Florida Senate - 2013 COMMITTEE AMENDMENT
Bill No. SB 690
Barcode 255538
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
02/22/2013 .
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The Committee on Rules (Thrasher) recommended the following:
1 Senate Amendment
2
3 Delete lines 3148 - 3251
4 and insert:
5
6 Section 79. Subsection (6) of section 430.205, Florida
7 Statutes, is amended to read:
8 430.205 Community care service system.—
9 (6) Notwithstanding other requirements of this chapter, the
10 Department of Elderly Affairs and the Agency for Health Care
11 Administration shall develop an integrated long-term-care
12 delivery system.
13 (a) The duties of the integrated system shall include
14 organizing and administering service delivery for the elderly,
15 obtaining contracts for services with providers in each service
16 area, monitoring the quality of services provided, determining
17 levels of need and disability for payment purposes, and other
18 activities determined by the department and the agency in order
19 to operate an integrated system.
20 (b) During the 2004-2005 state fiscal year:
21 1. The agency and the department shall reimburse providers
22 for case management services on a capitated basis and develop
23 uniform standards for case management within the Aged and
24 Disabled Adult Medicaid waiver program. The coordination of
25 acute and chronic medical services for individuals may be
26 included in the capitated rate for case management services. The
27 agency, in consultation with the department, shall adopt any
28 rules necessary to comply with or administer these requirements.
29 2. The Legislature finds that preservation of the historic
30 aging network of lead agencies is essential to the well-being of
31 Florida’s elderly population. The Legislature finds that the
32 Florida aging network constitutes a system of essential
33 community providers which should be nurtured and assisted to
34 develop systems of operations which allow the gradual assumption
35 of responsibility and financial risk for managing a client
36 through the entire continuum of long-term care services within
37 the area the lead agency is currently serving, and which allow
38 lead agency providers to develop managed systems of service
39 delivery. The department, in consultation with the agency, shall
40 therefore:
41 a. Develop a demonstration project in which existing
42 community care for the elderly lead agencies are assisted in
43 transferring their business model and the service delivery
44 system within their current community care service area to
45 enable assumption, over a period of time, of full risk as a
46 community diversion pilot project contractor providing long-term
47 care services in the areas of operation. The department, in
48 consultation with the agency and the Department of Children and
49 Family Services, shall develop an implementation plan for no
50 more than three lead agencies by October 31, 2004.
51 b. In the demonstration area, a community care for the
52 elderly lead agency shall be initially reimbursed on a prepaid
53 or fixed-sum basis for all home and community-based services
54 provided under the long-term care community diversion pilot
55 project. By the end of the third year of operation, the lead
56 agency shall be reimbursed on a prepaid or fixed-sum basis for
57 all services under the long-term care community diversion pilot
58 project.
59 c. During the first year of operation, the department, in
60 consultation with the agency, may place providers at risk to
61 provide nursing home services for the enrolled individuals who
62 are participating in the demonstration project. During the 3
63 year development period, the agency and the department may limit
64 the level of custodial nursing home risk that the administering
65 entities assume. Under risk-sharing arrangements, during the
66 first 3 years of operation, the department, in consultation with
67 the agency, may reimburse the administering entity for the cost
68 of providing nursing home care for Medicaid-eligible
69 participants who have been permanently placed and remain in a
70 nursing home for more than 1 year, or may disenroll such
71 participants from the demonstration project.
72 d. The agency, in consultation with the department, shall
73 develop reimbursement rates based on the federally approved,
74 actuarially certified rate methodology for the long-term care
75 community diversion pilot project.
76 e. The department, in consultation with the agency, shall
77 ensure that the entity or entities receiving prepaid or fixed
78 sum reimbursement are assisted in developing internal management
79 and financial control systems necessary to manage the risk
80 associated with providing services under a prepaid or fixed-sum
81 rate system.
82 f. If the department and the agency share risk of custodial
83 nursing home placement, payment rates during the first 3 years
84 of operation shall be set at not more than 100 percent of the
85 costs to the agency and the department of providing equivalent
86 services to the population within the area of the pilot project
87 for the year prior to the year in which the pilot project is
88 implemented, adjusted forward to account for inflation and
89 policy changes in the Medicaid program.
90 g. Community care for the elderly lead agencies that have
91 operated for a period of at least 20 years, which provide
92 Medicare-certified services to elders, and which have developed
93 a system of service provision by health care volunteers shall be
94 given priority in the selection of the pilot project if they
95 meet the minimum requirements specified in the competitive
96 procurement.
97 h. The agency and the department shall adopt rules
98 necessary to comply with or administer these requirements,
99 effect and implement interagency agreements between the agency
100 and the department, and comply with federal requirements.
101 i. The department and the agency shall seek federal waivers
102 necessary to implement the requirements of this section.
103 j. The Department of Elderly Affairs shall conduct or
104 contract for an evaluation of the demonstration project. The
105 department shall submit the evaluation to the Governor and the
106 Legislature by January 1, 2007. The evaluation must address the
107 effectiveness of the pilot project in providing a comprehensive
108 system of appropriate and high-quality, long-term care services
109 to elders in the least restrictive setting and make
110 recommendations on expanding the project to other parts of the
111 state. This subparagraph is subject to an appropriation by the
112 Legislature.
113 3. The agency, in consultation with the department, shall
114 work with the fiscal agent for the Medicaid program to develop a
115 service utilization reporting system that operates through the
116 fiscal agent for the capitated plans.
117 (c) During the 2005-2006 state fiscal year:
118 1. The agency, in consultation with the department, shall
119 monitor the newly integrated programs and report on the progress
120 of those programs to the Governor, the President of the Senate,
121 and the Speaker of the House of Representatives by June 30,
122 2006. The report must include an initial evaluation of the
123 programs in their early stages following the evaluation plan
124 developed by the department, in consultation with the agency and
125 the selected contractor.
126 2. The department shall monitor the pilot projects for
127 resource centers on aging and report on the progress of those
128 projects to the Governor, the President of the Senate, and the
129 Speaker of the House of Representatives by June 30, 2006. The
130 report must include an evaluation of the implementation process
131 in its early stages.
132 3. The department, in consultation with the agency, shall
133 integrate the database systems for the Comprehensive Assessment
134 and Review for Long-Term Care Services (CARES) program and the
135 Client Information and Referral Tracking System (CIRTS) into a
136 single operating assessment information system by June 30, 2006.
137 (d) During the 2006-2007 state fiscal year:
138 1. The agency, in consultation with the department, shall
139 evaluate the Alzheimer’s Disease waiver program and the Adult
140 Day Health Care waiver program to assess whether providing
141 limited intensive services through these waiver programs
142 produces better outcomes for individuals than providing those
143 services through the fee-for-service or capitated programs that
144 provide a larger array of services.
145 2. The agency, in consultation with the department, shall
146 begin discussions with the federal Centers for Medicare and
147 Medicaid Services regarding the inclusion of Medicare into the
148 integrated long-term care system. By December 31, 2006, the
149 agency shall provide to the Governor, the President of the
150 Senate, and the Speaker of the House of Representatives a plan
151 for including Medicare in the integrated long-term care system.
152