Florida Senate - 2021              PROPOSED COMMITTEE SUBSTITUTE
       Bill No. CS for SB 1242
       
       
       
       
       
                               Ì246400hÎ246400                          
       
       576-03900-21                                                    
       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 PACE services in the state; requiring
    8         applications to be reviewed and considered on a
    9         continuous basis; requiring notice of applications to
   10         be published in the Florida Administrative Register;
   11         providing specified application requirements for such
   12         prospective PACE organizations; requiring existing
   13         PACE organizations to meet specified requirements
   14         under certain circumstances; requiring prospective
   15         PACE organizations to submit a complete application to
   16         the agency and the Centers for Medicare and Medicaid
   17         Services within a specified period; requiring that
   18         PACE organizations meet certain federal and state
   19         quality and performance standards; requiring the
   20         agency to oversee and monitor the PACE program and
   21         organizations; providing that a PACE organization is
   22         exempt from certain requirements; providing an
   23         effective date.
   24          
   25  Be It Enacted by the Legislature of the State of Florida:
   26  
   27         Section 1. Section 430.84, Florida Statutes, is created to
   28  read:
   29         430.84Program of All-Inclusive Care for the Elderly.—
   30         (1)DEFINITIONS.—As used in this section, the term:
   31         (a)“Agency” means the Agency for Health Care
   32  Administration.
   33         (b)“Applicant” means an entity that has filed an
   34  application with the agency for consideration as a Program of
   35  All-Inclusive Care for the Elderly (PACE) organization.
   36         (c)“CMS” means the Centers for Medicare and Medicaid
   37  Services within the United States Department of Health and Human
   38  Services.
   39         (d)“Department” means the Department of Elderly Affairs.
   40         (e)“PACE organization” means an entity under contract with
   41  the agency to deliver PACE services.
   42         (f)“Participant” means an individual receiving services
   43  from a PACE organization who has been determined by the
   44  department to need the level of care required under the state
   45  Medicaid plan for coverage of nursing facility services.
   46         (2)PROGRAM CREATION.—The agency, in consultation with the
   47  department, may approve entities that have submitted
   48  applications required by the CMS to the agency for review and
   49  consideration which contain the data and information required in
   50  subsection (3) to provide benefits pursuant to the PACE program
   51  as established in 42 U.S.C. s. 1395eee and in accordance with
   52  the requirements set forth in this section.
   53         (3)PACE ORGANIZATION SELECTION.—The agency, in
   54  consultation with the department, shall, on a continuous basis,
   55  review and consider applications required by the CMS for PACE
   56  that have been submitted to the agency by entities seeking
   57  initial, state approval to become PACE organizations. Notice of
   58  such applications shall be published in the Florida
   59  Administrative Register.
   60         (a)A prospective PACE organization shall submit
   61  application documents to the agency before requesting program
   62  funding. Application documents submitted to and reviewed by the
   63  agency, in consultation with the department, must include all of
   64  the following:
   65         1.Evidence that the applicant has the ability to meet all
   66  of the applicable federal regulations and requirements,
   67  established by the CMS, for participation as a PACE organization
   68  by the proposed implementation date.
   69         2.Market studies, including an estimate of the number of
   70  potential participants and the geographic service area in which
   71  the applicant proposes to serve.
   72         3.A business plan of operation, including pro forma
   73  financial statements and projections, based on the proposed
   74  implementation date.
   75         (b)Each applicant must propose to serve a unique and
   76  defined geographic service area without duplication of services
   77  or target populations. No more than one PACE organization may be
   78  authorized to provide services within any unique and defined
   79  geographic service area.
   80         (c)Upon agency approval, a PACE organization that is
   81  authorized to provide and has received funding for PACE slots in
   82  a given geographic area may use such slots and funding to serve
   83  the needs of participants in a contiguous geographic area if
   84  such PACE organization is authorized to provide PACE services in
   85  that area.
   86         (d)An existing PACE organization seeking authority to
   87  serve an additional geographic service area not previously
   88  authorized by the agency or Legislature shall meet the
   89  requirements set forth in paragraphs (a) and (b).
   90         (e)Any prospective PACE organization that is granted
   91  initial state approval by the agency, in consultation with the
   92  department, shall submit its complete federal PACE application,
   93  in accordance with the application process and guidelines
   94  established by the CMS, to the agency and the CMS within 12
   95  months after the date of initial state approval, or such
   96  approval is void.
   97         (4)ACCOUNTABILITY.—All PACE organizations must meet
   98  specific quality and performance standards established by the
   99  CMS and the state administering agency for the PACE program. The
  100  agency shall oversee and monitor the PACE program and
  101  organizations based upon data and reports periodically submitted
  102  by PACE organizations to the agency and the CMS. A PACE
  103  organization is exempt from the requirements of chapter 641.
  104         Section 2. This act shall take effect July 1, 2021.