Florida Senate - 2017 SB 682
By Senator Stargel
22-00989F-17 2017682__
1 A bill to be entitled
2 An act relating to Medicaid managed care; amending s.
3 409.964, F.S.; revising parameters relating to the
4 establishment of the Medicaid program; deleting
5 obsolete provisions; amending s. 409.965, F.S.;
6 revising exemptions from the mandatory enrollment of
7 Medicaid recipients in statewide Medicaid managed
8 care; providing exemptions from participation in the
9 long-term care managed care program; requiring the
10 Agency for Health Care Administration to authorize
11 Medicaid recipients who are eligible for the long-term
12 care managed care program to enroll or remain enrolled
13 in the program, subject to specified requirements;
14 amending s. 409.967, F.S.; requiring the agency to
15 impose fines and authorizing other sanctions for
16 willful failure to comply with specified payment
17 provisions; amending s. 409.979, F.S.; revising
18 eligibility criteria for the long-term care managed
19 care program to conform to exemptions; amending s.
20 409.982, F.S.; revising parameters under which a long
21 term care managed care plan must contract with nursing
22 homes and hospices; specifying that the agency must
23 require certain plans to report information on the
24 quality or performance criteria used in making a
25 certain determination; providing effective dates.
26
27 Be It Enacted by the Legislature of the State of Florida:
28
29 Section 1. Section 409.964, Florida Statutes, is amended to
30 read:
31 409.964 Managed care program; state plan; waivers.—The
32 Medicaid program is established as a statewide, integrated
33 managed care program for all covered services, including long
34 term care services as specified under this part. The agency
35 shall apply for and implement state plan amendments or waivers
36 of applicable federal laws and regulations necessary to
37 implement the program. Before seeking a waiver, the agency shall
38 provide public notice and the opportunity for public comment and
39 include public feedback in the waiver application. The agency
40 shall hold one public meeting in each of the regions described
41 in s. 409.966(2), and the time period for public comment for
42 each region shall end no sooner than 30 days after the
43 completion of the public meeting in that region. The agency
44 shall submit any state plan amendments, new waiver requests, or
45 requests for extensions or expansions for existing waivers,
46 needed to implement the managed care program by August 1, 2011.
47 Section 2. Effective July 1, 2018, section 409.965, Florida
48 Statutes, is amended to read:
49 409.965 Mandatory enrollment.—All Medicaid recipients shall
50 receive covered services through the statewide managed care
51 program, except as provided by this part pursuant to an approved
52 federal waiver.
53 (1) The following Medicaid recipients are exempt from
54 participation in the statewide managed care program:
55 (a)(1) Women who are eligible only for family planning
56 services.
57 (b)(2) Women who are eligible only for breast and cervical
58 cancer services.
59 (c)(3) Persons who are eligible for emergency Medicaid for
60 aliens.
61 (2) Persons who are assigned into level of care 1 under s.
62 409.983(4) and have resided in a nursing facility for 60 or more
63 consecutive days are exempt from participation in the long-term
64 care managed care program. For a person who becomes exempt under
65 this subsection while enrolled in the long-term care managed
66 care program, the exemption shall take effect on the first day
67 of the first month after the person meets the criteria for the
68 exemption. Nothing in this subsection shall affect a person’s
69 eligibility for the Medicaid managed medical assistance program.
70 (3) Persons receiving hospice care while residing in a
71 nursing facility are exempt from participation in the long-term
72 care managed care program. For a person who becomes exempt under
73 this subsection while enrolled in the long-term care managed
74 care program, the exemption shall take effect on the first day
75 of the first month after the person meets the criteria for the
76 exemption. Nothing in this subsection shall affect a person’s
77 eligibility for the Medicaid managed medical assistance program.
78 (4) Notwithstanding subsections (2) and (3):
79 (a) The agency shall authorize a Medicaid recipient who is
80 otherwise eligible for the long-term care managed care program,
81 who is 18 years of age or older, and who is eligible for
82 Medicaid by reason of a disability to enroll or remain enrolled
83 in the long-term care managed care program under s. 409.979.
84 (b) The agency shall authorize a long-term care managed
85 care program enrollee to remain enrolled in the program if the
86 enrollee is residing in a nursing home for the purpose of
87 rehabilitation and has been identified by the nursing home and
88 the enrollee’s case manager as a candidate for home and
89 community-based services following rehabilitation.
90 Section 3. Paragraph (j) of subsection (2) of section
91 409.967, Florida Statutes, is amended to read:
92 409.967 Managed care plan accountability.—
93 (2) The agency shall establish such contract requirements
94 as are necessary for the operation of the statewide managed care
95 program. In addition to any other provisions the agency may deem
96 necessary, the contract must require:
97 (j) Prompt payment.—Managed care plans shall comply with
98 ss. 641.315, 641.3155, and 641.513, and the agency shall impose
99 fines, and may impose other sanctions, on a plan that willfully
100 fails to comply with those sections or s. 409.982(5).
101 Section 4. Subsection (1) of section 409.979, Florida
102 Statutes, is amended to read:
103 409.979 Eligibility.—
104 (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid
105 recipients who are not exempt under s. 409.965 and meet all of
106 the following criteria are eligible to receive long-term care
107 services and must receive long-term care services by
108 participating in the long-term care managed care program. The
109 recipient must be:
110 (a) Sixty-five years of age or older, or age 18 or older
111 and eligible for Medicaid by reason of a disability.
112 (b) Determined by the Comprehensive Assessment Review and
113 Evaluation for Long-Term Care Services (CARES) preadmission
114 screening program to require nursing facility care as defined in
115 s. 409.985(3).
116 Section 5. Subsections (1) and (2) of section 409.982,
117 Florida Statutes, are amended to read:
118 409.982 Long-term care managed care plan accountability.—In
119 addition to the requirements of s. 409.967, plans and providers
120 participating in the long-term care managed care program must
121 comply with the requirements of this section.
122 (1) PROVIDER NETWORKS.—Managed care plans may limit the
123 providers in their networks based on credentials, quality
124 indicators, and price. For the first 12 months of any contract
125 period following a procurement for the long-term care managed
126 care program under s. 409.981 between October 1, 2013, and
127 September 30, 2014, each selected plan must offer a network
128 contract to all nursing homes that meet the recredentialing
129 requirements and hospices that meet the credentialing
130 requirements specified in the plan’s contract with the agency
131 the following providers in the region or regions for which the
132 plan is awarded a contract.:
133 (a) Nursing homes.
134 (b) Hospices.
135 (c) Aging network service providers that have previously
136 participated in home and community-based waivers serving elders
137 or community-service programs administered by the Department of
138 Elderly Affairs. During the remainder of the contract period, a
139 After 12 months of active participation in a managed care plan’s
140 network, the plan may exclude any of the providers named in this
141 subsection from the plan’s network for failure to meet quality
142 or performance criteria. If a the plan excludes a provider from
143 its network the plan, the plan must provide written notice to
144 all recipients who have chosen that provider for care. The
145 notice must be provided at least 30 days before the effective
146 date of the exclusion. The agency shall establish contract
147 provisions governing the transfer of recipients from excluded
148 residential providers. The agency shall require a plan that
149 excludes a provider from its network or that fails to renew the
150 plan’s contract with a provider under this subsection to report
151 to the agency the quality or performance criteria the plan used
152 in deciding to exclude the provider and to demonstrate how the
153 provider failed to meet the plan’s criteria.
154 (2) SELECT PROVIDER PARTICIPATION.—Except as provided in
155 this subsection, providers may limit the managed care plans they
156 join. Nursing homes and hospices that are enrolled Medicaid
157 providers must participate in all eligible plans selected by the
158 agency in the region in which the provider is located, with the
159 exception of plans from which the provider has been excluded
160 under subsection (1).
161 Section 6. Except as otherwise provided in this act and
162 except for this section, which shall take effect upon this act
163 becoming a law, this act shall take effect July 1, 2017.