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Senator Jones moved the following amendment:

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     Senate Amendment (with title amendment)

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     Delete everything after the enacting clause

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and insert:

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     Section 1.  Section 400.462, Florida Statutes, is amended to

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read:

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     400.462  Definitions.--As used in this part, the term:

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     (1)  "Administrator" means a direct employee, as defined in

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subsection (9), who is. The administrator must be a licensed

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physician, physician assistant, or registered nurse licensed to

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practice in this state or an individual having at least 1 year of

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supervisory or administrative experience in home health care or

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in a facility licensed under chapter 395, under part II of this

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chapter, or under part I of chapter 429. An administrator may

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manage a maximum of five licensed home health agencies located

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within one agency service district or within an immediately

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contiguous county. If the home health agency is licensed under

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this chapter and is part of a retirement community that provides

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multiple levels of care, an employee of the retirement community

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may administer the home health agency and up to a maximum of four

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entities licensed under this chapter or chapter 429 that are

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owned, operated, or managed by the same corporate entity. An

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administrator shall designate, in writing, for each licensed

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entity, a qualified alternate administrator to serve during

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absences.

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     (2)  "Admission" means a decision by the home health agency,

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during or after an evaluation visit to the patient's home, that

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there is reasonable expectation that the patient's medical,

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nursing, and social needs for skilled care can be adequately met

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by the agency in the patient's place of residence. Admission

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includes completion of an agreement with the patient or the

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patient's legal representative to provide home health services as

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required in s. 400.487(1).

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     (3)  "Advanced registered nurse practitioner" means a person

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licensed in this state to practice professional nursing and

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certified in advanced or specialized nursing practice, as defined

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in s. 464.003.

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     (4)  "Agency" means the Agency for Health Care

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Administration.

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     (5)  "Certified nursing assistant" means any person who has

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been issued a certificate under part II of chapter 464. The

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licensed home health agency or licensed nurse registry shall

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ensure that the certified nursing assistant employed by or under

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contract with the home health agency or licensed nurse registry

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is adequately trained to perform the tasks of a home health aide

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in the home setting.

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     (6)  "Client" means an elderly, handicapped, or convalescent

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individual who receives companion services or homemaker services

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in the individual's home or place of residence.

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     (7)  "Companion" or "sitter" means a person who spends time

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with or cares for an elderly, handicapped, or convalescent

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individual and accompanies such individual on trips and outings

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and may prepare and serve meals to such individual. A companion

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may not provide hands-on personal care to a client.

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     (8)  "Department" means the Department of Children and

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Family Services.

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     (9)  "Direct employee" means an employee for whom one of the

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following entities pays withholding taxes: a home health agency;

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a management company that has a contract to manage the home

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health agency on a day-to-day basis; or an employee leasing

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company that has a contract with the home health agency to handle

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the payroll and payroll taxes for the home health agency.

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     (10)  "Director of nursing" means a registered nurse who is

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a direct employee, as defined in subsection (9), of the agency

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and who is a graduate of an approved school of nursing and is

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licensed in this state; who has at least 1 year of supervisory

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experience as a registered nurse; and who is responsible for

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overseeing the professional nursing and home health aid delivery

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of services of the agency. A director of nursing may be the

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director of a maximum of five licensed home health agencies

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operated by a related business entity and located within one

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agency service district or within an immediately contiguous

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county. If the home health agency is licensed under this chapter

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and is part of a retirement community that provides multiple

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levels of care, an employee of the retirement community may serve

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as the director of nursing of the home health agency and of up to

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four entities licensed under this chapter or chapter 429 which

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are owned, operated, or managed by the same corporate entity.

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     (11) "Fair market value" means the value in arms length

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transactions, consistent with the price that an asset would bring

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as the result of bona fide bargaining between well-informed

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buyers and sellers who are not otherwise in a position to

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generate business for the other party, or the compensation that

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would be included in a service agreement as the result of bona

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fide bargaining between well-informed parties to the agreement

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who are not otherwise in a position to generate business for the

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other party, on the date of acquisition of the asset or at the

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time of the service agreement.

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     (12)(11) "Home health agency" means an organization that

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provides home health services and staffing services.

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     (13)(12) "Home health agency personnel" means persons who

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are employed by or under contract with a home health agency and

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enter the home or place of residence of patients at any time in

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the course of their employment or contract.

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     (14)(13) "Home health services" means health and medical

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services and medical supplies furnished by an organization to an

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individual in the individual's home or place of residence. The

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term includes organizations that provide one or more of the

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following:

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     (a)  Nursing care.

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     (b)  Physical, occupational, respiratory, or speech therapy.

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     (c)  Home health aide services.

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     (d)  Dietetics and nutrition practice and nutrition

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counseling.

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     (e)  Medical supplies, restricted to drugs and biologicals

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prescribed by a physician.

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     (15)(14) "Home health aide" means a person who is trained

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or qualified, as provided by rule, and who provides hands-on

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personal care, performs simple procedures as an extension of

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therapy or nursing services, assists in ambulation or exercises,

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or assists in administering medications as permitted in rule and

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for which the person has received training established by the

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agency under s. 400.497(1). The licensed home health agency or

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licensed nurse registry shall ensure that the home health aide

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employed by or under contract with the home health agency or

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licensed nurse registry is adequately trained to perform the

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tasks of a home health aide in the home setting.

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     (16)(15) "Homemaker" means a person who performs household

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chores that include housekeeping, meal planning and preparation,

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shopping assistance, and routine household activities for an

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elderly, handicapped, or convalescent individual. A homemaker may

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not provide hands-on personal care to a client.

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     (17)(16) "Home infusion therapy provider" means an

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organization that employs, contracts with, or refers a licensed

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professional who has received advanced training and experience in

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intravenous infusion therapy and who administers infusion therapy

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to a patient in the patient's home or place of residence.

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     (18)(17) "Home infusion therapy" means the administration

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of intravenous pharmacological or nutritional products to a

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patient in his or her home.

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     (19) "Immediate family member" means a husband or wife; a

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birth or adoptive parent, child, or sibling; a stepparent,

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stepchild, stepbrother, or stepsister; a father-in-law, mother-

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in-law, son-in-law, daughter-in-law, brother-in-law, or sister-

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in-law; a grandparent or grandchild; or a spouse of a grandparent

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or grandchild.

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     (20) "Medical director" means a physician who is a

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volunteer with, or who receives remuneration from, a home health

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agency.

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     (21)(18) "Nurse registry" means any person that procures,

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offers, promises, or attempts to secure health-care-related

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contracts for registered nurses, licensed practical nurses,

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certified nursing assistants, home health aides, companions, or

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homemakers, who are compensated by fees as independent

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contractors, including, but not limited to, contracts for the

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provision of services to patients and contracts to provide

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private duty or staffing services to health care facilities

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licensed under chapter 395, this chapter, or chapter 429 or other

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business entities.

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     (22)(19) "Organization" means a corporation, government or

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governmental subdivision or agency, partnership or association,

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or any other legal or commercial entity, any of which involve

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more than one health care professional discipline; a health care

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professional and a home health aide or certified nursing

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assistant; more than one home health aide; more than one

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certified nursing assistant; or a home health aide and a

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certified nursing assistant. The term does not include an entity

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that provides services using only volunteers or only individuals

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related by blood or marriage to the patient or client.

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     (23)(20) "Patient" means any person who receives home

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health services in his or her home or place of residence.

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     (24)(21) "Personal care" means assistance to a patient in

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the activities of daily living, such as dressing, bathing,

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eating, or personal hygiene, and assistance in physical transfer,

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ambulation, and in administering medications as permitted by

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rule.

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     (25)(22) "Physician" means a person licensed under chapter

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458, chapter 459, chapter 460, or chapter 461.

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     (26)(23) "Physician assistant" means a person who is a

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graduate of an approved program or its equivalent, or meets

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standards approved by the boards, and is licensed to perform

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medical services delegated by the supervising physician, as

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defined in s. 458.347 or s. 459.022.

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     (27) "Remuneration" means any payment or other benefit made

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directly or indirectly, overtly or covertly, in cash or in kind.

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     (28)(24) "Skilled care" means nursing services or

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therapeutic services required by law to be delivered by a health

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care professional who is licensed under part I of chapter 464;

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part I, part III, or part V of chapter 468; or chapter 486 and

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who is employed by or under contract with a licensed home health

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agency or is referred by a licensed nurse registry.

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     (29)(25) "Staffing services" means services provided to a

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health care facility, school, or other business entity on a

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temporary or school-year basis pursuant to a written contract by

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licensed health care personnel and by certified nursing

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assistants and home health aides who are employed by, or work

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under the auspices of, a licensed home health agency or who are

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registered with a licensed nurse registry. Staffing services may

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be provided anywhere within the state.

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     Section 2.  Subsection (3) of section 400.464, Florida

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Statutes, is amended to read:

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400.464  Home Health agencies to be licensed; expiration of

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license; exemptions; unlawful acts; penalties.--

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     (3) A Any home infusion therapy provider must shall be

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licensed as a home health agency or nurse registry. Any infusion

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therapy provider currently authorized to receive Medicare

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reimbursement under a DME - Part B Provider number for the

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provision of infusion therapy shall be licensed as a non

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certified home health agency. Such a provider shall continue to

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receive that specified Medicare reimbursement without being

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certified so long as the reimbursement is limited to those items

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authorized pursuant to the DME - Part B Provider Agreement and

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the agency is licensed in compliance with the other provisions of

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this part.

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     Section 3.  Paragraphs (d), (e), (f), (g), and (h) are added

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to subsection (2) of section 400.471, Florida Statutes, and

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subsections (7), (8), and (9), are added to that section, to

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read:

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     400.471  Application for license; fee.--

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     (2)  In addition to the requirements of part II of chapter

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408, the initial applicant must file with the application

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satisfactory proof that the home health agency is in compliance

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with this part and applicable rules, including:

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     (d) A business plan, signed by the applicant, which details

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the home health agency's methods to obtain patients and its plan

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to recruit and maintain staff.

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     (e) Evidence of contingency funding equal to 1 month's

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average operating expenses during the first year of operation.

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     (f) A balance sheet, income and expense statement, and

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statement of cash flows for the first 2 years of operation which

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provide evidence of having sufficient assets, credit, and

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projected revenues to cover liabilities and expenses. The

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applicant has demonstrated financial ability to operate if the

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applicant's assets, credit, and projected revenues meet or exceed

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projected liabilities and expenses. An applicant may not project

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an operating margin of 15 percent or greater for any month in the

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first year of operation. All documents required under this

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paragraph must be prepared in accordance with generally accepted

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accounting principles and compiled and signed by a certified

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public accountant.

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     (g) All other ownership interests in health care entities

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for each controlling interest, as defined in part II of chapter

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408.

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     (h) In the case of an application for initial licensure,

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documentation of accreditation, or an application for

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accreditation, from an accrediting organization that is

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recognized by the agency as having standards comparable to those

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required by this part and part II of chapter 408. Notwithstanding

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s. 408.806, an applicant that has applied for accreditation must

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provide proof of accreditation that is not conditional or

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provisional within 120 days after the date of the agency's

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receipt of the application for licensure or the application shall

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be withdrawn from further consideration. Such accreditation must

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be maintained by the home health agency to maintain licensure.

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The agency shall accept, in lieu of its own periodic licensure

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survey, the submission of the survey of an accrediting

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organization that is recognized by the agency if the

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accreditation of the licensed home health agency is not

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provisional and if the licensed home health agency authorizes

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releases of, and the agency receives the report of, the

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accrediting organization.

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     (7) The agency may not issue an initial license to an

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applicant for a home health agency license if the applicant

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shares common controlling interests with another licensed home

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health agency that is located within 10 miles of the applicant

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and is in the same county. The agency must return the application

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and fees to the applicant.

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     (8) An application for a home health agency license may not

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be transferred to another home health agency or controlling

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interest before issuance of the license.

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     (9) A licensed home health agency that seeks to relocate to

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a different geographic service area not listed on its license

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must submit an initial application for a home health agency

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license for the new location.

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     Section 4.  Section 400.474, Florida Statutes, is amended to

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read:

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     400.474  Administrative penalties.--

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     (1)  The agency may deny, revoke, and suspend a license and

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impose an administrative fine in the manner provided in chapter

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120.

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     (2)  Any of the following actions by a home health agency or

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its employee is grounds for disciplinary action by the agency:

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     (a)  Violation of this part, part II of chapter 408, or of

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applicable rules.

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     (b)  An intentional, reckless, or negligent act that

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materially affects the health or safety of a patient.

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     (c)  Knowingly providing home health services in an

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unlicensed assisted living facility or unlicensed adult family-

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care home, unless the home health agency or employee reports the

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unlicensed facility or home to the agency within 72 hours after

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providing the services.

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     (d) Preparing or maintaining fraudulent patient records,

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such as, but not limited to, charting ahead, recording vital

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signs or symptoms that were not personally obtained or observed

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by the home health agency's staff at the time indicated,

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borrowing patients or patient records from other home health

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agencies to pass a survey or inspection, or falsifying

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signatures.

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     (e) Failing to provide at least one service directly to a

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patient for a period of 60 days.

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     (3) The agency shall impose a fine of $1,000 against a home

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health agency that demonstrates a pattern of falsifying:

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     (a) Documents of training for home health aides or

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certified nursing assistants; or

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     (b) Health statements for staff providing direct care to

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patients.

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A pattern may be demonstrated by a showing of at least three

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fraudulent entries or documents. The fine shall be imposed for

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each fraudulent document or, if multiple staff members are

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included on one document, for each fraudulent entry on the

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document.

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     (4) The agency shall impose a fine of $5,000 against a home

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health agency that demonstrates a pattern of billing any payor

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for services not provided. A pattern may be demonstrated by a

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showing of at least three billings for services not provided

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within a 12-month period. The fine must be imposed for each

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incident that is falsely billed. The agency may also:

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     (a) Require payback of all funds;

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     (b) Revoke the license; or

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     (c) Issue a moratorium in accordance with s. 408.814.

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     (5) The agency shall impose a fine of $5,000 against a home

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health agency that demonstrates a pattern of failing to provide a

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service specified in the home health agency's written agreement

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with a patient or the patient's legal representative, or the plan

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of care for that patient, unless a reduction in service is

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mandated by Medicare, Medicaid, or a state program or as provided

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in s. 400.492(3). A pattern may be demonstrated by a showing of

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at least three incidences, regardless of the patient or service,

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where the home health agency did not provide a service specified

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in a written agreement or plan of care during a 3-month period.

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The agency shall impose the fine for each occurrence. The agency

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may also impose additional administrative fines under s. 400.484

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for the direct or indirect harm to a patient, or deny, revoke, or

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suspend the license of the home health agency for a pattern of

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failing to provide a service specified in the home health

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agency's written agreement with a patient or the plan of care for

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that patient.

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     (6) The agency may deny, revoke, or suspend the license of

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a home health agency and shall impose a fine of $5,000 against a

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home health agency that:

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     (a) Gives remuneration for staffing services to:

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     1. Another home health agency with which it has formal or

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informal patient-referral transactions or arrangements; or

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     2. A health services pool with which it has formal or

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informal patient-referral transactions or arrangements,

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unless the home health agency has activated its comprehensive

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emergency management plan in accordance with s. 400.492. This

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paragraph does not apply to a Medicare-certified home health

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agency that provides fair market value remuneration for staffing

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services to a non-Medicare-certified home health agency that is

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part of a continuing care facility licensed under chapter 651 for

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providing services to its own residents if each resident

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receiving home health services pursuant to this arrangement

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attests in writing that he or she made a decision without

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influence from staff of the facility to select, from a list of

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Medicare-certified home health agencies provided by the facility,

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that Medicare-certified home health agency to provide the

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services.

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     (b) Provides services to residents in an assisted living

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facility for which the home health agency does not receive fair

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market value remuneration.

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     (c) Provides staffing to an assisted living facility for

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which the home health agency does not receive fair market value

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remuneration.

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     (d) Fails to provide the agency, upon request, with copies

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of all contracts with assisted living facilities which were

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executed within 5 years before the request.

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     (e) Gives remuneration to a case manager, discharge

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planner, facility-based staff member, or third-party vendor who

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is involved in the discharge-planning process of a facility

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licensed under chapter 395 or this chapter from whom the home

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health agency receives referrals.

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     (f) Fails to submit to the agency, within 15 days after the

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end of each calendar quarter, a written report that includes the

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following data based on data as it existed on the last day of the

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quarter:

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     1. The number of insulin-dependent diabetic patients

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receiving insulin-injection services from the home health agency;

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     2. The number of patients receiving both home health

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services from the home health agency and hospice services;

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     3. The number of patients receiving home health services

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from that home health agency; and

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     4. The names and license numbers of nurses whose primary

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job responsibility is to provide home health services to patients

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and who received remuneration from the home health agency in

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excess of $25,000 during the calendar quarter.

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     (g) Gives cash, or its equivalent, to a Medicare or

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Medicaid beneficiary.

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     (h) Has more than one medical director contract in effect

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at one time or more than one medical director contract and one

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contract with a physician-specialist whose services are mandated

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for the home health agency in order to qualify to participate in

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a federal or state health care program at one time.

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     (i) Gives remuneration to a physician without a medical

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director contract being in effect. The contract must:

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     1. Be in writing and signed by both parties;

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     2. Provide for remuneration that is at fair market value

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for an hourly rate, which must be supported by invoices submitted

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by the medical director describing the work performed, the dates

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on which that work was performed, and the duration of that work;

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and

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     3. Be for a term of at least 1 year.

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The hourly rate specified in the contract may not be increased

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during the term of the contract. The home health agency may not

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execute a subsequent contract with that physician which has an

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increased hourly rate and covers any portion of the term that was

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in the original contract.

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     (j) Gives remuneration to:

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     1. A physician, and the home health agency is in violation

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of paragraph (h) or paragraph (i);

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     2. A member of the physician's office staff; or

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     3. An immediate family member of the physician,

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if the home health agency has received a patient referral in the

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preceding 12 months from that physician or physician's office

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staff.

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     (k) Fails to provide to the agency, upon request, copies of

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all contracts with a medical director which were executed within

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5 years before the request.

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     (7)(3)(a) In addition to the requirements of s. 408.813,

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any person, partnership, or corporation that violates s. 408.812

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or s. 408.813 and that previously operated a licensed home health

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agency or concurrently operates both a licensed home health

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agency and an unlicensed home health agency commits a felony of

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the third degree punishable as provided in s. 775.082, s.

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775.083, or s. 775.084.

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     (b)  If any home health agency is found to be operating

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without a license and that home health agency has received any

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government reimbursement for services, the agency shall make a

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fraud referral to the appropriate government reimbursement

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program.

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     Section 5.  Section 400.476, Florida Statutes, is created to

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read:

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     400.476 Staffing requirements; notifications; limitations

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on staffing services.--

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     (1) ADMINISTRATOR.--

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     (a) An administrator may manage only one home health

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agency, except that an administrator may manage up to five home

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health agencies if all five home health agencies have identical

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controlling interests as defined in s. 408.803 and are located

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within one agency geographic service area or within an

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immediately contiguous county. If the home health agency is

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licensed under this chapter and is part of a retirement community

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that provides multiple levels of care, an employee of the

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retirement community may administer the home health agency and up

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to a maximum of four entities licensed under this chapter or

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chapter 429 which all have identical controlling interests as

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defined in s. 408.803. An administrator shall designate, in

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writing, for each licensed entity, a qualified alternate

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administrator to serve during the administrator's absence.

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     (b) An administrator of a home health agency who is a

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licensed physician, physician assistant, or registered nurse

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licensed to practice in this state may also be the director of

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nursing for a home health agency. An administrator may serve as a

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director of nursing for up to the number of entities authorized

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in subsection (2) only if there are 10 or fewer full-time

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equivalent employees and contracted personnel in each home health

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agency.

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     (2) DIRECTOR OF NURSING.--

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     (a) A director of nursing may be the director of nursing

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for:

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     1. Up to two licensed home health agencies if the agencies

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have identical controlling interests as defined in s. 408.803 and

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are located within one agency geographic service area or within

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an immediately contiguous county; or

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     2. Up to five licensed home health agencies if:

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     a. All of the home health agencies have identical

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controlling interests as defined in s. 408.803;

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     b. All of the home health agencies are located within one

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agency geographic service area or within an immediately

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contiguous county; and

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     c. Each home health agency has a registered nurse who meets

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the qualifications of a director of nursing and who has a written

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delegation from the director of nursing to serve as the director

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of nursing for that home health agency when the director of

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nursing is not present.

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If a home health agency licensed under this chapter is part of a

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retirement community that provides multiple levels of care, an

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employee of the retirement community may serve as the director of

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nursing of the home health agency and up to a maximum of four

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entities, other than home health agencies, licensed under this

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chapter or chapter 429 which all have identical controlling

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interests as defined in s. 408.803.

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     (b) A home health agency that provides skilled nursing care

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may not operate for more than 30 calendar days without a director

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of nursing. A home health agency that provides skilled nursing

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care and the director of nursing of a home health agency must

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notify the agency within 10 business days after termination of

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the services of the director of nursing for the home health

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agency. A home health agency that provides skilled nursing care

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must notify the agency of the identity and qualifications of the

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new director of nursing within 10 days after the new director is

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hired. If a home health agency that provides skilled nursing care

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operates for more than 30 calendar days without a director of

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nursing, the home health agency commits a class II deficiency. In

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addition to the fine for a class II deficiency, the agency may

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issue a moratorium in accordance with s. 408.814 or revoke the

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license. The agency shall fine a home health agency that fails to

494

notify the agency as required in this paragraph $1,000 for the

495

first violation and $2,000 for a repeat violation. The agency may

496

not take administrative action against a home health agency if

497

the director of nursing fails to notify the department upon

498

termination of services as the director of nursing for the home

499

health agency.

500

     (c) A home health agency that is not Medicare or Medicaid

501

certified and does not provide skilled care or provides only

502

physical, occupational, or speech therapy is not required to have

503

a director of nursing and is exempt from paragraph (b).

504

     (3) TRAINING.--A home health agency shall ensure that each

505

certified nursing assistant employed by or under contract with

506

the home health agency and each home health aide employed by or

507

under contract with the home health agency is adequately trained

508

to perform the tasks of a home health aide in the home setting.

509

     (4) STAFFING.--Staffing services may be provided anywhere

510

within the state.

511

     Section 6.  Section 400.484, Florida Statutes, is amended to

512

read:

513

     400.484  Right of inspection; deficiencies; fines.--

514

     (1)  In addition to the requirements of s. 408.811, the

515

agency may make such inspections and investigations as are

516

necessary in order to determine the state of compliance with this

517

part, part II of chapter 408, and applicable rules.

518

     (2)  The agency shall impose fines for various classes of

519

deficiencies in accordance with the following schedule:

520

     (a)  A class I deficiency is any act, omission, or practice

521

that results in a patient's death, disablement, or permanent

522

injury, or places a patient at imminent risk of death,

523

disablement, or permanent injury. Upon finding a class I

524

deficiency, the agency shall may impose an administrative fine in

525

the amount of $15,000 $5,000 for each occurrence and each day

526

that the deficiency exists.

527

     (b)  A class II deficiency is any act, omission, or practice

528

that has a direct adverse effect on the health, safety, or

529

security of a patient. Upon finding a class II deficiency, the

530

agency shall may impose an administrative fine in the amount of

531

$5,000 $1,000 for each occurrence and each day that the

532

deficiency exists.

533

     (c)  A class III deficiency is any act, omission, or

534

practice that has an indirect, adverse effect on the health,

535

safety, or security of a patient. Upon finding an uncorrected or

536

repeated class III deficiency, the agency shall may impose an

537

administrative fine not to exceed $1,000 $500 for each occurrence

538

and each day that the uncorrected or repeated deficiency exists.

539

     (d)  A class IV deficiency is any act, omission, or practice

540

related to required reports, forms, or documents which does not

541

have the potential of negatively affecting patients. These

542

violations are of a type that the agency determines do not

543

threaten the health, safety, or security of patients. Upon

544

finding an uncorrected or repeated class IV deficiency, the

545

agency shall may impose an administrative fine not to exceed $500

546

$200 for each occurrence and each day that the uncorrected or

547

repeated deficiency exists.

548

     (3)  In addition to any other penalties imposed pursuant to

549

this section or part, the agency may assess costs related to an

550

investigation that results in a successful prosecution, excluding

551

costs associated with an attorney's time.

552

     Section 7.  Subsection (2) of section 400.491, Florida

553

Statutes, is amended to read:

554

     400.491  Clinical records.--

555

     (2)  The home health agency must maintain for each client

556

who receives nonskilled care a service provision plan. Such

557

records must be maintained by the home health agency for 3 years

558

1 year following termination of services.

559

     Section 8.  Present subsections (5), (6), (7), and (8) of

560

section 400.497, Florida Statutes, are renumbered as subsections

561

(7), (8), (9), and (10), respectively, and a new subsections (5)

562

and (6) are added to that section, to read:

563

     400.497  Rules establishing minimum standards.--The agency

564

shall adopt, publish, and enforce rules to implement part II of

565

chapter 408 and this part, including, as applicable, ss. 400.506

566

and 400.509, which must provide reasonable and fair minimum

567

standards relating to:

568

     (5) Oversight by the director of nursing. The agency shall

569

develop rules related to:

570

     (a) Standards that address oversight responsibilities by

571

the director of nursing of skilled nursing and personal care

572

services provided by the home health agency's staff;

573

     (b) Requirements for a director of nursing to provide to

574

the agency, upon request, a certified daily report of the home

575

health services provided by a specified direct employee or

576

contracted staff member on behalf of the home health agency. The

577

agency may request a certified daily report only for a period not

578

to exceed 2 years prior to the date of the request; and

579

     (c) A quality assurance program for home health services

580

provided by the home health agency.

581

     (6) Conditions for using a recent unannounced licensure

582

inspection for the inspection required in s. 408.806 related to a

583

licensure application associated with a change in ownership of a

584

licensed home health agency.

585

     Section 9.  Paragraph (a) of subsection (6) of section

586

400.506, Florida Statutes, is amended, present subsections (15)

587

and (16) of that section are renumbered as subsections (16) and

588

(17), respectively, and a new subsection (15) is added to that

589

section, to read:

590

     400.506  Licensure of nurse registries; requirements;

591

penalties.--

592

     (6)(a)  A nurse registry may refer for contract in private

593

residences registered nurses and licensed practical nurses

594

registered and licensed under part I of chapter 464, certified

595

nursing assistants certified under part II of chapter 464, home

596

health aides who present documented proof of successful

597

completion of the training required by rule of the agency, and

598

companions or homemakers for the purposes of providing those

599

services authorized under s. 400.509(1). A licensed nurse

600

registry shall ensure that each certified nursing assistant

601

referred for contract by the nurse registry and each home health

602

aide referred for contract by the nurse registry is adequately

603

trained to perform the tasks of a home health aide in the home

604

setting. Each person referred by a nurse registry must provide

605

current documentation that he or she is free from communicable

606

diseases.

607

     (15)(a) The agency may deny, suspend, or revoke the

608

license of a nurse registry and shall impose a fine of $5,000

609

against a nurse registry that:

610

     1. Provides services to residents in an assisted living

611

facility for which the nurse registry does not receive fair

612

market value remuneration.

613

     2. Provides staffing to an assisted living facility for

614

which the nurse registry does not receive fair market value

615

remuneration.

616

     3. Fails to provide the agency, upon request, with copies

617

of all contracts with assisted living facilities which were

618

executed within the last 5 years.

619

     4. Gives remuneration to a case manager, discharge

620

planner, facility-based staff member, or third-party vendor who

621

is involved in the discharge-planning process of a facility

622

licensed under chapter 395 or this chapter and from whom the

623

nurse registry receives referrals.

624

     5. Gives remuneration to a physician, a member of the

625

physician's office staff, or an immediate family member of the

626

physician, and the nurse registry received a patient referral

627

in the last 12 months from that physician or the physician's

628

office staff.

629

     (b) The agency shall also impose an administrative fine

630

of $15,000 if the nurse registry refers nurses, certified

631

nursing assistants, home health aides, or other staff without

632

charge to a facility licensed under chapter 429 in return for

633

patient referrals from the facility.

634

     (c) The proceeds of all fines collected under this

635

subsection shall be deposited into the Health Care Trust Fund.

636

     Section 10.  Subsection (4) is added to section 400.518,

637

Florida Statutes, to read:

638

     400.518  Prohibited referrals to home health agencies.--

639

     (4) The agency shall impose an administrative fine of

640

$15,000 if a home health agency provides nurses, certified

641

nursing assistants, home health aides, or other staff without

642

charge to a facility licensed under chapter 429 in return for

643

patient referrals from the facility. The proceeds of such fines

644

shall be deposited into the Health Care Trust Fund.

645

     Section 11.  Subsections (5) through (27) of section

646

409.901, Florida Statutes, are redesignated as subsections (6)

647

through (28), respectively, and a new subsection (5) is added to

648

that section to read:

649

     409.901  Definitions; ss. 409.901-409.920.--As used in ss.

650

409.901-409.920, except as otherwise specifically provided, the

651

term:

652

     (5) "Change of ownership" means an event in which the

653

provider changes to a different legal entity or in which 45

654

percent or more of the ownership, voting shares, or controlling

655

interest in a corporation whose shares are not publicly traded on

656

a recognized stock exchange is transferred or assigned, including

657

the final transfer or assignment of multiple transfers or

658

assignments over a 2-year period that cumulatively total 45

659

percent or more. A change solely in the management company or

660

board of directors is not a change of ownership.

661

     Section 12.  Subsections (6) and (9) of section 409.907,

662

Florida Statutes, are amended to read:

663

     409.907  Medicaid provider agreements.--The agency may make

664

payments for medical assistance and related services rendered to

665

Medicaid recipients only to an individual or entity who has a

666

provider agreement in effect with the agency, who is performing

667

services or supplying goods in accordance with federal, state,

668

and local law, and who agrees that no person shall, on the

669

grounds of handicap, race, color, or national origin, or for any

670

other reason, be subjected to discrimination under any program or

671

activity for which the provider receives payment from the agency.

672

     (6)  A Medicaid provider agreement may be revoked, at the

673

option of the agency, as the result of a change of ownership of

674

any facility, association, partnership, or other entity named as

675

the provider in the provider agreement. A provider shall give the

676

agency 60 days' notice before making any change in ownership of

677

the entity named in the provider agreement as the provider.

678

     (a) In the event of a change of ownership, the transferor

679

remains liable for all outstanding overpayments, administrative

680

fines, and any other moneys owed to the agency before the

681

effective date of the change of ownership. In addition to the

682

continuing liability of the transferor, the transferee is liable

683

to the agency for all outstanding overpayments identified by the

684

agency on or before the effective date of the change of

685

ownership. For purposes of this subsection, the term "outstanding

686

overpayment" includes any amount identified in a preliminary

687

audit report issued to the transferor by the agency on or before

688

the effective date of the change of ownership. In the event of a

689

change of ownership for a skilled nursing facility or

690

intermediate care facility, the Medicaid provider agreement shall

691

be assigned to the transferee if the transferee meets all other

692

Medicaid provider qualifications. In the event of a change of

693

ownership involving a skilled nursing facility licensed under

694

part II of chapter 400, liability for all outstanding

695

overpayments, administrative fines, and any moneys owed to the

696

agency before the effective date of the change of ownership shall

697

be determined in accordance with s. 400.179.

698

     (b) At least 60 days before the anticipated date of the

699

change of ownership, the transferor shall notify the agency of

700

the intended change of ownership and the transferee shall submit

701

to the agency a Medicaid provider enrollment application. If a

702

change of ownership occurs without compliance with the notice

703

requirements of this subsection, the transferor and transferee

704

shall be jointly and severally liable for all overpayments,

705

administrative fines, and other moneys due to the agency,

706

regardless of whether the agency identified the overpayments,

707

administrative fines, or other moneys before or after the

708

effective date of the change of ownership. The agency may not

709

approve a transferee's Medicaid provider enrollment application

710

if the transferee or transferor has not paid or agreed in writing

711

to a payment plan for all outstanding overpayments,

712

administrative fines, and other moneys due to the agency. This

713

subsection does not preclude the agency from seeking any other

714

legal or equitable remedies available to the agency for the

715

recovery of moneys owed to the Medicaid program. In the event of

716

a change of ownership involving a skilled nursing facility

717

licensed under part II of chapter 400, liability for all

718

outstanding overpayments, administrative fines, and any moneys

719

owed to the agency before the effective date of the change of

720

ownership shall be determined in accordance with the s. 400.179

721

if the Medicaid provider enrollment application for change of

722

ownership is submitted before the change of ownership.

723

     (9)  Upon receipt of a completed, signed, and dated

724

application, and completion of any necessary background

725

investigation and criminal history record check, the agency must

726

either:

727

     (a)  Enroll the applicant as a Medicaid provider upon

728

approval of the provider application. The enrollment effective

729

date shall be the date the agency receives the provider

730

application. With respect to a provider that requires a Medicare

731

certification survey, the enrollment effective date is the date

732

the certification is awarded. With respect to a provider that

733

completes a change of ownership, the effective date is the date

734

the agency received the application, the date the change of

735

ownership was complete, or the date the applicant became eligible

736

to provide services under Medicaid, whichever date is later. With

737

respect to a provider of emergency medical services

738

transportation or emergency services and care, the effective date

739

is the date the services were rendered. Payment for any claims

740

for services provided to Medicaid recipients between the date of

741

receipt of the application and the date of approval is contingent

742

on applying any and all applicable audits and edits contained in

743

the agency's claims adjudication and payment processing systems;

744

or

745

     (b)  Deny the application if the agency finds that it is in

746

the best interest of the Medicaid program to do so. The agency

747

may consider the factors listed in subsection (10), as well as

748

any other factor that could affect the effective and efficient

749

administration of the program, including, but not limited to, the

750

applicant's demonstrated ability to provide services, conduct

751

business, and operate a financially viable concern; the current

752

availability of medical care, services, or supplies to

753

recipients, taking into account geographic location and

754

reasonable travel time; the number of providers of the same type

755

already enrolled in the same geographic area; and the

756

credentials, experience, success, and patient outcomes of the

757

provider for the services that it is making application to

758

provide in the Medicaid program. The agency shall deny the

759

application if the agency finds that a provider; any officer,

760

director, agent, managing employee, or affiliated person; or any

761

partner or shareholder having an ownership interest equal to 5

762

percent or greater in the provider if the provider is a

763

corporation, partnership, or other business entity, has failed to

764

pay all outstanding fines or overpayments assessed by final order

765

of the agency or final order of the Centers for Medicare and

766

Medicaid Services, not subject to further appeal, unless the

767

provider agrees to a repayment plan that includes withholding

768

Medicaid reimbursement until the amount due is paid in full.

769

     Section 13.  Subsection (20) of section 409.910, Florida

770

Statutes, is amended to read:

771

     409.910  Responsibility for payments on behalf of Medicaid-

772

eligible persons when other parties are liable.--

773

     (20)  Entities providing health insurance as defined in s.

774

624.603, health maintenance organizations and prepaid health

775

clinics as defined in chapter 641, and, on behalf of their

776

clients, third-party administrators and pharmacy benefits

777

managers as defined in s. 409.901 (27) s. 409.901(26) shall

778

provide such records and information as are necessary to

779

accomplish the purpose of this section, unless such requirement

780

results in an unreasonable burden.

781

     (a)  The director of the agency and the Director of the

782

Office of Insurance Regulation of the Financial Services

783

Commission shall enter into a cooperative agreement for

784

requesting and obtaining information necessary to effect the

785

purpose and objective of this section.

786

     1.  The agency shall request only that information necessary

787

to determine whether health insurance as defined pursuant to s.

788

624.603, or those health services provided pursuant to chapter

789

641, could be, should be, or have been claimed and paid with

790

respect to items of medical care and services furnished to any

791

person eligible for services under this section.

792

     2.  All information obtained pursuant to subparagraph 1. is

793

confidential and exempt from s. 119.07(1).

794

     3.  The cooperative agreement or rules adopted under this

795

subsection may include financial arrangements to reimburse the

796

reporting entities for reasonable costs or a portion thereof

797

incurred in furnishing the requested information. Neither the

798

cooperative agreement nor the rules shall require the automation

799

of manual processes to provide the requested information.

800

     (b)  The agency and the Financial Services Commission

801

jointly shall adopt rules for the development and administration

802

of the cooperative agreement. The rules shall include the

803

following:

804

     1.  A method for identifying those entities subject to

805

furnishing information under the cooperative agreement.

806

     2.  A method for furnishing requested information.

807

     3.  Procedures for requesting exemption from the cooperative

808

agreement based on an unreasonable burden to the reporting

809

entity.

810

     Section 14.  Subsection (48) of section 409.912, Florida

811

Statutes, is amended to read:

812

     409.912  Cost-effective purchasing of health care.--The

813

agency shall purchase goods and services for Medicaid recipients

814

in the most cost-effective manner consistent with the delivery of

815

quality medical care. To ensure that medical services are

816

effectively utilized, the agency may, in any case, require a

817

confirmation or second physician's opinion of the correct

818

diagnosis for purposes of authorizing future services under the

819

Medicaid program. This section does not restrict access to

820

emergency services or poststabilization care services as defined

821

in 42 C.F.R. part 438.114. Such confirmation or second opinion

822

shall be rendered in a manner approved by the agency. The agency

823

shall maximize the use of prepaid per capita and prepaid

824

aggregate fixed-sum basis services when appropriate and other

825

alternative service delivery and reimbursement methodologies,

826

including competitive bidding pursuant to s. 287.057, designed to

827

facilitate the cost-effective purchase of a case-managed

828

continuum of care. The agency shall also require providers to

829

minimize the exposure of recipients to the need for acute

830

inpatient, custodial, and other institutional care and the

831

inappropriate or unnecessary use of high-cost services. The

832

agency shall contract with a vendor to monitor and evaluate the

833

clinical practice patterns of providers in order to identify

834

trends that are outside the normal practice patterns of a

835

provider's professional peers or the national guidelines of a

836

provider's professional association. The vendor must be able to

837

provide information and counseling to a provider whose practice

838

patterns are outside the norms, in consultation with the agency,

839

to improve patient care and reduce inappropriate utilization. The

840

agency may mandate prior authorization, drug therapy management,

841

or disease management participation for certain populations of

842

Medicaid beneficiaries, certain drug classes, or particular drugs

843

to prevent fraud, abuse, overuse, and possible dangerous drug

844

interactions. The Pharmaceutical and Therapeutics Committee shall

845

make recommendations to the agency on drugs for which prior

846

authorization is required. The agency shall inform the

847

Pharmaceutical and Therapeutics Committee of its decisions

848

regarding drugs subject to prior authorization. The agency is

849

authorized to limit the entities it contracts with or enrolls as

850

Medicaid providers by developing a provider network through

851

provider credentialing. The agency may competitively bid single-

852

source-provider contracts if procurement of goods or services

853

results in demonstrated cost savings to the state without

854

limiting access to care. The agency may limit its network based

855

on the assessment of beneficiary access to care, provider

856

availability, provider quality standards, time and distance

857

standards for access to care, the cultural competence of the

858

provider network, demographic characteristics of Medicaid

859

beneficiaries, practice and provider-to-beneficiary standards,

860

appointment wait times, beneficiary use of services, provider

861

turnover, provider profiling, provider licensure history,

862

previous program integrity investigations and findings, peer

863

review, provider Medicaid policy and billing compliance records,

864

clinical and medical record audits, and other factors. Providers

865

shall not be entitled to enrollment in the Medicaid provider

866

network. The agency shall determine instances in which allowing

867

Medicaid beneficiaries to purchase durable medical equipment and

868

other goods is less expensive to the Medicaid program than long-

869

term rental of the equipment or goods. The agency may establish

870

rules to facilitate purchases in lieu of long-term rentals in

871

order to protect against fraud and abuse in the Medicaid program

872

as defined in s. 409.913. The agency may seek federal waivers

873

necessary to administer these policies.

874

     (48)(a) A provider is not entitled to enrollment in the

875

Medicaid provider network. The agency may implement a Medicaid

876

fee-for-service provider network controls, including, but not

877

limited to, competitive procurement and provider credentialing.

878

If a credentialing process is used, the agency may limit its

879

provider network based upon the following considerations:

880

beneficiary access to care, provider availability, provider

881

quality standards and quality assurance processes, cultural

882

competency, demographic characteristics of beneficiaries,

883

practice standards, service wait times, provider turnover,

884

provider licensure and accreditation history, program integrity

885

history, peer review, Medicaid policy and billing compliance

886

records, clinical and medical record audit findings, and such

887

other areas that are considered necessary by the agency to ensure

888

the integrity of the program.

889

     (b) The agency shall limit its network of durable medical

890

equipment and medical supply providers. For dates of service

891

after January 1, 2009, the agency shall limit payment for durable

892

medical equipment and supplies to providers that meet all the

893

requirements of this paragraph.

894

     1. Providers must be accredited by a Centers for Medicare

895

and Medicaid Services deemed accreditation organization for

896

suppliers of durable medical equipment, prosthetics, orthotics,

897

and supplies. The provider must maintain accreditation and is

898

subject to unannounced reviews by the accrediting organization.

899

     2. Providers must provide the services or supplies directly

900

to the Medicaid recipient or caregiver at the provider location

901

or recipient's residence or send the supplies directly to the

902

recipient's residence with receipt of mailed delivery.

903

Subcontracting or consignment of the service or supply to a third

904

party is prohibited.

905

     3. Notwithstanding subparagraph 2., a durable medical

906

equipment provider may store nebulizers at a physician's office

907

for the purpose of having the physician's staff issue the

908

equipment if it meets all of the following conditions:

909

     a. The physician must document the medical necessity and

910

need to prevent further deterioration of the patient's

911

respiratory status by the timely delivery of the nebulizer in the

912

physician's office.

913

     b. The durable medical equipment provider must have written

914

documentation of the competency and training by a Florida-

915

licensed registered respiratory therapist of any durable medical

916

equipment staff who participate in the training of physician

917

office staff for the use of nebulizers, including cleaning,

918

warranty, and special needs of patients.

919

     c. The physician's office must have documented the training

920

and competency of any staff member who initiates the delivery of

921

nebulizers to patients. The durable medical equipment provider

922

must maintain copies of all physician office training.

923

     d. The physician's office must maintain inventory records

924

of stored nebulizers, including documentation of the durable

925

medical equipment provider source.

926

     e. A physician contracted with a Medicaid durable medical

927

equipment provider may not have a financial relationship with

928

that provider or receive any financial gain from the delivery of

929

nebulizers to patients.

930

     4. Providers must have a physical business location and a

931

functional landline business phone. The location must be within

932

the state or not more than 50 miles from the Florida state line.

933

The agency may make exceptions for providers of durable medical

934

equipment or supplies not otherwise available from other enrolled

935

providers located within the state.

936

     5. Physical business locations must be clearly identified

937

as a business that furnishes durable medical equipment or medical

938

supplies by signage that can be read from 20 feet away. The

939

location must be readily accessible to the public during normal,

940

posted business hours and must operate no less than 5 hours per

941

day and no less than 5 days per week, with the exception of

942

scheduled and posted holidays. The location may not be located

943

within or at the same numbered street address as another enrolled

944

Medicaid durable medical equipment or medical supply provider or

945

as an enrolled Medicaid pharmacy that is also enrolled as a

946

durable medical equipment provider. A licensed orthotist or

947

prosthetist that provides only orthotic or prosthetic devices as

948

a Medicaid durable medical equipment provider is exempt from the

949

provisions in this paragraph.

950

     6. Providers must maintain a stock of durable medical

951

equipment and medical supplies on site that is readily available

952

to meet the needs of the durable medical equipment business

953

location's customers.

954

     7. Providers must provide a surety bond of $50,000 for each

955

provider location, up to a maximum of 5 bonds statewide or an

956

aggregate bond of $250,000 statewide, as identified by Federal

957

Employer Identification Number. Providers who post a statewide or

958

an aggregate bond must identify all of their locations in any

959

Medicaid durable medical equipment and medical supply provider

960

enrollment application or bond renewal. Each provider location's

961

surety bond must be renewed annually and the provider must submit

962

proof of renewal even if the original bond is a continuous bond.

963

A licensed orthotist or prosthetist that provides only orthotic

964

or prosthetic devices as a Medicaid durable medical equipment

965

provider is exempt from the provisions in this paragraph.

966

     8. Providers must obtain a level 2 background screening, as

967

provided under s. 435.04, for each provider employee in direct

968

contact with or providing direct services to recipients of

969

durable medical equipment and medical supplies in their homes.

970

This requirement includes, but is not limited to, repair and

971

service technicians, fitters, and delivery staff. The provider

972

shall pay for the cost of the background screening.

973

     9. The following providers are exempt from the requirements

974

of subparagraphs 1. and 7.:

975

     a. Durable medical equipment providers owned and operated

976

by a government entity.

977

     b. Durable medical equipment providers that are operating

978

within a pharmacy that is currently enrolled as a Medicaid

979

pharmacy provider.

980

     c. Active, Medicaid-enrolled orthopedic physician groups,

981

primarily owned by physicians, which provide only orthotic and

982

prosthetic devices.

983

     Section 15. The Agency for Health Care Administration shall

984

review the process, procedures, and contractor's performance for

985

the prior authorization of home health agency visits that are in

986

excess of 60 visits over the lifetime of a Medicaid recipient.

987

The agency shall determine whether modifications are necessary in

988

order to reduce Medicaid fraud and abuse related to home health

989

services for a Medicaid recipient which are not medically

990

necessary. If modifications to the prior authorization function

991

are necessary, the agency shall amend the contract to require

992

contractor performance that reduces potential Medicaid fraud and

993

abuse with respect to home health agency visits.

994

     Section 16. The Agency for Health Care Administration shall

995

report to the Legislature by January 1, 2009, on the feasibility

996

and costs of accessing the Medicare system to disallow Medicaid

997

payment for home health services that are paid for under the

998

Medicare prospective payment system for recipients who are dually

999

eligible for Medicaid and Medicare.

1000

     Section 17.  This act shall take effect July 1, 2008.

1001

1002

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

1003

And the title is amended as follows:

1004

     Delete everything before the enacting clause

1005

and insert:

1006

A bill to be entitled

1007

An act relating to health care fraud and abuse; amending

1008

s. 400.462, F.S.; revising and adding definitions;

1009

amending s. 400.464, F.S.; authorizing a home infusion

1010

therapy provider to be licensed as a nurse registry;

1011

deleting provisions related to Medicare reimbursement;

1012

amending s. 400.471, F.S.; requiring an applicant for a

1013

home health agency license to submit to the Agency for

1014

Health Care Administration a business plan and evidence of

1015

contingency funding, and disclose other controlling

1016

ownership interests in health care entities; requiring

1017

certain standards in documentation demonstrating financial

1018

ability to operate; requiring home health agencies to

1019

maintain certain accreditation to maintain licensure;

1020

permitting certain accrediting organizations to submit

1021

surveys regarding licensure of home health agencies;

1022

prohibiting the agency from issuing an initial license to

1023

an applicant for a home health agency license which is

1024

located within a certain distance of a licensed home

1025

health agency that has common controlling interests;

1026

prohibiting the transfer of an application to another home

1027

health agency before issuance of the license; requiring

1028

submission of an initial application to relocate a

1029

licensed home health agency to another geographic service

1030

area; amending s. 400.474, F.S.; providing additional

1031

grounds under which the Agency for Health Care

1032

Administration may take  disciplinary action against a

1033

home health agency; creating s. 400.476, F.S.;

1034

establishing staffing requirements for home health

1035

agencies; reducing the number of home health agencies that

1036

an administrator or director of nursing may serve;

1037

requiring that an alternate administrator be designated in

1038

writing; limiting the period that a home health agency

1039

that provides skilled nursing care may operate without a

1040

director of nursing; requiring notification upon the

1041

termination and replacement of a director of nursing;

1042

requiring the Agency for Health Care Administration to

1043

take administrative enforcement action against a home

1044

health agency for noncompliance with the notification and

1045

staffing requirements for a director of nursing; providing

1046

for fines; exempting a home health agency that is not

1047

Medicare or Medicaid certified and does not provide

1048

skilled care or provides only physical, occupational, or

1049

speech therapy from requirements related to a director of

1050

nursing; providing training requirements for certified

1051

nursing assistants and home health aides; amending s.

1052

400.484, F.S.; requiring the agency to impose

1053

administrative fines for certain deficiencies; increasing

1054

the administrative fines imposed for certain deficiencies;

1055

amending s. 400.491, F.S.; extending the period that a

1056

home health agency must retain records of the nonskilled

1057

care it provides; amending s. 400.497, F.S.; requiring

1058

that the Agency for Health Care Administration adopt rules

1059

related to standards for the director of nursing of a home

1060

health agency, requirements for a director of nursing to

1061

submit certified staff activity logs pursuant to an agency

1062

request, quality assurance programs, and inspections

1063

related to an application for a change in ownership;

1064

amending s. 400.506, F.S.; providing training requirements

1065

for certified nursing assistants and home health aides

1066

referred for contract by a nurse registry; providing for

1067

the denial, suspension, or revocation of nurse registry

1068

license and fines for paying remuneration to certain

1069

entities in exchange for patient referrals or refusing

1070

fair remuneration in exchange for patient referrals;

1071

amending s. 400.518, F.S.; providing for a fine to be

1072

imposed against a home health agency that provides

1073

complimentary staffing to an assisted care community in

1074

exchange for patient referrals; amending s, 409.901, F.S.;

1075

defining the term "change of ownership"; amending s.

1076

409.907, F.S.; revising provisions relating to change of

1077

ownership of Medicaid provider agreements; providing for

1078

continuing financial liability of a transferor under

1079

certain circumstances; defining the term "outstanding

1080

overpayment"; requiring the transferor to provide notice

1081

of change of ownership to the agency within a specified

1082

time period; requiring the transferee to submit a Medicaid

1083

provider enrollment application to the agency; providing

1084

for joint and several liability under certain

1085

circumstances; requiring a written payment plan for

1086

certain outstanding financial obligations; providing

1087

conditions under which additional enrollment effective

1088

dates apply; amending s. 409.910, F.S.; conforming a

1089

cross-reference; amending s. 409.912, F.S.; requiring the

1090

agency to limit its network of Medicaid durable medical

1091

equipment and medical supply providers; prohibiting

1092

reimbursement for dates of service after a certain date;

1093

requiring accreditation; requiring direct provision of

1094

services or supplies; authorizing a provider to store

1095

nebulizers at a physician's office under certain

1096

circumstances; imposing certain physical location

1097

requirements; requiring a provider to maintain a certain

1098

stock of equipment and supplies; requiring a surety bond;

1099

requiring background screenings of employees; providing

1100

for certain exemptions; requiring the Agency for Health

1101

Care Administration to review the process for prior

1102

authorization of home health agency visits and determine

1103

whether modifications to the process are necessary;

1104

requiring the agency to report to the Legislature on the

1105

feasibility of accessing the Medicare system to determine

1106

recipient eligibility for home health services; providing

1107

an effective date.

1108

4/22/2008  4:48:00 PM     13-08418-08