HB 5301

1	A bill to be entitled
2	An act relating to Medicaid services; amending s. 400.141,
3	F.S.; conforming a cross-reference to changes made by the
4	act; amending s. 400.179, F.S.; revising requirements for
5	nursing home lease bond alternative fees; amending s.
6	400.23, F.S.; providing for flexibility in how to meet the
7	minimum staffing requirements for nursing home facilities;
8	amending s. 409.904, F.S.; revising the expiration date of
9	provisions authorizing the federal waiver for certain
10	persons age 65 and over or who have a disability; revising
11	the expiration date of provisions authorizing a specified
12	medically needy program; amending s. 409.905, F.S.;
13	authorizing the Agency for Health Care Administration to
14	develop and implement a program to reduce hospital
15	readmissions for a certain population in certain areas of
16	the state; amending s. 409.907, F.S.; authorizing the
17	agency to enroll entities as Medicare crossover-only
18	providers for payment and claims processing purposes only;
19	specifying requirements for Medicare crossover-only
20	agreements; amending s. 409.908, F.S.; providing penalties
21	for providers that fail to report suspension or
22	disenrollment from Medicare within a specified time;
23	amending s. 409.9082, F.S.; revising the purpose of the
24	use of the nursing home facility quality assessment and
25	federal matching funds; amending s. 409.9083, F.S.;
26	revising the purpose of the use of the privately operated
27	intermediate care facilities for the developmentally
28	disabled quality assessment and federal matching funds;
29	amending s. 409.911, F.S.; continuing the audited data
30	specified for use in calculating disproportionate share;
31	revising the formula used to pay disproportionate share
32	dollars to provider service network hospitals; amending s.
33	409.9112, F.S.; continuing the prohibition against
34	distributing moneys under the perinatal intensive care
35	centers disproportionate share program; amending s.
36	409.9113, F.S.; continuing authorization for the
37	distribution of moneys to teaching hospitals under the
38	disproportionate share program; amending s. 409.9117,
39	F.S.; continuing the prohibition against distributing
40	moneys under the primary care disproportionate share
41	program; authorizing the agency to contract with an
42	organization to provide certain benefits under a federal
43	program in Polk, Highlands, Hardee, and Hillsborough
44	Counties; providing an exemption from ch. 641, F.S., for
45	the organization; authorizing, subject to appropriation,
46	enrollment slots for the Program of All-inclusive Care for
47	the Elderly in Polk, Highlands, and Hardee Counties;
48	authorizing the agency, subject to appropriation and
49	federal approval of an expansion application, to contract
50	with an Organized Health Care Delivery System in Miami-
51	Dade County to provide certain benefits under a federal
52	program; providing an exemption from ch. 641, F.S., for
53	the Organized Health Care Delivery System; authorizing,
54	subject to appropriation, enrollment slots for the Program
55	of All-inclusive Care for the Elderly in Southwest Miami-
56	Dade County; providing an effective date.
57
58	Be It Enacted by the Legislature of the State of Florida:
59
60	Section 1.  Paragraph (o) of subsection (1) of section
61	400.141, Florida Statutes, is amended to read:
62	400.141  Administration and management of nursing home
63	facilities.-
64	(1)  Every licensed facility shall comply with all
65	applicable standards and rules of the agency and shall:
66	(o)1.  Submit semiannually to the agency, or more
67	frequently if requested by the agency, information regarding
68	facility staff-to-resident ratios, staff turnover, and staff
69	stability, including information regarding certified nursing
70	assistants, licensed nurses, the director of nursing, and the
71	facility administrator. For purposes of this reporting:
72	a.  Staff-to-resident ratios must be reported in the
73	categories specified in s. 400.23(3)(a) and applicable rules.
74	The ratio must be reported as an average for the most recent
75	calendar quarter.
76	b.  Staff turnover must be reported for the most recent 12-
77	month period ending on the last workday of the most recent
78	calendar quarter prior to the date the information is submitted.
79	The turnover rate must be computed quarterly, with the annual
80	rate being the cumulative sum of the quarterly rates. The
81	turnover rate is the total number of terminations or separations
82	experienced during the quarter, excluding any employee
83	terminated during a probationary period of 3 months or less,
84	divided by the total number of staff employed at the end of the
85	period for which the rate is computed, and expressed as a
86	percentage.
87	c.  The formula for determining staff stability is the
88	total number of employees that have been employed for more than
89	12 months, divided by the total number of employees employed at
90	the end of the most recent calendar quarter, and expressed as a
91	percentage.
92	d.  A nursing facility that has failed to comply with state
93	minimum-staffing requirements for 2 consecutive days is
94	prohibited from accepting new admissions until the facility has
95	achieved the minimum-staffing requirements for a period of 6
96	consecutive days. For the purposes of this sub-subparagraph, any
97	person who was a resident of the facility and was absent from
98	the facility for the purpose of receiving medical care at a
99	separate location or was on a leave of absence is not considered
100	a new admission. Failure to impose such an admissions moratorium
101	constitutes a class II deficiency.
102	e.  A nursing facility which does not have a conditional
103	license may be cited for failure to comply with the standards in
104	s. 400.23(3)(a)1.b. and c. s. 400.23(3)(a)1.a. only if it has
105	failed to meet those standards on 2 consecutive days or if it
106	has failed to meet at least 97 percent of those standards on any
107	one day.
108	f.  A facility which has a conditional license must be in
109	compliance with the standards in s. 400.23(3)(a) at all times.
110	2.  This paragraph does not limit the agency's ability to
111	impose a deficiency or take other actions if a facility does not
112	have enough staff to meet the residents' needs.
113	Section 2.  Paragraph (d) of subsection (2) of section
114	400.179, Florida Statutes, is amended to read:
115	400.179  Liability for Medicaid underpayments and
116	overpayments.-
117	(2)  Because any transfer of a nursing facility may expose
118	the fact that Medicaid may have underpaid or overpaid the
119	transferor, and because in most instances, any such underpayment
120	or overpayment can only be determined following a formal field
121	audit, the liabilities for any such underpayments or
122	overpayments shall be as follows:
123	(d)  Where the transfer involves a facility that has been
124	leased by the transferor:
125	1.  The transferee shall, as a condition to being issued a
126	license by the agency, acquire, maintain, and provide proof to
127	the agency of a bond with a term of 30 months, renewable
128	annually, in an amount not less than the total of 3 months'
129	Medicaid payments to the facility computed on the basis of the
130	preceding 12-month average Medicaid payments to the facility.
131	2.  A leasehold licensee may meet the requirements of
132	subparagraph 1. by payment of a nonrefundable fee, paid at
133	initial licensure, paid at the time of any subsequent change of
134	ownership, and paid annually thereafter, in the amount of 1
135	percent of the total of 3 months' Medicaid payments to the
136	facility computed on the basis of the preceding 12-month average
137	Medicaid payments to the facility. If a preceding 12-month
138	average is not available, projected Medicaid payments may be
139	used. The fee shall be deposited into the Grants and Donations
140	Trust Fund and shall be accounted for separately as a Medicaid
141	nursing home overpayment account. These fees shall be used at
142	the sole discretion of the agency to repay nursing home Medicaid
143	overpayments. Payment of this fee shall not release the licensee
144	from any liability for any Medicaid overpayments, nor shall
145	payment bar the agency from seeking to recoup overpayments from
146	the licensee and any other liable party. As a condition of
147	exercising this lease bond alternative, licensees paying this
148	fee must maintain an existing lease bond through the end of the
149	30-month term period of that bond. The agency is herein granted
150	specific authority to promulgate all rules pertaining to the
151	administration and management of this account, including
152	withdrawals from the account, subject to federal review and
153	approval. This provision shall take effect upon becoming law and
154	shall apply to any leasehold license application. The financial
155	viability of the Medicaid nursing home overpayment account shall
156	be determined by the agency through annual review of the account
157	balance and the amount of total outstanding, unpaid Medicaid
158	overpayments owing from leasehold licensees to the agency as
159	determined by final agency audits. By March 31 of each year, the
160	agency shall assess the cumulative fees collected under this
161	subparagraph, minus any amounts used to repay nursing home
162	Medicaid overpayments and amounts transferred to contribute to
163	the General Revenue Fund pursuant to s. 215.20. If the net
164	cumulative collections, minus amounts utilized to repay nursing
165	home Medicaid overpayments, exceed $25 million, the provisions
166	of this subparagraph shall not apply for the subsequent fiscal
167	year.
168	3.  The leasehold licensee may meet the bond requirement
169	through other arrangements acceptable to the agency. The agency
170	is herein granted specific authority to promulgate rules
171	pertaining to lease bond arrangements.
172	4.  All existing nursing facility licensees, operating the
173	facility as a leasehold, shall acquire, maintain, and provide
174	proof to the agency of the 30-month bond required in
175	subparagraph 1., above, on and after July 1, 1993, for each
176	license renewal.
177	5.  It shall be the responsibility of all nursing facility
178	operators, operating the facility as a leasehold, to renew the
179	30-month bond and to provide proof of such renewal to the agency
180	annually.
181	6.  Any failure of the nursing facility operator to
182	acquire, maintain, renew annually, or provide proof to the
183	agency shall be grounds for the agency to deny, revoke, and
184	suspend the facility license to operate such facility and to
185	take any further action, including, but not limited to,
186	enjoining the facility, asserting a moratorium pursuant to part
187	II of chapter 408, or applying for a receiver, deemed necessary
188	to ensure compliance with this section and to safeguard and
189	protect the health, safety, and welfare of the facility's
190	residents. A lease agreement required as a condition of bond
191	financing or refinancing under s. 154.213 by a health facilities
192	authority or required under s. 159.30 by a county or
193	municipality is not a leasehold for purposes of this paragraph
194	and is not subject to the bond requirement of this paragraph.
195	Section 3.  Paragraph (a) of subsection (3) of section
196	400.23, Florida Statutes, is amended to read:
197	400.23  Rules; evaluation and deficiencies; licensure
198	status.-
199	(3)(a)1.  The agency shall adopt rules providing minimum
200	staffing requirements for nursing homes. These requirements
201	shall include, for each nursing home facility:
202	a.  A minimum weekly average of certified nursing assistant
203	and licensed nursing staffing combined of 3.9 hours of direct
204	care per resident per day. As used in this sub-subparagraph, a
205	week is defined as Sunday through Saturday.
206	b.  A minimum certified nursing assistant staffing of 2.7
207	hours of direct care per resident per day. A facility may not
208	staff below one certified nursing assistant per 20 residents.
209	c.  A minimum licensed nursing staffing of 1.0 hour of
210	direct care per resident per day. A facility may not staff below
211	one licensed nurse per 40 residents.
212	a.  A minimum certified nursing assistant staffing of 2.6
213	hours of direct care per resident per day beginning January 1,
214	2003, and increasing to 2.7 hours of direct care per resident
215	per day beginning January 1, 2007. Beginning January 1, 2002, no
216	facility shall staff below one certified nursing assistant per
217	20 residents, and a minimum licensed nursing staffing of 1.0
218	hour of direct care per resident per day but never below one
219	licensed nurse per 40 residents.
220	b.  Beginning January 1, 2007, a minimum weekly average
221	certified nursing assistant staffing of 2.9 hours of direct care
222	per resident per day. For the purpose of this sub-subparagraph,
223	a week is defined as Sunday through Saturday.
224	2.  Nursing assistants employed under s. 400.211(2) may be
225	included in computing the staffing ratio for certified nursing
226	assistants only if their job responsibilities include only
227	nursing-assistant-related duties.
228	3.  Each nursing home must document compliance with
229	staffing standards as required under this paragraph and post
230	daily the names of staff on duty for the benefit of facility
231	residents and the public.
232	4.  The agency shall recognize the use of licensed nurses
233	for compliance with minimum staffing requirements for certified
234	nursing assistants, provided that the facility otherwise meets
235	the minimum staffing requirements for licensed nurses and that
236	the licensed nurses are performing the duties of a certified
237	nursing assistant. Unless otherwise approved by the agency,
238	licensed nurses counted toward the minimum staffing requirements
239	for certified nursing assistants must exclusively perform the
240	duties of a certified nursing assistant for the entire shift and
241	not also be counted toward the minimum staffing requirements for
242	licensed nurses. If the agency approved a facility's request to
243	use a licensed nurse to perform both licensed nursing and
244	certified nursing assistant duties, the facility must allocate
245	the amount of staff time specifically spent on certified nursing
246	assistant duties for the purpose of documenting compliance with
247	minimum staffing requirements for certified and licensed nursing
248	staff. In no event may the hours of a licensed nurse with dual
249	job responsibilities be counted twice.
250	Section 4.  Subsections (1) and (2) of section 409.904,
251	Florida Statutes, are amended to read:
252	409.904  Optional payments for eligible persons.-The agency
253	may make payments for medical assistance and related services on
254	behalf of the following persons who are determined to be
255	eligible subject to the income, assets, and categorical
256	eligibility tests set forth in federal and state law. Payment on
257	behalf of these Medicaid eligible persons is subject to the
258	availability of moneys and any limitations established by the
259	General Appropriations Act or chapter 216.
260	(1)  Effective January 1, 2006, and subject to federal
261	waiver approval, a person who is age 65 or older or is
262	determined to be disabled, whose income is at or below 88
263	percent of the federal poverty level, whose assets do not exceed
264	established limitations, and who is not eligible for Medicare
265	or, if eligible for Medicare, is also eligible for and receiving
266	Medicaid-covered institutional care services, hospice services,
267	or home and community-based services. The agency shall seek
268	federal authorization through a waiver to provide this coverage.
269	This subsection expires June 30, 2011 December 31, 2010.
270	(2)(a)  A family, a pregnant woman, a child under age 21, a
271	person age 65 or over, or a blind or disabled person, who would
272	be eligible under any group listed in s. 409.903(1), (2), or
273	(3), except that the income or assets of such family or person
274	exceed established limitations. For a family or person in one of
275	these coverage groups, medical expenses are deductible from
276	income in accordance with federal requirements in order to make
277	a determination of eligibility. A family or person eligible
278	under the coverage known as the "medically needy," is eligible
279	to receive the same services as other Medicaid recipients, with
280	the exception of services in skilled nursing facilities and
281	intermediate care facilities for the developmentally disabled.
282	This paragraph expires June 30, 2011 December 31, 2010.
283	(b)  Effective July 1, 2011 January 1, 2011, a pregnant
284	woman or a child younger than 21 years of age who would be
285	eligible under any group listed in s. 409.903, except that the
286	income or assets of such group exceed established limitations.
287	For a person in one of these coverage groups, medical expenses
288	are deductible from income in accordance with federal
289	requirements in order to make a determination of eligibility. A
290	person eligible under the coverage known as the "medically
291	needy" is eligible to receive the same services as other
292	Medicaid recipients, with the exception of services in skilled
293	nursing facilities and intermediate care facilities for the
294	developmentally disabled.
295	Section 5.  Paragraph (f) is added to subsection (5) of
296	section 409.905, Florida Statutes, to read:
297	409.905  Mandatory Medicaid services.-The agency may make
298	payments for the following services, which are required of the
299	state by Title XIX of the Social Security Act, furnished by
300	Medicaid providers to recipients who are determined to be
301	eligible on the dates on which the services were provided. Any
302	service under this section shall be provided only when medically
303	necessary and in accordance with state and federal law.
304	Mandatory services rendered by providers in mobile units to
305	Medicaid recipients may be restricted by the agency. Nothing in
306	this section shall be construed to prevent or limit the agency
307	from adjusting fees, reimbursement rates, lengths of stay,
308	number of visits, number of services, or any other adjustments
309	necessary to comply with the availability of moneys and any
310	limitations or directions provided for in the General
311	Appropriations Act or chapter 216.
312	(5)  HOSPITAL INPATIENT SERVICES.-The agency shall pay for
313	all covered services provided for the medical care and treatment
314	of a recipient who is admitted as an inpatient by a licensed
315	physician or dentist to a hospital licensed under part I of
316	chapter 395. However, the agency shall limit the payment for
317	inpatient hospital services for a Medicaid recipient 21 years of
318	age or older to 45 days or the number of days necessary to
319	comply with the General Appropriations Act.
320	(f)  The agency may develop and implement a program to
321	reduce the number of hospital readmissions among the non-
322	Medicare population eligible in areas 9, 10, and 11.
323	Section 6.  Paragraphs (d) and (e) are added to subsection
324	(5) of section 409.907, Florida Statutes, to read:
325	409.907  Medicaid provider agreements.-The agency may make
326	payments for medical assistance and related services rendered to
327	Medicaid recipients only to an individual or entity who has a
328	provider agreement in effect with the agency, who is performing
329	services or supplying goods in accordance with federal, state,
330	and local law, and who agrees that no person shall, on the
331	grounds of handicap, race, color, or national origin, or for any
332	other reason, be subjected to discrimination under any program
333	or activity for which the provider receives payment from the
334	agency.
335	(5)  The agency:
336	(d)  May enroll entities as Medicare crossover-only
337	providers for payment and claims processing purposes only. The
338	provider agreement shall:
339	1.  Require that the provider be able to demonstrate to the
340	satisfaction of the agency that the provider is an eligible
341	Medicare provider and has a current provider agreement in place
342	with the Centers for Medicare and Medicaid Services.
343	2.  Require the provider to notify the agency immediately
344	in writing upon being suspended or disenrolled as a Medicare
345	provider. If the provider does not provide such notification
346	within 5 business days after suspension or disenrollment,
347	sanctions may be imposed pursuant to this chapter and the
348	provider may be required to return funds paid to the provider
349	during the period of time that the provider was suspended or
350	disenrolled as a Medicare provider.
351	3.  Require that all records pertaining to health care
352	services provided to each of the provider's recipients be kept
353	for a minimum of 6 years. The agreement shall also require that
354	records and any information relating to payments claimed by the
355	provider for services under the agreement be delivered to the
356	agency or the Office of the Attorney General Medicaid Fraud
357	Control Unit when requested. If a provider does not provide such
358	records and information when requested, sanctions may be imposed
359	pursuant to this chapter.
360	4.  Disclose that the agreement is for the purposes of
361	paying and processing Medicare crossover claims only.
362
363	This paragraph pertains solely to Medicare crossover-only
364	providers. In order to become a standard Medicaid provider, the
365	requirements of this section and applicable rules must be met.
366	(e)  Providers that are required to post a surety bond as
367	part of the Medicaid enrollment process are excluded for
368	enrollment under paragraph (d).
369	Section 7.  Subsection (24) is added to section 409.908,
370	Florida Statutes, to read:
371	409.908  Reimbursement of Medicaid providers.-Subject to
372	specific appropriations, the agency shall reimburse Medicaid
373	providers, in accordance with state and federal law, according
374	to methodologies set forth in the rules of the agency and in
375	policy manuals and handbooks incorporated by reference therein.
376	These methodologies may include fee schedules, reimbursement
377	methods based on cost reporting, negotiated fees, competitive
378	bidding pursuant to s. 287.057, and other mechanisms the agency
379	considers efficient and effective for purchasing services or
380	goods on behalf of recipients. If a provider is reimbursed based
381	on cost reporting and submits a cost report late and that cost
382	report would have been used to set a lower reimbursement rate
383	for a rate semester, then the provider's rate for that semester
384	shall be retroactively calculated using the new cost report, and
385	full payment at the recalculated rate shall be effected
386	retroactively. Medicare-granted extensions for filing cost
387	reports, if applicable, shall also apply to Medicaid cost
388	reports. Payment for Medicaid compensable services made on
389	behalf of Medicaid eligible persons is subject to the
390	availability of moneys and any limitations or directions
391	provided for in the General Appropriations Act or chapter 216.
392	Further, nothing in this section shall be construed to prevent
393	or limit the agency from adjusting fees, reimbursement rates,
394	lengths of stay, number of visits, or number of services, or
395	making any other adjustments necessary to comply with the
396	availability of moneys and any limitations or directions
397	provided for in the General Appropriations Act, provided the
398	adjustment is consistent with legislative intent.
399	(24)  If a provider fails to notify the agency within 5
400	business days after suspension or disenrollment from Medicare,
401	sanctions may be imposed pursuant to this chapter and the
402	provider may be required to return funds paid to the provider
403	during the period of time that the provider was suspended or
404	disenrolled as a Medicare provider.
405	Section 8.  Subsection (4) of section 409.9082, Florida
406	Statutes, is amended to read:
407	409.9082  Quality assessment on nursing home facility
408	providers; exemptions; purpose; federal approval required;
409	remedies.-
410	(4)  The purpose of the nursing home facility quality
411	assessment is to ensure continued quality of care. Collected
412	assessment funds shall be used to obtain federal financial
413	participation through the Medicaid program to make Medicaid
414	payments for nursing home facility services up to the amount of
415	nursing home facility Medicaid rates as calculated in accordance
416	with the approved state Medicaid plan in effect on December 31,
417	2007. The quality assessment and federal matching funds shall be
418	used exclusively for the following purposes and in the following
419	order of priority:
420	(a)  To reimburse the Medicaid share of the quality
421	assessment as a pass-through, Medicaid-allowable cost;
422	(b)  To increase to each nursing home facility's Medicaid
423	rate, as needed, an amount that restores the rate reductions
424	effective on or after implemented January 1, 2008, as provided
425	in the General Appropriations Act; January 1, 2009; and March 1,
426	2009; and
427	(c)  To increase to each nursing home facility's Medicaid
428	rate, as needed, an amount that restores any rate reductions for
429	the 2009-2010 fiscal year; and
430	(c)(d)  To increase each nursing home facility's Medicaid
431	rate that accounts for the portion of the total assessment not
432	included in paragraphs (a) and (b) (a)-(c) which begins a phase-
433	in to a pricing model for the operating cost component.
434	Section 9.  Subsection (3) of section 409.9083, Florida
435	Statutes, is amended to read:
436	409.9083  Quality assessment on privately operated
437	intermediate care facilities for the developmentally disabled;
438	exemptions; purpose; federal approval required; remedies.-
439	(3)  The purpose of the facility quality assessment is to
440	ensure continued quality of care. Collected assessment funds
441	shall be used to obtain federal financial participation through
442	the Medicaid program to make Medicaid payments for ICF/DD
443	services up to the amount of the Medicaid rates for such
444	facilities as calculated in accordance with the approved state
445	Medicaid plan in effect on April 1, 2008. The quality assessment
446	and federal matching funds shall be used exclusively for the
447	following purposes and in the following order of priority to:
448	(a)  Reimburse the Medicaid share of the quality assessment
449	as a pass-through, Medicaid-allowable cost.
450	(b)  Increase each privately operated ICF/DD Medicaid rate,
451	as needed, by an amount that restores the rate reductions
452	effective on or after implemented on October 1, 2008, as
453	provided in the General Appropriations Act.
454	(c)  Increase each ICF/DD Medicaid rate, as needed, by an
455	amount that restores any rate reductions for the 2008-2009
456	fiscal year and the 2009-2010 fiscal year.
457	(c)(d)  Increase payments to such facilities to fund
458	covered services to Medicaid beneficiaries.
459	Section 10.  Paragraph (a) of subsection (2) and subsection
460	(5) of section 409.911, Florida Statutes, are amended to read:
461	409.911  Disproportionate share program.-Subject to
462	specific allocations established within the General
463	Appropriations Act and any limitations established pursuant to
464	chapter 216, the agency shall distribute, pursuant to this
465	section, moneys to hospitals providing a disproportionate share
466	of Medicaid or charity care services by making quarterly
467	Medicaid payments as required. Notwithstanding the provisions of
468	s. 409.915, counties are exempt from contributing toward the
469	cost of this special reimbursement for hospitals serving a
470	disproportionate share of low-income patients.
471	(2)  The Agency for Health Care Administration shall use
472	the following actual audited data to determine the Medicaid days
473	and charity care to be used in calculating the disproportionate
474	share payment:
475	(a)  The average of the 2003, 2004, and 2005 audited
476	disproportionate share data to determine each hospital's
477	Medicaid days and charity care for the 2010-2011 2009-2010 state
478	fiscal year.
479	(5)  The following formula shall be used to pay
480	disproportionate share dollars to provider service network (PSN)
481	hospitals:
482	DSHP = TAAPSNH x (IHPSND/THPSND IHPSND x THPSND)
483	Where:
484	DSHP = Disproportionate share hospital payments.
485	TAAPSNH = Total amount available for PSN hospitals.
486	IHPSND = Individual hospital PSN days.
487	THPSND = Total of all hospital PSN days.
488	For purposes of this subsection, the PSN inpatient days shall be
489	provided in the General Appropriations Act.
490	Section 11.  Section 409.9112, Florida Statutes, is amended
491	to read:
492	409.9112  Disproportionate share program for regional
493	perinatal intensive care centers.-In addition to the payments
494	made under s. 409.911, the agency shall design and implement a
495	system for making disproportionate share payments to those
496	hospitals that participate in the regional perinatal intensive
497	care center program established pursuant to chapter 383. The
498	system of payments must conform to federal requirements and
499	distribute funds in each fiscal year for which an appropriation
500	is made by making quarterly Medicaid payments. Notwithstanding
501	s. 409.915, counties are exempt from contributing toward the
502	cost of this special reimbursement for hospitals serving a
503	disproportionate share of low-income patients. For the 2010-2011
504	2009-2010 state fiscal year, the agency may not distribute
505	moneys under the regional perinatal intensive care centers
506	disproportionate share program.
507	(1)  The following formula shall be used by the agency to
508	calculate the total amount earned for hospitals that participate
509	in the regional perinatal intensive care center program:
510	TAE = HDSP/THDSP
511	Where:
512	TAE = total amount earned by a regional perinatal intensive
513	care center.
514	HDSP = the prior state fiscal year regional perinatal
515	intensive care center disproportionate share payment to the
516	individual hospital.
517	THDSP = the prior state fiscal year total regional
518	perinatal intensive care center disproportionate share payments
519	to all hospitals.
520	(2)  The total additional payment for hospitals that
521	participate in the regional perinatal intensive care center
522	program shall be calculated by the agency as follows:
523	TAP = TAE x TA
524	Where:
525	TAP = total additional payment for a regional perinatal
526	intensive care center.
527	TAE = total amount earned by a regional perinatal intensive
528	care center.
529	TA = total appropriation for the regional perinatal
530	intensive care center disproportionate share program.
531	(3)  In order to receive payments under this section, a
532	hospital must be participating in the regional perinatal
533	intensive care center program pursuant to chapter 383 and must
534	meet the following additional requirements:
535	(a)  Agree to conform to all departmental and agency
536	requirements to ensure high quality in the provision of
537	services, including criteria adopted by departmental and agency
538	rule concerning staffing ratios, medical records, standards of
539	care, equipment, space, and such other standards and criteria as
540	the department and agency deem appropriate as specified by rule.
541	(b)  Agree to provide information to the department and
542	agency, in a form and manner to be prescribed by rule of the
543	department and agency, concerning the care provided to all
544	patients in neonatal intensive care centers and high-risk
545	maternity care.
546	(c)  Agree to accept all patients for neonatal intensive
547	care and high-risk maternity care, regardless of ability to pay,
548	on a functional space-available basis.
549	(d)  Agree to develop arrangements with other maternity and
550	neonatal care providers in the hospital's region for the
551	appropriate receipt and transfer of patients in need of
552	specialized maternity and neonatal intensive care services.
553	(e)  Agree to establish and provide a developmental
554	evaluation and services program for certain high-risk neonates,
555	as prescribed and defined by rule of the department.
556	(f)  Agree to sponsor a program of continuing education in
557	perinatal care for health care professionals within the region
558	of the hospital, as specified by rule.
559	(g)  Agree to provide backup and referral services to the
560	county health departments and other low-income perinatal
561	providers within the hospital's region, including the
562	development of written agreements between these organizations
563	and the hospital.
564	(h)  Agree to arrange for transportation for high-risk
565	obstetrical patients and neonates in need of transfer from the
566	community to the hospital or from the hospital to another more
567	appropriate facility.
568	(4)  Hospitals which fail to comply with any of the
569	conditions in subsection (3) or the applicable rules of the
570	department and agency may not receive any payments under this
571	section until full compliance is achieved. A hospital which is
572	not in compliance in two or more consecutive quarters may not
573	receive its share of the funds. Any forfeited funds shall be
574	distributed by the remaining participating regional perinatal
575	intensive care center program hospitals.
576	Section 12.  Section 409.9113, Florida Statutes, is amended
577	to read:
578	409.9113  Disproportionate share program for teaching
579	hospitals.-In addition to the payments made under ss. 409.911
580	and 409.9112, the agency shall make disproportionate share
581	payments to statutorily defined teaching hospitals for their
582	increased costs associated with medical education programs and
583	for tertiary health care services provided to the indigent. This
584	system of payments must conform to federal requirements and
585	distribute funds in each fiscal year for which an appropriation
586	is made by making quarterly Medicaid payments. Notwithstanding
587	s. 409.915, counties are exempt from contributing toward the
588	cost of this special reimbursement for hospitals serving a
589	disproportionate share of low-income patients. For the 2010-2011
590	2009-2010 state fiscal year, the agency shall distribute the
591	moneys provided in the General Appropriations Act to statutorily
592	defined teaching hospitals and family practice teaching
593	hospitals under the teaching hospital disproportionate share
594	program. The funds provided for statutorily defined teaching
595	hospitals shall be distributed in the same proportion as the
596	state fiscal year 2003-2004 teaching hospital disproportionate
597	share funds were distributed or as otherwise provided in the
598	General Appropriations Act. The funds provided for family
599	practice teaching hospitals shall be distributed equally among
600	family practice teaching hospitals.
601	(1)  On or before September 15 of each year, the agency
602	shall calculate an allocation fraction to be used for
603	distributing funds to state statutory teaching hospitals.
604	Subsequent to the end of each quarter of the state fiscal year,
605	the agency shall distribute to each statutory teaching hospital,
606	as defined in s. 408.07, an amount determined by multiplying
607	one-fourth of the funds appropriated for this purpose by the
608	Legislature times such hospital's allocation fraction. The
609	allocation fraction for each such hospital shall be determined
610	by the sum of the following three primary factors, divided by
611	three:
612	(a)  The number of nationally accredited graduate medical
613	education programs offered by the hospital, including programs
614	accredited by the Accreditation Council for Graduate Medical
615	Education and the combined Internal Medicine and Pediatrics
616	programs acceptable to both the American Board of Internal
617	Medicine and the American Board of Pediatrics at the beginning
618	of the state fiscal year preceding the date on which the
619	allocation fraction is calculated. The numerical value of this
620	factor is the fraction that the hospital represents of the total
621	number of programs, where the total is computed for all state
622	statutory teaching hospitals.
623	(b)  The number of full-time equivalent trainees in the
624	hospital, which comprises two components:
625	1.  The number of trainees enrolled in nationally
626	accredited graduate medical education programs, as defined in
627	paragraph (a). Full-time equivalents are computed using the
628	fraction of the year during which each trainee is primarily
629	assigned to the given institution, over the state fiscal year
630	preceding the date on which the allocation fraction is
631	calculated. The numerical value of this factor is the fraction
632	that the hospital represents of the total number of full-time
633	equivalent trainees enrolled in accredited graduate programs,
634	where the total is computed for all state statutory teaching
635	hospitals.
636	2.  The number of medical students enrolled in accredited
637	colleges of medicine and engaged in clinical activities,
638	including required clinical clerkships and clinical electives.
639	Full-time equivalents are computed using the fraction of the
640	year during which each trainee is primarily assigned to the
641	given institution, over the course of the state fiscal year
642	preceding the date on which the allocation fraction is
643	calculated. The numerical value of this factor is the fraction
644	that the given hospital represents of the total number of full-
645	time equivalent students enrolled in accredited colleges of
646	medicine, where the total is computed for all state statutory
647	teaching hospitals.
648
649	The primary factor for full-time equivalent trainees is computed
650	as the sum of these two components, divided by two.
651	(c)  A service index that comprises three components:
652	1.  The Agency for Health Care Administration Service
653	Index, computed by applying the standard Service Inventory
654	Scores established by the agency to services offered by the
655	given hospital, as reported on Worksheet A-2 for the last fiscal
656	year reported to the agency before the date on which the
657	allocation fraction is calculated. The numerical value of this
658	factor is the fraction that the given hospital represents of the
659	total Agency for Health Care Administration Service Index
660	values, where the total is computed for all state statutory
661	teaching hospitals.
662	2.  A volume-weighted service index, computed by applying
663	the standard Service Inventory Scores established by the Agency
664	for Health Care Administration to the volume of each service,
665	expressed in terms of the standard units of measure reported on
666	Worksheet A-2 for the last fiscal year reported to the agency
667	before the date on which the allocation factor is calculated.
668	The numerical value of this factor is the fraction that the
669	given hospital represents of the total volume-weighted service
670	index values, where the total is computed for all state
671	statutory teaching hospitals.
672	3.  Total Medicaid payments to each hospital for direct
673	inpatient and outpatient services during the fiscal year
674	preceding the date on which the allocation factor is calculated.
675	This includes payments made to each hospital for such services
676	by Medicaid prepaid health plans, whether the plan was
677	administered by the hospital or not. The numerical value of this
678	factor is the fraction that each hospital represents of the
679	total of such Medicaid payments, where the total is computed for
680	all state statutory teaching hospitals.
681
682	The primary factor for the service index is computed as the sum
683	of these three components, divided by three.
684	(2)  By October 1 of each year, the agency shall use the
685	following formula to calculate the maximum additional
686	disproportionate share payment for statutorily defined teaching
687	hospitals:
688	TAP = THAF x A
689	Where:
690	TAP = total additional payment.
691	THAF = teaching hospital allocation factor.
692	A = amount appropriated for a teaching hospital
693	disproportionate share program.
694	Section 13.  Section 409.9117, Florida Statutes, is amended
695	to read:
696	409.9117  Primary care disproportionate share program.-For
697	the 2010-2011 2009-2010 state fiscal year, the agency shall not
698	distribute moneys under the primary care disproportionate share
699	program.
700	(1)  If federal funds are available for disproportionate
701	share programs in addition to those otherwise provided by law,
702	there shall be created a primary care disproportionate share
703	program.
704	(2)  The following formula shall be used by the agency to
705	calculate the total amount earned for hospitals that participate
706	in the primary care disproportionate share program:
707	TAE = HDSP/THDSP
708	Where:
709	TAE = total amount earned by a hospital participating in
710	the primary care disproportionate share program.
711	HDSP = the prior state fiscal year primary care
712	disproportionate share payment to the individual hospital.
713	THDSP = the prior state fiscal year total primary care
714	disproportionate share payments to all hospitals.
715	(3)  The total additional payment for hospitals that
716	participate in the primary care disproportionate share program
717	shall be calculated by the agency as follows:
718	TAP = TAE x TA
719	Where:
720	TAP = total additional payment for a primary care hospital.
721	TAE = total amount earned by a primary care hospital.
722	TA = total appropriation for the primary care
723	disproportionate share program.
724	(4)  In the establishment and funding of this program, the
725	agency shall use the following criteria in addition to those
726	specified in s. 409.911, and payments may not be made to a
727	hospital unless the hospital agrees to:
728	(a)  Cooperate with a Medicaid prepaid health plan, if one
729	exists in the community.
730	(b)  Ensure the availability of primary and specialty care
731	physicians to Medicaid recipients who are not enrolled in a
732	prepaid capitated arrangement and who are in need of access to
733	such physicians.
734	(c)  Coordinate and provide primary care services free of
735	charge, except copayments, to all persons with incomes up to 100
736	percent of the federal poverty level who are not otherwise
737	covered by Medicaid or another program administered by a
738	governmental entity, and to provide such services based on a
739	sliding fee scale to all persons with incomes up to 200 percent
740	of the federal poverty level who are not otherwise covered by
741	Medicaid or another program administered by a governmental
742	entity, except that eligibility may be limited to persons who
743	reside within a more limited area, as agreed to by the agency
744	and the hospital.
745	(d)  Contract with any federally qualified health center,
746	if one exists within the agreed geopolitical boundaries,
747	concerning the provision of primary care services, in order to
748	guarantee delivery of services in a nonduplicative fashion, and
749	to provide for referral arrangements, privileges, and
750	admissions, as appropriate. The hospital shall agree to provide
751	at an onsite or offsite facility primary care services within 24
752	hours to which all Medicaid recipients and persons eligible
753	under this paragraph who do not require emergency room services
754	are referred during normal daylight hours.
755	(e)  Cooperate with the agency, the county, and other
756	entities to ensure the provision of certain public health
757	services, case management, referral and acceptance of patients,
758	and sharing of epidemiological data, as the agency and the
759	hospital find mutually necessary and desirable to promote and
760	protect the public health within the agreed geopolitical
761	boundaries.
762	(f)  In cooperation with the county in which the hospital
763	resides, develop a low-cost, outpatient, prepaid health care
764	program to persons who are not eligible for the Medicaid
765	program, and who reside within the area.
766	(g)  Provide inpatient services to residents within the
767	area who are not eligible for Medicaid or Medicare, and who do
768	not have private health insurance, regardless of ability to pay,
769	on the basis of available space, except that hospitals may not
770	be prevented from establishing bill collection programs based on
771	ability to pay.
772	(h)  Work with the Florida Healthy Kids Corporation, the
773	Florida Health Care Purchasing Cooperative, and business health
774	coalitions, as appropriate, to develop a feasibility study and
775	plan to provide a low-cost comprehensive health insurance plan
776	to persons who reside within the area and who do not have access
777	to such a plan.
778	(i)  Work with public health officials and other experts to
779	provide community health education and prevention activities
780	designed to promote healthy lifestyles and appropriate use of
781	health services.
782	(j)  Work with the local health council to develop a plan
783	for promoting access to affordable health care services for all
784	persons who reside within the area, including, but not limited
785	to, public health services, primary care services, inpatient
786	services, and affordable health insurance generally.
787
788	Any hospital that fails to comply with any of the provisions of
789	this subsection, or any other contractual condition, may not
790	receive payments under this section until full compliance is
791	achieved.
792	Section 14.  Notwithstanding s. 430.707, Florida Statutes,
793	and subject to federal approval of the application to be a site
794	for the Program of All-inclusive Care for the Elderly, the
795	Agency for Health Care Administration shall contract with one
796	private health care organization, the sole member of which is a
797	private, not-for-profit corporation that owns and manages health
798	care organizations which provide comprehensive services,
799	including hospice and palliative care services, to frail and
800	elderly persons who reside in Polk, Highlands, Hardee, and
801	Hillsborough Counties. Such an entity shall be exempt from the
802	requirements of chapter 641, Florida Statutes. The agency, in
803	consultation with the Department of Elderly Affairs and subject
804	to appropriation, shall approve up to 150 initial enrollees in
805	the Program of All-inclusive Care for the Elderly established by
806	this organization to serve persons in Polk, Highlands, and
807	Hardee Counties.
808	Section 15.  Notwithstanding s. 430.707, Florida Statutes,
809	and subject to federal approval of an application for expansion
810	to a new site, the Agency for Health Care Administration shall
811	contract with an Organized Health Care Delivery System (OHCDS)
812	in Miami-Dade County that currently offers benefits pursuant to
813	the Program of All-inclusive Care for the Elderly to provide
814	comprehensive services to frail and elderly persons residing in
815	Southwest Miami-Dade County. Such an entity shall be exempt from
816	the requirements of chapter 641, Florida Statutes. The agency,
817	in consultation with the Department of Elderly Affairs and
818	subject to appropriation, shall approve up to 50 initial
819	enrollees in the Program of All-inclusive Care for the Elderly
820	established by this organization to serve persons in Southwest
821	Miami-Dade County.
822	Section 16.  This act shall take effect July 1, 2010.

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