Florida Senate - 2013 SB 1094
By Senator Flores
37-00921A-13 20131094__
1 A bill to be entitled
2 An act relating to home health agencies; amending s.
3 400.474, F.S.; deleting requirements for the quarterly
4 reporting by a home health agency of certain data
5 submitted to the Agency for Health Care
6 Administration; providing an effective date.
7
8 Be It Enacted by the Legislature of the State of Florida:
9
10 Section 1. Subsection (6) of section 400.474, Florida
11 Statutes, is amended to read:
12 400.474 Administrative penalties.—
13 (6) The agency may deny, revoke, or suspend the license of
14 a home health agency and shall impose a fine of $5,000 against a
15 home health agency that:
16 (a) Gives remuneration for staffing services to:
17 1. Another home health agency with which it has formal or
18 informal patient-referral transactions or arrangements; or
19 2. A health services pool with which it has formal or
20 informal patient-referral transactions or arrangements,
21
22 unless the home health agency has activated its comprehensive
23 emergency management plan in accordance with s. 400.492. This
24 paragraph does not apply to a Medicare-certified home health
25 agency that provides fair market value remuneration for staffing
26 services to a non-Medicare-certified home health agency that is
27 part of a continuing care facility licensed under chapter 651
28 for providing services to its own residents if each resident
29 receiving home health services pursuant to this arrangement
30 attests in writing that he or she made a decision without
31 influence from staff of the facility to select, from a list of
32 Medicare-certified home health agencies provided by the
33 facility, that Medicare-certified home health agency to provide
34 the services.
35 (b) Provides services to residents in an assisted living
36 facility for which the home health agency does not receive fair
37 market value remuneration.
38 (c) Provides staffing to an assisted living facility for
39 which the home health agency does not receive fair market value
40 remuneration.
41 (d) Fails to provide the agency, upon request, with copies
42 of all contracts with assisted living facilities which were
43 executed within 5 years before the request.
44 (e) Gives remuneration to a case manager, discharge
45 planner, facility-based staff member, or third-party vendor who
46 is involved in the discharge planning process of a facility
47 licensed under chapter 395, chapter 429, or this chapter from
48 whom the home health agency receives referrals.
49 (f) Fails to submit to the agency, within 15 days after the
50 end of each calendar quarter, a written report that includes the
51 following data based on data as it existed on the last day of
52 the quarter:
53 1. The number of insulin-dependent diabetic patients
54 receiving insulin-injection services from the home health
55 agency;
56 2. The number of patients receiving both home health
57 services from the home health agency and hospice services;
58 3. The number of patients receiving home health services
59 from that home health agency; and
60 4. The names and license numbers of nurses whose primary
61 job responsibility is to provide home health services to
62 patients and who received remuneration from the home health
63 agency in excess of $25,000 during the calendar quarter.
64 (f)(g) Gives cash, or its equivalent, to a Medicare or
65 Medicaid beneficiary.
66 (g)(h) Has more than one medical director contract in
67 effect at one time or more than one medical director contract
68 and one contract with a physician-specialist whose services are
69 mandated for the home health agency in order to qualify to
70 participate in a federal or state health care program at one
71 time.
72 (h)(i) Gives remuneration to a physician without a medical
73 director contract being in effect. The contract must:
74 1. Be in writing and signed by both parties;
75 2. Provide for remuneration that is at fair market value
76 for an hourly rate, which must be supported by invoices
77 submitted by the medical director describing the work performed,
78 the dates on which that work was performed, and the duration of
79 that work; and
80 3. Be for a term of at least 1 year.
81
82 The hourly rate specified in the contract may not be increased
83 during the term of the contract. The home health agency may not
84 execute a subsequent contract with that physician which has an
85 increased hourly rate and covers any portion of the term that
86 was in the original contract.
87 (i)(j) Gives remuneration to:
88 1. A physician, and the home health agency is in violation
89 of paragraph (g) (h) or paragraph (h) (i);
90 2. A member of the physician’s office staff; or
91 3. An immediate family member of the physician,
92
93 if the home health agency has received a patient referral in the
94 preceding 12 months from that physician or physician’s office
95 staff.
96 (j)(k) Fails to provide to the agency, upon request, copies
97 of all contracts with a medical director which were executed
98 within 5 years before the request.
99 (k)(l) Demonstrates a pattern of billing the Medicaid
100 program for services to Medicaid recipients which are medically
101 unnecessary as determined by a final order. A pattern may be
102 demonstrated by a showing of at least two such medically
103 unnecessary services within one Medicaid program integrity audit
104 period.
105
106 Nothing in paragraph (e) or paragraph (i) (j) shall be
107 interpreted as applying to or precluding any discount,
108 compensation, waiver of payment, or payment practice permitted
109 by 42 U.S.C. s. 1320a-7(b) or regulations adopted thereunder,
110 including 42 C.F.R. s. 1001.952 or s. 1395nn or regulations
111 adopted thereunder.
112 Section 2. This act shall take effect July 1, 2013.