HB 947

1	A bill to be entitled
2	An act relating to long-term care coverage; amending s.
3	409.905, F.S.; revising conditions for eligibility for
4	nursing and rehabilitative services; repealing s.
5	409.905(8), F.S., as amended, to delete a conflicting
6	provision relating to eligibility for nursing and
7	rehabilitative services that was contingent upon amendment
8	to the Social Security Act; reenacting and amending s.
9	409.9102, F.S.; directing the Agency for Health Care
10	Administration to amend the Medicaid state plan that
11	established the Florida Long-term Care Partnership Program
12	for purposes of compliance with provisions of the Social
13	Security Act; revising conditions for qualification for
14	coverage; requiring consultation with the Department of
15	Children and Family Services; amending s. 4, ch. 2005-252,
16	Laws of Florida, to delete a contingency in an effective
17	date; providing an effective date.
18
19	Be It Enacted by the Legislature of the State of Florida:
20
21	Section 1.  Subsection (8) of section 409.905, Florida
22	Statutes, is amended to read:
23	409.905  Mandatory Medicaid services.--The agency may make
24	payments for the following services, which are required of the
25	state by Title XIX of the Social Security Act, furnished by
26	Medicaid providers to recipients who are determined to be
27	eligible on the dates on which the services were provided. Any
28	service under this section shall be provided only when medically
29	necessary and in accordance with state and federal law.
30	Mandatory services rendered by providers in mobile units to
31	Medicaid recipients may be restricted by the agency. Nothing in
32	this section shall be construed to prevent or limit the agency
33	from adjusting fees, reimbursement rates, lengths of stay,
34	number of visits, number of services, or any other adjustments
35	necessary to comply with the availability of moneys and any
36	limitations or directions provided for in the General
37	Appropriations Act or chapter 216.
38	(8)  NURSING FACILITY SERVICES.--The agency shall pay for
39	24-hour-a-day nursing and rehabilitative services for a
40	recipient in a nursing facility licensed under part II of
41	chapter 400 or in a rural hospital, as defined in s. 395.602, or
42	in a Medicare certified skilled nursing facility operated by a
43	hospital, as defined by s. 395.002(11), that is licensed under
44	part I of chapter 395, and in accordance with provisions set
45	forth in s. 409.908(2)(a), which services are ordered by and
46	provided under the direction of a licensed physician. However,
47	if a nursing facility has been destroyed or otherwise made
48	uninhabitable by natural disaster or other emergency and another
49	nursing facility is not available, the agency must pay for
50	similar services temporarily in a hospital licensed under part I
51	of chapter 395 provided federal funding is approved and
52	available. The agency shall pay only for bed-hold days if the
53	facility has an occupancy rate of 95 percent or greater. The
54	agency is authorized to seek any federal waivers to implement
55	this policy. When determining eligibility for nursing and
56	rehabilitative services, if the individual is a beneficiary of a
57	Florida long-term care partnership program policy and has
58	exhausted the benefits of the policy, the total countable assets
59	of the individual shall be reduced by an amount equal to the
60	insurance benefit payments that are made to or on behalf of the
61	individual.
62	Section 2.  Subsection (8) of section 409.905, Florida
63	Statutes, as amended by chapter 2005-252, Laws of Florida, is
64	repealed:
65	409.905  Mandatory Medicaid services.--The agency may make
66	payments for the following services, which are required of the
67	state by Title XIX of the Social Security Act, furnished by
68	Medicaid providers to recipients who are determined to be
69	eligible on the dates on which the services were provided. Any
70	service under this section shall be provided only when medically
71	necessary and in accordance with state and federal law.
72	Mandatory services rendered by providers in mobile units to
73	Medicaid recipients may be restricted by the agency. Nothing in
74	this section shall be construed to prevent or limit the agency
75	from adjusting fees, reimbursement rates, lengths of stay,
76	number of visits, number of services, or any other adjustments
77	necessary to comply with the availability of moneys and any
78	limitations or directions provided for in the General
79	Appropriations Act or chapter 216.
80	(8)  NURSING FACILITY SERVICES.--The agency shall pay for
81	24-hour-a-day nursing and rehabilitative services for a
82	recipient in a nursing facility licensed under part II of
83	chapter 400 or in a rural hospital, as defined in s. 395.602, or
84	in a Medicare certified skilled nursing facility operated by a
85	hospital, as defined by s. 395.002(11), that is licensed under
86	part I of chapter 395, and in accordance with provisions set
87	forth in s. 409.908(2)(a), which services are ordered by and
88	provided under the direction of a licensed physician. However,
89	if a nursing facility has been destroyed or otherwise made
90	uninhabitable by natural disaster or other emergency and another
91	nursing facility is not available, the agency must pay for
92	similar services temporarily in a hospital licensed under part I
93	of chapter 395 provided federal funding is approved and
94	available. The agency shall pay only for bed-hold days if the
95	facility has an occupancy rate of 95 percent or greater. When
96	determining eligibility for nursing and rehabilitative services,
97	if the individual is a beneficiary of an approved long-term care
98	partnership program policy and has exhausted the benefits of the
99	policy, the total countable assets of the individual shall be
100	reduced by $1 for each $1 of benefits paid out under the
101	individual's approved long-term care partnership program policy.
102	The agency is authorized to seek any federal waivers to
103	implement this policy.
104	Section 3.  Section 409.9102, Florida Statutes, as created
105	by chapter 2005-252, Laws of Florida, is reenacted and amended
106	to read:
107	409.9102  Florida Long-term Care Partnership Program.--The
108	Agency for Health Care Administration is directed to amend the
109	Medicaid state plan establishing establish the Florida Long-term
110	Care Partnership Program, in compliance with the requirements of
111	s. 1921(b) of the Social Security Act, as amended, which shall:
112	(1)  Provide incentives for an individual to obtain
113	insurance to cover the costs of long-term care.
114	(2)  Establish standards for long-term care insurance
115	policies for designation as approved long-term care partnership
116	program policies in consultation with the Office of Insurance
117	Regulation.
118	(3)  Provide a mechanism to qualify for coverage of the
119	costs of long-term care needs under Medicaid without first being
120	required to substantially exhaust his or her resources,
121	including a provision for the disregard of any assets or
122	resources in an amount equal to the insurance benefit payments
123	that are made to or on behalf of an individual who is a
124	beneficiary under a Florida long-term care partnership program
125	policy reduction of the individual's asset valuation by $1 for
126	each $1 of benefits paid out under the individual's approved
127	long-term care partnership program policy as a determination of
128	Medicaid eligibility, in consultation with the Department of
129	Children and Family Services.
130	(4)  Provide and approve long-term care partnership plan
131	information distributed to individuals through insurance
132	companies offering approved partnership policies.
133	(5)  Alleviate the financial burden on the state's medical
134	assistance program by encouraging the pursuit of private
135	initiatives.
136	Section 4.  Section 4 of chapter 2005-252, Laws of Florida,
137	is amended to read:
138	Section 4.  This act shall take effect upon becoming a law,
139	except that the amendments to section 409.905, Florida Statutes,
140	and the newly created section 409.9102, Florida Statutes,
141	provided in this act shall take effect contingent upon amendment
142	to section 1917(b)(1)(c) of the Social Security Act by the
143	United States Congress to delete the "May 14, 1993," deadline
144	for approval by states of long-term care partnership plans.
145	Section 5.  This act shall take effect July 1, 2006.

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