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.
   41  Be It Enacted by the Legislature of the State of Florida:
   43         Section 1. Section 430.84, Florida Statutes, is created to
   44  read:
   45         430.84Program 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.—
  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.