Florida Senate - 2019 PROPOSED COMMITTEE SUBSTITUTE Bill No. SB 778 Ì5591188Î559118 576-03881-19 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. 33 34 Be It Enacted by the Legislature of the State of Florida: 35 36 Section 1. Section 430.84, Florida Statutes, is created to 37 read: 38 430.84 Program 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.— 139 (4) PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY. 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
plans144 may continue toprovide services to participants individualsat 145 such levels and enrollment capsas authorized by the General 146 Appropriations Act pursuant to s. 430.84. 147 Section 3. This act shall take effect July 1, 2019.