CS/HB 7083

1	A bill to be entitled
2	An act relating to health care fraud and abuse; amending
3	s. 400.462, F.S.; revising and adding definitions;
4	amending s. 400.464, F.S.; authorizing a home infusion
5	therapy provider to be licensed as a nurse registry;
6	deleting provisions related to Medicare reimbursement;
7	amending s. 400.471, F.S.; requiring an applicant for a
8	home health agency license to submit to the Agency for
9	Health Care Administration a business plan and evidence of
10	contingency funding, and disclose other controlling
11	ownership interests in health care entities; requiring
12	certain standards in documentation demonstrating financial
13	ability to operate; requiring home health agencies to
14	maintain certain accreditation to maintain licensure;
15	permitting certain accrediting organizations to submit
16	surveys regarding licensure of home health agencies;
17	prohibiting the agency from issuing an initial license to
18	an applicant for a home health agency license which is
19	located within a certain distance of a licensed home
20	health agency that has common controlling interests;
21	prohibiting the transfer of an application to another home
22	health agency before issuance of the license; requiring
23	submission of an initial application to relocate a
24	licensed home health agency to another geographic service
25	area; amending s. 400.474, F.S.; providing additional
26	grounds under which the Agency for Health Care
27	Administration may take  disciplinary action against a
28	home health agency; creating s. 400.476, F.S.;
29	establishing staffing requirements for home health
30	agencies; reducing the number of home health agencies that
31	an administrator or director of nursing may serve;
32	requiring that an alternate administrator be designated in
33	writing; limiting the period that a home health agency
34	that provides skilled nursing care may operate without a
35	director of nursing; requiring notification upon the
36	termination and replacement of a director of nursing;
37	requiring the Agency for Health Care Administration to
38	take administrative enforcement action against a home
39	health agency for noncompliance with the notification and
40	staffing requirements for a director of nursing; providing
41	for fines; exempting a home health agency that is not
42	Medicare or Medicaid certified and does not provide
43	skilled care or provides only physical, occupational, or
44	speech therapy from requirements related to a director of
45	nursing; providing training requirements for certified
46	nursing assistants and home health aides; amending s.
47	400.484, F.S.; requiring the agency to impose
48	administrative fines for certain deficiencies; increasing
49	the administrative fines imposed for certain deficiencies;
50	amending s. 400.491, F.S.; extending the period that a
51	home health agency must retain records of the nonskilled
52	care it provides; amending s. 400.497, F.S.; requiring
53	that the Agency for Health Care Administration adopt rules
54	related to standards for the director of nursing of a home
55	health agency, requirements for a director of nursing to
56	submit certified staff activity logs pursuant to an agency
57	request, quality assurance programs, and inspections
58	related to an application for a change in ownership;
59	amending s. 400.506, F.S.; providing training requirements
60	for certified nursing assistants and home health aides
61	referred for contract by a nurse registry; providing for
62	the denial, suspension, or revocation of nurse registry
63	license and fines for paying remuneration to certain
64	entities in exchange for patient referrals or refusing
65	fair remuneration in exchange for patient referrals;
66	amending s. 400.518, F.S.; providing for a fine to be
67	imposed against a home health agency that provides
68	complimentary staffing to an assisted care community in
69	exchange for patient referrals; amending s, 409.901, F.S.;
70	defining the term "change of ownership"; amending s.
71	409.907, F.S.; revising provisions relating to change of
72	ownership of Medicaid provider agreements; providing for
73	continuing financial liability of a transferor under
74	certain circumstances; defining the term "outstanding
75	overpayment"; requiring the transferor to provide notice
76	of change of ownership to the agency within a specified
77	time period; requiring the transferee to submit a Medicaid
78	provider enrollment application to the agency; providing
79	for joint and several liability under certain
80	circumstances; requiring a written payment plan for
81	certain outstanding financial obligations; providing
82	conditions under which additional enrollment effective
83	dates apply; amending s. 409.910, F.S.; conforming a
84	cross-reference; amending s. 409.912, F.S.; requiring the
85	agency to limit its network of Medicaid durable medical
86	equipment and medical supply providers; prohibiting
87	reimbursement for dates of service after a certain date;
88	requiring accreditation; requiring direct provision of
89	services or supplies; authorizing a provider to store
90	nebulizers at a physician's office under certain
91	circumstances; imposing certain physical location
92	requirements; requiring a provider to maintain a certain
93	stock of equipment and supplies; requiring a surety bond;
94	requiring background screenings of employees; providing
95	for certain exemptions; requiring the Agency for Health
96	Care Administration to review the process for prior
97	authorization of home health agency visits and determine
98	whether modifications to the process are necessary;
99	requiring the agency to report to the Legislature on the
100	feasibility of accessing the Medicare system to determine
101	recipient eligibility for home health services; providing
102	an effective date.
103
104	Be It Enacted by the Legislature of the State of Florida:
105
106	Section 1.  Section 400.462, Florida Statutes, is amended
107	to read:
108	400.462  Definitions.--As used in this part, the term:
109	(1)  "Administrator" means a direct employee, as defined in
110	subsection (9), who is. The administrator must be a licensed
111	physician, physician assistant, or registered nurse licensed to
112	practice in this state or an individual having at least 1 year
113	of supervisory or administrative experience in home health care
114	or in a facility licensed under chapter 395, under part II of
115	this chapter, or under part I of chapter 429. An administrator
116	may manage a maximum of five licensed home health agencies
117	located within one agency service district or within an
118	immediately contiguous county. If the home health agency is
119	licensed under this chapter and is part of a retirement
120	community that provides multiple levels of care, an employee of
121	the retirement community may administer the home health agency
122	and up to a maximum of four entities licensed under this chapter
123	or chapter 429 that are owned, operated, or managed by the same
124	corporate entity. An administrator shall designate, in writing,
125	for each licensed entity, a qualified alternate administrator to
126	serve during absences.
127	(2)  "Admission" means a decision by the home health
128	agency, during or after an evaluation visit to the patient's
129	home, that there is reasonable expectation that the patient's
130	medical, nursing, and social needs for skilled care can be
131	adequately met by the agency in the patient's place of
132	residence. Admission includes completion of an agreement with
133	the patient or the patient's legal representative to provide
134	home health services as required in s. 400.487(1).
135	(3)  "Advanced registered nurse practitioner" means a
136	person licensed in this state to practice professional nursing
137	and certified in advanced or specialized nursing practice, as
138	defined in s. 464.003.
139	(4)  "Agency" means the Agency for Health Care
140	Administration.
141	(5)  "Certified nursing assistant" means any person who has
142	been issued a certificate under part II of chapter 464. The
143	licensed home health agency or licensed nurse registry shall
144	ensure that the certified nursing assistant employed by or under
145	contract with the home health agency or licensed nurse registry
146	is adequately trained to perform the tasks of a home health aide
147	in the home setting.
148	(6)  "Client" means an elderly, handicapped, or
149	convalescent individual who receives companion services or
150	homemaker services in the individual's home or place of
151	residence.
152	(7)  "Companion" or "sitter" means a person who spends time
153	with or cares for an elderly, handicapped, or convalescent
154	individual and accompanies such individual on trips and outings
155	and may prepare and serve meals to such individual. A companion
156	may not provide hands-on personal care to a client.
157	(8)  "Department" means the Department of Children and
158	Family Services.
159	(9)  "Direct employee" means an employee for whom one of
160	the following entities pays withholding taxes: a home health
161	agency; a management company that has a contract to manage the
162	home health agency on a day-to-day basis; or an employee leasing
163	company that has a contract with the home health agency to
164	handle the payroll and payroll taxes for the home health agency.
165	(10)  "Director of nursing" means a registered nurse who is
166	a direct employee, as defined in subsection (9), of the agency
167	and who is a graduate of an approved school of nursing and is
168	licensed in this state; who has at least 1 year of supervisory
169	experience as a registered nurse; and who is responsible for
170	overseeing the professional nursing and home health aid delivery
171	of services of the agency. A director of nursing may be the
172	director of a maximum of five licensed home health agencies
173	operated by a related business entity and located within one
174	agency service district or within an immediately contiguous
175	county. If the home health agency is licensed under this chapter
176	and is part of a retirement community that provides multiple
177	levels of care, an employee of the retirement community may
178	serve as the director of nursing of the home health agency and
179	of up to four entities licensed under this chapter or chapter
180	429 which are owned, operated, or managed by the same corporate
181	entity.
182	(11)  "Fair market value" means the value in arms length
183	transactions, consistent with the price that an asset would
184	bring as the result of bona fide bargaining between well-
185	informed buyers and sellers who are not otherwise in a position
186	to generate business for the other party, or the compensation
187	that would be included in a service agreement as the result of
188	bona fide bargaining between well-informed parties to the
189	agreement who are not otherwise in a position to generate
190	business for the other party, on the date of acquisition of the
191	asset or at the time of the service agreement.
192	(12)(11)  "Home health agency" means an organization that
193	provides home health services and staffing services.
194	(13)(12)  "Home health agency personnel" means persons who
195	are employed by or under contract with a home health agency and
196	enter the home or place of residence of patients at any time in
197	the course of their employment or contract.
198	(14)(13)  "Home health services" means health and medical
199	services and medical supplies furnished by an organization to an
200	individual in the individual's home or place of residence. The
201	term includes organizations that provide one or more of the
202	following:
203	(a)  Nursing care.
204	(b)  Physical, occupational, respiratory, or speech
205	therapy.
206	(c)  Home health aide services.
207	(d)  Dietetics and nutrition practice and nutrition
208	counseling.
209	(e)  Medical supplies, restricted to drugs and biologicals
210	prescribed by a physician.
211	(15)(14)  "Home health aide" means a person who is trained
212	or qualified, as provided by rule, and who provides hands-on
213	personal care, performs simple procedures as an extension of
214	therapy or nursing services, assists in ambulation or exercises,
215	or assists in administering medications as permitted in rule and
216	for which the person has received training established by the
217	agency under s. 400.497(1). The licensed home health agency or
218	licensed nurse registry shall ensure that the home health aide
219	employed by or under contract with the home health agency or
220	licensed nurse registry is adequately trained to perform the
221	tasks of a home health aide in the home setting.
222	(16)(15)  "Homemaker" means a person who performs household
223	chores that include housekeeping, meal planning and preparation,
224	shopping assistance, and routine household activities for an
225	elderly, handicapped, or convalescent individual. A homemaker
226	may not provide hands-on personal care to a client.
227	(17)(16)  "Home infusion therapy provider" means an
228	organization that employs, contracts with, or refers a licensed
229	professional who has received advanced training and experience
230	in intravenous infusion therapy and who administers infusion
231	therapy to a patient in the patient's home or place of
232	residence.
233	(18)(17)  "Home infusion therapy" means the administration
234	of intravenous pharmacological or nutritional products to a
235	patient in his or her home.
236	(19)  "Immediate family member" means a husband or wife; a
237	birth or adoptive parent, child, or sibling; a stepparent,
238	stepchild, stepbrother, or stepsister; a father-in-law, mother-
239	in-law, son-in-law, daughter-in-law, brother-in-law, or sister-
240	in-law; a grandparent or grandchild; or a spouse of a
241	grandparent or grandchild.
242	(20)  "Medical director" means a physician who is a
243	volunteer with, or who receives remuneration from, a home health
244	agency.
245	(21)(18)  "Nurse registry" means any person that procures,
246	offers, promises, or attempts to secure health-care-related
247	contracts for registered nurses, licensed practical nurses,
248	certified nursing assistants, home health aides, companions, or
249	homemakers, who are compensated by fees as independent
250	contractors, including, but not limited to, contracts for the
251	provision of services to patients and contracts to provide
252	private duty or staffing services to health care facilities
253	licensed under chapter 395, this chapter, or chapter 429 or
254	other business entities.
255	(22)(19)  "Organization" means a corporation, government or
256	governmental subdivision or agency, partnership or association,
257	or any other legal or commercial entity, any of which involve
258	more than one health care professional discipline; a health care
259	professional and a home health aide or certified nursing
260	assistant; more than one home health aide; more than one
261	certified nursing assistant; or a home health aide and a
262	certified nursing assistant. The term does not include an entity
263	that provides services using only volunteers or only individuals
264	related by blood or marriage to the patient or client.
265	(23)(20)  "Patient" means any person who receives home
266	health services in his or her home or place of residence.
267	(24)(21)  "Personal care" means assistance to a patient in
268	the activities of daily living, such as dressing, bathing,
269	eating, or personal hygiene, and assistance in physical
270	transfer, ambulation, and in administering medications as
271	permitted by rule.
272	(25)(22)  "Physician" means a person licensed under chapter
273	458, chapter 459, chapter 460, or chapter 461.
274	(26)(23)  "Physician assistant" means a person who is a
275	graduate of an approved program or its equivalent, or meets
276	standards approved by the boards, and is licensed to perform
277	medical services delegated by the supervising physician, as
278	defined in s. 458.347 or s. 459.022.
279	(27)  "Remuneration" means any payment or other benefit
280	made directly or indirectly, overtly or covertly, in cash or in
281	kind.
282	(28)(24)  "Skilled care" means nursing services or
283	therapeutic services required by law to be delivered by a health
284	care professional who is licensed under part I of chapter 464;
285	part I, part III, or part V of chapter 468; or chapter 486 and
286	who is employed by or under contract with a licensed home health
287	agency or is referred by a licensed nurse registry.
288	(29)(25)  "Staffing services" means services provided to a
289	health care facility, school, or other business entity on a
290	temporary or school-year basis pursuant to a written contract by
291	licensed health care personnel and by certified nursing
292	assistants and home health aides who are employed by, or work
293	under the auspices of, a licensed home health agency or who are
294	registered with a licensed nurse registry. Staffing services may
295	be provided anywhere within the state.
296	Section 2.  Subsection (3) of section 400.464, Florida
297	Statutes, is amended to read:
298	400.464  Home Health agencies to be licensed; expiration of
299	license; exemptions; unlawful acts; penalties.--
300	(3)  A Any home infusion therapy provider must shall be
301	licensed as a home health agency or nurse registry. Any infusion
302	therapy provider currently authorized to receive Medicare
303	reimbursement under a DME - Part B Provider number for the
304	provision of infusion therapy shall be licensed as a non
305	certified home health agency. Such a provider shall continue to
306	receive that specified Medicare reimbursement without being
307	certified so long as the reimbursement is limited to those items
308	authorized pursuant to the DME - Part B Provider Agreement and
309	the agency is licensed in compliance with the other provisions
310	of this part.
311	Section 3.  Paragraphs (d), (e), (f), (g), and (h) are
312	added to subsection (2) of section 400.471, Florida Statutes,
313	and subsections (7), (8), and (9), are added to that section, to
314	read:
315	400.471  Application for license; fee.--
316	(2)  In addition to the requirements of part II of chapter
317	408, the initial applicant must file with the application
318	satisfactory proof that the home health agency is in compliance
319	with this part and applicable rules, including:
320	(d)  A business plan, signed by the applicant, which
321	details the home health agency's methods to obtain patients and
322	its plan to recruit and maintain staff.
323	(e)  Evidence of contingency funding equal to 1 month's
324	average operating expenses during the first year of operation.
325	(f)  A balance sheet, income and expense statement, and
326	statement of cash flows for the first 2 years of operation which
327	provide evidence of having sufficient assets, credit, and
328	projected revenues to cover liabilities and expenses. The
329	applicant has demonstrated financial ability to operate if the
330	applicant's assets, credit, and projected revenues meet or
331	exceed projected liabilities and expenses. An applicant may not
332	project an operating margin of 15 percent or greater for any
333	month in the first year of operation. All documents required
334	under this paragraph must be prepared in accordance with
335	generally accepted accounting principles and compiled and signed
336	by a certified public accountant.
337	(g)  All other ownership interests in health care entities
338	for each controlling interest, as defined in part II of chapter
339	408.
340	(h)  In the case of an application for initial licensure,
341	documentation of accreditation, or an application for
342	accreditation, from an accrediting organization that is
343	recognized by the agency as having standards comparable to those
344	required by this part and part II of chapter 408.
345	Notwithstanding s. 408.806, an applicant that has applied for
346	accreditation must provide proof of accreditation that is not
347	conditional or provisional within 120 days after the date of the
348	agency's receipt of the application for licensure or the
349	application shall be withdrawn from further consideration. Such
350	accreditation must be maintained by the home health agency to
351	maintain licensure. The agency shall accept, in lieu of its own
352	periodic licensure survey, the submission of the survey of an
353	accrediting organization that is recognized by the agency if the
354	accreditation of the licensed home health agency is not
355	provisional and if the licensed home health agency authorizes
356	releases of, and the agency receives the report of, the
357	accrediting organization.
358	(7)  The agency may not issue an initial license to an
359	applicant for a home health agency license if the applicant
360	shares common controlling interests with another licensed home
361	health agency that is located within 10 miles of the applicant
362	and is in the same county. The agency must return the
363	application and fees to the applicant.
364	(8)  An application for a home health agency license may
365	not be transferred to another home health agency or controlling
366	interest before issuance of the license.
367	(9)  A licensed home health agency that seeks to relocate
368	to a different geographic service area not listed on its license
369	must submit an initial application for a home health agency
370	license for the new location.
371	Section 4.  Section 400.474, Florida Statutes, is amended
372	to read:
373	400.474  Administrative penalties.--
374	(1)  The agency may deny, revoke, and suspend a license and
375	impose an administrative fine in the manner provided in chapter
376	120.
377	(2)  Any of the following actions by a home health agency
378	or its employee is grounds for disciplinary action by the
379	agency:
380	(a)  Violation of this part, part II of chapter 408, or of
381	applicable rules.
382	(b)  An intentional, reckless, or negligent act that
383	materially affects the health or safety of a patient.
384	(c)  Knowingly providing home health services in an
385	unlicensed assisted living facility or unlicensed adult family-
386	care home, unless the home health agency or employee reports the
387	unlicensed facility or home to the agency within 72 hours after
388	providing the services.
389	(d)  Preparing or maintaining fraudulent patient records,
390	such as, but not limited to, charting ahead, recording vital
391	signs or symptoms that were not personally obtained or observed
392	by the home health agency's staff at the time indicated,
393	borrowing patients or patient records from other home health
394	agencies to pass a survey or inspection, or falsifying
395	signatures.
396	(e)  Failing to provide at least one service directly to a
397	patient for a period of 60 days.
398	(3)  The agency shall impose a fine of $1,000 against a
399	home health agency that demonstrates a pattern of falsifying:
400	(a)  Documents of training for home health aides or
401	certified nursing assistants; or
402	(b)  Health statements for staff providing direct care to
403	patients.
404
405	A pattern may be demonstrated by a showing of at least three
406	fraudulent entries or documents. The fine shall be imposed for
407	each fraudulent document or, if multiple staff members are
408	included on one document, for each fraudulent entry on the
409	document.
410	(4)  The agency shall impose a fine of $5,000 against a
411	home health agency that demonstrates a pattern of billing any
412	payor for services not provided. A pattern may be demonstrated
413	by a showing of at least three billings for services not
414	provided within a 12-month period. The fine must be imposed for
415	each incident that is falsely billed. The agency may also:
416	(a)  Require payback of all funds;
417	(b)  Revoke the license; or
418	(c)  Issue a moratorium in accordance with s. 408.814.
419	(5)  The agency shall impose a fine of $5,000 against a
420	home health agency that demonstrates a pattern of failing to
421	provide a service specified in the home health agency's written
422	agreement with a patient or the patient's legal representative,
423	or the plan of care for that patient, unless a reduction in
424	service is mandated by Medicare, Medicaid, or a state program or
425	as provided in s. 400.492(3). A pattern may be demonstrated by a
426	showing of at least three incidences, regardless of the patient
427	or service, where the home health agency did not provide a
428	service specified in a written agreement or plan of care during
429	a 3-month period. The agency shall impose the fine for each
430	occurrence. The agency may also impose additional administrative
431	fines under s. 400.484 for the direct or indirect harm to a
432	patient, or deny, revoke, or suspend the license of the home
433	health agency for a pattern of failing to provide a service
434	specified in the home health agency's written agreement with a
435	patient or the plan of care for that patient.
436	(6)  The agency may deny, revoke, or suspend the license of
437	a home health agency and shall impose a fine of $5,000 against a
438	home health agency that:
439	(a)  Gives remuneration for staffing services to:
440	1.  Another home health agency with which it has formal or
441	informal patient-referral transactions or arrangements; or
442	2.  A health services pool with which it has formal or
443	informal patient-referral transactions or arrangements,
444
445	unless the home health agency has activated its comprehensive
446	emergency management plan in accordance with s. 400.492. This
447	paragraph does not apply to a Medicare-certified home health
448	agency that provides fair market value remuneration for staffing
449	services to a non-Medicare-certified home health agency that is
450	part of a continuing care facility licensed under chapter 651
451	for providing services to its own residents if each resident
452	receiving home health services pursuant to this arrangement
453	attests in writing that he or she made a decision without
454	influence from staff of the facility to select, from a list of
455	Medicare-certified home health agencies provided by the
456	facility, that Medicare-certified home health agency to provide
457	the services.
458	(b)  Provides services to residents in an assisted living
459	facility for which the home health agency does not receive fair
460	market value remuneration.
461	(c)  Provides staffing to an assisted living facility for
462	which the home health agency does not receive fair market value
463	remuneration.
464	(d)  Fails to provide the agency, upon request, with copies
465	of all contracts with assisted living facilities which were
466	executed within 5 years before the request.
467	(e)  Gives remuneration to a case manager, discharge
468	planner, facility-based staff member, or third-party vendor who
469	is involved in the discharge-planning process of a facility
470	licensed under chapter 395 or this chapter from whom the home
471	health agency receives referrals.
472	(f)  Fails to submit to the agency, within 15 days after
473	the end of each calendar quarter, a written report that includes
474	the following data based on data as it existed on the last day
475	of the quarter:
476	1.  The number of insulin-dependent diabetic patients
477	receiving insulin-injection services from the home health
478	agency;
479	2.  The number of patients receiving both home health
480	services from the home health agency and hospice services;
481	3.  The number of patients receiving home health services
482	from that home health agency; and
483	4.  The names and license numbers of nurses whose primary
484	job responsibility is to provide home health services to
485	patients and who received remuneration from the home health
486	agency in excess of $25,000 during the calendar quarter.
487	(g)  Gives cash, or its equivalent, to a Medicare or
488	Medicaid beneficiary.
489	(h)  Has more than one medical director contract in effect
490	at one time or more than one medical director contract and one
491	contract with a physician-specialist whose services are mandated
492	for the home health agency in order to qualify to participate in
493	a federal or state health care program at one time.
494	(i)  Gives remuneration to a physician without a medical
495	director contract being in effect. The contract must:
496	1.  Be in writing and signed by both parties;
497	2.  Provide for remuneration that is at fair market value
498	for an hourly rate, which must be supported by invoices
499	submitted by the medical director describing the work performed,
500	the dates on which that work was performed, and the duration of
501	that work; and
502	3.  Be for a term of at least 1 year.
503
504	The hourly rate specified in the contract may not be increased
505	during the term of the contract. The home health agency may not
506	execute a subsequent contract with that physician which has an
507	increased hourly rate and covers any portion of the term that
508	was in the original contract.
509	(j)  Gives remuneration to:
510	1.  A physician, and the home health agency is in violation
511	of paragraph (h) or paragraph (i);
512	2.  A member of the physician's office staff; or
513	3.  An immediate family member of the physician,
514
515	if the home health agency has received a patient referral in the
516	preceding 12 months from that physician or physician's office
517	staff.
518	(k)  Fails to provide to the agency, upon request, copies
519	of all contracts with a medical director which were executed
520	within 5 years before the request.
521	(7)(3)(a)  In addition to the requirements of s. 408.813,
522	any person, partnership, or corporation that violates s. 408.812
523	or s. 408.813 and that previously operated a licensed home
524	health agency or concurrently operates both a licensed home
525	health agency and an unlicensed home health agency commits a
526	felony of the third degree punishable as provided in s. 775.082,
527	s. 775.083, or s. 775.084.
528	(b)  If any home health agency is found to be operating
529	without a license and that home health agency has received any
530	government reimbursement for services, the agency shall make a
531	fraud referral to the appropriate government reimbursement
532	program.
533	Section 5.  Section 400.476, Florida Statutes, is created
534	to read:
535	400.476  Staffing requirements; notifications; limitations
536	on staffing services.--
537	(1)  ADMINISTRATOR.--
538	(a)  An administrator may manage only one home health
539	agency, except that an administrator may manage up to five home
540	health agencies if all five home health agencies have identical
541	controlling interests as defined in s. 408.803 and are located
542	within one agency geographic service area or within an
543	immediately contiguous county. If the home health agency is
544	licensed under this chapter and is part of a retirement
545	community that provides multiple levels of care, an employee of
546	the retirement community may administer the home health agency
547	and up to a maximum of four entities licensed under this chapter
548	or chapter 429 which all have identical controlling interests as
549	defined in s. 408.803. An administrator shall designate, in
550	writing, for each licensed entity, a qualified alternate
551	administrator to serve during the administrator's absence.
552	(b)  An administrator of a home health agency who is a
553	licensed physician, physician assistant, or registered nurse
554	licensed to practice in this state may also be the director of
555	nursing for a home health agency. An administrator may serve as
556	a director of nursing for up to the number of entities
557	authorized in subsection (2) only if there are 10 or fewer full-
558	time equivalent employees and contracted personnel in each home
559	health agency.
560	(2)  DIRECTOR OF NURSING.--
561	(a)  A director of nursing may be the director of nursing
562	for:
563	1.  Up to two licensed home health agencies if the agencies
564	have identical controlling interests as defined in s. 408.803
565	and are located within one agency geographic service area or
566	within an immediately contiguous county; or
567	2.  Up to five licensed home health agencies if:
568	a.  All of the home health agencies have identical
569	controlling interests as defined in s. 408.803;
570	b.  All of the home health agencies are located within one
571	agency geographic service area or within an immediately
572	contiguous county; and
573	c.  Each home health agency has a registered nurse who
574	meets the qualifications of a director of nursing and who has a
575	written delegation from the director of nursing to serve as the
576	director of nursing for that home health agency when the
577	director of nursing is not present.
578
579	If a home health agency licensed under this chapter is part of a
580	retirement community that provides multiple levels of care, an
581	employee of the retirement community may serve as the director
582	of nursing of the home health agency and up to a maximum of four
583	entities, other than home health agencies, licensed under this
584	chapter or chapter 429 which all have identical controlling
585	interests as defined in s. 408.803.
586	(b)  A home health agency that provides skilled nursing
587	care may not operate for more than 30 calendar days without a
588	director of nursing. A home health agency that provides skilled
589	nursing care and the director of nursing of a home health agency
590	must notify the agency within 10 business days after termination
591	of the services of the director of nursing for the home health
592	agency. A home health agency that provides skilled nursing care
593	must notify the agency of the identity and qualifications of the
594	new director of nursing within 10 days after the new director is
595	hired. If a home health agency that provides skilled nursing
596	care operates for more than 30 calendar days without a director
597	of nursing, the home health agency commits a class II
598	deficiency. In addition to the fine for a class II deficiency,
599	the agency may issue a moratorium in accordance with s. 408.814
600	or revoke the license. The agency shall fine a home health
601	agency that fails to notify the agency as required in this
602	paragraph $1,000 for the first violation and $2,000 for a repeat
603	violation. The agency may not take administrative action against
604	a home health agency if the director of nursing fails to notify
605	the department upon termination of services as the director of
606	nursing for the home health agency.
607	(c)  A home health agency that is not Medicare or Medicaid
608	certified and does not provide skilled care or provides only
609	physical, occupational, or speech therapy is not required to
610	have a director of nursing and is exempt from paragraph (b).
611	(3)  TRAINING.--A home health agency shall ensure that each
612	certified nursing assistant employed by or under contract with
613	the home health agency and each home health aide employed by or
614	under contract with the home health agency is adequately trained
615	to perform the tasks of a home health aide in the home setting.
616	(4)  STAFFING.--Staffing services may be provided anywhere
617	within the state.
618	Section 6.  Section 400.484, Florida Statutes, is amended
619	to read:
620	400.484  Right of inspection; deficiencies; fines.--
621	(1)  In addition to the requirements of s. 408.811, the
622	agency may make such inspections and investigations as are
623	necessary in order to determine the state of compliance with
624	this part, part II of chapter 408, and applicable rules.
625	(2)  The agency shall impose fines for various classes of
626	deficiencies in accordance with the following schedule:
627	(a)  A class I deficiency is any act, omission, or practice
628	that results in a patient's death, disablement, or permanent
629	injury, or places a patient at imminent risk of death,
630	disablement, or permanent injury. Upon finding a class I
631	deficiency, the agency shall may impose an administrative fine
632	in the amount of $15,000 $5,000 for each occurrence and each day
633	that the deficiency exists.
634	(b)  A class II deficiency is any act, omission, or
635	practice that has a direct adverse effect on the health, safety,
636	or security of a patient. Upon finding a class II deficiency,
637	the agency shall may impose an administrative fine in the amount
638	of $5,000 $1,000 for each occurrence and each day that the
639	deficiency exists.
640	(c)  A class III deficiency is any act, omission, or
641	practice that has an indirect, adverse effect on the health,
642	safety, or security of a patient. Upon finding an uncorrected or
643	repeated class III deficiency, the agency shall may impose an
644	administrative fine not to exceed $1,000 $500 for each
645	occurrence and each day that the uncorrected or repeated
646	deficiency exists.
647	(d)  A class IV deficiency is any act, omission, or
648	practice related to required reports, forms, or documents which
649	does not have the potential of negatively affecting patients.
650	These violations are of a type that the agency determines do not
651	threaten the health, safety, or security of patients. Upon
652	finding an uncorrected or repeated class IV deficiency, the
653	agency shall may impose an administrative fine not to exceed
654	$500 $200 for each occurrence and each day that the uncorrected
655	or repeated deficiency exists.
656	(3)  In addition to any other penalties imposed pursuant to
657	this section or part, the agency may assess costs related to an
658	investigation that results in a successful prosecution,
659	excluding costs associated with an attorney's time.
660	Section 7.  Subsection (2) of section 400.491, Florida
661	Statutes, is amended to read:
662	400.491  Clinical records.--
663	(2)  The home health agency must maintain for each client
664	who receives nonskilled care a service provision plan. Such
665	records must be maintained by the home health agency for 3 years
666	1 year following termination of services.
667	Section 8.  Present subsections (5), (6), (7), and (8) of
668	section 400.497, Florida Statutes, are renumbered as subsections
669	(7), (8), (9), and (10), respectively, and a new subsections (5)
670	and (6) are added to that section, to read:
671	400.497  Rules establishing minimum standards.--The agency
672	shall adopt, publish, and enforce rules to implement part II of
673	chapter 408 and this part, including, as applicable, ss. 400.506
674	and 400.509, which must provide reasonable and fair minimum
675	standards relating to:
676	(5)  Oversight by the director of nursing. The agency shall
677	develop rules related to:
678	(a)  Standards that address oversight responsibilities by
679	the director of nursing of skilled nursing and personal care
680	services provided by the home health agency's staff;
681	(b)  Requirements for a director of nursing to provide to
682	the agency, upon request, a certified daily report of the home
683	health services provided by a specified direct employee or
684	contracted staff member on behalf of the home health agency. The
685	agency may request a certified daily report only for a period
686	not to exceed 2 years prior to the date of the request; and
687	(c)  A quality assurance program for home health services
688	provided by the home health agency.
689	(6)  Conditions for using a recent unannounced licensure
690	inspection for the inspection required in s. 408.806 related to
691	a licensure application associated with a change in ownership of
692	a licensed home health agency.
693	Section 9.  Paragraph (a) of subsection (6) of section
694	400.506, Florida Statutes, is amended, present subsections (15)
695	and (16) of that section are renumbered as subsections (16) and
696	(17), respectively, and a new subsection (15) is added to that
697	section, to read:
698	400.506  Licensure of nurse registries; requirements;
699	penalties.--
700	(6)(a)  A nurse registry may refer for contract in private
701	residences registered nurses and licensed practical nurses
702	registered and licensed under part I of chapter 464, certified
703	nursing assistants certified under part II of chapter 464, home
704	health aides who present documented proof of successful
705	completion of the training required by rule of the agency, and
706	companions or homemakers for the purposes of providing those
707	services authorized under s. 400.509(1). A licensed nurse
708	registry shall ensure that each certified nursing assistant
709	referred for contract by the nurse registry and each home health
710	aide referred for contract by the nurse registry is adequately
711	trained to perform the tasks of a home health aide in the home
712	setting. Each person referred by a nurse registry must provide
713	current documentation that he or she is free from communicable
714	diseases.
715	(15)(a)  The agency may deny, suspend, or revoke the
716	license of a nurse registry and shall impose a fine of $5,000
717	against a nurse registry that:
718	1.  Provides services to residents in an assisted living
719	facility for which the nurse registry does not receive fair
720	market value remuneration.
721	2.  Provides staffing to an assisted living facility for
722	which the nurse registry does not receive fair market value
723	remuneration.
724	3.  Fails to provide the agency, upon request, with copies
725	of all contracts with assisted living facilities which were
726	executed within the last 5 years.
727	4.  Gives remuneration to a case manager, discharge
728	planner, facility-based staff member, or third-party vendor who
729	is involved in the discharge-planning process of a facility
730	licensed under chapter 395 or this chapter and from whom the
731	nurse registry receives referrals.
732	5.  Gives remuneration to a physician, a member of the
733	physician's office staff, or an immediate family member of the
734	physician, and the nurse registry received a patient referral
735	in the last 12 months from that physician or the physician's
736	office staff.
737	(b)  The agency shall also impose an administrative fine
738	of $15,000 if the nurse registry refers nurses, certified
739	nursing assistants, home health aides, or other staff without
740	charge to a facility licensed under chapter 429 in return for
741	patient referrals from the facility.
742	(c)  The proceeds of all fines collected under this
743	subsection shall be deposited into the Health Care Trust Fund.
744	Section 10.  Subsection (4) is added to section 400.518,
745	Florida Statutes, to read:
746	400.518  Prohibited referrals to home health agencies.--
747	(4)  The agency shall impose an administrative fine of
748	$15,000 if a home health agency provides nurses, certified
749	nursing assistants, home health aides, or other staff without
750	charge to a facility licensed under chapter 429 in return for
751	patient referrals from the facility. The proceeds of such fines
752	shall be deposited into the Health Care Trust Fund.
753	Section 11.  Subsections (5) through (27) of section
754	409.901, Florida Statutes, are redesignated as subsections (6)
755	through (28), respectively, and a new subsection (5) is added to
756	that section to read:
757	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
758	409.901-409.920, except as otherwise specifically provided, the
759	term:
760	(5)  "Change of ownership" means an event in which the
761	provider changes to a different legal entity or in which 45
762	percent or more of the ownership, voting shares, or controlling
763	interest in a corporation whose shares are not publicly traded
764	on a recognized stock exchange is transferred or assigned,
765	including the final transfer or assignment of multiple transfers
766	or assignments over a 2-year period that cumulatively total 45
767	percent or more. A change solely in the management company or
768	board of directors is not a change of ownership.
769	Section 12.  Subsections (6) and (9) of section 409.907,
770	Florida Statutes, are amended to read:
771	409.907  Medicaid provider agreements.--The agency may make
772	payments for medical assistance and related services rendered to
773	Medicaid recipients only to an individual or entity who has a
774	provider agreement in effect with the agency, who is performing
775	services or supplying goods in accordance with federal, state,
776	and local law, and who agrees that no person shall, on the
777	grounds of handicap, race, color, or national origin, or for any
778	other reason, be subjected to discrimination under any program
779	or activity for which the provider receives payment from the
780	agency.
781	(6)  A Medicaid provider agreement may be revoked, at the
782	option of the agency, as the result of a change of ownership of
783	any facility, association, partnership, or other entity named as
784	the provider in the provider agreement. A provider shall give
785	the agency 60 days' notice before making any change in ownership
786	of the entity named in the provider agreement as the provider.
787	(a)  In the event of a change of ownership, the transferor
788	remains liable for all outstanding overpayments, administrative
789	fines, and any other moneys owed to the agency before the
790	effective date of the change of ownership. In addition to the
791	continuing liability of the transferor, the transferee is liable
792	to the agency for all outstanding overpayments identified by the
793	agency on or before the effective date of the change of
794	ownership. For purposes of this subsection, the term
795	"outstanding overpayment" includes any amount identified in a
796	preliminary audit report issued to the transferor by the agency
797	on or before the effective date of the change of ownership. In
798	the event of a change of ownership for a skilled nursing
799	facility or intermediate care facility, the Medicaid provider
800	agreement shall be assigned to the transferee if the transferee
801	meets all other Medicaid provider qualifications. In the event
802	of a change of ownership involving a skilled nursing facility
803	licensed under part II of chapter 400, liability for all
804	outstanding overpayments, administrative fines, and any moneys
805	owed to the agency before the effective date of the change of
806	ownership shall be determined in accordance with s. 400.179.
807	(b)  At least 60 days before the anticipated date of the
808	change of ownership, the transferor shall notify the agency of
809	the intended change of ownership and the transferee shall submit
810	to the agency a Medicaid provider enrollment application. If a
811	change of ownership occurs without compliance with the notice
812	requirements of this subsection, the transferor and transferee
813	shall be jointly and severally liable for all overpayments,
814	administrative fines, and other moneys due to the agency,
815	regardless of whether the agency identified the overpayments,
816	administrative fines, or other moneys before or after the
817	effective date of the change of ownership. The agency may not
818	approve a transferee's Medicaid provider enrollment application
819	if the transferee or transferor has not paid or agreed in
820	writing to a payment plan for all outstanding overpayments,
821	administrative fines, and other moneys due to the agency. This
822	subsection does not preclude the agency from seeking any other
823	legal or equitable remedies available to the agency for the
824	recovery of moneys owed to the Medicaid program. In the event of
825	a change of ownership involving a skilled nursing facility
826	licensed under part II of chapter 400, liability for all
827	outstanding overpayments, administrative fines, and any moneys
828	owed to the agency before the effective date of the change of
829	ownership shall be determined in accordance with the s. 400.179
830	if the Medicaid provider enrollment application for change of
831	ownership is submitted before the change of ownership.
832	(9)  Upon receipt of a completed, signed, and dated
833	application, and completion of any necessary background
834	investigation and criminal history record check, the agency must
835	either:
836	(a)  Enroll the applicant as a Medicaid provider upon
837	approval of the provider application. The enrollment effective
838	date shall be the date the agency receives the provider
839	application. With respect to a provider that requires a Medicare
840	certification survey, the enrollment effective date is the date
841	the certification is awarded. With respect to a provider that
842	completes a change of ownership, the effective date is the date
843	the agency received the application, the date the change of
844	ownership was complete, or the date the applicant became
845	eligible to provide services under Medicaid, whichever date is
846	later. With respect to a provider of emergency medical services
847	transportation or emergency services and care, the effective
848	date is the date the services were rendered. Payment for any
849	claims for services provided to Medicaid recipients between the
850	date of receipt of the application and the date of approval is
851	contingent on applying any and all applicable audits and edits
852	contained in the agency's claims adjudication and payment
853	processing systems; or
854	(b)  Deny the application if the agency finds that it is in
855	the best interest of the Medicaid program to do so. The agency
856	may consider the factors listed in subsection (10), as well as
857	any other factor that could affect the effective and efficient
858	administration of the program, including, but not limited to,
859	the applicant's demonstrated ability to provide services,
860	conduct business, and operate a financially viable concern; the
861	current availability of medical care, services, or supplies to
862	recipients, taking into account geographic location and
863	reasonable travel time; the number of providers of the same type
864	already enrolled in the same geographic area; and the
865	credentials, experience, success, and patient outcomes of the
866	provider for the services that it is making application to
867	provide in the Medicaid program. The agency shall deny the
868	application if the agency finds that a provider; any officer,
869	director, agent, managing employee, or affiliated person; or any
870	partner or shareholder having an ownership interest equal to 5
871	percent or greater in the provider if the provider is a
872	corporation, partnership, or other business entity, has failed
873	to pay all outstanding fines or overpayments assessed by final
874	order of the agency or final order of the Centers for Medicare
875	and Medicaid Services, not subject to further appeal, unless the
876	provider agrees to a repayment plan that includes withholding
877	Medicaid reimbursement until the amount due is paid in full.
878	Section 13.  Subsection (20) of section 409.910, Florida
879	Statutes, is amended to read:
880	409.910  Responsibility for payments on behalf of Medicaid-
881	eligible persons when other parties are liable.--
882	(20)  Entities providing health insurance as defined in s.
883	624.603, health maintenance organizations and prepaid health
884	clinics as defined in chapter 641, and, on behalf of their
885	clients, third-party administrators and pharmacy benefits
886	managers as defined in s. 409.901 (27) s. 409.901(26) shall
887	provide such records and information as are necessary to
888	accomplish the purpose of this section, unless such requirement
889	results in an unreasonable burden.
890	(a)  The director of the agency and the Director of the
891	Office of Insurance Regulation of the Financial Services
892	Commission shall enter into a cooperative agreement for
893	requesting and obtaining information necessary to effect the
894	purpose and objective of this section.
895	1.  The agency shall request only that information
896	necessary to determine whether health insurance as defined
897	pursuant to s. 624.603, or those health services provided
898	pursuant to chapter 641, could be, should be, or have been
899	claimed and paid with respect to items of medical care and
900	services furnished to any person eligible for services under
901	this section.
902	2.  All information obtained pursuant to subparagraph 1. is
903	confidential and exempt from s. 119.07(1).
904	3.  The cooperative agreement or rules adopted under this
905	subsection may include financial arrangements to reimburse the
906	reporting entities for reasonable costs or a portion thereof
907	incurred in furnishing the requested information. Neither the
908	cooperative agreement nor the rules shall require the automation
909	of manual processes to provide the requested information.
910	(b)  The agency and the Financial Services Commission
911	jointly shall adopt rules for the development and administration
912	of the cooperative agreement. The rules shall include the
913	following:
914	1.  A method for identifying those entities subject to
915	furnishing information under the cooperative agreement.
916	2.  A method for furnishing requested information.
917	3.  Procedures for requesting exemption from the
918	cooperative agreement based on an unreasonable burden to the
919	reporting entity.
920	Section 14.  Subsection (48) of section 409.912, Florida
921	Statutes, is amended to read:
922	409.912  Cost-effective purchasing of health care.--The
923	agency shall purchase goods and services for Medicaid recipients
924	in the most cost-effective manner consistent with the delivery
925	of quality medical care. To ensure that medical services are
926	effectively utilized, the agency may, in any case, require a
927	confirmation or second physician's opinion of the correct
928	diagnosis for purposes of authorizing future services under the
929	Medicaid program. This section does not restrict access to
930	emergency services or poststabilization care services as defined
931	in 42 C.F.R. part 438.114. Such confirmation or second opinion
932	shall be rendered in a manner approved by the agency. The agency
933	shall maximize the use of prepaid per capita and prepaid
934	aggregate fixed-sum basis services when appropriate and other
935	alternative service delivery and reimbursement methodologies,
936	including competitive bidding pursuant to s. 287.057, designed
937	to facilitate the cost-effective purchase of a case-managed
938	continuum of care. The agency shall also require providers to
939	minimize the exposure of recipients to the need for acute
940	inpatient, custodial, and other institutional care and the
941	inappropriate or unnecessary use of high-cost services. The
942	agency shall contract with a vendor to monitor and evaluate the
943	clinical practice patterns of providers in order to identify
944	trends that are outside the normal practice patterns of a
945	provider's professional peers or the national guidelines of a
946	provider's professional association. The vendor must be able to
947	provide information and counseling to a provider whose practice
948	patterns are outside the norms, in consultation with the agency,
949	to improve patient care and reduce inappropriate utilization.
950	The agency may mandate prior authorization, drug therapy
951	management, or disease management participation for certain
952	populations of Medicaid beneficiaries, certain drug classes, or
953	particular drugs to prevent fraud, abuse, overuse, and possible
954	dangerous drug interactions. The Pharmaceutical and Therapeutics
955	Committee shall make recommendations to the agency on drugs for
956	which prior authorization is required. The agency shall inform
957	the Pharmaceutical and Therapeutics Committee of its decisions
958	regarding drugs subject to prior authorization. The agency is
959	authorized to limit the entities it contracts with or enrolls as
960	Medicaid providers by developing a provider network through
961	provider credentialing. The agency may competitively bid single-
962	source-provider contracts if procurement of goods or services
963	results in demonstrated cost savings to the state without
964	limiting access to care. The agency may limit its network based
965	on the assessment of beneficiary access to care, provider
966	availability, provider quality standards, time and distance
967	standards for access to care, the cultural competence of the
968	provider network, demographic characteristics of Medicaid
969	beneficiaries, practice and provider-to-beneficiary standards,
970	appointment wait times, beneficiary use of services, provider
971	turnover, provider profiling, provider licensure history,
972	previous program integrity investigations and findings, peer
973	review, provider Medicaid policy and billing compliance records,
974	clinical and medical record audits, and other factors. Providers
975	shall not be entitled to enrollment in the Medicaid provider
976	network. The agency shall determine instances in which allowing
977	Medicaid beneficiaries to purchase durable medical equipment and
978	other goods is less expensive to the Medicaid program than long-
979	term rental of the equipment or goods. The agency may establish
980	rules to facilitate purchases in lieu of long-term rentals in
981	order to protect against fraud and abuse in the Medicaid program
982	as defined in s. 409.913. The agency may seek federal waivers
983	necessary to administer these policies.
984	(48)(a)  A provider is not entitled to enrollment in the
985	Medicaid provider network. The agency may implement a Medicaid
986	fee-for-service provider network controls, including, but not
987	limited to, competitive procurement and provider credentialing.
988	If a credentialing process is used, the agency may limit its
989	provider network based upon the following considerations:
990	beneficiary access to care, provider availability, provider
991	quality standards and quality assurance processes, cultural
992	competency, demographic characteristics of beneficiaries,
993	practice standards, service wait times, provider turnover,
994	provider licensure and accreditation history, program integrity
995	history, peer review, Medicaid policy and billing compliance
996	records, clinical and medical record audit findings, and such
997	other areas that are considered necessary by the agency to
998	ensure the integrity of the program.
999	(b)  The agency shall limit its network of durable medical
1000	equipment and medical supply providers. For dates of service
1001	after January 1, 2009, the agency shall limit payment for
1002	durable medical equipment and supplies to providers that meet
1003	all the requirements of this paragraph.
1004	1.  Providers must be accredited by a Centers for Medicare
1005	and Medicaid Services deemed accreditation organization for
1006	suppliers of durable medical equipment, prosthetics, orthotics,
1007	and supplies. The provider must maintain accreditation and is
1008	subject to unannounced reviews by the accrediting organization.
1009	2.  Providers must provide the services or supplies
1010	directly to the Medicaid recipient or caregiver at the provider
1011	location or recipient's residence or send the supplies directly
1012	to the recipient's residence with receipt of mailed delivery.
1013	Subcontracting or consignment of the service or supply to a
1014	third party is prohibited.
1015	3.  Notwithstanding subparagraph 2., a durable medical
1016	equipment provider may store nebulizers at a physician's office
1017	for the purpose of having the physician's staff issue the
1018	equipment if it meets all of the following conditions:
1019	a.  The physician must document the medical necessity and
1020	need to prevent further deterioration of the patient's
1021	respiratory status by the timely delivery of the nebulizer in
1022	the physician's office.
1023	b.  The durable medical equipment provider must have
1024	written documentation of the competency and training by a
1025	Florida-licensed registered respiratory therapist of any durable
1026	medical equipment staff who participate in the training of
1027	physician office staff for the use of nebulizers, including
1028	cleaning, warranty, and special needs of patients.
1029	c.  The physician's office must have documented the
1030	training and competency of any staff member who initiates the
1031	delivery of nebulizers to patients. The durable medical
1032	equipment provider must maintain copies of all physician office
1033	training.
1034	d.  The physician's office must maintain inventory records
1035	of stored nebulizers, including documentation of the durable
1036	medical equipment provider source.
1037	e.  A physician contracted with a Medicaid durable medical
1038	equipment provider may not have a financial relationship with
1039	that provider or receive any financial gain from the delivery of
1040	nebulizers to patients.
1041	4.  Providers must have a physical business location and a
1042	functional landline business phone. The location must be within
1043	the state or not more than 50 miles from the Florida state line.
1044	The agency may make exceptions for providers of durable medical
1045	equipment or supplies not otherwise available from other
1046	enrolled providers located within the state.
1047	5.  Physical business locations must be clearly identified
1048	as a business that furnishes durable medical equipment or
1049	medical supplies by signage that can be read from 20 feet away.
1050	The location must be readily accessible to the public during
1051	normal, posted business hours and must operate no less than 5
1052	hours per day and no less than 5 days per week, with the
1053	exception of scheduled and posted holidays. The location may not
1054	be located within or at the same numbered street address as
1055	another enrolled Medicaid durable medical equipment or medical
1056	supply provider or as an enrolled Medicaid pharmacy that is also
1057	enrolled as a durable medical equipment provider. A licensed
1058	orthotist or prosthetist that provides only orthotic or
1059	prosthetic devices as a Medicaid durable medical equipment
1060	provider is exempt from the provisions in this paragraph.
1061	6.  Providers must maintain a stock of durable medical
1062	equipment and medical supplies on site that is readily available
1063	to meet the needs of the durable medical equipment business
1064	location's customers.
1065	7.  Providers must provide a surety bond of $50,000 for
1066	each provider location, up to a maximum of 5 bonds statewide or
1067	an aggregate bond of $250,000 statewide, as identified by
1068	Federal Employer Identification Number. Providers who post a
1069	statewide or an aggregate bond must identify all of their
1070	locations in any Medicaid durable medical equipment and medical
1071	supply provider enrollment application or bond renewal. Each
1072	provider location's surety bond must be renewed annually and the
1073	provider must submit proof of renewal even if the original bond
1074	is a continuous bond. A licensed orthotist or prosthetist that
1075	provides only orthotic or prosthetic devices as a Medicaid
1076	durable medical equipment provider is exempt from the provisions
1077	in this paragraph.
1078	8.  Providers must obtain a level 2 background screening,
1079	as provided under s. 435.04, for each provider employee in
1080	direct contact with or providing direct services to recipients
1081	of durable medical equipment and medical supplies in their
1082	homes. This requirement includes, but is not limited to, repair
1083	and service technicians, fitters, and delivery staff. The
1084	provider shall pay for the cost of the background screening.
1085	9.  The following providers are exempt from the
1086	requirements of subparagraphs 1. and 7.:
1087	a.  Durable medical equipment providers owned and operated
1088	by a government entity.
1089	b.  Durable medical equipment providers that are operating
1090	within a pharmacy that is currently enrolled as a Medicaid
1091	pharmacy provider.
1092	c.  Active, Medicaid-enrolled orthopedic physician groups,
1093	primarily owned by physicians, which provide only orthotic and
1094	prosthetic devices.
1095	Section 15.  The Agency for Health Care Administration
1096	shall review the process, procedures, and contractor's
1097	performance for the prior authorization of home health agency
1098	visits that are in excess of 60 visits over the lifetime of a
1099	Medicaid recipient. The agency shall determine whether
1100	modifications are necessary in order to reduce Medicaid fraud
1101	and abuse related to home health services for a Medicaid
1102	recipient which are not medically necessary. If modifications to
1103	the prior authorization function are necessary, the agency shall
1104	amend the contract to require contractor performance that
1105	reduces potential Medicaid fraud and abuse with respect to home
1106	health agency visits.
1107	Section 16.  The Agency for Health Care Administration
1108	shall report to the Legislature by January 1, 2009, on the
1109	feasibility and costs of accessing the Medicare system to
1110	disallow Medicaid payment for home health services that are paid
1111	for under the Medicare prospective payment system for recipients
1112	who are dually eligible for Medicaid and Medicare.
1113	Section 17.  This act shall take effect July 1, 2008.

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