Florida Senate - 2019              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. SB 778
       Proposed Committee Substitute by the Committee on Appropriations
       (Appropriations Subcommittee on Health and Human Services)
    1                        A bill to be entitled                      
    2         An act relating to the Program of All-Inclusive Care
    3         for the Elderly; creating s. 430.84, F.S.; defining
    4         terms; authorizing the Agency for Health Care
    5         Administration, in consultation with the Department of
    6         Elderly Affairs, to approve entities applying to
    7         deliver Program of All-Inclusive Care for the Elderly
    8         (PACE) services in the state; requiring the agency, in
    9         consultation with the department, to review and
   10         consider applications; requiring that notice of such
   11         applications be published in the Florida
   12         Administrative Register; specifying application
   13         requirements; requiring prospective PACE organizations
   14         that are granted initial state approval to submit a
   15         complete application to the agency and the Federal
   16         Government within a certain timeframe; requiring PACE
   17         organizations to enroll participants at certain
   18         levels; requiring PACE organizations to annually
   19         submit certain information to the agency; requiring
   20         the agency to submit a report to the Social Services
   21         Estimating Conference; requiring the agency to include
   22         certain information in its legislative budget request;
   23         providing that funds may be used within any PACE
   24         organization’s authorized geographic service area;
   25         requiring the department and the agency to provide
   26         certain notices to certain individuals; requiring PACE
   27         organizations to meet certain standards; requiring the
   28         agency to oversee and monitor the PACE program based
   29         on certain information; exempting PACE organizations
   30         from the requirements of ch. 641, F.S.; amending s.
   31         409.981, F.S.; conforming a provision to changes made
   32         by the act; providing an effective date.
   34  Be It Enacted by the Legislature of the State of Florida:
   36         Section 1. Section 430.84, Florida Statutes, is created to
   37  read:
   38         430.84Program of All-Inclusive Care for the Elderly.—
   39         (1)DEFINITIONS.—As used in this section, the term:
   40         (a)“Agency” means the Agency for Health Care
   41  Administration.
   42         (b)“Applicant” means an entity that has filed an
   43  application with the agency for consideration as a Program of
   44  All-Inclusive Care for the Elderly (PACE) organization.
   45         (c)“CMS” means the Centers for Medicare and Medicaid
   46  Services within the United States Department of Health and Human
   47  Services.
   48         (d)“Department” means the Department of Elderly Affairs.
   49         (e)“PACE organization” means an entity under contract with
   50  the agency to deliver PACE services.
   51         (f)“Participant” means an individual receiving PACE
   52  services who the department has determined needs the level of
   53  care required under the state Medicaid plan for coverage of
   54  nursing facility services.
   55         (2)PROGRAM CREATION.—The agency, in consultation with the
   56  department, may approve entities that have submitted the
   57  application the CMS requires to the agency for review and
   58  consideration. An entity must submit the data and information
   59  required in subsection (3) to provide benefits pursuant to the
   60  PACE program as established in 42 U.S.C. s. 1395eee and in
   61  accordance with the requirements set forth in this section.
   62         (3)PACE ORGANIZATION SELECTION.—The agency, in
   63  consultation with the department, shall review and consider on a
   64  continuous basis applications the CMS requires for PACE which
   65  have been submitted to the agency by entities seeking initial
   66  state approval to become PACE organizations. Notice of such
   67  applications must be published in the Florida Administrative
   68  Register.
   69         (a)A prospective PACE organization shall submit
   70  application documents to the agency before requesting program
   71  funding. Application documents submitted to and reviewed by the
   72  agency, in consultation with the department, must include all of
   73  the following:
   74         1.Evidence that the applicant is able to meet all of the
   75  applicable federal regulations and requirements established by
   76  the CMS for participation as a PACE organization by the proposed
   77  implementation date.
   78         2.Market studies, including an estimate of the number of
   79  potential participants and the geographic service area the
   80  applicant proposes to serve.
   81         3.A business plan of operation, including pro forma
   82  financial statements and projections, based on the proposed
   83  implementation date.
   84         (b)Each applicant must propose to serve a unique and
   85  defined geographic service area without duplication of services
   86  or target populations. No more than one PACE organization may be
   87  authorized to provide services within any unique and defined
   88  geographic service area.
   89         (c)An existing PACE organization seeking authority to
   90  serve an additional geographic service area not previously
   91  authorized by the agency or Legislature must meet the
   92  requirements set forth in paragraphs (a) and (b).
   93         (d)A prospective PACE organization granted initial state
   94  approval by the agency, in consultation with the department,
   95  shall submit its complete federal PACE application, in
   96  accordance with the application process and guidelines
   97  established by the CMS, to the agency and the CMS within 12
   98  months after the date of initial state approval, or such
   99  approval is void.
  100         (4)FUNDING AND ENROLLMENT.—
  101         (a)1.PACE organizations shall enroll participants at the
  102  levels funded each fiscal year in the General Appropriations
  103  Act.
  104         2.Each PACE organization shall annually submit information
  105  to the agency which reflects its reasonable capacity for growth
  106  to meet demonstrated community needs and which must be
  107  consistent with the pro forma or other projections submitted
  108  pursuant to paragraph (3)(a) or other projections of PACE census
  109  and demand growth. The agency, in consultation with the
  110  department, shall submit a report to the Social Services
  111  Estimating Conference summarizing such information.
  112         3.The agency shall include in its legislative budget
  113  request submitted pursuant to chapter 216 the amount of funding
  114  estimated by the Social Services Estimating Conference needed to
  115  fund demonstrated growth in community needs which is consistent
  116  with PACE census and demand growth.
  117         (b)Funds may be used within any PACE organization’s
  118  authorized geographic service area, regardless of county lines.
  119         (c)The department shall notify individuals who are
  120  determined to need the level of care required under the state
  121  Medicaid plan for coverage of nursing facility services that the
  122  PACE program is a service plan option and that enrollment in the
  123  PACE program is voluntary.
  124         (d)The agency shall notify individuals who are determined
  125  eligible for managed long-term care that the PACE program is
  126  available as a choice for a managed care plan pursuant to s.
  127  409.969 in statewide Medicaid managed care regions wherein a
  128  PACE organization operates.
  129         (5)ACCOUNTABILITY.—All PACE organizations must meet
  130  specific quality and performance standards established by the
  131  CMS and the agency for the PACE program. The agency shall
  132  oversee and monitor the PACE program and organizations based
  133  upon data and reports PACE organizations submit periodically to
  134  the agency and the CMS. A PACE organization is exempt from the
  135  requirements of chapter 641.
  136         Section 2. Subsection (4) of section 409.981, Florida
  137  Statutes, is amended to read:
  138         409.981 Eligible long-term care plans.—
  140  Participation by the Program of All-inclusive Care for the
  141  Elderly (PACE) shall be pursuant to a contract with the agency
  142  and not subject to the procurement requirements or regional plan
  143  number limits of this section. PACE organizations shall plans
  144  may continue to provide services to participants individuals at
  145  such levels and enrollment caps as authorized by the General
  146  Appropriations Act pursuant to s. 430.84.
  147         Section 3. This act shall take effect July 1, 2019.