CS/HB 5105

1	A bill to be entitled
2	An act relating to health care; amending s. 409.814, F.S.;
3	providing Florida Kidcare eligibility determination
4	requirements; amending s. 409.815, F.S.; revising
5	mandatory benefit requirements for behavioral health and
6	dental services; providing reimbursement requirements for
7	federally qualified health centers and rural health
8	clinics; amending s. 409.818, F.S.; requiring the Agency
9	for Health Care Administration to monitor the compliance
10	and quality of health insurance plans in the Florida
11	Kidcare program as required by federal law; amending s.
12	409.904, F.S.; revising the expiration date of provisions
13	authorizing the federal waiver for certain persons age 65
14	and over or who have a disability; revising the expiration
15	date of provisions authorizing a specified medically needy
16	program; amending s. 409.905, F.S., relating to mandatory
17	Medicaid services; requiring prior authorization for
18	certain home health services; requiring home health
19	agencies to submit certain supporting documentation when
20	requesting prior authorization; establishing reimbursement
21	requirements for home health services; providing an
22	exemption for certain home health agencies; revising
23	conditions for adjustment of a hospital's inpatient per
24	diem rate; amending s. 409.906, F.S., relating to optional
25	Medicaid services; providing limitations on the provision
26	of adult vision services; amending s. 409.9082, F.S.;
27	authorizing the agency to exempt certain nursing home
28	facility providers from quality assessments or apply a
29	lower assessment rate to the facility; modifying
30	circumstances requiring discontinuance of the quality
31	assessment on nursing home facility providers; creating s.
32	409.9083, F.S.; providing definitions; providing for a
33	quality assessment to be imposed upon privately operated
34	intermediate care facility providers for the
35	developmentally disabled; requiring the agency to
36	calculate the quality assessment rate annually; providing
37	requirements for reporting and collecting the assessment;
38	specifying the purposes of the assessment and an order of
39	priority; requiring that the agency seek federal
40	authorization to implement the act; specifying
41	circumstances requiring discontinuance of the quality
42	assessment; authorizing the agency to impose certain
43	penalties against providers that fail to pay the
44	assessment; requiring the agency to adopt rules; providing
45	for future repeal; amending s. 409.911, F.S.; revising the
46	share data used to calculate disproportionate share
47	payments to hospitals; amending s. 409.9112, F.S.;
48	revising the time period during which the agency is
49	prohibited from distributing disproportionate share
50	payments to regional perinatal intensive care centers;
51	amending s. 409.9113, F.S.; requiring the agency to
52	distribute moneys provided in the General Appropriations
53	Act to statutorily defined teaching hospitals and family
54	practice teaching hospitals under the teaching hospital
55	disproportionate share program for the 2009-2010 fiscal
56	year; amending s. 409.9117, F.S.; prohibiting the agency
57	from distributing moneys under the primary care
58	disproportionate share program for the 2009-2010 fiscal
59	year; amending s. 409.912, F.S.; providing that the
60	continuance of the integrated fixed-payment delivery pilot
61	program for certain elderly or dually eligible recipients
62	is contingent upon an appropriation; creating a pilot
63	project in Miami-Dade County to monitor the delivery of
64	home health services and provide for electronic claims for
65	home health services; authorizing the agency to seek
66	amendments to the state plan and waivers of federal law to
67	implement the project; requiring the agency to award
68	contracts based on a competitive solicitation process;
69	requiring a report to the Governor and Legislature;
70	creating a comprehensive care management pilot project in
71	Miami-Dade County for home health services; authorizing
72	the agency to seek amendments to the state plan and
73	waivers of federal law to implement the project; amending
74	s. 409.91211, F.S.; revising the date when provider
75	service networks convert from fee-for-service to
76	capitation rates; amending s. 430.04, F.S.; requiring the
77	Department of Elderly Affairs to administer all Medicaid
78	waivers and programs relating to elders and their
79	appropriations; amending s. 430.707, F.S.; requiring the
80	agency, in consultation with the Department of Elderly
81	Affairs, to accept and forward to the Centers for Medicare
82	and Medicaid Services an application for expansion of a
83	pilot project from an entity that provides certain
84	benefits under a federal program; providing an effective
85	date.
86
87	Be It Enacted by the Legislature of the State of Florida:
88
89	Section 1.  Paragraph (c) is added to subsection (8) of
90	section 409.814, Florida Statutes, to read:
91	409.814  Eligibility.--A child who has not reached 19 years
92	of age whose family income is equal to or below 200 percent of
93	the federal poverty level is eligible for the Florida Kidcare
94	program as provided in this section. For enrollment in the
95	Children's Medical Services Network, a complete application
96	includes the medical or behavioral health screening. If,
97	subsequently, an individual is determined to be ineligible for
98	coverage, he or she must immediately be disenrolled from the
99	respective Florida Kidcare program component.
100	(8)  In determining the eligibility of a child, an assets
101	test is not required. Each applicant shall provide written
102	documentation during the application process and the
103	redetermination process, including, but not limited to, the
104	following:
105	(a)  Proof of family income, which must include a copy of
106	the applicant's most recent federal income tax return. In the
107	absence of a federal income tax return, an applicant may submit
108	wages and earnings statements (pay stubs), W-2 forms, or other
109	appropriate documents.
110	(b)  A statement from all family members that:
111	1.  Their employer does not sponsor a health benefit plan
112	for employees; or
113	2.  The potential enrollee is not covered by the employer-
114	sponsored health benefit plan because the potential enrollee is
115	not eligible for coverage, or, if the potential enrollee is
116	eligible but not covered, a statement of the cost to enroll the
117	potential enrollee in the employer-sponsored health benefit
118	plan.
119	(c)  Effective no later than January 1, 2010, verification
120	of the potential enrollee's or enrollee's citizenship status to
121	the extent required under Title XXI of the Social Security Act.
122	Section 2.  Paragraphs (g) and (q) of subsection (2) of
123	section 409.815, Florida Statutes, are amended, and paragraph
124	(w) is added to that subsection, to read:
125	409.815  Health benefits coverage; limitations.--
126	(2)  BENCHMARK BENEFITS.--In order for health benefits
127	coverage to qualify for premium assistance payments for an
128	eligible child under ss. 409.810-409.820, the health benefits
129	coverage, except for coverage under Medicaid and Medikids, must
130	include the following minimum benefits, as medically necessary.
131	(g)  Behavioral health services.--
132	1.  Mental health benefits include:
133	a.  Inpatient services, limited to not more than 30
134	inpatient days per contract year for psychiatric admissions, or
135	residential services in facilities licensed under s. 394.875(6)
136	or s. 395.003 in lieu of inpatient psychiatric admissions;
137	however, a minimum of 10 of the 30 days shall be available only
138	for inpatient psychiatric services when authorized by a
139	physician; and
140	b.  Outpatient services, including outpatient visits for
141	psychological or psychiatric evaluation, diagnosis, and
142	treatment by a licensed mental health professional, limited to a
143	maximum of 40 outpatient visits each contract year.
144	2.  Substance abuse services include:
145	a.  Inpatient services, limited to not more than 7
146	inpatient days per contract year for medical detoxification only
147	and 30 days of residential services; and
148	b.  Outpatient services, including evaluation, diagnosis,
149	and treatment by a licensed practitioner, limited to a maximum
150	of 40 outpatient visits per contract year.
151	3.  Effective October 1, 2009, covered services include
152	inpatient and outpatient services for mental and nervous
153	disorders as defined in the most recent edition of the
154	Diagnostic and Statistical Manual of Mental Disorders published
155	by the American Psychiatric Association. Such benefits include
156	psychological or psychiatric evaluation, diagnosis, and
157	treatment by a licensed mental health professional and
158	inpatient, outpatient, and residential treatment services for
159	the diagnosis and treatment of substance abuse disorders. Any
160	benefit limitations, including duration of services, number of
161	visits, or number of days for hospitalization or residential
162	services may not be any less favorable than those for physical
163	illnesses generally for the care and treatment of schizophrenia
164	and psychotic disorders, mood disorders, anxiety disorders,
165	substance abuse disorders, eating disorders, and childhood
166	attention deficit disorders. The program may also implement
167	appropriate financial incentives, peer review, utilization
168	requirements, and other methods used for the management of
169	benefits provided for other medical conditions in order to
170	reduce service costs and utilization without compromising
171	quality of care.
172	(q)  Dental services.--Effective October 1, 2009, dental
173	services shall be covered as required under federal law and may
174	also include those dental benefits provided to children by the
175	Florida Medicaid program under s. 409.906(6). Changes to the
176	dental benefit in order to comply with federal law are effective
177	October 1, 2009.
178	(w)  Reimbursement of federally qualified health centers
179	and rural health clinics.--Effective October 1, 2009, payments
180	for services provided to enrollees by federally qualified health
181	centers and rural health clinics under this section shall be
182	reimbursed using the Medicaid Prospective Payment System as
183	provided for under s. 2107(e)(1)(D) of the Social Security Act,
184	42 U.S.C. s. 1397gg(e)(1)(D), as added by Pub. L. No 105-33,
185	Title IV, s. 4901(a). If such services are paid for by health
186	insurers or health care providers under contract with the
187	Florida Healthy Kids Corporation, such entities are responsible
188	for this payment. The agency may seek any available federal
189	grants to assist with this transition.
190	Section 3.  Paragraph (c) of subsection (3) of section
191	409.818, Florida Statutes, is amended to read:
192	409.818  Administration.--In order to implement ss.
193	409.810-409.820, the following agencies shall have the following
194	duties:
195	(3)  The Agency for Health Care Administration, under the
196	authority granted in s. 409.914(1), shall:
197	(c)  Monitor compliance with quality assurance and access
198	standards developed under s. 409.820 and in accordance with s.
199	2103(f) of the Social Security Act, 42 U.S.C. s. 1397cc(f).
200
201	The agency is designated the lead state agency for Title XXI of
202	the Social Security Act for purposes of receipt of federal
203	funds, for reporting purposes, and for ensuring compliance with
204	federal and state regulations and rules.
205	Section 4.  Subsections (1) and (2) of section 409.904,
206	Florida Statutes, are amended to read:
207	409.904  Optional payments for eligible persons.--The
208	agency may make payments for medical assistance and related
209	services on behalf of the following persons who are determined
210	to be eligible subject to the income, assets, and categorical
211	eligibility tests set forth in federal and state law. Payment on
212	behalf of these Medicaid eligible persons is subject to the
213	availability of moneys and any limitations established by the
214	General Appropriations Act or chapter 216.
215	(1)  Effective January 1, 2006, and subject to federal
216	waiver approval, a person who is age 65 or older or is
217	determined to be disabled, whose income is at or below 88
218	percent of the federal poverty level, whose assets do not exceed
219	established limitations, and who is not eligible for Medicare
220	or, if eligible for Medicare, is also eligible for and receiving
221	Medicaid-covered institutional care services, hospice services,
222	or home and community-based services. The agency shall seek
223	federal authorization through a waiver to provide this coverage.
224	This subsection expires June 30, 2010 2009.
225	(2)(a)  A family, a pregnant woman, a child under age 21, a
226	person age 65 or over, or a blind or disabled person, who would
227	be eligible under any group listed in s. 409.903(1), (2), or
228	(3), except that the income or assets of such family or person
229	exceed established limitations. For a family or person in one of
230	these coverage groups, medical expenses are deductible from
231	income in accordance with federal requirements in order to make
232	a determination of eligibility. A family or person eligible
233	under the coverage known as the "medically needy," is eligible
234	to receive the same services as other Medicaid recipients, with
235	the exception of services in skilled nursing facilities and
236	intermediate care facilities for the developmentally disabled.
237	This paragraph subsection expires June 30, 2010 2009.
238	(b)  Effective July 1, 2010 2009, a pregnant woman or a
239	child younger than 21 years of age who would be eligible under
240	any group listed in s. 409.903, except that the income or assets
241	of such group exceed established limitations. For a person in
242	one of these coverage groups, medical expenses are deductible
243	from income in accordance with federal requirements in order to
244	make a determination of eligibility. A person eligible under the
245	coverage known as the "medically needy" is eligible to receive
246	the same services as other Medicaid recipients, with the
247	exception of services in skilled nursing facilities and
248	intermediate care facilities for the developmentally disabled.
249	Section 5.  Subsection (4) and paragraph (c) of subsection
250	(5) of section 409.905, Florida Statutes, are amended to read:
251	409.905  Mandatory Medicaid services.--The agency may make
252	payments for the following services, which are required of the
253	state by Title XIX of the Social Security Act, furnished by
254	Medicaid providers to recipients who are determined to be
255	eligible on the dates on which the services were provided. Any
256	service under this section shall be provided only when medically
257	necessary and in accordance with state and federal law.
258	Mandatory services rendered by providers in mobile units to
259	Medicaid recipients may be restricted by the agency. Nothing in
260	this section shall be construed to prevent or limit the agency
261	from adjusting fees, reimbursement rates, lengths of stay,
262	number of visits, number of services, or any other adjustments
263	necessary to comply with the availability of moneys and any
264	limitations or directions provided for in the General
265	Appropriations Act or chapter 216.
266	(4)  HOME HEALTH CARE SERVICES.--The agency shall pay for
267	nursing and home health aide services, supplies, appliances, and
268	durable medical equipment, necessary to assist a recipient
269	living at home. An entity that provides services pursuant to
270	this subsection shall be licensed under part III of chapter 400.
271	These services, equipment, and supplies, or reimbursement
272	therefor, may be limited as provided in the General
273	Appropriations Act and do not include services, equipment, or
274	supplies provided to a person residing in a hospital or nursing
275	facility.
276	(a)  In providing home health care services, the agency may
277	require prior authorization of care based on diagnosis or
278	utilization rates. Prior authorization is required for home
279	health services visits not associated with a skilled nursing
280	visit if the home health agency's utilization rates exceed the
281	state average by 50 percent or more. The home health agency must
282	submit documentation that supports the recipient's diagnosis and
283	the recipient's plan of care to the agency when requesting prior
284	authorization.
285	(b)  The agency shall implement a comprehensive utilization
286	management program that requires prior authorization of all
287	private duty nursing services, an individualized treatment plan
288	that includes information about medication and treatment orders,
289	treatment goals, methods of care to be used, and plans for care
290	coordination by nurses and other health professionals. The
291	utilization management program shall also include a process for
292	periodically reviewing the ongoing use of private duty nursing
293	services. For a child, the assessment of need shall be based on
294	a child's condition, family support and care supplements, a
295	family's ability to provide care, and a family's and child's
296	schedule regarding work, school, sleep, and care for other
297	family dependents. When implemented, the private duty nursing
298	utilization management program shall replace the current
299	authorization program used by the Agency for Health Care
300	Administration and the Children's Medical Services program of
301	the Department of Health. The agency may competitively bid on a
302	contract to select a qualified organization to provide
303	utilization management of private duty nursing services. The
304	agency is authorized to seek federal waivers to implement this
305	initiative.
306	(c)  The agency may provide reimbursement only for those
307	home health services that are medically necessary and if:
308	1.  The services are ordered by a physician.
309	2.  The written prescription for services is signed and
310	dated by the recipient's physician before the development of a
311	plan of care and before any required request for prior
312	authorization.
313	3.  The physician ordering the services is not employed,
314	under contract with, or otherwise affiliated with the home
315	health agency rendering the services. However, this provision
316	does not apply to a home health agency affiliated with a
317	retirement community, of which the parent corporation or a
318	related legal entity owns a rural health clinic certified under
319	42 C.F.R., part 491, subpart A, ss. 1-11, a nursing home
320	licensed under part II of chapter 400, and apartments and
321	single-family homes for independent living.
322	4.  The physician ordering the services has examined the
323	recipient within 30 days before the initial request for services
324	and biannually thereafter.
325	5.  The written prescription for the services includes the
326	recipient's acute or chronic medical condition or diagnosis; the
327	home health service required, including the minimum skill level
328	required to perform the service; and the frequency and duration
329	of the services.
330	6.  The national provider identifier, Medicaid
331	identification number, or professional license number of the
332	physician ordering the services is listed on the written
333	prescription for the services, the claim for home health
334	reimbursement, and the prior authorization request.
335	(5)  HOSPITAL INPATIENT SERVICES.--The agency shall pay for
336	all covered services provided for the medical care and treatment
337	of a recipient who is admitted as an inpatient by a licensed
338	physician or dentist to a hospital licensed under part I of
339	chapter 395. However, the agency shall limit the payment for
340	inpatient hospital services for a Medicaid recipient 21 years of
341	age or older to 45 days or the number of days necessary to
342	comply with the General Appropriations Act.
343	(c)  The Agency for Health Care Administration shall adjust
344	a hospital's current inpatient per diem rate to reflect the cost
345	of serving the Medicaid population at that institution if:
346	1.  The hospital experiences an increase in Medicaid
347	caseload by more than 25 percent in any year, primarily
348	resulting from the closure of a hospital in the same service
349	area occurring after July 1, 1995;
350	2.  The hospital's Medicaid per diem rate is at least 25
351	percent below the Medicaid per patient cost for that year; or
352	3.  The hospital is located in a county that has six five
353	or fewer acute care bed hospitals, began offering obstetrical
354	services on or after September 1999, and has submitted a request
355	in writing to the agency for a rate adjustment after July 1,
356	2000, but before September 30, 2000, in which case such
357	hospital's Medicaid inpatient per diem rate shall be adjusted to
358	cost, effective July 1, 2002.
359
360	No later than October 1 of each year, the agency must provide
361	estimated costs for any adjustment in a hospital inpatient per
362	diem pursuant to this paragraph to the Executive Office of the
363	Governor, the House of Representatives General Appropriations
364	Committee, and the Senate Appropriations Committee. Before the
365	agency implements a change in a hospital's inpatient per diem
366	rate pursuant to this paragraph, the Legislature must have
367	specifically appropriated sufficient funds in the General
368	Appropriations Act to support the increase in cost as estimated
369	by the agency.
370	Section 6.  Subsection (23) of section 409.906, Florida
371	Statutes, is amended to read:
372	409.906  Optional Medicaid services.--Subject to specific
373	appropriations, the agency may make payments for services which
374	are optional to the state under Title XIX of the Social Security
375	Act and are furnished by Medicaid providers to recipients who
376	are determined to be eligible on the dates on which the services
377	were provided. Any optional service that is provided shall be
378	provided only when medically necessary and in accordance with
379	state and federal law. Optional services rendered by providers
380	in mobile units to Medicaid recipients may be restricted or
381	prohibited by the agency. Nothing in this section shall be
382	construed to prevent or limit the agency from adjusting fees,
383	reimbursement rates, lengths of stay, number of visits, or
384	number of services, or making any other adjustments necessary to
385	comply with the availability of moneys and any limitations or
386	directions provided for in the General Appropriations Act or
387	chapter 216. If necessary to safeguard the state's systems of
388	providing services to elderly and disabled persons and subject
389	to the notice and review provisions of s. 216.177, the Governor
390	may direct the Agency for Health Care Administration to amend
391	the Medicaid state plan to delete the optional Medicaid service
392	known as "Intermediate Care Facilities for the Developmentally
393	Disabled." Optional services may include:
394	(23)  VISUAL SERVICES.--The agency may pay for visual
395	examinations, eyeglasses, and eyeglass repairs for a recipient
396	if they are prescribed by a licensed physician specializing in
397	diseases of the eye or by a licensed optometrist. Eyeglass
398	frames Eyeglasses for adult recipients shall be limited to one
399	pair two pairs per year per recipient every 2 years, except a
400	second third pair may be provided during that period after prior
401	authorization. Eyeglass lenses for adult recipients shall be
402	limited to one pair per year and may only be provided after
403	prior authorization.
404	Section 7.  Subsection (6) of section 409.9082, Florida
405	Statutes, as created by chapter 2009-4, Laws of Florida, is
406	amended, and paragraph (d) is added to subsection (3) of that
407	section, to read:
408	409.9082  Quality assessment on nursing home facility
409	providers; exemptions; purpose; federal approval required;
410	remedies.--
411	(3)
412	(d)  The agency may exempt a qualified public nursing
413	facility that is not owned or operated by the state from the
414	quality assessment or apply a lower quality assessment rate to
415	that facility if the facility's total annual census days for
416	indigent care exceed 25 percent of the facility's total annual
417	census days.
418	(6)  The quality assessment shall terminate and the agency
419	shall discontinue the imposition, assessment, and collection of
420	the nursing facility quality assessment if any of the following
421	occur:
422	(a)  the agency does not obtain necessary federal approval
423	for the nursing home facility quality assessment or the payment
424	rates required by subsection (4); or
425	(b)  The weighted average Medicaid rate paid to nursing
426	home facilities is reduced below the weighted average Medicaid
427	rate to nursing home facilities in effect on December 31, 2008,
428	plus any future annual amount of the quality assessment and the
429	applicable matching federal funds.
430
431	Upon termination of the quality assessment, all collected
432	assessment revenues, less any amounts expended by the agency,
433	shall be returned on a pro rata basis to the nursing facilities
434	that paid them.
435	Section 8.  Section 409.9083, Florida Statutes, is created
436	to read:
437	409.9083  Quality assessment on privately operated
438	intermediate care facilities for the developmentally disabled;
439	exemptions; purpose; federal approval required; remedies.--
440	(1)  As used in this section, the term:
441	(a)  "Intermediate care facility for the developmentally
442	disabled" or "ICF/DD" means a privately operated intermediate
443	care facility for the developmentally disabled licensed under
444	part VIII of chapter 400.
445	(b)  "Net patient service revenue" means gross revenues
446	from services provided to ICF/DD facility residents, less
447	reductions from gross revenue resulting from an inability to
448	collect payment of charges. Net patient service revenue excludes
449	nonresident care revenues such as gain or loss on asset
450	disposal, prior year revenue, donations, and physician billings,
451	and all outpatient revenues. Reductions from gross revenue
452	include bad debts; contractual adjustments; uncompensated care;
453	administrative, courtesy, and policy discounts and adjustments;
454	and other such revenue deductions.
455	(c)  "Resident day" means a calendar day of care provided
456	to an ICF/DD facility resident, including the day of admission
457	and excluding the day of discharge, except that, when admission
458	and discharge occur on the same day, 1 day of care exists.
459	(2)  Effective October 1, 2009, there is imposed upon each
460	intermediate care facility for the developmentally disabled a
461	quality assessment. The aggregated amount of assessments for all
462	ICF/DDs in a given year shall be an amount not exceeding the
463	maximum percentage allowed under federal law of the total
464	aggregate net patient service revenue of assessed facilities.
465	The agency shall calculate the quality assessment rate annually
466	on a per-resident-day basis as reported by the facilities. The
467	per-resident-day assessment rate shall be uniform. Each facility
468	shall report monthly to the agency its total number of resident
469	days and shall remit an amount equal to the assessment rate
470	times the reported number of days. The agency shall collect, and
471	each facility shall pay, the quality assessment each month. The
472	agency shall collect the assessment from facility providers no
473	later than the 15th of the next succeeding calendar month. The
474	agency shall notify providers of the quality assessment rate and
475	provide a standardized form to complete and submit with
476	payments. The collection of the quality assessment shall
477	commence no sooner than 15 days after the agency's initial
478	payment to the facilities that implement the increased Medicaid
479	rates containing the elements prescribed in subsection (3) and
480	monthly thereafter. Intermediate care facilities for the
481	developmentally disabled may increase their rates to incorporate
482	the assessment but may not create a separate line-item charge
483	for the purpose of passing through the assessment to residents.
484	(3)  The purpose of the facility quality assessment is to
485	ensure continued quality of care. Collected assessment funds
486	shall be used to obtain federal financial participation through
487	the Medicaid program to make Medicaid payments for ICF/DD
488	services up to the amount of the Medicaid rates for such
489	facilities as calculated in accordance with the approved state
490	Medicaid plan in effect on April 1, 2008. The quality assessment
491	and federal matching funds shall be used exclusively for the
492	following purposes and in the following order of priority:
493	(a)  To reimburse the Medicaid share of the quality
494	assessment as a pass-through, Medicaid-allowable cost.
495	(b)  To increase each privately operated ICF/DD Medicaid
496	rate, as needed, by an amount that restores the rate reductions
497	implemented on October 1, 2008.
498	(c)  To increase each ICF/DD Medicaid rate, as needed, by
499	an amount that restores any rate reductions for the 2008-2009
500	fiscal year.
501	(d)  To increase payments to such facilities to fund
502	covered services to Medicaid beneficiaries.
503	(4)  The agency shall seek necessary federal approval in
504	the form of state plan amendments in order to implement the
505	provisions of this section.
506	(5)(a)  The quality assessment shall terminate and the
507	agency shall discontinue the imposition, assessment, and
508	collection of the quality assessment if the agency does not
509	obtain necessary federal approval for the facility quality
510	assessment or the payment rates required by subsection (3).
511	(b)  Upon termination of the quality assessment, all
512	collected assessment revenues, less any amounts expended by the
513	agency, shall be returned on a pro rata basis to the facilities
514	that paid such assessments.
515	(6)  The agency may seek any of the following remedies for
516	failure of any ICF/DD provider to timely pay its assessment:
517	(a)  Withholding any medical assistance reimbursement
518	payments until the assessment amount is recovered.
519	(b)  Suspending or revoking the facility's license.
520	(c)  Imposing a fine of up to $1,000 per day for each
521	delinquent payment, not to exceed the amount of the assessment.
522	(7)  The agency shall adopt rules necessary to administer
523	this section.
524	(8)  This section is repealed October 1, 2011.
525	Section 9.  Paragraph (a) of subsection (2) of section
526	409.911, Florida Statutes, is amended to read:
527	409.911  Disproportionate share program.--Subject to
528	specific allocations established within the General
529	Appropriations Act and any limitations established pursuant to
530	chapter 216, the agency shall distribute, pursuant to this
531	section, moneys to hospitals providing a disproportionate share
532	of Medicaid or charity care services by making quarterly
533	Medicaid payments as required. Notwithstanding the provisions of
534	s. 409.915, counties are exempt from contributing toward the
535	cost of this special reimbursement for hospitals serving a
536	disproportionate share of low-income patients.
537	(2)  The Agency for Health Care Administration shall use
538	the following actual audited data to determine the Medicaid days
539	and charity care to be used in calculating the disproportionate
540	share payment:
541	(a)  The average of the 2003, 2004, and 2005 2002, 2003,
542	and 2004 audited disproportionate share data to determine each
543	hospital's Medicaid days and charity care for the 2009-2010
544	2008-2009 state fiscal year.
545	Section 10.  Section 409.9112, Florida Statutes, is amended
546	to read:
547	409.9112  Disproportionate share program for regional
548	perinatal intensive care centers.--
549	(1)  In addition to the payments made under s. 409.911, the
550	Agency for Health Care Administration shall design and implement
551	a system of making disproportionate share payments to those
552	hospitals that participate in the regional perinatal intensive
553	care center program established pursuant to chapter 383. This
554	system of payments shall conform with federal requirements and
555	shall distribute funds in each fiscal year for which an
556	appropriation is made by making quarterly Medicaid payments.
557	Notwithstanding the provisions of s. 409.915, counties are
558	exempt from contributing toward the cost of this special
559	reimbursement for hospitals serving a disproportionate share of
560	low-income patients. For the state fiscal year 2009-2010 2008-
561	2009, the agency shall not distribute moneys under the regional
562	perinatal intensive care centers disproportionate share program.
563	(2)(1)  The following formula shall be used by the agency
564	to calculate the total amount earned for hospitals that
565	participate in the regional perinatal intensive care center
566	program:
567
568	TAE = HDSP/THDSP
569
570	Where:
571	TAE = total amount earned by a regional perinatal intensive
572	care center.
573	HDSP = the prior state fiscal year regional perinatal
574	intensive care center disproportionate share payment to the
575	individual hospital.
576	THDSP = the prior state fiscal year total regional
577	perinatal intensive care center disproportionate share payments
578	to all hospitals.
579	(3)(2)  The total additional payment for hospitals that
580	participate in the regional perinatal intensive care center
581	program shall be calculated by the agency as follows:
582
583	TAP = TAE x TA
584
585	Where:
586	TAP = total additional payment for a regional perinatal
587	intensive care center.
588	TAE = total amount earned by a regional perinatal intensive
589	care center.
590	TA = total appropriation for the regional perinatal
591	intensive care center disproportionate share program.
592	(4)(3)  In order to receive payments under this section, a
593	hospital must be participating in the regional perinatal
594	intensive care center program pursuant to chapter 383 and must
595	meet the following additional requirements:
596	(a)  Agree to conform to all departmental and agency
597	requirements to ensure high quality in the provision of
598	services, including criteria adopted by departmental and agency
599	rule concerning staffing ratios, medical records, standards of
600	care, equipment, space, and such other standards and criteria as
601	the department and agency deem appropriate as specified by rule.
602	(b)  Agree to provide information to the department and
603	agency, in a form and manner to be prescribed by rule of the
604	department and agency, concerning the care provided to all
605	patients in neonatal intensive care centers and high-risk
606	maternity care.
607	(c)  Agree to accept all patients for neonatal intensive
608	care and high-risk maternity care, regardless of ability to pay,
609	on a functional space-available basis.
610	(d)  Agree to develop arrangements with other maternity and
611	neonatal care providers in the hospital's region for the
612	appropriate receipt and transfer of patients in need of
613	specialized maternity and neonatal intensive care services.
614	(e)  Agree to establish and provide a developmental
615	evaluation and services program for certain high-risk neonates,
616	as prescribed and defined by rule of the department.
617	(f)  Agree to sponsor a program of continuing education in
618	perinatal care for health care professionals within the region
619	of the hospital, as specified by rule.
620	(g)  Agree to provide backup and referral services to the
621	department's county health departments and other low-income
622	perinatal providers within the hospital's region, including the
623	development of written agreements between these organizations
624	and the hospital.
625	(h)  Agree to arrange for transportation for high-risk
626	obstetrical patients and neonates in need of transfer from the
627	community to the hospital or from the hospital to another more
628	appropriate facility.
629	(5)(4)  Hospitals which fail to comply with any of the
630	conditions in subsection (4) (3) or the applicable rules of the
631	department and agency shall not receive any payments under this
632	section until full compliance is achieved. A hospital which is
633	not in compliance in two or more consecutive quarters shall not
634	receive its share of the funds. Any forfeited funds shall be
635	distributed by the remaining participating regional perinatal
636	intensive care center program hospitals.
637	Section 11.  Section 409.9113, Florida Statutes, is amended
638	to read:
639	409.9113  Disproportionate share program for teaching
640	hospitals.--
641	(1)  In addition to the payments made under ss. 409.911 and
642	409.9112, the Agency for Health Care Administration shall make
643	disproportionate share payments to statutorily defined teaching
644	hospitals for their increased costs associated with medical
645	education programs and for tertiary health care services
646	provided to the indigent. This system of payments shall conform
647	with federal requirements and shall distribute funds in each
648	fiscal year for which an appropriation is made by making
649	quarterly Medicaid payments. Notwithstanding s. 409.915,
650	counties are exempt from contributing toward the cost of this
651	special reimbursement for hospitals serving a disproportionate
652	share of low-income patients. For the state fiscal year 2009-
653	2010 2008-2009, the agency shall distribute the moneys provided
654	in the General Appropriations Act to statutorily defined
655	teaching hospitals and family practice teaching hospitals under
656	the teaching hospital disproportionate share program. The funds
657	provided for statutorily defined teaching hospitals shall be
658	distributed in the same proportion as the state fiscal year
659	2003-2004 teaching hospital disproportionate share funds were
660	distributed or as otherwise provided in the General
661	Appropriations Act. The funds provided for family practice
662	teaching hospitals shall be distributed equally among family
663	practice teaching hospitals.
664	(2)(1)  On or before September 15 of each year, the Agency
665	for Health Care Administration shall calculate an allocation
666	fraction to be used for distributing funds to state statutory
667	teaching hospitals. Subsequent to the end of each quarter of the
668	state fiscal year, the agency shall distribute to each statutory
669	teaching hospital, as defined in s. 408.07, an amount determined
670	by multiplying one-fourth of the funds appropriated for this
671	purpose by the Legislature times such hospital's allocation
672	fraction. The allocation fraction for each such hospital shall
673	be determined by the sum of three primary factors, divided by
674	three. The primary factors are:
675	(a)  The number of nationally accredited graduate medical
676	education programs offered by the hospital, including programs
677	accredited by the Accreditation Council for Graduate Medical
678	Education and the combined Internal Medicine and Pediatrics
679	programs acceptable to both the American Board of Internal
680	Medicine and the American Board of Pediatrics at the beginning
681	of the state fiscal year preceding the date on which the
682	allocation fraction is calculated. The numerical value of this
683	factor is the fraction that the hospital represents of the total
684	number of programs, where the total is computed for all state
685	statutory teaching hospitals.
686	(b)  The number of full-time equivalent trainees in the
687	hospital, which comprises two components:
688	1.  The number of trainees enrolled in nationally
689	accredited graduate medical education programs, as defined in
690	paragraph (a). Full-time equivalents are computed using the
691	fraction of the year during which each trainee is primarily
692	assigned to the given institution, over the state fiscal year
693	preceding the date on which the allocation fraction is
694	calculated. The numerical value of this factor is the fraction
695	that the hospital represents of the total number of full-time
696	equivalent trainees enrolled in accredited graduate programs,
697	where the total is computed for all state statutory teaching
698	hospitals.
699	2.  The number of medical students enrolled in accredited
700	colleges of medicine and engaged in clinical activities,
701	including required clinical clerkships and clinical electives.
702	Full-time equivalents are computed using the fraction of the
703	year during which each trainee is primarily assigned to the
704	given institution, over the course of the state fiscal year
705	preceding the date on which the allocation fraction is
706	calculated. The numerical value of this factor is the fraction
707	that the given hospital represents of the total number of full-
708	time equivalent students enrolled in accredited colleges of
709	medicine, where the total is computed for all state statutory
710	teaching hospitals.
711
712	The primary factor for full-time equivalent trainees is computed
713	as the sum of these two components, divided by two.
714	(c)  A service index that comprises three components:
715	1.  The Agency for Health Care Administration Service
716	Index, computed by applying the standard Service Inventory
717	Scores established by the Agency for Health Care Administration
718	to services offered by the given hospital, as reported on
719	Worksheet A-2 for the last fiscal year reported to the agency
720	before the date on which the allocation fraction is calculated.
721	The numerical value of this factor is the fraction that the
722	given hospital represents of the total Agency for Health Care
723	Administration Service Index values, where the total is computed
724	for all state statutory teaching hospitals.
725	2.  A volume-weighted service index, computed by applying
726	the standard Service Inventory Scores established by the Agency
727	for Health Care Administration to the volume of each service,
728	expressed in terms of the standard units of measure reported on
729	Worksheet A-2 for the last fiscal year reported to the agency
730	before the date on which the allocation factor is calculated.
731	The numerical value of this factor is the fraction that the
732	given hospital represents of the total volume-weighted service
733	index values, where the total is computed for all state
734	statutory teaching hospitals.
735	3.  Total Medicaid payments to each hospital for direct
736	inpatient and outpatient services during the fiscal year
737	preceding the date on which the allocation factor is calculated.
738	This includes payments made to each hospital for such services
739	by Medicaid prepaid health plans, whether the plan was
740	administered by the hospital or not. The numerical value of this
741	factor is the fraction that each hospital represents of the
742	total of such Medicaid payments, where the total is computed for
743	all state statutory teaching hospitals.
744
745	The primary factor for the service index is computed as the sum
746	of these three components, divided by three.
747	(3)(2)  By October 1 of each year, the agency shall use the
748	following formula to calculate the maximum additional
749	disproportionate share payment for statutorily defined teaching
750	hospitals:
751
752	TAP = THAF x A
753
754	Where:
755	TAP = total additional payment.
756	THAF = teaching hospital allocation factor.
757	A = amount appropriated for a teaching hospital
758	disproportionate share program.
759	Section 12.  Section 409.9117, Florida Statutes, is amended
760	to read:
761	409.9117  Primary care disproportionate share program.--
762	(1)  For the state fiscal year 2009-2010 2008-2009, the
763	agency shall not distribute moneys under the primary care
764	disproportionate share program.
765	(2)(1)  If federal funds are available for disproportionate
766	share programs in addition to those otherwise provided by law,
767	there shall be created a primary care disproportionate share
768	program.
769	(3)(2)  The following formula shall be used by the agency
770	to calculate the total amount earned for hospitals that
771	participate in the primary care disproportionate share program:
772
773	TAE = HDSP/THDSP
774
775	Where:
776	TAE = total amount earned by a hospital participating in
777	the primary care disproportionate share program.
778	HDSP = the prior state fiscal year primary care
779	disproportionate share payment to the individual hospital.
780	THDSP = the prior state fiscal year total primary care
781	disproportionate share payments to all hospitals.
782	(4)(3)  The total additional payment for hospitals that
783	participate in the primary care disproportionate share program
784	shall be calculated by the agency as follows:
785
786	TAP = TAE x TA
787
788	Where:
789	TAP = total additional payment for a primary care hospital.
790	TAE = total amount earned by a primary care hospital.
791	TA = total appropriation for the primary care
792	disproportionate share program.
793	(5)(4)  In the establishment and funding of this program,
794	the agency shall use the following criteria in addition to those
795	specified in s. 409.911, payments may not be made to a hospital
796	unless the hospital agrees to:
797	(a)  Cooperate with a Medicaid prepaid health plan, if one
798	exists in the community.
799	(b)  Ensure the availability of primary and specialty care
800	physicians to Medicaid recipients who are not enrolled in a
801	prepaid capitated arrangement and who are in need of access to
802	such physicians.
803	(c)  Coordinate and provide primary care services free of
804	charge, except copayments, to all persons with incomes up to 100
805	percent of the federal poverty level who are not otherwise
806	covered by Medicaid or another program administered by a
807	governmental entity, and to provide such services based on a
808	sliding fee scale to all persons with incomes up to 200 percent
809	of the federal poverty level who are not otherwise covered by
810	Medicaid or another program administered by a governmental
811	entity, except that eligibility may be limited to persons who
812	reside within a more limited area, as agreed to by the agency
813	and the hospital.
814	(d)  Contract with any federally qualified health center,
815	if one exists within the agreed geopolitical boundaries,
816	concerning the provision of primary care services, in order to
817	guarantee delivery of services in a nonduplicative fashion, and
818	to provide for referral arrangements, privileges, and
819	admissions, as appropriate. The hospital shall agree to provide
820	at an onsite or offsite facility primary care services within 24
821	hours to which all Medicaid recipients and persons eligible
822	under this paragraph who do not require emergency room services
823	are referred during normal daylight hours.
824	(e)  Cooperate with the agency, the county, and other
825	entities to ensure the provision of certain public health
826	services, case management, referral and acceptance of patients,
827	and sharing of epidemiological data, as the agency and the
828	hospital find mutually necessary and desirable to promote and
829	protect the public health within the agreed geopolitical
830	boundaries.
831	(f)  In cooperation with the county in which the hospital
832	resides, develop a low-cost, outpatient, prepaid health care
833	program to persons who are not eligible for the Medicaid
834	program, and who reside within the area.
835	(g)  Provide inpatient services to residents within the
836	area who are not eligible for Medicaid or Medicare, and who do
837	not have private health insurance, regardless of ability to pay,
838	on the basis of available space, except that nothing shall
839	prevent the hospital from establishing bill collection programs
840	based on ability to pay.
841	(h)  Work with the Florida Healthy Kids Corporation, the
842	Florida Health Care Purchasing Cooperative, and business health
843	coalitions, as appropriate, to develop a feasibility study and
844	plan to provide a low-cost comprehensive health insurance plan
845	to persons who reside within the area and who do not have access
846	to such a plan.
847	(i)  Work with public health officials and other experts to
848	provide community health education and prevention activities
849	designed to promote healthy lifestyles and appropriate use of
850	health services.
851	(j)  Work with the local health council to develop a plan
852	for promoting access to affordable health care services for all
853	persons who reside within the area, including, but not limited
854	to, public health services, primary care services, inpatient
855	services, and affordable health insurance generally.
856
857	Any hospital that fails to comply with any of the provisions of
858	this subsection, or any other contractual condition, may not
859	receive payments under this section until full compliance is
860	achieved.
861	Section 13.  Paragraph (g) is added to subsection (5) of
862	section 409.912, Florida Statutes, and subsections (54) and (55)
863	are added to that section, to read:
864	409.912  Cost-effective purchasing of health care.--The
865	agency shall purchase goods and services for Medicaid recipients
866	in the most cost-effective manner consistent with the delivery
867	of quality medical care. To ensure that medical services are
868	effectively utilized, the agency may, in any case, require a
869	confirmation or second physician's opinion of the correct
870	diagnosis for purposes of authorizing future services under the
871	Medicaid program. This section does not restrict access to
872	emergency services or poststabilization care services as defined
873	in 42 C.F.R. part 438.114. Such confirmation or second opinion
874	shall be rendered in a manner approved by the agency. The agency
875	shall maximize the use of prepaid per capita and prepaid
876	aggregate fixed-sum basis services when appropriate and other
877	alternative service delivery and reimbursement methodologies,
878	including competitive bidding pursuant to s. 287.057, designed
879	to facilitate the cost-effective purchase of a case-managed
880	continuum of care. The agency shall also require providers to
881	minimize the exposure of recipients to the need for acute
882	inpatient, custodial, and other institutional care and the
883	inappropriate or unnecessary use of high-cost services. The
884	agency shall contract with a vendor to monitor and evaluate the
885	clinical practice patterns of providers in order to identify
886	trends that are outside the normal practice patterns of a
887	provider's professional peers or the national guidelines of a
888	provider's professional association. The vendor must be able to
889	provide information and counseling to a provider whose practice
890	patterns are outside the norms, in consultation with the agency,
891	to improve patient care and reduce inappropriate utilization.
892	The agency may mandate prior authorization, drug therapy
893	management, or disease management participation for certain
894	populations of Medicaid beneficiaries, certain drug classes, or
895	particular drugs to prevent fraud, abuse, overuse, and possible
896	dangerous drug interactions. The Pharmaceutical and Therapeutics
897	Committee shall make recommendations to the agency on drugs for
898	which prior authorization is required. The agency shall inform
899	the Pharmaceutical and Therapeutics Committee of its decisions
900	regarding drugs subject to prior authorization. The agency is
901	authorized to limit the entities it contracts with or enrolls as
902	Medicaid providers by developing a provider network through
903	provider credentialing. The agency may competitively bid single-
904	source-provider contracts if procurement of goods or services
905	results in demonstrated cost savings to the state without
906	limiting access to care. The agency may limit its network based
907	on the assessment of beneficiary access to care, provider
908	availability, provider quality standards, time and distance
909	standards for access to care, the cultural competence of the
910	provider network, demographic characteristics of Medicaid
911	beneficiaries, practice and provider-to-beneficiary standards,
912	appointment wait times, beneficiary use of services, provider
913	turnover, provider profiling, provider licensure history,
914	previous program integrity investigations and findings, peer
915	review, provider Medicaid policy and billing compliance records,
916	clinical and medical record audits, and other factors. Providers
917	shall not be entitled to enrollment in the Medicaid provider
918	network. The agency shall determine instances in which allowing
919	Medicaid beneficiaries to purchase durable medical equipment and
920	other goods is less expensive to the Medicaid program than long-
921	term rental of the equipment or goods. The agency may establish
922	rules to facilitate purchases in lieu of long-term rentals in
923	order to protect against fraud and abuse in the Medicaid program
924	as defined in s. 409.913. The agency may seek federal waivers
925	necessary to administer these policies.
926	(5)  The Agency for Health Care Administration, in
927	partnership with the Department of Elderly Affairs, shall create
928	an integrated, fixed-payment delivery program for Medicaid
929	recipients who are 60 years of age or older or dually eligible
930	for Medicare and Medicaid. The Agency for Health Care
931	Administration shall implement the integrated program initially
932	on a pilot basis in two areas of the state. The pilot areas
933	shall be Area 7 and Area 11 of the Agency for Health Care
934	Administration. Enrollment in the pilot areas shall be on a
935	voluntary basis and in accordance with approved federal waivers
936	and this section. The agency and its program contractors and
937	providers shall not enroll any individual in the integrated
938	program because the individual or the person legally responsible
939	for the individual fails to choose to enroll in the integrated
940	program. Enrollment in the integrated program shall be
941	exclusively by affirmative choice of the eligible individual or
942	by the person legally responsible for the individual. The
943	integrated program must transfer all Medicaid services for
944	eligible elderly individuals who choose to participate into an
945	integrated-care management model designed to serve Medicaid
946	recipients in the community. The integrated program must combine
947	all funding for Medicaid services provided to individuals who
948	are 60 years of age or older or dually eligible for Medicare and
949	Medicaid into the integrated program, including funds for
950	Medicaid home and community-based waiver services; all Medicaid
951	services authorized in ss. 409.905 and 409.906, excluding funds
952	for Medicaid nursing home services unless the agency is able to
953	demonstrate how the integration of the funds will improve
954	coordinated care for these services in a less costly manner; and
955	Medicare coinsurance and deductibles for persons dually eligible
956	for Medicaid and Medicare as prescribed in s. 409.908(13).
957	(g)  The implementation of the integrated, fixed-payment
958	delivery program created under this subsection is subject to an
959	appropriation in the General Appropriations Act.
960	(54)  The agency shall develop and implement a home health
961	agency monitoring pilot project in Miami-Dade County by January
962	1, 2010. The agency shall contract with a vendor to verify the
963	utilization and the delivery of home health services and provide
964	an electronic billing interface for home health services. The
965	contract must require the creation of a program to submit claims
966	for the home health services electronically. The program must
967	verify visits for the delivery of home health services
968	telephonically using voice biometrics. The agency may seek
969	amendments to the Medicaid state plan and waivers of federal
970	laws, as necessary, to implement the pilot project.
971	Notwithstanding s. 287.057(5)(f), the agency must award the
972	contract through the competitive solicitation process. The
973	agency shall submit a report to the Governor, the President of
974	the Senate, and the Speaker of the House of Representatives
975	evaluating the pilot project by February 1, 2011.
976	(55)  The agency shall implement a comprehensive care
977	management pilot project in Miami-Dade County for home health
978	services by January 1, 2010, which includes face-to-face
979	assessments by a state-licensed nurse, consultation with
980	physicians ordering services to substantiate the medical
981	necessity for services, and onsite or desk reviews of
982	recipients' medical records. The agency may enter into a
983	contract with a qualified organization to implement the pilot
984	project. The agency may seek amendments to the Medicaid state
985	plan and waivers of federal laws, as necessary, to implement the
986	pilot project.
987	Section 14.  Paragraph (e) of subsection (3) and subsection
988	(12) of section 409.91211, Florida Statutes, are amended to
989	read:
990	409.91211  Medicaid managed care pilot program.--
991	(3)  The agency shall have the following powers, duties,
992	and responsibilities with respect to the pilot program:
993	(e)  To implement policies and guidelines for phasing in
994	financial risk for approved provider service networks over a 5-
995	year 3-year period. These policies and guidelines must include
996	an option for a provider service network to be paid fee-for-
997	service rates. For any provider service network established in a
998	managed care pilot area, the option to be paid fee-for-service
999	rates shall include a savings-settlement mechanism that is
1000	consistent with s. 409.912(44). This model shall be converted to
1001	a risk-adjusted capitated rate no later than the beginning of
1002	the sixth fourth year of operation, and may be converted earlier
1003	at the option of the provider service network. Federally
1004	qualified health centers may be offered an opportunity to accept
1005	or decline a contract to participate in any provider network for
1006	prepaid primary care services.
1007	(12)  For purposes of this section, the term "capitated
1008	managed care plan" includes health insurers authorized under
1009	chapter 624, exclusive provider organizations authorized under
1010	chapter 627, health maintenance organizations authorized under
1011	chapter 641, the Children's Medical Services Network under
1012	chapter 391, and provider service networks that elect to be paid
1013	fee-for-service for up to 5 3 years as authorized under this
1014	section.
1015	Section 15.  Subsection (18) is added to section 430.04,
1016	Florida Statutes, to read:
1017	430.04  Duties and responsibilities of the Department of
1018	Elderly Affairs.--The Department of Elderly Affairs shall:
1019	(18)  Administer all Medicaid waivers and programs relating
1020	to elders and their appropriations. The waivers include, but are
1021	not limited to, the following:
1022	(a)  Alzheimer's Dementia-Specific Medicaid Waiver as
1023	defined in s. 430.502(7),(8), and (9).
1024	(b)  Assisted Living for the Elderly Medicaid Waiver.
1025	(c)  Aged and Disabled Adult Medicaid Waiver.
1026	(d)  Adult Day Health Care Waiver.
1027	(e)  Consumer-directed care program as defined in s.
1028	409.221.
1029	(f)  Program of All-inclusive Care for the Elderly.
1030	(g)  Long-term care community-based diversion pilot
1031	projects as defined in s. 430.705.
1032	(h)  Channeling Services Waiver for Frail Elders.
1033	Section 16.  Section 430.707, Florida Statutes, is amended
1034	to read:
1035	430.707  Contracts.--
1036	(1)  The department, in consultation with the agency, shall
1037	select and contract with managed care organizations and, on a
1038	prepaid basis, with other qualified providers as defined in s.
1039	430.703(7) to provide long-term care within community diversion
1040	pilot project areas. All providers shall report quarterly to the
1041	department regarding the entity's compliance with all the
1042	financial and quality assurance requirements of the contract.
1043	(2)  The department, in consultation with the agency, may
1044	contract with entities that which have submitted an application
1045	as a community nursing home diversion project as of July 1,
1046	1998, to provide benefits pursuant to the "Program of All-
1047	inclusive Care for the Elderly" as established in Pub. L. No.
1048	105-33. For the purposes of this community nursing home
1049	diversion project, such entities are shall be exempt from the
1050	requirements of chapter 641, if the entity is a private,
1051	nonprofit, superior-rated nursing home and if with at least 50
1052	percent of its residents are eligible for Medicaid. The agency,
1053	in consultation with the department, shall accept and forward to
1054	the Centers for Medicare and Medicaid Services an application
1055	for expansion of the pilot project from an entity that provides
1056	benefits pursuant to the Program of All-inclusive Care for the
1057	Elderly and that is in good standing with the agency, the
1058	department, and the Centers for Medicare and Medicaid Services.
1059	Section 17.  This act shall take effect July 1, 2009.

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