| 1 | Representative R. Garcia offered the following: |
| 2 |
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| 3 | Amendment (with title amendment) |
| 4 | Remove line 254 and insert: |
| 5 | (3) The agency shall impose a fine of $5,000 against a |
| 6 | home health agency that demonstrates a pattern of billing any |
| 7 | payor for services not provided. A pattern may be demonstrated |
| 8 | by a showing of at least three billings for services not |
| 9 | provided within a 12-month period. The fine must be imposed for |
| 10 | each incident that is falsely billed. The agency may also: |
| 11 | (a) Require payback of all funds; |
| 12 | (b) Revoke the license; or |
| 13 | (c) Issue a moratorium in accordance with s. 408.814. |
| 14 | (4) The agency shall impose a fine of $5,000 against a |
| 15 | home health agency that demonstrates a pattern of failing to |
| 16 | provide a service specified in the home health agency's written |
| 17 | agreement with a patient or the patient's legal representative, |
| 18 | or the plan of care for that patient, unless a reduction in |
| 19 | service is mandated by Medicare, Medicaid, or a state program or |
| 20 | as provided in s. 400.492(3). A pattern may be demonstrated by a |
| 21 | showing of at least three incidences, regardless of the patient |
| 22 | or service, when the home health agency did not provide a |
| 23 | service specified in a written agreement or plan of care during |
| 24 | a 3-month period. The agency shall impose the fine for each |
| 25 | occurrence. The agency may also impose additional administrative |
| 26 | fines under s. 400.484 for the direct or indirect harm to a |
| 27 | patient, or deny, revoke, or suspend the license of the home |
| 28 | health agency for a pattern of failing to provide a service |
| 29 | specified in the home health agency's written agreement with a |
| 30 | patient or the plan of care for that patient. |
| 31 | (5) The agency may deny, revoke, or suspend the license of |
| 32 | a home health agency and shall impose a fine of $5,000 against a |
| 33 | home health agency that: |
| 34 | (a) Gives remuneration for staffing services to: |
| 35 | 1. Another home health agency with which it has formal or |
| 36 | informal patient-referral transactions or arrangements; or |
| 37 | 2. A health services pool with which it has formal or |
| 38 | informal patient-referral transactions or arrangements, |
| 39 | |
| 40 | unless the home health agency has activated its comprehensive |
| 41 | emergency management plan in accordance with s. 400.492. This |
| 42 | paragraph does not apply to a Medicare-certified home health |
| 43 | agency that provides fair market value remuneration for staffing |
| 44 | services to a non-Medicare-certified home health agency that is |
| 45 | part of a continuing care facility licensed under chapter 651 |
| 46 | providing services to its own residents if each resident |
| 47 | receiving home health services pursuant to this arrangement |
| 48 | attests in writing that he or she made a decision without |
| 49 | influence from the staff of the facility to select, from a list |
| 50 | of Medicare-certified home health agencies provided by the |
| 51 | facility, that Medicare-certified home health agency to provide |
| 52 | the services. |
| 53 | (b) Provides services to residents in an assisted living |
| 54 | facility for which the home health agency does not receive fair |
| 55 | market value remuneration. |
| 56 | (c) Provides staffing to an assisted living facility for |
| 57 | which the home health agency does not receive fair market value |
| 58 | remuneration. |
| 59 | (d) Fails to provide the agency, upon request, with copies |
| 60 | of all contracts with assisted living facilities which were |
| 61 | executed within 5 years before the request was submitted. |
| 62 | (e) Gives remuneration to a case manager, discharge |
| 63 | planner, facility-based staff member, or third-party vendor who |
| 64 | is involved in the discharge-planning process of a facility |
| 65 | licensed under chapter 395 or this chapter from whom the home |
| 66 | health agency receives referrals. |
| 67 | (f) Fails to submit to the agency, within 10 days after |
| 68 | the end of each calendar quarter, a written report that includes |
| 69 | the following data based on data as it existed on the last day |
| 70 | of the quarter: |
| 71 | 1. The number of insulin-dependent diabetic patients |
| 72 | receiving insulin-injection services from the home health |
| 73 | agency; |
| 74 | 2. The number of patients receiving both home health |
| 75 | services from the home health agency and hospice services; |
| 76 | 3. The number of patients receiving home health services |
| 77 | from that home health agency; and |
| 78 | 4. The names and license numbers of nurses whose primary |
| 79 | job responsibility is to provide home health services to |
| 80 | patients and who received remuneration from the home health |
| 81 | agency in excess of $25,000 during the calendar quarter. |
| 82 | (g) Gives cash, or its equivalent, to a Medicare or |
| 83 | Medicaid beneficiary. |
| 84 | (h) Has more than one medical director contract in effect |
| 85 | at one time or more than one medical director contract and one |
| 86 | contract with a physician-specialist whose services are mandated |
| 87 | for the home health agency in order to qualify to participate in |
| 88 | a federal or state health care program at one time. |
| 89 | (i) Gives remuneration to a physician without a medical |
| 90 | director contract being in effect. The contract must: |
| 91 | 1. Be in writing and signed by both parties; |
| 92 | 2. Provide for remuneration that is at fair market value |
| 93 | for an hourly rate, which must be supported by invoices |
| 94 | submitted by the medical director describing the work performed, |
| 95 | the dates on which that work was performed, and the duration of |
| 96 | that work; and |
| 97 | 3. Be for a term of at least 1 year. |
| 98 |
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| 99 | The hourly rate specified in the contract may not be increased |
| 100 | during the term of the contract. The home health agency may not |
| 101 | execute a subsequent contract with that physician which has an |
| 102 | increased hourly rate and covers any portion of the term that |
| 103 | was in the original contract. |
| 104 | (j) Gives remuneration to: |
| 105 | 1. A physician, and the home health agency is in violation |
| 106 | of paragraph (h) or paragraph (i); |
| 107 | 2. A member of the physician's office staff; or |
| 108 | 3. An immediate family member of the physician, |
| 109 | |
| 110 | if the home health agency has received a patient referral in the |
| 111 | preceding 12 months from that physician or members of that |
| 112 | physician's office staff. |
| 113 | (k) Fails to provide to the agency, upon request, copies |
| 114 | of all contracts with a medical director which were executed |
| 115 | within 5 years before the request. |
| 116 | (6)(3)(a) In addition to the requirements of s. 408.813, |
| 117 | any |
| 118 | ====== T I T L E A M E N D M E N T ===== |
| 119 | Between lines 267 and 268, insert: |
| 120 | authorizing the agency to impose a fine, deny, revoke, or |
| 121 | suspend the license of against a home health agency under |
| 122 | certain circumstances; |