HB 7083

1
A bill to be entitled
2An act relating to health care; amending s. 400.462, F.S.;
3revising definitions; amending s. 400.464, F.S.;
4authorizing a home infusion therapy provider to be
5licensed as a nurse registry; deleting provisions relating
6to Medicare reimbursement; amending s. 400.471, F.S.;
7requiring an applicant for a home health agency license to
8submit to the Agency for Health Care Administration a
9business plan and evidence of contingency funding and
10disclose other controlling ownership interests in health
11care entities; requiring certain standards in
12documentation demonstrating financial ability to operate;
13prohibiting the agency from issuing an initial license to
14a home health agency licensure applicant located within 10
15miles of a licensed home health agency that has common
16controlling interests; prohibiting the transfer of an
17application to another home health agency prior to
18issuance of the license; requiring submission of an
19initial application to relocate a licensed home health
20agency to another geographic service area; amending s.
21400.474, F.S.; providing additional grounds under which
22the agency may take disciplinary action against a home
23health agency; providing for a fine; creating s. 400.476,
24F.S.; establishing staffing requirements for home health
25agencies; reducing the number of home health agencies that
26an administrator or director of nursing may serve;
27requiring that an alternate administrator be designated in
28writing; limiting the period that a home health agency
29that provides skilled nursing care may operate without a
30director of nursing; requiring notification upon the
31termination and replacement of a director of nursing;
32requiring the agency to take administrative enforcement
33action against a home health agency for noncompliance with
34the notification and staffing requirements for a director
35of nursing; providing for fines; exempting a home health
36agency that provides only physical, occupational, or
37speech therapy from requirements related to a director of
38nursing; providing training requirements for certified
39nursing assistants and home health aides; amending s.
40400.484, F.S.; requiring the agency to impose
41administrative fines for certain deficiencies; increasing
42the administrative fines imposed for certain deficiencies;
43amending s. 400.491, F.S.; extending the period that a
44home health agency must retain records of the nonskilled
45care it provides; amending s. 400.497, F.S.; requiring
46that the agency adopt rules related to standards for the
47director of nursing of a home health agency, requirements
48for a director of nursing to submit certified staff
49activity logs pursuant to an agency request, quality
50assurance programs, and inspections related to an
51application for a change in ownership; amending s.
52400.506, F.S.; providing training requirements for
53certified nursing assistants and home health aides
54referred for contract by a nurse registry; amending s,
55409.901, F.S.; defining the term "change of ownership";
56amending s. 409.907, F.S.; revising provisions relating to
57change of ownership of Medicaid provider agreements;
58providing for continuing financial liability of a
59transferor under certain circumstances; defining the term
60"outstanding overpayment"; requiring the transferor to
61provide notice of change of ownership to the agency within
62a specified time period; requiring the transferee to
63submit a Medicaid provider enrollment application to the
64agency; providing for joint and several liability under
65certain circumstances; requiring a written payment plan
66for certain outstanding financial obligations; providing
67conditions under which additional enrollment effective
68dates apply; amending s. 409.910, F.S.; conforming a
69cross-reference; amending s. 409.912, F.S.; requiring the
70agency to limit its network of Medicaid durable medical
71equipment and medical supply providers; prohibiting
72reimbursement for dates of service after January 1, 2009;
73requiring accreditation; requiring direct provision of
74services or supplies; authorizing provider to store
75nebulizers at a physician's office under certain
76circumstances; imposing certain physical location
77requirements; requiring providers to maintain a certain
78stock of equipment and supplies; requiring a surety bond;
79requiring background screening of employees; providing for
80certain exemptions; providing an effective date.
81
82Be It Enacted by the Legislature of the State of Florida:
83
84     Section 1.  Subsections (1), (5), (10), (14), and (25) of
85section 400.462, Florida Statutes, are amended to read:
86     400.462  Definitions.--As used in this part, the term:
87     (1)  "Administrator" means a direct employee, as defined in
88subsection (9), who is. The administrator must be a licensed
89physician, physician assistant, or registered nurse licensed to
90practice in this state or an individual having at least 1 year
91of supervisory or administrative experience in home health care
92or in a facility licensed under chapter 395, under part II of
93this chapter, or under part I of chapter 429. An administrator
94may manage a maximum of five licensed home health agencies
95located within one agency service district or within an
96immediately contiguous county. If the home health agency is
97licensed under this chapter and is part of a retirement
98community that provides multiple levels of care, an employee of
99the retirement community may administer the home health agency
100and up to a maximum of four entities licensed under this chapter
101or chapter 429 that are owned, operated, or managed by the same
102corporate entity. An administrator shall designate, in writing,
103for each licensed entity, a qualified alternate administrator to
104serve during absences.
105     (5)  "Certified nursing assistant" means any person who has
106been issued a certificate under part II of chapter 464. The
107licensed home health agency or licensed nurse registry shall
108ensure that the certified nursing assistant employed by or under
109contract with the home health agency or licensed nurse registry
110is adequately trained to perform the tasks of a home health aide
111in the home setting.
112     (10)  "Director of nursing" means a registered nurse who is
113a direct employee, as defined in subsection (9), of the agency
114and who is a graduate of an approved school of nursing and is
115licensed in this state; who has at least 1 year of supervisory
116experience as a registered nurse; and who is responsible for
117overseeing the professional nursing and home health aid delivery
118of services of the agency. A director of nursing may be the
119director of a maximum of five licensed home health agencies
120operated by a related business entity and located within one
121agency service district or within an immediately contiguous
122county. If the home health agency is licensed under this chapter
123and is part of a retirement community that provides multiple
124levels of care, an employee of the retirement community may
125serve as the director of nursing of the home health agency and
126of up to four entities licensed under this chapter or chapter
127429 which are owned, operated, or managed by the same corporate
128entity.
129     (14)  "Home health aide" means a person who is trained or
130qualified, as provided by rule, and who provides hands-on
131personal care, performs simple procedures as an extension of
132therapy or nursing services, assists in ambulation or exercises,
133or assists in administering medications as permitted in rule and
134for which the person has received training established by the
135agency under s. 400.497(1). The licensed home health agency or
136licensed nurse registry shall ensure that the home health aide
137employed by or under contract with the home health agency or
138licensed nurse registry is adequately trained to perform the
139tasks of a home health aide in the home setting.
140     (25)  "Staffing services" means services provided to a
141health care facility, school, or other business entity on a
142temporary or school-year basis pursuant to a written contract by
143licensed health care personnel and by certified nursing
144assistants and home health heath aides who are employed by, or
145work under the auspices of, a licensed home health agency or who
146are registered with a licensed nurse registry. Staffing services
147may be provided anywhere within the state.
148     Section 2.  Subsection (3) of section 400.464, Florida
149Statutes, is amended to read:
150     400.464  Home health agencies to be licensed; expiration of
151license; exemptions; unlawful acts; penalties.--
152     (3)  A Any home infusion therapy provider must shall be
153licensed as a home health agency or nurse registry. Any infusion
154therapy provider currently authorized to receive Medicare
155reimbursement under a DME - Part B Provider number for the
156provision of infusion therapy shall be licensed as a
157noncertified home health agency. Such a provider shall continue
158to receive that specified Medicare reimbursement without being
159certified so long as the reimbursement is limited to those items
160authorized pursuant to the DME - Part B Provider Agreement and
161the agency is licensed in compliance with the other provisions
162of this part.
163     Section 3.  Paragraphs (d), (e), (f), and (g) are added to
164subsection (2) of section 400.471, Florida Statutes, and
165subsections (7), (8), and (9) are added to that section, to
166read:
167     400.471  Application for license; fee.--
168     (2)  In addition to the requirements of part II of chapter
169408, the initial applicant must file with the application
170satisfactory proof that the home health agency is in compliance
171with this part and applicable rules, including:
172     (d)  A business plan, signed by the applicant, which
173details the home health agency's methods to obtain patients and
174its plan to recruit and maintain staff.
175     (e)  Evidence of contingency funding equal to 1 month's
176average operating expenses during the first year of operation.
177     (f)  A balance sheet, income and expense statement, and
178statement of cash flows for the first 2 years of operation which
179provide evidence of having sufficient assets, credit, and
180projected revenues to cover liabilities and expenses. The
181applicant has demonstrated financial ability to operate if the
182applicant's assets, credit, and projected revenues meet or
183exceed projected liabilities and expenses. An applicant may not
184project an operating margin of 15 percent or greater for any
185month in the first year of operation. All documents required
186under this paragraph must be prepared in accordance with
187generally accepted accounting principles and compiled and signed
188by a certified public accountant.
189     (g)  All other ownership interests in health care entities
190for each controlling interest, as defined in part II of chapter
191408.
192     (7)  The agency may not issue an initial license to a home
193health agency licensure applicant if the applicant shares common
194controlling interests with another licensed home health agency
195that is located within 10 miles of the applicant. The agency
196must return the application and fees to the applicant.
197     (8)  An application for a home health agency license may
198not be transferred to another home health agency or controlling
199interest prior to issuance of the license.
200     (9)  A licensed home health agency that seeks to relocate
201to a different geographic service area not listed on its license
202must submit an initial application for a home health agency
203license for the new location.
204     Section 4.  Section 400.474, Florida Statutes, is amended
205to read:
206     400.474  Administrative penalties.--
207     (1)(a)  The agency may deny, revoke, and suspend a license
208and impose an administrative fine in the manner provided in
209chapter 120.
210     (b)  The agency shall impose a fine of $1,000 against a
211home health agency that demonstrates a pattern of falsifying:
212     1.  Documents of training for home health aides or
213certified nursing assistants; or
214     2.  Health statements for staff providing direct care to
215patients.
216
217A pattern may be demonstrated by a showing of at least three
218fraudulent entries or documents. The fine shall be imposed for
219each fraudulent document or, if multiple staff members are
220included on one document, for each fraudulent entry on the
221document.
222     (2)  Any of the following actions by a home health agency
223or its employee is grounds for disciplinary action by the
224agency:
225     (a)  Violation of this part, part II of chapter 408, or of
226applicable rules.
227     (b)  An intentional, reckless, or negligent act that
228materially affects the health or safety of a patient.
229     (c)  Knowingly providing home health services in an
230unlicensed assisted living facility or unlicensed adult family-
231care home, unless the home health agency or employee reports the
232unlicensed facility or home to the agency within 72 hours after
233providing the services.
234     (d)  Preparing or maintaining fraudulent patient records,
235such as, but not limited to, charting ahead, recording vital
236signs or symptoms that were not personally obtained or observed
237by the home health agency's staff at the time indicated,
238borrowing patients or patient records from other home health
239agencies to pass a survey or inspection, or falsifying
240signatures.
241     (e)  Failing to provide at least one service directly to a
242patient for a period of 60 days.
243     (3)(a)  In addition to the requirements of s. 408.813, any
244person, partnership, or corporation that violates s. 408.813 and
245that previously operated a licensed home health agency or
246concurrently operates both a licensed home health agency and an
247unlicensed home health agency commits a felony of the third
248degree punishable as provided in s. 775.082, s. 775.083, or s.
249775.084.
250     (b)  If any home health agency is found to be operating
251without a license and that home health agency has received any
252government reimbursement for services, the agency shall make a
253fraud referral to the appropriate government reimbursement
254program.
255     Section 5.  Section 400.476, Florida Statutes, is created
256to read:
257     400.476  Staffing requirements; notifications; limitations
258on staffing services.--
259     (1)  ADMINISTRATOR.--
260     (a)  An administrator may manage only one home health
261agency, except that an administrator may manage up to five home
262health agencies if all five home health agencies have identical
263controlling interests as defined in s. 408.803 and are located
264within one agency geographic service area or within an
265immediately contiguous county. If the home health agency is
266licensed under this chapter and is part of a retirement
267community that provides multiple levels of care, an employee of
268the retirement community may administer the home health agency
269and up to a maximum of four entities licensed under this chapter
270or chapter 429 which all have identical controlling interests as
271defined in s. 408.803. An administrator shall designate, in
272writing, for each licensed entity, a qualified alternate
273administrator to serve during the administrator's absence.
274     (b)  An administrator of a home health agency who is a
275licensed physician, physician assistant, or registered nurse
276licensed to practice in this state may also be the director of
277nursing for a home health agency. An administrator may serve as
278a director of nursing for up to the number of entities
279authorized in subsection (2) only if there are 10 or fewer full-
280time equivalent employees and contracted personnel in each home
281health agency.
282     (2)  DIRECTOR OF NURSING.--
283     (a)  A director of nursing may be the director of nursing
284for:
285     1.  Up to two licensed home health agencies if the agencies
286have identical controlling interests as defined in s. 408.803
287and are located within one agency geographic service area or
288within an immediately contiguous county; or
289     2.  Up to five licensed home health agencies if:
290     a.  All of the home health agencies have identical
291controlling interests as defined in s. 408.803;
292     b.  All of the home health agencies are located within one
293agency geographic service area or within an immediately
294contiguous county; and
295     c.  Each home health agency has a registered nurse who
296meets the qualifications of a director of nursing and who has a
297written delegation from the director of nursing to serve as the
298director of nursing for that home health agency when the
299director of nursing is not present.
300
301If a home health agency licensed under this chapter is part of a
302retirement community that provides multiple levels of care, an
303employee of the retirement community may serve as the director
304of nursing of the home health agency and up to a maximum of four
305entities, other than home health agencies, licensed under this
306chapter or chapter 429 which all have identical controlling
307interests as defined in s. 408.803.
308     (b)  A home health agency that provides skilled nursing
309care may not operate for more than 30 calendar days without a
310director of nursing. A home health agency that provides skilled
311nursing care and the director of nursing of the home health
312agency must notify the agency within 10 business days after
313termination of the services of the director of nursing for the
314home health agency. A home health agency that provides skilled
315nursing care must notify the agency of the identity and
316qualifications of the new director of nursing within 10 days
317after the new director is hired. If a home health agency that
318provides skilled nursing care operates for more than 30 calendar
319days without a director of nursing, the home health agency
320commits a class II deficiency. In addition to the fine for a
321class II deficiency, the agency may issue a moratorium in
322accordance with s. 408.814 or revoke the license. The agency
323shall fine a home health agency that fails to notify the agency
324as required in this paragraph $1,000 for the first violation and
325$2,000 for a repeat violation. The agency may not take
326administrative action against a home health agency if the
327director of nursing fails to notify the department upon
328termination of services as the director of nursing for the home
329health agency.
330     (c)  A home health agency that provides only physical,
331occupational, or speech therapy is not required to have a
332director of nursing and is exempt from paragraph (b).
333     (3)  TRAINING.--A home health agency shall ensure that each
334certified nursing assistant employed by or under contract with
335the home health agency and each home health aide employed by or
336under contract with the home health agency is adequately trained
337to perform the tasks of a home health aide in the home setting.
338     (4)  STAFFING.--Staffing services may be provided anywhere
339within the state.
340     Section 6.  Section 400.484, Florida Statutes, is amended
341to read:
342     400.484  Right of inspection; deficiencies; fines.--
343     (1)  In addition to the requirements of s. 408.811, the
344agency may make such inspections and investigations as are
345necessary in order to determine the state of compliance with
346this part, part II of chapter 408, and applicable rules.
347     (2)  The agency shall impose fines for various classes of
348deficiencies in accordance with the following schedule:
349     (a)  A class I deficiency is any act, omission, or practice
350that results in a patient's death, disablement, or permanent
351injury, or places a patient at imminent risk of death,
352disablement, or permanent injury. Upon finding a class I
353deficiency, the agency shall may impose an administrative fine
354in the amount of $15,000 $5,000 for each occurrence and each day
355that the deficiency exists.
356     (b)  A class II deficiency is any act, omission, or
357practice that has a direct adverse effect on the health, safety,
358or security of a patient. Upon finding a class II deficiency,
359the agency shall may impose an administrative fine in the amount
360of $5,000 $1,000 for each occurrence and each day that the
361deficiency exists.
362     (c)  A class III deficiency is any act, omission, or
363practice that has an indirect, adverse effect on the health,
364safety, or security of a patient. Upon finding an uncorrected or
365repeated class III deficiency, the agency shall may impose an
366administrative fine not to exceed $1,000 $500 for each
367occurrence and each day that the uncorrected or repeated
368deficiency exists.
369     (d)  A class IV deficiency is any act, omission, or
370practice related to required reports, forms, or documents which
371does not have the potential of negatively affecting patients.
372These violations are of a type that the agency determines do not
373threaten the health, safety, or security of patients. Upon
374finding an uncorrected or repeated class IV deficiency, the
375agency shall may impose an administrative fine not to exceed
376$500 $200 for each occurrence and each day that the uncorrected
377or repeated deficiency exists.
378     (3)  In addition to any other penalties imposed pursuant to
379this section or part, the agency may assess costs related to an
380investigation that results in a successful prosecution,
381excluding costs associated with an attorney's time.
382     Section 7.  Subsection (2) of section 400.491, Florida
383Statutes, is amended to read:
384     400.491  Clinical records.--
385     (2)  The home health agency must maintain for each client
386who receives nonskilled care a service provision plan. Such
387records must be maintained by the home health agency for 3 years
3881 year following termination of services.
389     Section 8.  Subsections (5), (6), (7), and (8) of section
390400.497, Florida Statutes, are renumbered as subsections (7),
391(8), (9), and (10), respectively, and new subsections (5) and
392(6) are added to that section to read:
393     400.497  Rules establishing minimum standards.--The agency
394shall adopt, publish, and enforce rules to implement part II of
395chapter 408 and this part, including, as applicable, ss. 400.506
396and 400.509, which must provide reasonable and fair minimum
397standards relating to:
398     (5)  Oversight by the director of nursing. The agency shall
399develop rules related to:
400     (a)  Standards that address oversight responsibilities by
401the director of nursing of skilled nursing and personal care
402services provided by the home health agency's staff;
403     (b)  Requirements for a director of nursing to provide to
404the agency, upon request, a certified daily report of the home
405health services provided by a specified direct employee or
406contracted staff member on behalf of the home health agency. The
407agency may request a certified daily report only for a period
408not to exceed 2 years prior to the date of the request; and
409     (c)  A quality assurance program for home health services
410provided by the home health agency.
411     (6)  Conditions for using a recent unannounced licensure
412inspection for the inspection required in s. 408.806 related to
413a licensure application associated with a change in ownership of
414a licensed home health agency.
415     Section 9.  Paragraph (a) of subsection (6) of section
416400.506, Florida Statutes, is amended to read:
417     400.506  Licensure of nurse registries; requirements;
418penalties.--
419     (6)(a)  A nurse registry may refer for contract in private
420residences registered nurses and licensed practical nurses
421registered and licensed under part I of chapter 464, certified
422nursing assistants certified under part II of chapter 464, home
423health aides who present documented proof of successful
424completion of the training required by rule of the agency, and
425companions or homemakers for the purposes of providing those
426services authorized under s. 400.509(1). A licensed nurse
427registry shall ensure that each certified nursing assistant
428referred for contract by the nurse registry and each home health
429aide referred for contract by the nurse registry is adequately
430trained to perform the tasks of a home health aide in the home
431setting. Each person referred by a nurse registry must provide
432current documentation that he or she is free from communicable
433diseases.
434     Section 10.  Subsections (5) through (27) of section
435409.901, Florida Statutes, are renumbered as subsections (6)
436through (28), respectively, and a new subsection (5) is added to
437that section to read:
438     409.901  Definitions; ss. 409.901-409.920.--As used in ss.
439409.901-409.920, except as otherwise specifically provided, the
440term:
441     (5)  "Change of ownership" means an event in which the
442provider changes to a different legal entity or in which 45
443percent or more of the ownership, voting shares, or controlling
444interest in a corporation whose shares are not publicly traded
445on a recognized stock exchange is transferred or assigned,
446including the final transfer or assignment of multiple transfers
447or assignments over a 2-year period that cumulatively total 45
448percent or greater. A change solely in the management company or
449board of directors is not a change of ownership.
450     Section 11.  Subsections (6) and (9) of section 409.907,
451Florida Statutes, are amended to read:
452     409.907  Medicaid provider agreements.--The agency may make
453payments for medical assistance and related services rendered to
454Medicaid recipients only to an individual or entity who has a
455provider agreement in effect with the agency, who is performing
456services or supplying goods in accordance with federal, state,
457and local law, and who agrees that no person shall, on the
458grounds of handicap, race, color, or national origin, or for any
459other reason, be subjected to discrimination under any program
460or activity for which the provider receives payment from the
461agency.
462     (6)  A Medicaid provider agreement may be revoked, at the
463option of the agency, as the result of a change of ownership of
464any facility, association, partnership, or other entity named as
465the provider in the provider agreement. A provider shall give
466the agency 60 days' notice before making any change in ownership
467of the entity named in the provider agreement as the provider.
468     (a)  In the event of a change of ownership, the transferor
469shall remain liable for all outstanding overpayments,
470administrative fines, and any other moneys owed to the agency
471prior to the effective date of the change of ownership. In
472addition to the continuing liability of the transferor, the
473transferee shall be liable to the agency for all outstanding
474overpayments identified by the agency on or before the effective
475date of the change of ownership. For purposes of this
476subsection, the term "outstanding overpayment" includes any
477amount identified in a preliminary audit report issued to the
478transferor by the agency on or before the effective date of the
479change of ownership. In the event of a change of ownership for a
480skilled nursing facility or intermediate care facility, the
481Medicaid provider agreement shall be assigned to the transferee
482if the transferee meets all other Medicaid provider
483qualifications.
484     (b)  At least 60 days prior to the anticipated date of the
485change of ownership, the transferor shall notify the agency of
486the intended change of ownership and the transferee shall submit
487to the agency a Medicaid provider enrollment application. In the
488event a change of ownership occurs without compliance with the
489notice requirements of this subsection, the transferor and
490transferee shall be jointly and severally liable for all
491overpayments, administrative fines, and other moneys due to the
492agency, regardless of whether the agency identified the
493overpayments, administrative fines, or other moneys before or
494after the effective date of the change of ownership. The agency
495shall not approve a transferee's Medicaid provider enrollment
496application if the transferee or transferor has not paid or
497agreed in writing to a payment plan for all outstanding
498overpayments, administrative fines, and other moneys due to the
499agency. This subsection does not preclude the agency from
500seeking any other legal or equitable remedies available to the
501agency for the recovery of moneys owed to the Medicaid program.
502     (9)  Upon receipt of a completed, signed, and dated
503application, and completion of any necessary background
504investigation and criminal history record check, the agency must
505either:
506     (a)  Enroll the applicant as a Medicaid provider upon
507approval of the provider application. The enrollment effective
508date shall be the date the agency receives the provider
509application. With respect to a provider that requires a Medicare
510certification survey, the enrollment effective date shall be the
511date the certification is awarded. With respect to a provider
512that completes a change of ownership, the effective date shall
513be the date the agency received the application, the date the
514change of ownership was complete, or the date the applicant
515became eligible to provide services under Medicaid, whichever
516date is later. With respect to a provider of emergency medical
517services transportation or emergency services and care, the
518effective date is the date the services were rendered. Payment
519for any claims for services provided to Medicaid recipients
520between the date of receipt of the application and the date of
521approval is contingent on applying any and all applicable audits
522and edits contained in the agency's claims adjudication and
523payment processing systems; or
524     (b)  Deny the application if the agency finds that it is in
525the best interest of the Medicaid program to do so. The agency
526may consider the factors listed in subsection (10), as well as
527any other factor that could affect the effective and efficient
528administration of the program, including, but not limited to,
529the applicant's demonstrated ability to provide services,
530conduct business, and operate a financially viable concern; the
531current availability of medical care, services, or supplies to
532recipients, taking into account geographic location and
533reasonable travel time; the number of providers of the same type
534already enrolled in the same geographic area; and the
535credentials, experience, success, and patient outcomes of the
536provider for the services that it is making application to
537provide in the Medicaid program. The agency shall deny the
538application if the agency finds that a provider; any officer,
539director, agent, managing employee, or affiliated person; or any
540partner or shareholder having an ownership interest equal to 5
541percent or greater in the provider if the provider is a
542corporation, partnership, or other business entity, has failed
543to pay all outstanding fines or overpayments assessed by final
544order of the agency or final order of the Centers for Medicare
545and Medicaid Services, not subject to further appeal, unless the
546provider agrees to a repayment plan that includes withholding
547Medicaid reimbursement until the amount due is paid in full.
548     Section 12.  Subsection (20) of section 409.910, Florida
549Statutes, is amended to read:
550     409.910  Responsibility for payments on behalf of Medicaid-
551eligible persons when other parties are liable.--
552     (20)  Entities providing health insurance as defined in s.
553624.603, health maintenance organizations and prepaid health
554clinics as defined in chapter 641, and, on behalf of their
555clients, third-party administrators and pharmacy benefits
556managers as defined in s. 409.901(27)(26) shall provide such
557records and information as are necessary to accomplish the
558purpose of this section, unless such requirement results in an
559unreasonable burden.
560     (a)  The director of the agency and the Director of the
561Office of Insurance Regulation of the Financial Services
562Commission shall enter into a cooperative agreement for
563requesting and obtaining information necessary to effect the
564purpose and objective of this section.
565     1.  The agency shall request only that information
566necessary to determine whether health insurance as defined
567pursuant to s. 624.603, or those health services provided
568pursuant to chapter 641, could be, should be, or have been
569claimed and paid with respect to items of medical care and
570services furnished to any person eligible for services under
571this section.
572     2.  All information obtained pursuant to subparagraph 1. is
573confidential and exempt from s. 119.07(1).
574     3.  The cooperative agreement or rules adopted under this
575subsection may include financial arrangements to reimburse the
576reporting entities for reasonable costs or a portion thereof
577incurred in furnishing the requested information. Neither the
578cooperative agreement nor the rules shall require the automation
579of manual processes to provide the requested information.
580     (b)  The agency and the Financial Services Commission
581jointly shall adopt rules for the development and administration
582of the cooperative agreement. The rules shall include the
583following:
584     1.  A method for identifying those entities subject to
585furnishing information under the cooperative agreement.
586     2.  A method for furnishing requested information.
587     3.  Procedures for requesting exemption from the
588cooperative agreement based on an unreasonable burden to the
589reporting entity.
590     Section 13.  Subsection (48) of section 409.912, Florida
591Statutes, is amended to read:
592     409.912  Cost-effective purchasing of health care.--The
593agency shall purchase goods and services for Medicaid recipients
594in the most cost-effective manner consistent with the delivery
595of quality medical care. To ensure that medical services are
596effectively utilized, the agency may, in any case, require a
597confirmation or second physician's opinion of the correct
598diagnosis for purposes of authorizing future services under the
599Medicaid program. This section does not restrict access to
600emergency services or poststabilization care services as defined
601in 42 C.F.R. part 438.114. Such confirmation or second opinion
602shall be rendered in a manner approved by the agency. The agency
603shall maximize the use of prepaid per capita and prepaid
604aggregate fixed-sum basis services when appropriate and other
605alternative service delivery and reimbursement methodologies,
606including competitive bidding pursuant to s. 287.057, designed
607to facilitate the cost-effective purchase of a case-managed
608continuum of care. The agency shall also require providers to
609minimize the exposure of recipients to the need for acute
610inpatient, custodial, and other institutional care and the
611inappropriate or unnecessary use of high-cost services. The
612agency shall contract with a vendor to monitor and evaluate the
613clinical practice patterns of providers in order to identify
614trends that are outside the normal practice patterns of a
615provider's professional peers or the national guidelines of a
616provider's professional association. The vendor must be able to
617provide information and counseling to a provider whose practice
618patterns are outside the norms, in consultation with the agency,
619to improve patient care and reduce inappropriate utilization.
620The agency may mandate prior authorization, drug therapy
621management, or disease management participation for certain
622populations of Medicaid beneficiaries, certain drug classes, or
623particular drugs to prevent fraud, abuse, overuse, and possible
624dangerous drug interactions. The Pharmaceutical and Therapeutics
625Committee shall make recommendations to the agency on drugs for
626which prior authorization is required. The agency shall inform
627the Pharmaceutical and Therapeutics Committee of its decisions
628regarding drugs subject to prior authorization. The agency is
629authorized to limit the entities it contracts with or enrolls as
630Medicaid providers by developing a provider network through
631provider credentialing. The agency may competitively bid single-
632source-provider contracts if procurement of goods or services
633results in demonstrated cost savings to the state without
634limiting access to care. The agency may limit its network based
635on the assessment of beneficiary access to care, provider
636availability, provider quality standards, time and distance
637standards for access to care, the cultural competence of the
638provider network, demographic characteristics of Medicaid
639beneficiaries, practice and provider-to-beneficiary standards,
640appointment wait times, beneficiary use of services, provider
641turnover, provider profiling, provider licensure history,
642previous program integrity investigations and findings, peer
643review, provider Medicaid policy and billing compliance records,
644clinical and medical record audits, and other factors. Providers
645shall not be entitled to enrollment in the Medicaid provider
646network. The agency shall determine instances in which allowing
647Medicaid beneficiaries to purchase durable medical equipment and
648other goods is less expensive to the Medicaid program than long-
649term rental of the equipment or goods. The agency may establish
650rules to facilitate purchases in lieu of long-term rentals in
651order to protect against fraud and abuse in the Medicaid program
652as defined in s. 409.913. The agency may seek federal waivers
653necessary to administer these policies.
654     (48)(a)  A provider is not entitled to enrollment in the
655Medicaid provider network. The agency may implement a Medicaid
656fee-for-service provider network controls, including, but not
657limited to, competitive procurement and provider credentialing.
658If a credentialing process is used, the agency may limit its
659provider network based upon the following considerations:
660beneficiary access to care, provider availability, provider
661quality standards and quality assurance processes, cultural
662competency, demographic characteristics of beneficiaries,
663practice standards, service wait times, provider turnover,
664provider licensure and accreditation history, program integrity
665history, peer review, Medicaid policy and billing compliance
666records, clinical and medical record audit findings, and such
667other areas that are considered necessary by the agency to
668ensure the integrity of the program.
669     (b)  The agency shall limit its network of durable medical
670equipment and medical supply providers. For dates of service
671after January 1, 2009, the agency shall limit payment for
672durable medical equipment and supplies to providers that meet
673all the requirements of this paragraph.
674     1.  Providers must be accredited by a Centers for Medicare
675and Medicaid Services Deemed Accreditation Organization for
676suppliers of durable medical equipment, prosthetics, orthotics,
677and supplies.  The provider must maintain accreditation and
678shall be subject to unannounced reviews by the accrediting
679organization.
680     2.  Providers must provide the services or supplies
681directly to the Medicaid recipient or caregiver at the provider
682location or recipient's residence or sent directly to the
683recipient's residence with receipt of mailed delivery.  
684Subcontracting or consignment of the service or supply to a
685third party is prohibited.
686     3.  Notwithstanding subparagraph 2., a durable medical
687equipment provider may store nebulizers at a physician's office
688for the purpose of having the physician's staff issue the
689equipment if it meets all of the following conditions:
690     a.  The physician must document the medical necessity and
691need to prevent further deterioration of the patient's
692respiratory status by the timely delivery of the nebulizer in
693the physician's office.
694     b.  The durable medical equipment provider must have
695written documentation of the competency and training by a
696Florida-licensed registered respiratory therapist of any durable
697medical equipment staff who participates in the training of
698physician office staff for the use of nebulizers, including
699cleaning, warranty, and special needs of patients.
700     c.  The physician's office must have documented the
701training and competency of any staff member who initiates the
702delivery of nebulizers to patients. The durable medical
703equipment provider must maintain copies of all physician office
704training.
705     d.  The durable medical equipment provider must be
706contracted with the physician to provide services.
707     4.  Providers must have a physical business location
708clearly identified as a business that furnishes durable medical
709equipment or medical supplies by signage that can be read from
71020 feet away. The location must be readily accessible to the
711public during normal, scheduled, posted business hours and must
712operate no less than 5 hours per day and no less than 5 days per
713week, with the exception of scheduled and posted holidays, and
714must have a functional landline business phone. The location
715shall not be located within or at the same numbered street
716address as another enrolled Medicaid durable medical equipment
717or medical supply provider or as an enrolled Medicaid pharmacy
718that is also enrolled as a durable medical equipment provider.
719The location shall be within the state or no more than 50 miles
720from the Florida state line. The agency may make exceptions for
721providers of durable medical equipment or supplies not otherwise
722available from other enrolled providers located within the
723state.
724     5.  Providers must maintain a stock of durable medical
725equipment and medical supplies on site that is readily available
726to meet the needs of the durable medical equipment business
727location's customers.
728     6.  Providers must provide a surety bond of $50,000 for
729each provider location, up to a maximum of five bonds statewide
730or an aggregate bond of $250,000 statewide, as identified by
731Federal Employer Identification Number. Providers who post a
732statewide or an aggregate bond must identify all of their
733locations in any Medicaid durable medical equipment and medical
734supply provider enrollment application or bond renewal. Each
735provider location's surety bond must be renewed annually, and
736the provider must submit proof of renewal even if the original
737bond is a continuous bond.
738     7.  Providers must obtain a level 2 background screening,
739as provided under s. 435.04, for each provider employee in
740direct contact with or providing direct services to recipients
741of durable medical equipment and medical supplies in their
742homes. This requirement includes, but is not limited to, repair
743and service technicians, fitters, and delivery staff. The cost
744of the background screening shall be borne by the provider.
745     8.  The following providers are exempt from the
746requirements of subparagraphs 1. and 7.:
747     a.  Durable medical equipment providers owned and operated
748by a government entity.
749     b.  Durable medical equipment providers that are operating
750within a pharmacy that is currently enrolled as a Medicaid
751pharmacy provider.
752     c.  Active, Medicaid-enrolled orthopedic physician groups,
753primarily owned by physicians, that provide only orthotic and
754prosthetic devices.
755     d.  Durable medical equipment providers approved through
756the federal competitive bid process to provide services in any
757metropolitan services area in the state.
758     Section 14.  This act shall take effect July 1, 2008.


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