mandatory services rendered by

15  providers in mobile units to Medicaid recipients may be

16  restricted by the agency. Nothing in this section shall be

17  construed to prevent or limit the agency from adjusting fees,

18  reimbursement rates, lengths of stay, number of visits, number

19  of services, or any other adjustments necessary to comply with

20  the availability of moneys and any limitations or directions

21  provided for in the General Appropriations Act or chapter 216.

22         (8)  NURSING FACILITY SERVICES.--The agency shall pay

23  for 24-hour-a-day nursing and rehabilitative services for a

24  recipient in a nursing facility licensed under part II of

25  chapter 400 or in a rural hospital, as defined in s. 395.602,

26  or in a Medicare certified skilled nursing facility operated

27  by a hospital, as defined by s. 395.002(11), that is licensed

28  under part I of chapter 395, and in accordance with provisions

29  set forth in s. 409.908(2)(a), which services are ordered by

30  and provided under the direction of a licensed physician.

31  However, if a nursing facility has been destroyed or otherwise

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






    Florida Senate - 2006                                  SB 1924
    2-1177-06                                               See HB




 1  made uninhabitable by natural disaster or other emergency and

 2  another nursing facility is not available, the agency must pay

 3  for similar services temporarily in a hospital licensed under

 4  part I of chapter 395 provided federal funding is approved and

 5  available. The agency shall pay only for bed-hold days if the

 6  facility has an occupancy rate of 95 percent or greater. When

 7  determining eligibility for nursing and rehabilitative

 8  services, if the individual is a beneficiary of an approved

 9  long-term care partnership program policy and has exhausted

10  the benefits of the policy, the total countable assets of the

11  individual shall be reduced by $1 for each $1 of benefits paid

12  out under the individual's approved long-term care partnership

13  program policy. The agency is authorized to seek any federal

14  waivers to implement this policy.

15         Section 3.  Section 409.9102, Florida Statutes, as

16  created by chapter 2005-252, Laws of Florida, is reenacted and

17  amended to read:

18         409.9102  Florida Long-term Care Partnership

19  Program.--The Agency for Health Care Administration is

20  directed to amend the Medicaid state plan establishing

21  establish the Florida Long-term Care Partnership Program, in

22  compliance with the requirements of s. 1921(b) of the Social

23  Security Act, as amended, which shall:

24         (1)  Provide incentives for an individual to obtain

25  insurance to cover the costs of long-term care.

26         (2)  Establish standards for long-term care insurance

27  policies for designation as approved long-term care

28  partnership program policies in consultation with the Office

29  of Insurance Regulation.

30         (3)  Provide a mechanism to qualify for coverage of the

31  costs of long-term care needs under Medicaid without first

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    Florida Senate - 2006                                  SB 1924
    2-1177-06                                               See HB




 1  being required to substantially exhaust his or her resources,

 2  including a provision for the disregard of any assets or

 3  resources in an amount equal to the insurance benefit payments

 4  that are made to or on behalf of an individual who is a

 5  beneficiary under a Florida long-term care partnership program

 6  policy reduction of the individual's asset valuation by $1 for

 7  each $1 of benefits paid out under the individual's approved

 8  long-term care partnership program policy as a determination

 9  of Medicaid eligibility, in consultation with the Department

10  of Children and Family Services.

11         (4)  Provide and approve long-term care partnership

12  plan information distributed to individuals through insurance

13  companies offering approved partnership policies.

14         (5)  Alleviate the financial burden on the state's

15  medical assistance program by encouraging the pursuit of

16  private initiatives.

17         Section 4.  Section 4 of chapter 2005-252, Laws of

18  Florida, is amended to read:

19         Section 4.  This act shall take effect upon becoming a

20  law, except that the amendments to section 409.905, Florida

21  Statutes, and the newly created section 409.9102, Florida

22  Statutes, provided in this act shall take effect contingent

23  upon amendment to section 1917(b)(1)(c) of the Social Security

24  Act by the United States Congress to delete the "May 14,

25  1993," deadline for approval by states of long-term care

26  partnership plans.

27         Section 5.  This act shall take effect July 1, 2006.

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31  

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