Florida Senate - 2017 COMMITTEE AMENDMENT
Bill No. SB 682
Ì2041968Î204196
LEGISLATIVE ACTION
Senate . House
Comm: WD .
03/27/2017 .
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The Committee on Health Policy (Young) recommended the
following:
1 Senate Amendment to Amendment (716712) (with title
2 amendment)
3
4 Delete lines 5 - 99
5 and insert:
6 Section 1. Section 409.964, Florida Statutes, is amended to
7 read:
8 409.964 Managed care program; state plan; waivers.—The
9 Medicaid program is established as a statewide, integrated
10 managed care program for all covered services, including long
11 term care services as specified under this part. The agency
12 shall apply for and implement state plan amendments or waivers
13 of applicable federal laws and regulations necessary to
14 implement the program. Before seeking a waiver, the agency shall
15 provide public notice and the opportunity for public comment and
16 include public feedback in the waiver application. The agency
17 shall hold one public meeting in each of the regions described
18 in s. 409.966(2), and the time period for public comment for
19 each region shall end no sooner than 30 days after the
20 completion of the public meeting in that region. The agency
21 shall submit any state plan amendments, new waiver requests, or
22 requests for extensions or expansions for existing waivers,
23 needed to implement the managed care program by August 1, 2011.
24 Section 2. Effective October 1, 2018, section 409.965,
25 Florida Statutes, is amended to read
26 409.965 Mandatory enrollment.—All Medicaid recipients shall
27 receive covered services through the statewide managed care
28 program, except as provided by this part pursuant to an approved
29 federal waiver.
30 (1) The following Medicaid recipients are exempt from
31 participation in the statewide managed care program:
32 (a)(1) Women who are eligible only for family planning
33 services.
34 (b)(2) Women who are eligible only for breast and cervical
35 cancer services.
36 (c)(3) Persons who are eligible for emergency Medicaid for
37 aliens.
38 (2)(a) Persons who are assigned into level of care 1 under
39 s. 409.983(4) and have resided in a nursing facility for 365
40 consecutive days shall undergo a consultation and determination
41 pursuant to subsection (3)(c) to determine whether they should
42 be exempt from participation in the long-term care managed care
43 program. For a person who becomes exempt under this paragraph
44 while enrolled in the long-term care managed care program, the
45 exemption shall take effect on the first day of the first month
46 after the person meets the criteria for the exemption. This
47 paragraph does not affect a person’s eligibility for the
48 Medicaid managed medical assistance program.
49 (b) Persons receiving hospice care while residing in a
50 nursing facility are exempt from participation in the long-term
51 care managed care program. For a person who becomes exempt under
52 this paragraph while enrolled in the long-term care managed care
53 program, the exemption takes effect on the first day of the
54 first month after the person meets the criteria for the
55 exemption. This paragraph does not affect a person’s eligibility
56 for the Medicaid managed medical assistance program.
57 (3) Notwithstanding subsection (2):
58 (a) A Medicaid recipient who is otherwise eligible for the
59 long-term care managed care program, who is 18 years of age or
60 older, and who is eligible for Medicaid by reason of a
61 disability is not exempt from the long-term care managed care
62 program under subsection (2).
63 (b) A person who is afforded priority enrollment for home
64 and community-based services under s. 409.979(3)(f) is not
65 exempt from the long-term care managed care program under
66 subsection (2).
67 (c) A nursing facility resident is not exempt from the
68 long-term care managed care program under paragraph (2)(a) if
69 the resident has been identified as a candidate for home and
70 community-based services by the nursing facility administrator
71 and any long-term care plan case manager assigned to the
72 resident pursuant to the consultation and determination set
73 forth in this section. Such identification must be made in
74 consultation with the following persons:
75 1. The resident or the resident’s legal representative or
76 designee;
77 2. The resident’s personal physician or, if the resident
78 does not have a personal physician, the facility’s medical
79 director; and
80 3. A registered nurse who has participated in developing,
81 maintaining, or reviewing the individual’s resident care plan as
82 defined in s. 400.021.
83 (d) Before determining that a person is exempt from the
84 long-term care managed care program under paragraph (2)(a), the
85 agency shall confirm whether the person has been identified as a
86 candidate for home and community-based services under paragraph
87 (c). If a nursing facility resident who has been determined
88 exempt is later identified as a candidate for home and
89 community-based services, the nursing facility administrator
90 shall promptly notify the agency.
91 (4) A nursing facility resident's eligibility for home and
92 community-based services shall be re-determined every 90 days
93 after the determination made pursuant to subsection (3)(c) until
94 the nursing facility care resident has been in nursing care for
95 720 consecutive days. At 720 days of nursing facility care,
96 there is a rebuttable presumption that the resident is no longer
97 eligible for home and community-based services. This presumption
98 may be rebutted by compelling evidence presented in an
99 evaluation as set forth in paragraph (c) of this section. The
100 agency must approve the final determination of eligibility.
101
102 ================= T I T L E A M E N D M E N T ================
103 And the title is amended as follows:
104 Delete lines 180 - 201
105 and insert:
106 An act relating to Medicaid managed care; amending s.
107 409.964, F.S.; providing that covered services for
108 long-term care under the Medicaid managed care program
109 are those specified in part IV of ch. 409, F.S.;
110 deleting an obsolete provision; amending s. 409.965,
111 F.S.; providing that certain residents of nursing
112 facilities are exempt from participation in the long
113 term care managed care program; providing that
114 eligibility for the Medicaid managed medical
115 assistance program is not affected by such provisions;
116 providing conditions under which the exemption does
117 not apply; requiring re-determinations at specified
118 intervals; creating a rebuttable presumption for
119 nursing facility care; amending s. 409.967, F.S.;
120 requiring