Florida Senate - 2017 SB 712 By Senator Bean 4-01261-17 2017712__ 1 A bill to be entitled 2 An act relating to nursing homes; amending s. 409.908, 3 F.S.; revising provisions related to the setting of 4 Medicaid reimbursement rates for nursing homes; 5 requiring the Agency for Healthcare Administration to 6 recalculate nursing home reimbursement ceilings every 7 3 years and to make some adjustments; amending s. 8 409.9082, F.S.; requiring that an increase in a 9 nursing home facility’s Medicaid rate be allocated 10 proportionately in accordance with a certain quality 11 matrix; providing an effective date. 12 13 Be It Enacted by the Legislature of the State of Florida: 14 15 Section 1. Subsection (2) of section 409.908, Florida 16 Statutes, is amended to read: 17 409.908 Reimbursement of Medicaid providers.—Subject to 18 specific appropriations, the agency shall reimburse Medicaid 19 providers, in accordance with state and federal law, according 20 to methodologies set forth in the rules of the agency and in 21 policy manuals and handbooks incorporated by reference therein. 22 These methodologies may include fee schedules, reimbursement 23 methods based on cost reporting, negotiated fees, competitive 24 bidding pursuant to s. 287.057, and other mechanisms the agency 25 considers efficient and effective for purchasing services or 26 goods on behalf of recipients. If a provider is reimbursed based 27 on cost reporting and submits a cost report late and that cost 28 report would have been used to set a lower reimbursement rate 29 for a rate semester, then the provider’s rate for that semester 30 shall be retroactively calculated using the new cost report, and 31 full payment at the recalculated rate shall be effected 32 retroactively. Medicare-granted extensions for filing cost 33 reports, if applicable, shall also apply to Medicaid cost 34 reports. Payment for Medicaid compensable services made on 35 behalf of Medicaid eligible persons is subject to the 36 availability of moneys and any limitations or directions 37 provided for in the General Appropriations Act or chapter 216. 38 Further, nothing in this section shall be construed to prevent 39 or limit the agency from adjusting fees, reimbursement rates, 40 lengths of stay, number of visits, or number of services, or 41 making any other adjustments necessary to comply with the 42 availability of moneys and any limitations or directions 43 provided for in the General Appropriations Act, provided the 44 adjustment is consistent with legislative intent. 45 (2)(a)1. Reimbursement to nursing homes licensed under part 46 II of chapter 400 and state-owned-and-operated intermediate care 47 facilities for the developmentally disabled licensed under part 48 VIII of chapter 400 must be made prospectively. 49 2. Unless otherwise limited or directed in the General 50 Appropriations Act, reimbursement to hospitals licensed under 51 part I of chapter 395 for the provision of swing-bed nursing 52 home services must be made on the basis of the average statewide 53 nursing home payment, and reimbursement to a hospital licensed 54 under part I of chapter 395 for the provision of skilled nursing 55 services must be made on the basis of the average nursing home 56 payment for those services in the county in which the hospital 57 is located. When a hospital is located in a county that does not 58 have any community nursing homes, reimbursement shall be 59 determined by averaging the nursing home payments in counties 60 that surround the county in which the hospital is located. 61 Reimbursement to hospitals, including Medicaid payment of 62 Medicare copayments, for skilled nursing services shall be 63 limited to 30 days, unless a prior authorization has been 64 obtained from the agency. Medicaid reimbursement may be extended 65 by the agency beyond 30 days, and approval must be based upon 66 verification by the patient’s physician that the patient 67 requires short-term rehabilitative and recuperative services 68 only, in which case an extension of no more than 15 days may be 69 approved. Reimbursement to a hospital licensed under part I of 70 chapter 395 for the temporary provision of skilled nursing 71 services to nursing home residents who have been displaced as 72 the result of a natural disaster or other emergency may not 73 exceed the average county nursing home payment for those 74 services in the county in which the hospital is located and is 75 limited to the period of time which the agency considers 76 necessary for continued placement of the nursing home residents 77 in the hospital. 78 (b) Subject to any limitations or directions in the General 79 Appropriations Act, the agency shall establish and implement a 80 state Title XIX Long-Term Care Reimbursement Plan for nursing 81 home care in order to provide care and services in conformance 82 with the applicable state and federal laws, rules, regulations, 83 and quality and safety standards and to ensure that individuals 84 eligible for medical assistance have reasonable geographic 85 access to such care. 86 1. The agency shall amend the long-term care reimbursement 87 plan and cost reporting system to create direct care and 88 indirect care subcomponents of the patient care component of the 89 per diem rate. These two subcomponents together shall equal the 90 patient care component of the per diem rate. Separate cost-based 91 ceilings shall be calculated for each patient care subcomponent. 92 The direct care subcomponent of the per diem rate shall be 93 limited by the cost-based class ceiling, and the indirect care 94 subcomponent may be limited by the lower of the cost-based class 95 ceiling, the target rate class ceiling, or the individual 96 provider target. 97 2. The direct care subcomponent shall include salaries and 98 benefits of direct care staff providing nursing services 99 including registered nurses, licensed practical nurses, and 100 certified nursing assistants who deliver care directly to 101 residents in the nursing home facility. This excludes nursing 102 administration, staff development, the staffing coordinator, and 103 the administrative portion of the minimum data set and care plan 104 coordinators. The direct care subcomponent also includes 105 medically necessary dental care, vision care, hearing care, and 106 podiatric care. 107 3. All other patient care costs shall be included in the 108 indirect care cost subcomponent of the patient care per diem 109 rate. Costs may not be allocated directly or indirectly to the 110 direct care subcomponent from a home office or management 111 company. 112 4. On July 1 of each year, the agency shall report to the 113 Legislature direct and indirect care costs, including average 114 direct and indirect care costs per resident per facility and 115 direct care and indirect care salaries and benefits per category 116 of staff member per facility. 117 5. In order to offset the cost of general and professional 118 liability insurance, the agency shall amend the plan to allow 119 for interim rate adjustments to reflect increases in the cost of 120 general or professional liability insurance for nursing homes. 121 This provision shall be implemented to the extent existing 122 appropriations are available. 123 6. After July 1, 2017, the agency shall set nursing home 124 rates based only on audited cost reports and may not make 125 retroactive rate adjustments. 126 a. The property component of the reimbursement rates shall 127 be calculated based on the Fair Rental Value System developed by 128 Navigant Consulting, Inc., as part of the study pursuant to 129 Specific Appropriation 186 of the 2016-2017 General 130 Appropriations Act. 131 b. Newly constructed facilities shall be paid the average 132 reimbursement rate of the geographic and size grouping in which 133 they are located. 134 c. Newly licensed providers pursuant to changes of 135 ownership shall be paid the reimbursement rate of the previous 136 licensee. 137 d. The agency shall recalculate nursing home reimbursement 138 ceilings and rates every 3 years and shall adjust the rates in 139 the intervening years with an appropriate inflation adjustment. 140 141 It is the intent of the Legislature that the reimbursement plan 142 achieve the goal of providing access to health care for nursing 143 home residents who require large amounts of care while 144 encouraging diversion services as an alternative to nursing home 145 care for residents who can be served within the community. The 146 agency shall base the establishment of any maximum rate of 147 payment, whether overall or component, on the available moneys 148 as provided for in the General Appropriations Act. The agency 149 may base the maximum rate of payment on the results of 150 scientifically valid analysis and conclusions derived from 151 objective statistical data pertinent to the particular maximum 152 rate of payment. 153 Section 2. Subsection (4) of section 409.9082, Florida 154 Statutes, is amended to read: 155 409.9082 Quality assessment on nursing home facility 156 providers; exemptions; purpose; federal approval required; 157 remedies.— 158 (4) The purpose of the nursing home facility quality 159 assessment is to ensure continued quality of care. Collected 160 assessment funds shall be used to obtain federal financial 161 participation through the Medicaid program to make Medicaid 162 payments for nursing home facility services up to the amount of 163 nursing home facility Medicaid rates as calculated in accordance 164 with the approved state Medicaid plan in effect on December 31, 165 2007. The quality assessment and federal matching funds shall be 166 used exclusively for the following purposes and in the following 167 order of priority: 168 (a) To reimburse the Medicaid share of the quality 169 assessment as a pass-through, Medicaid-allowable cost; 170 (b) To increase to each nursing home facility’s Medicaid 171 rate, as needed, an amount that restores rate reductions 172 effective on or after January 1, 2008, as provided in the 173 General Appropriations Act; and 174 (c) To increase each nursing home facility’s Medicaid rate 175 that accounts for the portion of the total assessment not 176 included in paragraphs (a) and (b) which begins a phase-in to a 177 pricing model for the operating cost component. This increase 178 shall be allocated proportionately to each nursing home facility 179 based on the Quality Matrix without a lower threshold developed 180 by Navigant Consulting, Inc., as part of the study pursuant to 181 Specific Appropriation 186 of the 2016-2017 General 182 Appropriations Act. 183 Section 3. This act shall take effect July 1, 2017.