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The Committee on Health and Human Services Appropriations

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(Peaden) recommended the following amendment:

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     Senate Amendment (with title amendment)

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     Between line(s) 45 and 46,

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insert:

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     Section 1.  Paragraph (d) of subsection (2) of section

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400.179, Florida Statutes, is amended to read:

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     400.179  Liability for Medicaid underpayments and

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overpayments.--

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     (2)  Because any transfer of a nursing facility may expose

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the fact that Medicaid may have underpaid or overpaid the

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transferor, and because in most instances, any such underpayment

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or overpayment can only be determined following a formal field

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audit, the liabilities for any such underpayments or overpayments

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shall be as follows:

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     (d)  Where the transfer involves a facility that has been

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leased by the transferor:

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     1.  The transferee shall, as a condition to being issued a

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license by the agency, acquire, maintain, and provide proof to

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the agency of a bond with a term of 30 months, renewable

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annually, in an amount not less than the total of 3 months'

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Medicaid payments to the facility computed on the basis of the

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preceding 12-month average Medicaid payments to the facility.

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     2.  A leasehold licensee may meet the requirements of

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subparagraph 1. by payment of a nonrefundable fee, paid at

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initial licensure, paid at the time of any subsequent change of

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ownership, and paid annually thereafter, in the amount of 1

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percent of the total of 3 months' Medicaid payments to the

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facility computed on the basis of the preceding 12-month average

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Medicaid payments to the facility. If a preceding 12-month

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average is not available, projected Medicaid payments may be

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used. The fee shall be deposited into the Health Care Trust Fund

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and shall be accounted for separately as a Medicaid nursing home

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overpayment account. These fees shall be used at the sole

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discretion of the agency to repay nursing home Medicaid

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overpayments. The agency may transfer funds to the Grants and

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Donations Trust Fund for such repayments. Payment of this fee

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shall not release the licensee from any liability for any

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Medicaid overpayments, nor shall payment bar the agency from

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seeking to recoup overpayments from the licensee and any other

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liable party. As a condition of exercising this lease bond

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alternative, licensees paying this fee must maintain an existing

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lease bond through the end of the 30-month term period of that

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bond. The agency is herein granted specific authority to

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promulgate all rules pertaining to the administration and

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management of this account, including withdrawals from the

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account, subject to federal review and approval. This provision

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shall take effect upon becoming law and shall apply to any

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leasehold license application. The financial viability of the

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Medicaid nursing home overpayment account shall be determined by

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the agency through annual review of the account balance and the

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amount of total outstanding, unpaid Medicaid overpayments owing

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from leasehold licensees to the agency as determined by final

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agency audits.

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     3.  The leasehold licensee may meet the bond requirement

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through other arrangements acceptable to the agency. The agency

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is herein granted specific authority to promulgate rules

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pertaining to lease bond arrangements.

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     4.  All existing nursing facility licensees, operating the

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facility as a leasehold, shall acquire, maintain, and provide

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proof to the agency of the 30-month bond required in subparagraph

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1., above, on and after July 1, 1993, for each license renewal.

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     5.  It shall be the responsibility of all nursing facility

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operators, operating the facility as a leasehold, to renew the

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30-month bond and to provide proof of such renewal to the agency

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annually.

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     6.  Any failure of the nursing facility operator to acquire,

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maintain, renew annually, or provide proof to the agency shall be

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grounds for the agency to deny, revoke, and suspend the facility

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license to operate such facility and to take any further action,

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including, but not limited to, enjoining the facility, asserting

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a moratorium pursuant to part II of chapter 408, or applying for

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a receiver, deemed necessary to ensure compliance with this

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section and to safeguard and protect the health, safety, and

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welfare of the facility's residents. A lease agreement required

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as a condition of bond financing or refinancing under s. 154.213

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by a health facilities authority or required under s. 159.30 by a

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county or municipality is not a leasehold for purposes of this

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paragraph and is not subject to the bond requirement of this

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paragraph.

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================ T I T L E  A M E N D M E N T ================

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And the title is amended as follows:

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     On line(s) 2, after the semicolon,

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insert:

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amending s. 400.179, F.S.; authorizing the Agency for

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Health Care Administration to transfer fees used to repay

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nursing home Medicaid overpayments to the Grants and

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Donations Trust Fund within the agency;

4/1/2008  1:20:00 PM     603-06342-08