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 to provide services to participants
148 individuals at such levels and enrollment caps as 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.