Florida Senate - 2019 SB 778 By Senator Baxley 12-01151A-19 2019778__ 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; specifying 17 funding and enrollment requirements for PACE 18 organizations; requiring the agency, in consultation 19 with the department and the Social Services Estimating 20 Conference, to submit a certain report to the 21 Legislature; requiring the agency and department to 22 provide certain notices to certain individuals; 23 requiring PACE organizations to meet certain 24 standards; requiring the agency to oversee and monitor 25 the PACE program based on certain information; 26 exempting PACE organizations from ch. 641, F.S.; 27 amending s. 409.981, F.S.; conforming a provision to 28 changes made by the act; providing that specified 29 individuals may be enrolled in the PACE program under 30 certain circumstances; requiring the Comprehensive 31 Assessment and Review for Long-Term Care Services 32 program to determine a PACE applicant’s eligibility 33 within a certain timeframe; requiring the Department 34 of Children and Families to determine a PACE 35 applicant’s financial eligibility; specifying 36 requirements for the agency in paying contractors 37 providing services to eligible applicants; authorizing 38 certain actions by a contractor with respect to 39 certain applicants; providing an effective date. 40 41 Be It Enacted by the Legislature of the State of Florida: 42 43 Section 1. Section 430.84, Florida Statutes, is created to 44 read: 45 430.84 Program of All-Inclusive Care for the Elderly.— 46 (1) DEFINITIONS.—As used in this section, the term: 47 (a) “Agency” means the Agency for Health Care 48 Administration. 49 (b) “Applicant” means an entity that has filed an 50 application with the agency for consideration as a Program of 51 All-Inclusive Care for the Elderly (PACE) organization. 52 (c) “CMS” means the Centers for Medicare and Medicaid 53 Services within the United States Department of Health and Human 54 Services. 55 (d) “Department” means the Department of Elderly Affairs. 56 (e) “PACE organization” means an entity under contract with 57 the agency to deliver PACE services. 58 (f) “Participant” means an individual receiving PACE 59 services who the department has determined needs the level of 60 care required under the state Medicaid plan for coverage of 61 nursing facility services. 62 (2) PROGRAM CREATION.—The agency, in consultation with the 63 department, may approve entities that have submitted the 64 application the CMS requires to the agency for review and 65 consideration. An entity must submit the data and information 66 required in subsection (3) to provide benefits pursuant to the 67 PACE program as established in 42 U.S.C. s. 1395eee and in 68 accordance with the requirements set forth in this section. 69 (3) PACE ORGANIZATION SELECTION.—The agency, in 70 consultation with the department, shall review and consider on a 71 continuous basis applications the CMS requires for PACE which 72 have been submitted to the agency by entities seeking initial 73 state approval to become PACE organizations. Notice of such 74 applications must be published in the Florida Administrative 75 Register. 76 (a) A prospective PACE organization shall submit 77 application documents to the agency before requesting program 78 funding. Application documents submitted to and reviewed by the 79 agency, in consultation with the department, must include all of 80 the following: 81 1. Evidence that the applicant is able to meet all of the 82 applicable federal regulations and requirements established by 83 the CMS for participation as a PACE organization by the proposed 84 implementation date. 85 2. Market studies, including an estimate of the number of 86 potential participants and the geographic service area the 87 applicant proposes to serve. 88 3. A business plan of operation, including pro forma 89 financial statements and projections, based on the proposed 90 implementation date. 91 (b) Each applicant must propose to serve a unique and 92 defined geographic service area without duplication of services 93 or target populations. No more than one PACE organization may be 94 authorized to provide services within any unique and defined 95 geographic service area. 96 (c) An existing PACE organization seeking authority to 97 serve an additional geographic service area not previously 98 authorized by the agency or Legislature must meet the 99 requirements set forth in paragraphs (a) and (b). 100 (d) A prospective PACE organization granted initial state 101 approval by the agency, in consultation with the department, 102 shall submit its complete federal PACE application, in 103 accordance with the application process and guidelines 104 established by the CMS, to the agency and the CMS within 12 105 months after the date of initial state approval, or such 106 approval is void. 107 (4) FUNDING AND ENROLLMENT.— 108 (a) PACE organizations shall enroll participants at such 109 levels as funded by the General Appropriations Act, which must 110 reflect a reasonable growth of capacity sufficient to meet 111 community needs and which must be consistent with the pro forma 112 or other projections submitted pursuant to paragraph (3)(a) or 113 projections of PACE census and demand growth that are 114 periodically submitted by PACE organizations. The agency, in 115 consultation with the department and the Social Services 116 Estimating Conference, shall submit a report to the Legislature 117 requesting the amount of funding necessary for prospective PACE 118 participants to have access to PACE services as a program 119 service option in all authorized geographic service areas. 120 (b) Funds may be used within any PACE organization’s 121 authorized geographic service area, regardless of county lines. 122 (c) The department shall notify individuals who are 123 determined to need the level of care required under the state 124 Medicaid plan for coverage of nursing facility services that the 125 PACE program is a service plan option and that enrollment in the 126 PACE program is voluntary. 127 (d) The agency shall notify individuals who are determined 128 eligible for managed long-term care that the PACE program is 129 available as a choice for a managed care plan pursuant to s. 130 409.969 in statewide Medicaid managed care regions wherein a 131 PACE organization operates. 132 (5) ACCOUNTABILITY.—All PACE organizations must meet 133 specific quality and performance standards established by the 134 CMS for the PACE program. The agency shall oversee and monitor 135 the PACE program and organizations based upon data and reports 136 PACE organizations submit periodically to the agency and the 137 CMS. A PACE organization is exempt from the requirements of 138 chapter 641. 139 Section 2. Subsection (4) of section 409.981, Florida 140 Statutes, is amended to read: 141 409.981 Eligible long-term care plans.— 142 (4) PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY.— 143 (a) Participation by the Program of All-inclusive Care for 144 the Elderly (PACE) shall be pursuant to a contract with the 145 agency and not subject to the procurement requirements or 146 regional plan number limits of this section. PACE organizations 147 shall
plans may continue toprovide services to participants 148 individualsat such levels and enrollment capsas authorized by 149 the General Appropriations Act pursuant to s. 430.84. 150 (b) A prospective participant who applies for the PACE 151 program and has been determined by the Comprehensive Assessment 152 and Review for Long-Term Care Services (CARES) program to be 153 medically eligible but has not been determined financially 154 eligible for Medicaid by the Department of Children and 155 Families, or who has been determined financially eligible for 156 Medicaid by the Department of Children and Families but has not 157 been determined medically eligible by the CARES program, may be 158 enrolled in the PACE program if contractors elect to provide 159 services to PACE program applicants pending final determination 160 of eligibility. The CARES program shall determine each 161 applicant’s medical eligibility within 21 days after receiving 162 the complete application packet. The Department of Children and 163 Families shall determine each applicant’s financial eligibility 164 according to federal and state requirements. If the applicant is 165 determined eligible, the Agency for Health Care Administration 166 shall pay the contractor that provided the services the 167 applicable Medicaid rate, retroactive to the first day of the 168 month following the CARES program eligibility determination. If 169 the applicant is not eligible for the PACE program with Medicaid 170 as the payor, the contractor may continue to provide services as 171 a private-pay PACE participant or terminate services and seek 172 reimbursement from the applicant. 173 Section 3. This act shall take effect July 1, 2019.