SB 2518 First Engrossed
20212518e1
1 A bill to be entitled
2 An act relating to health care; amending s. 296.37,
3 F.S.; revising the amount of money residents of a
4 veterans’ nursing home must receive monthly before
5 being required to contribute to their maintenance and
6 support; reenacting s. 400.179(2)(d), F.S., relating
7 to liability for Medicaid underpayments and
8 overpayments; amending s. 408.061, F.S.; requiring
9 nursing homes and their home offices to annually
10 submit to the Agency for Health Care Administration
11 certain information within a specified timeframe;
12 amending s. 408.07, F.S.; defining the terms “FNHURS”
13 and “home office”; amending s. 409.903, F.S.; revising
14 the postpartum Medicaid eligibility period for
15 pregnant women; amending s. 409.904, F.S.; deleting
16 the effective date and the expiration date of a
17 provision requiring the agency to make payments to
18 Medicaid-covered services; reenacting s. 409.908(23),
19 F.S., relating to reimbursement of Medicaid providers;
20 amending s. 409.908, F.S.; authorizing the agency to
21 receive funds to be used for Low Income Pool Program
22 payments; requiring certain essential providers to
23 offer to contract with certain managed care plans to
24 be eligible for low-income pool funding; requiring the
25 agency to evaluate contract negotiations and withhold
26 supplemental payments under certain circumstances;
27 requiring the agency to notify and afford hearing
28 rights to providers under certain circumstances;
29 amending s. 409.911, F.S.; revising the years of
30 audited disproportionate share data the agency must
31 use for calculating an average for purposes of
32 calculating disproportionate share payments;
33 authorizing the agency to use data available for a
34 hospital; conforming provisions to changes made by the
35 act; revising the requirement that the agency
36 distribute moneys to hospitals providing a
37 disproportionate share of Medicaid or charity care
38 services, as provided in the General Appropriations
39 Act, to apply to each fiscal year, rather than a
40 specified fiscal year; deleting the expiration date of
41 such requirement; amending s. 409.9113, F.S.; revising
42 the requirement that the agency make disproportionate
43 share payments to teaching hospitals, as provided in
44 the General Appropriations Act, to apply to each
45 fiscal year, rather than a specified fiscal year;
46 deleting the expiration date of such requirement;
47 amending s. 409.9119, F.S.; revising the requirement
48 that the agency make disproportionate share payments
49 to certain specialty hospitals for children to apply
50 to each fiscal year, rather than a specified fiscal
51 year; deleting the expiration date of such
52 requirement; amending s. 409.975, F.S.; conforming a
53 cross-reference; amending s. 430.502, F.S.; revising
54 the name of a memory disorder clinic in Pensacola;
55 reenacting s. 624.91(5)(b), F.S., relating to The
56 Florida Healthy Kids Corporation Act; amending s.
57 1011.52, F.S.; conforming a cross-reference; requiring
58 the agency to contract with organizations for the
59 provision of elder care services in specified counties
60 if certain conditions are met; requiring the agency to
61 contract with hospitals for the provision of elder
62 care services in specified counties if certain
63 conditions are met; authorizing an organization
64 providing elder care services in specified counties to
65 provide elder care services in additional specified
66 counties if certain conditions are met; authorizing
67 the consolidation of organizations providing elder
68 care services in specified counties; authorizing an
69 organization to provide elder care services with the
70 consolidation if certain criteria are met; authorizing
71 an organization to provide elder care services in
72 specified counties if certain criteria are met;
73 providing an effective date.
74
75 Be It Enacted by the Legislature of the State of Florida:
76
77 Section 1. Subsections (1) and (3) of section 296.37,
78 Florida Statutes, are amended to read:
79 296.37 Residents; contribution to support.—
80 (1) Every resident of the home who receives a pension,
81 compensation, or gratuity from the United States Government, or
82 income from any other source of more than $130 $105 per month,
83 shall contribute to his or her maintenance and support while a
84 resident of the home in accordance with a schedule of payment
85 determined by the administrator and approved by the director.
86 The total amount of such contributions shall be to the fullest
87 extent possible but may shall not exceed the actual cost of
88 operating and maintaining the home.
89 (3) Notwithstanding subsection (1), each resident of the
90 home who receives a pension, compensation, or gratuity from the
91 United States Government, or income from any other source, of
92 more than $130 per month shall contribute to his or her
93 maintenance and support while a resident of the home in
94 accordance with a payment schedule determined by the
95 administrator and approved by the director. The total amount of
96 such contributions shall be to the fullest extent possible, but,
97 in no case, shall exceed the actual cost of operating and
98 maintaining the home. This subsection expires July 1, 2021.
99 Section 2. Notwithstanding the expiration date in section
100 51 of chapter 2020-114, Laws of Florida, paragraph (d) of
101 subsection (2) of section 400.179, Florida Statutes, is
102 reenacted to read:
103 400.179 Liability for Medicaid underpayments and
104 overpayments.—
105 (2) Because any transfer of a nursing facility may expose
106 the fact that Medicaid may have underpaid or overpaid the
107 transferor, and because in most instances, any such underpayment
108 or overpayment can only be determined following a formal field
109 audit, the liabilities for any such underpayments or
110 overpayments shall be as follows:
111 (d) Where the transfer involves a facility that has been
112 leased by the transferor:
113 1. The transferee shall, as a condition to being issued a
114 license by the agency, acquire, maintain, and provide proof to
115 the agency of a bond with a term of 30 months, renewable
116 annually, in an amount not less than the total of 3 months’
117 Medicaid payments to the facility computed on the basis of the
118 preceding 12-month average Medicaid payments to the facility.
119 2. A leasehold licensee may meet the requirements of
120 subparagraph 1. by payment of a nonrefundable fee, paid at
121 initial licensure, paid at the time of any subsequent change of
122 ownership, and paid annually thereafter, in the amount of 1
123 percent of the total of 3 months’ Medicaid payments to the
124 facility computed on the basis of the preceding 12-month average
125 Medicaid payments to the facility. If a preceding 12-month
126 average is not available, projected Medicaid payments may be
127 used. The fee shall be deposited into the Grants and Donations
128 Trust Fund and shall be accounted for separately as a Medicaid
129 nursing home overpayment account. These fees shall be used at
130 the sole discretion of the agency to repay nursing home Medicaid
131 overpayments or for enhanced payments to nursing facilities as
132 specified in the General Appropriations Act or other law.
133 Payment of this fee shall not release the licensee from any
134 liability for any Medicaid overpayments, nor shall payment bar
135 the agency from seeking to recoup overpayments from the licensee
136 and any other liable party. As a condition of exercising this
137 lease bond alternative, licensees paying this fee must maintain
138 an existing lease bond through the end of the 30-month term
139 period of that bond. The agency is herein granted specific
140 authority to promulgate all rules pertaining to the
141 administration and management of this account, including
142 withdrawals from the account, subject to federal review and
143 approval. This provision shall take effect upon becoming law and
144 shall apply to any leasehold license application. The financial
145 viability of the Medicaid nursing home overpayment account shall
146 be determined by the agency through annual review of the account
147 balance and the amount of total outstanding, unpaid Medicaid
148 overpayments owing from leasehold licensees to the agency as
149 determined by final agency audits. By March 31 of each year, the
150 agency shall assess the cumulative fees collected under this
151 subparagraph, minus any amounts used to repay nursing home
152 Medicaid overpayments and amounts transferred to contribute to
153 the General Revenue Fund pursuant to s. 215.20. If the net
154 cumulative collections, minus amounts utilized to repay nursing
155 home Medicaid overpayments, exceed $10 million, the provisions
156 of this subparagraph shall not apply for the subsequent fiscal
157 year.
158 3. The leasehold licensee may meet the bond requirement
159 through other arrangements acceptable to the agency. The agency
160 is herein granted specific authority to promulgate rules
161 pertaining to lease bond arrangements.
162 4. All existing nursing facility licensees, operating the
163 facility as a leasehold, shall acquire, maintain, and provide
164 proof to the agency of the 30-month bond required in
165 subparagraph 1., above, on and after July 1, 1993, for each
166 license renewal.
167 5. It shall be the responsibility of all nursing facility
168 operators, operating the facility as a leasehold, to renew the
169 30-month bond and to provide proof of such renewal to the agency
170 annually.
171 6. Any failure of the nursing facility operator to acquire,
172 maintain, renew annually, or provide proof to the agency shall
173 be grounds for the agency to deny, revoke, and suspend the
174 facility license to operate such facility and to take any
175 further action, including, but not limited to, enjoining the
176 facility, asserting a moratorium pursuant to part II of chapter
177 408, or applying for a receiver, deemed necessary to ensure
178 compliance with this section and to safeguard and protect the
179 health, safety, and welfare of the facility’s residents. A lease
180 agreement required as a condition of bond financing or
181 refinancing under s. 154.213 by a health facilities authority or
182 required under s. 159.30 by a county or municipality is not a
183 leasehold for purposes of this paragraph and is not subject to
184 the bond requirement of this paragraph.
185 Section 3. Present subsections (5) through (13) of section
186 408.061, Florida Statutes, are redesignated as subsections (7)
187 through (15), respectively, subsection (4) is amended, and new
188 subsections (5) and (6) are added to that section, to read:
189 408.061 Data collection; uniform systems of financial
190 reporting; information relating to physician charges;
191 confidential information; immunity.—
192 (4) Within 120 days after the end of its fiscal year, each
193 health care facility, excluding continuing care facilities, and
194 hospitals operated by state agencies, and nursing homes as those
195 terms are defined in s. 408.07, shall file with the agency, on
196 forms adopted by the agency and based on the uniform system of
197 financial reporting, its actual financial experience for that
198 fiscal year, including expenditures, revenues, and statistical
199 measures. Such data may be based on internal financial reports
200 which are certified to be complete and accurate by the provider.
201 However, hospitals’ actual financial experience shall be their
202 audited actual experience. Every nursing home shall submit to
203 the agency, in a format designated by the agency, a statistical
204 profile of the nursing home residents. The agency, in
205 conjunction with the Department of Elderly Affairs and the
206 Department of Health, shall review these statistical profiles
207 and develop recommendations for the types of residents who might
208 more appropriately be placed in their homes or other
209 noninstitutional settings.
210 (5) Within 120 days after the end of its fiscal year, each
211 nursing home as defined in s. 408.07 shall file with the agency,
212 on forms adopted by the agency and based on the uniform system
213 of financial reporting, its actual financial experience for that
214 fiscal year, including expenditures, revenues, and statistical
215 measures. Such data may be based on internal financial reports
216 that are certified to be complete and accurate by the chief
217 financial officer of the nursing home. This actual experience
218 must include the fiscal year-end balance sheet, income
219 statement, statement of cash flow, and statement of retained
220 earnings and must be submitted to the agency in addition to the
221 information filed in the uniform system of financial reporting.
222 The financial statements must tie to the information submitted
223 in the uniform system of financial reporting, and a crosswalk
224 must be submitted along with the financial statements.
225 (6) Within 120 days after the end of its fiscal year, the
226 home office of each nursing home as defined in s. 408.07 shall
227 file with the agency, on forms adopted by the agency and based
228 on the uniform system of financial reporting, its actual
229 financial experience for that fiscal year, including
230 expenditures, revenues, and statistical measures. Such data may
231 be based on internal financial reports that are certified to be
232 complete and accurate by the chief financial officer of the
233 nursing home. This actual experience must include the fiscal
234 year-end balance sheet, income statement, statement of cash
235 flow, and statement of retained earnings and must be submitted
236 to the agency in addition to the information filed in the
237 uniform system of financial reporting. The financial statements
238 must tie to the information submitted in the uniform system of
239 financial reporting, and a crosswalk must be submitted along
240 with the audited financial statements.
241 Section 4. Present subsections (19) through (27) of section
242 408.07, Florida Statutes, are redesignated as subsections (20)
243 through (28), respectively, and present subsections (28) through
244 (44) are redesignated as subsections (30) through (46),
245 respectively, and new subsections (19) and (29) are added to
246 that section, to read:
247 408.07 Definitions.—As used in this chapter, with the
248 exception of ss. 408.031-408.045, the term:
249 (19) “FNHURS” means the Florida Nursing Home Uniform
250 Reporting System developed by the agency.
251 (29) “Home office” has the same meaning as provided in the
252 Provider Reimbursement Manual, Part 1 (Centers for Medicare and
253 Medicaid Services, Pub. 15-1), as that definition exists on the
254 effective date of this act.
255 Section 5. Subsection (5) of section 409.903, Florida
256 Statutes, is amended to read:
257 409.903 Mandatory payments for eligible persons.—The agency
258 shall make payments for medical assistance and related services
259 on behalf of the following persons who the department, or the
260 Social Security Administration by contract with the Department
261 of Children and Families, determines to be eligible, subject to
262 the income, assets, and categorical eligibility tests set forth
263 in federal and state law. Payment on behalf of these Medicaid
264 eligible persons is subject to the availability of moneys and
265 any limitations established by the General Appropriations Act or
266 chapter 216.
267 (5) A pregnant woman for the duration of her pregnancy and
268 for the postpartum period consisting of the 12-month period
269 beginning on the last day of her pregnancy as defined in federal
270 law and rule, or a child under age 1, if either is living in a
271 family that has an income that which is at or below 150 percent
272 of the most current federal poverty level, or, effective January
273 1, 1992, that has an income which is at or below 185 percent of
274 the most current federal poverty level. Such a person is not
275 subject to an assets test. Further, a pregnant woman who applies
276 for eligibility for the Medicaid program through a qualified
277 Medicaid provider must be offered the opportunity, subject to
278 federal rules, to be made presumptively eligible for the
279 Medicaid program.
280 Section 6. Subsection (12) of section 409.904, Florida
281 Statutes, is amended to read:
282 409.904 Optional payments for eligible persons.—The agency
283 may make payments for medical assistance and related services on
284 behalf of the following persons who are determined to be
285 eligible subject to the income, assets, and categorical
286 eligibility tests set forth in federal and state law. Payment on
287 behalf of these Medicaid eligible persons is subject to the
288 availability of moneys and any limitations established by the
289 General Appropriations Act or chapter 216.
290 (12) Effective July 1, 2020, The agency shall make payments
291 to Medicaid-covered services:
292 (a) For eligible children and pregnant women, retroactive
293 for a period of no more than 90 days before the month in which
294 an application for Medicaid is submitted.
295 (b) For eligible nonpregnant adults, retroactive to the
296 first day of the month in which an application for Medicaid is
297 submitted.
298
299 This subsection expires July 1, 2021.
300 Section 7. Notwithstanding the expiration date in section
301 13 of chapter 2020-114, Laws of Florida, subsection (23) of
302 section 409.908, Florida Statutes, is reenacted to read:
303 409.908 Reimbursement of Medicaid providers.—Subject to
304 specific appropriations, the agency shall reimburse Medicaid
305 providers, in accordance with state and federal law, according
306 to methodologies set forth in the rules of the agency and in
307 policy manuals and handbooks incorporated by reference therein.
308 These methodologies may include fee schedules, reimbursement
309 methods based on cost reporting, negotiated fees, competitive
310 bidding pursuant to s. 287.057, and other mechanisms the agency
311 considers efficient and effective for purchasing services or
312 goods on behalf of recipients. If a provider is reimbursed based
313 on cost reporting and submits a cost report late and that cost
314 report would have been used to set a lower reimbursement rate
315 for a rate semester, then the provider’s rate for that semester
316 shall be retroactively calculated using the new cost report, and
317 full payment at the recalculated rate shall be effected
318 retroactively. Medicare-granted extensions for filing cost
319 reports, if applicable, shall also apply to Medicaid cost
320 reports. Payment for Medicaid compensable services made on
321 behalf of Medicaid eligible persons is subject to the
322 availability of moneys and any limitations or directions
323 provided for in the General Appropriations Act or chapter 216.
324 Further, nothing in this section shall be construed to prevent
325 or limit the agency from adjusting fees, reimbursement rates,
326 lengths of stay, number of visits, or number of services, or
327 making any other adjustments necessary to comply with the
328 availability of moneys and any limitations or directions
329 provided for in the General Appropriations Act, provided the
330 adjustment is consistent with legislative intent.
331 (23)(a) The agency shall establish rates at a level that
332 ensures no increase in statewide expenditures resulting from a
333 change in unit costs for county health departments effective
334 July 1, 2011. Reimbursement rates shall be as provided in the
335 General Appropriations Act.
336 (b)1. Base rate reimbursement for inpatient services under
337 a diagnosis-related group payment methodology shall be provided
338 in the General Appropriations Act.
339 2. Base rate reimbursement for outpatient services under an
340 enhanced ambulatory payment group methodology shall be provided
341 in the General Appropriations Act.
342 3. Prospective payment system reimbursement for nursing
343 home services shall be as provided in subsection (2) and in the
344 General Appropriations Act.
345 Section 8. Upon the expiration and reversion of the
346 amendments made to section 409.908, Florida Statutes, pursuant
347 to section 15 of chapter 2020-114, Laws of Florida, subsection
348 (26) of section 409.908, Florida Statutes, is amended to read:
349 409.908 Reimbursement of Medicaid providers.—Subject to
350 specific appropriations, the agency shall reimburse Medicaid
351 providers, in accordance with state and federal law, according
352 to methodologies set forth in the rules of the agency and in
353 policy manuals and handbooks incorporated by reference therein.
354 These methodologies may include fee schedules, reimbursement
355 methods based on cost reporting, negotiated fees, competitive
356 bidding pursuant to s. 287.057, and other mechanisms the agency
357 considers efficient and effective for purchasing services or
358 goods on behalf of recipients. If a provider is reimbursed based
359 on cost reporting and submits a cost report late and that cost
360 report would have been used to set a lower reimbursement rate
361 for a rate semester, then the provider’s rate for that semester
362 shall be retroactively calculated using the new cost report, and
363 full payment at the recalculated rate shall be effected
364 retroactively. Medicare-granted extensions for filing cost
365 reports, if applicable, shall also apply to Medicaid cost
366 reports. Payment for Medicaid compensable services made on
367 behalf of Medicaid eligible persons is subject to the
368 availability of moneys and any limitations or directions
369 provided for in the General Appropriations Act or chapter 216.
370 Further, nothing in this section shall be construed to prevent
371 or limit the agency from adjusting fees, reimbursement rates,
372 lengths of stay, number of visits, or number of services, or
373 making any other adjustments necessary to comply with the
374 availability of moneys and any limitations or directions
375 provided for in the General Appropriations Act, provided the
376 adjustment is consistent with legislative intent.
377 (26) The agency may receive funds from state entities,
378 including, but not limited to, the Department of Health, local
379 governments, and other local political subdivisions, for the
380 purpose of making special exception payments and Low Income Pool
381 Program payments, including federal matching funds. Funds
382 received for this purpose shall be separately accounted for and
383 may not be commingled with other state or local funds in any
384 manner. The agency may certify all local governmental funds used
385 as state match under Title XIX of the Social Security Act to the
386 extent and in the manner authorized under the General
387 Appropriations Act and pursuant to an agreement between the
388 agency and the local governmental entity. In order for the
389 agency to certify such local governmental funds, a local
390 governmental entity must submit a final, executed letter of
391 agreement to the agency, which must be received by October 1 of
392 each fiscal year and provide the total amount of local
393 governmental funds authorized by the entity for that fiscal year
394 under the General Appropriations Act. The local governmental
395 entity shall use a certification form prescribed by the agency.
396 At a minimum, the certification form must identify the amount
397 being certified and describe the relationship between the
398 certifying local governmental entity and the local health care
399 provider. Local governmental funds outlined in the letters of
400 agreement must be received by the agency no later than October
401 31 of each fiscal year in which such funds are pledged, unless
402 an alternative plan is specifically approved by the agency. To
403 be eligible for low-income pool funding or other forms of
404 supplemental payments funded by intergovernmental transfers, and
405 in addition to any other applicable requirements, essential
406 providers identified in s. 409.975(1)(a)2. must offer to
407 contract with each managed care plan in their region and
408 essential providers identified in s. 409.975(1)(b)1. and 3. must
409 offer to contract with each managed care plan in the state.
410 Before releasing such supplemental payments, in the event the
411 parties have not executed network contracts, the agency shall
412 evaluate the parties’ efforts to complete negotiations. If such
413 efforts continue to fail, the agency must withhold such
414 supplemental payments beginning in the third quarter of the
415 fiscal year if it determines that, based upon the totality of
416 the circumstances, the essential provider has negotiated with
417 the managed care plan in bad faith. If the agency determines
418 that an essential provider has negotiated in bad faith, it must
419 notify the essential provider at least 90 days in advance of the
420 start of the third quarter of the fiscal year and afford the
421 essential provider hearing rights in accordance with chapter
422 120.
423 Section 9. Subsections (2), (3), and (10) of section
424 409.911, Florida Statutes, are amended to read:
425 409.911 Disproportionate share program.—Subject to specific
426 allocations established within the General Appropriations Act
427 and any limitations established pursuant to chapter 216, the
428 agency shall distribute, pursuant to this section, moneys to
429 hospitals providing a disproportionate share of Medicaid or
430 charity care services by making quarterly Medicaid payments as
431 required. Notwithstanding the provisions of s. 409.915, counties
432 are exempt from contributing toward the cost of this special
433 reimbursement for hospitals serving a disproportionate share of
434 low-income patients.
435 (2) The Agency for Health Care Administration shall use the
436 following actual audited data to determine the Medicaid days and
437 charity care to be used in calculating the disproportionate
438 share payment:
439 (a) The average of the 3 most recent years of 2012, 2013,
440 and 2014 audited disproportionate share data available for a
441 hospital to determine each hospital’s Medicaid days and charity
442 care for each the 2020-2021 state fiscal year.
443 (b) If the Agency for Health Care Administration does not
444 have the prescribed 3 years of audited disproportionate share
445 data as noted in paragraph (a) for a hospital, the agency shall
446 use the average of the years of the audited disproportionate
447 share data as noted in paragraph (a) which is available.
448 (c) In accordance with s. 1923(b) of the Social Security
449 Act, a hospital with a Medicaid inpatient utilization rate
450 greater than one standard deviation above the statewide mean or
451 a hospital with a low-income utilization rate of 25 percent or
452 greater shall qualify for reimbursement.
453 (3) Hospitals that qualify for a disproportionate share
454 payment solely under paragraph (2)(b) (2)(c) shall have their
455 payment calculated in accordance with the following formulas:
456
457 DSHP = (HMD/TMSD) x $1 million
458
459 Where:
460 DSHP = disproportionate share hospital payment.
461 HMD = hospital Medicaid days.
462 TSD = total state Medicaid days.
463
464 Any funds not allocated to hospitals qualifying under this
465 section shall be redistributed to the non-state government owned
466 or operated hospitals with greater than 3,100 Medicaid days.
467 (10) Notwithstanding any provision of this section to the
468 contrary, for each the 2020-2021 state fiscal year, the agency
469 shall distribute moneys to hospitals providing a
470 disproportionate share of Medicaid or charity care services as
471 provided in the 2020-2021 General Appropriations Act. This
472 subsection expires July 1, 2021.
473 Section 10. Subsection (3) of section 409.9113, Florida
474 Statutes, is amended to read:
475 409.9113 Disproportionate share program for teaching
476 hospitals.—In addition to the payments made under s. 409.911,
477 the agency shall make disproportionate share payments to
478 teaching hospitals, as defined in s. 408.07, for their increased
479 costs associated with medical education programs and for
480 tertiary health care services provided to the indigent. This
481 system of payments must conform to federal requirements and
482 distribute funds in each fiscal year for which an appropriation
483 is made by making quarterly Medicaid payments. Notwithstanding
484 s. 409.915, counties are exempt from contributing toward the
485 cost of this special reimbursement for hospitals serving a
486 disproportionate share of low-income patients. The agency shall
487 distribute the moneys provided in the General Appropriations Act
488 to statutorily defined teaching hospitals and family practice
489 teaching hospitals, as defined in s. 395.805, pursuant to this
490 section. The funds provided for statutorily defined teaching
491 hospitals shall be distributed as provided in the General
492 Appropriations Act. The funds provided for family practice
493 teaching hospitals shall be distributed equally among family
494 practice teaching hospitals.
495 (3) Notwithstanding any provision of this section to the
496 contrary, for each the 2020-2021 state fiscal year, the agency
497 shall make disproportionate share payments to teaching
498 hospitals, as defined in s. 408.07, as provided in the 2020-2021
499 General Appropriations Act. This subsection expires July 1,
500 2021.
501 Section 11. Subsection (4) of section 409.9119, Florida
502 Statutes, is amended to read:
503 409.9119 Disproportionate share program for specialty
504 hospitals for children.—In addition to the payments made under
505 s. 409.911, the Agency for Health Care Administration shall
506 develop and implement a system under which disproportionate
507 share payments are made to those hospitals that are separately
508 licensed by the state as specialty hospitals for children, have
509 a federal Centers for Medicare and Medicaid Services
510 certification number in the 3300-3399 range, have Medicaid days
511 that exceed 55 percent of their total days and Medicare days
512 that are less than 5 percent of their total days, and were
513 licensed on January 1, 2013, as specialty hospitals for
514 children. This system of payments must conform to federal
515 requirements and must distribute funds in each fiscal year for
516 which an appropriation is made by making quarterly Medicaid
517 payments. Notwithstanding s. 409.915, counties are exempt from
518 contributing toward the cost of this special reimbursement for
519 hospitals that serve a disproportionate share of low-income
520 patients. The agency may make disproportionate share payments to
521 specialty hospitals for children as provided for in the General
522 Appropriations Act.
523 (4) Notwithstanding any provision of this section to the
524 contrary, for each the 2020-2021 state fiscal year, for
525 hospitals achieving full compliance under subsection (3), the
526 agency shall make disproportionate share payments to specialty
527 hospitals for children as provided in the 2020-2021 General
528 Appropriations Act. This subsection expires July 1, 2021.
529 Section 12. Paragraph (a) of subsection (1) of section
530 409.975, Florida Statutes, is amended to read:
531 409.975 Managed care plan accountability.—In addition to
532 the requirements of s. 409.967, plans and providers
533 participating in the managed medical assistance program shall
534 comply with the requirements of this section.
535 (1) PROVIDER NETWORKS.—Managed care plans must develop and
536 maintain provider networks that meet the medical needs of their
537 enrollees in accordance with standards established pursuant to
538 s. 409.967(2)(c). Except as provided in this section, managed
539 care plans may limit the providers in their networks based on
540 credentials, quality indicators, and price.
541 (a) Plans must include all providers in the region that are
542 classified by the agency as essential Medicaid providers, unless
543 the agency approves, in writing, an alternative arrangement for
544 securing the types of services offered by the essential
545 providers. Providers are essential for serving Medicaid
546 enrollees if they offer services that are not available from any
547 other provider within a reasonable access standard, or if they
548 provided a substantial share of the total units of a particular
549 service used by Medicaid patients within the region during the
550 last 3 years and the combined capacity of other service
551 providers in the region is insufficient to meet the total needs
552 of the Medicaid patients. The agency may not classify physicians
553 and other practitioners as essential providers. The agency, at a
554 minimum, shall determine which providers in the following
555 categories are essential Medicaid providers:
556 1. Federally qualified health centers.
557 2. Statutory teaching hospitals as defined in s. 408.07(46)
558 s. 408.07(44).
559 3. Hospitals that are trauma centers as defined in s.
560 395.4001(15).
561 4. Hospitals located at least 25 miles from any other
562 hospital with similar services.
563
564 Managed care plans that have not contracted with all essential
565 providers in the region as of the first date of recipient
566 enrollment, or with whom an essential provider has terminated
567 its contract, must negotiate in good faith with such essential
568 providers for 1 year or until an agreement is reached, whichever
569 is first. Payments for services rendered by a nonparticipating
570 essential provider shall be made at the applicable Medicaid rate
571 as of the first day of the contract between the agency and the
572 plan. A rate schedule for all essential providers shall be
573 attached to the contract between the agency and the plan. After
574 1 year, managed care plans that are unable to contract with
575 essential providers shall notify the agency and propose an
576 alternative arrangement for securing the essential services for
577 Medicaid enrollees. The arrangement must rely on contracts with
578 other participating providers, regardless of whether those
579 providers are located within the same region as the
580 nonparticipating essential service provider. If the alternative
581 arrangement is approved by the agency, payments to
582 nonparticipating essential providers after the date of the
583 agency’s approval shall equal 90 percent of the applicable
584 Medicaid rate. Except for payment for emergency services, if the
585 alternative arrangement is not approved by the agency, payment
586 to nonparticipating essential providers shall equal 110 percent
587 of the applicable Medicaid rate.
588 Section 13. Subsection (1) of section 430.502, Florida
589 Statutes, is amended to read:
590 430.502 Alzheimer’s disease; memory disorder clinics and
591 day care and respite care programs.—
592 (1) There is established:
593 (a) A memory disorder clinic at each of the three medical
594 schools in this state;
595 (b) A memory disorder clinic at a major private nonprofit
596 research-oriented teaching hospital, and may fund a memory
597 disorder clinic at any of the other affiliated teaching
598 hospitals;
599 (c) A memory disorder clinic at the Mayo Clinic in
600 Jacksonville;
601 (d) A memory disorder clinic at the West Florida Regional
602 Medical Center Clinic in Pensacola;
603 (e) A memory disorder clinic operated by Health First in
604 Brevard County;
605 (f) A memory disorder clinic at the Orlando Regional
606 Healthcare System, Inc.;
607 (g) A memory disorder center located in a public hospital
608 that is operated by an independent special hospital taxing
609 district that governs multiple hospitals and is located in a
610 county with a population greater than 800,000 persons;
611 (h) A memory disorder clinic at St. Mary’s Medical Center
612 in Palm Beach County;
613 (i) A memory disorder clinic at Tallahassee Memorial
614 Healthcare;
615 (j) A memory disorder clinic at Lee Memorial Hospital
616 created by chapter 63-1552, Laws of Florida, as amended;
617 (k) A memory disorder clinic at Sarasota Memorial Hospital
618 in Sarasota County;
619 (l) A memory disorder clinic at Morton Plant Hospital,
620 Clearwater, in Pinellas County;
621 (m) A memory disorder clinic at Florida Atlantic
622 University, Boca Raton, in Palm Beach County;
623 (n) A memory disorder clinic at AdventHealth in Orange
624 County; and
625 (o) A memory disorder clinic at Miami Jewish Health System
626 in Miami-Dade County,
627
628 for the purpose of conducting research and training in a
629 diagnostic and therapeutic setting for persons suffering from
630 Alzheimer’s disease and related memory disorders. However,
631 memory disorder clinics may shall not receive decreased funding
632 due solely to subsequent additions of memory disorder clinics in
633 this subsection.
634 Section 14. Notwithstanding the expiration date in section
635 19 of chapter 2020-114, Laws of Florida, paragraph (b) of
636 subsection (5) of section 624.91, Florida Statutes, is reenacted
637 to read:
638 624.91 The Florida Healthy Kids Corporation Act.—
639 (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
640 (b) The Florida Healthy Kids Corporation shall:
641 1. Arrange for the collection of any family, local
642 contributions, or employer payment or premium, in an amount to
643 be determined by the board of directors, to provide for payment
644 of premiums for comprehensive insurance coverage and for the
645 actual or estimated administrative expenses.
646 2. Arrange for the collection of any voluntary
647 contributions to provide for payment of Florida Kidcare program
648 premiums for children who are not eligible for medical
649 assistance under Title XIX or Title XXI of the Social Security
650 Act.
651 3. Subject to the provisions of s. 409.8134, accept
652 voluntary supplemental local match contributions that comply
653 with the requirements of Title XXI of the Social Security Act
654 for the purpose of providing additional Florida Kidcare coverage
655 in contributing counties under Title XXI.
656 4. Establish the administrative and accounting procedures
657 for the operation of the corporation.
658 5. Establish, with consultation from appropriate
659 professional organizations, standards for preventive health
660 services and providers and comprehensive insurance benefits
661 appropriate to children, provided that such standards for rural
662 areas shall not limit primary care providers to board-certified
663 pediatricians.
664 6. Determine eligibility for children seeking to
665 participate in the Title XXI-funded components of the Florida
666 Kidcare program consistent with the requirements specified in s.
667 409.814, as well as the non-Title-XXI-eligible children as
668 provided in subsection (3).
669 7. Establish procedures under which providers of local
670 match to, applicants to and participants in the program may have
671 grievances reviewed by an impartial body and reported to the
672 board of directors of the corporation.
673 8. Establish participation criteria and, if appropriate,
674 contract with an authorized insurer, health maintenance
675 organization, or third-party administrator to provide
676 administrative services to the corporation.
677 9. Establish enrollment criteria that include penalties or
678 waiting periods of 30 days for reinstatement of coverage upon
679 voluntary cancellation for nonpayment of family premiums.
680 10. Contract with authorized insurers or any provider of
681 health care services, meeting standards established by the
682 corporation, for the provision of comprehensive insurance
683 coverage to participants. Such standards shall include criteria
684 under which the corporation may contract with more than one
685 provider of health care services in program sites. Health plans
686 shall be selected through a competitive bid process. The Florida
687 Healthy Kids Corporation shall purchase goods and services in
688 the most cost-effective manner consistent with the delivery of
689 quality medical care. The maximum administrative cost for a
690 Florida Healthy Kids Corporation contract shall be 15 percent.
691 For health care contracts, the minimum medical loss ratio for a
692 Florida Healthy Kids Corporation contract shall be 85 percent.
693 For dental contracts, the remaining compensation to be paid to
694 the authorized insurer or provider under a Florida Healthy Kids
695 Corporation contract shall be no less than an amount which is 85
696 percent of premium; to the extent any contract provision does
697 not provide for this minimum compensation, this section shall
698 prevail. For an insurer or any provider of health care services
699 which achieves an annual medical loss ratio below 85 percent,
700 the Florida Healthy Kids Corporation shall validate the medical
701 loss ratio and calculate an amount to be refunded by the insurer
702 or any provider of health care services to the state which shall
703 be deposited into the General Revenue Fund unallocated. The
704 health plan selection criteria and scoring system, and the
705 scoring results, shall be available upon request for inspection
706 after the bids have been awarded.
707 11. Establish disenrollment criteria in the event local
708 matching funds are insufficient to cover enrollments.
709 12. Develop and implement a plan to publicize the Florida
710 Kidcare program, the eligibility requirements of the program,
711 and the procedures for enrollment in the program and to maintain
712 public awareness of the corporation and the program.
713 13. Secure staff necessary to properly administer the
714 corporation. Staff costs shall be funded from state and local
715 matching funds and such other private or public funds as become
716 available. The board of directors shall determine the number of
717 staff members necessary to administer the corporation.
718 14. In consultation with the partner agencies, provide a
719 report on the Florida Kidcare program annually to the Governor,
720 the Chief Financial Officer, the Commissioner of Education, the
721 President of the Senate, the Speaker of the House of
722 Representatives, and the Minority Leaders of the Senate and the
723 House of Representatives.
724 15. Provide information on a quarterly basis to the
725 Legislature and the Governor which compares the costs and
726 utilization of the full-pay enrolled population and the Title
727 XXI-subsidized enrolled population in the Florida Kidcare
728 program. The information, at a minimum, must include:
729 a. The monthly enrollment and expenditure for full-pay
730 enrollees in the Medikids and Florida Healthy Kids programs
731 compared to the Title XXI-subsidized enrolled population; and
732 b. The costs and utilization by service of the full-pay
733 enrollees in the Medikids and Florida Healthy Kids programs and
734 the Title XXI-subsidized enrolled population.
735 16. Establish benefit packages that conform to the
736 provisions of the Florida Kidcare program, as created in ss.
737 409.810-409.821.
738 Section 15. Subsection (2) of section 1011.52, Florida
739 Statutes, is amended to read:
740 1011.52 Appropriation to first accredited medical school.—
741 (2) In order for a medical school to qualify under this
742 section and to be entitled to the benefits herein, such medical
743 school:
744 (a) Must be primarily operated and established to offer,
745 afford, and render a medical education to residents of the state
746 qualifying for admission to such institution;
747 (b) Must be operated by a municipality or county of this
748 state, or by a nonprofit organization heretofore or hereafter
749 established exclusively for educational purposes;
750 (c) Must, upon the formation and establishment of an
751 accredited medical school, transmit and file with the Department
752 of Education documentary proof evidencing the facts that such
753 institution has been certified and approved by the council on
754 medical education and hospitals of the American Medical
755 Association and has adequately met the requirements of that
756 council in regard to its administrative facilities,
757 administrative plant, clinical facilities, curriculum, and all
758 other such requirements as may be necessary to qualify with the
759 council as a recognized, approved, and accredited medical
760 school;
761 (d) Must certify to the Department of Education the name,
762 address, and educational history of each student approved and
763 accepted for enrollment in such institution for the ensuing
764 school year; and
765 (e) Must have in place an operating agreement with a
766 government-owned hospital that is located in the same county as
767 the medical school and that is a statutory teaching hospital as
768 defined in s. 408.07(46) s. 408.07(44). The operating agreement
769 must provide for the medical school to maintain the same level
770 of affiliation with the hospital, including the level of
771 services to indigent and charity care patients served by the
772 hospital, which was in place in the prior fiscal year. Each
773 year, documentation demonstrating that an operating agreement is
774 in effect shall be submitted jointly to the Department of
775 Education by the hospital and the medical school prior to the
776 payment of moneys from the annual appropriation.
777 Section 16. Subject to federal approval of the application
778 to be a site for the Program of All-inclusive Care for the
779 Elderly (PACE), the Agency for Health Care Administration shall
780 contract with one private health care organization, the sole
781 member of which is a private, not-for-profit corporation that
782 owns and manages health care organizations that provide
783 comprehensive long-term care services, including nursing home,
784 assisted living, independent housing, home care, adult day care,
785 and care management. This organization shall provide these
786 services to frail and elderly persons who reside in Escambia,
787 Okaloosa, and Santa Rosa Counties. The organization is exempt
788 from the requirements of chapter 641, Florida Statutes. The
789 agency, in consultation with the Department of Elderly Affairs
790 and subject to an appropriation, shall approve up to 200 initial
791 enrollees in the PACE program established by this organization
792 to serve elderly persons who reside in Escambia, Okaloosa, and
793 Santa Rosa Counties.
794 Section 17. Subject to federal approval of the application
795 to be a site for the Program of All-inclusive Care for the
796 Elderly (PACE), the Agency for Health Care Administration shall
797 contract with one private, not-for-profit hospital located in
798 Miami-Dade County to provide comprehensive services to frail and
799 elderly persons residing in Northwest Miami-Dade County, as
800 defined by the agency. The hospital is exempt from the
801 requirements of chapter 641, Florida Statutes. The agency, in
802 consultation with the Department of Elderly Affairs and subject
803 to appropriation, shall approve up to 100 initial enrollees in
804 the PACE program established by this hospital to serve persons
805 in Northwest Miami-Dade County.
806 Section 18. Subject to federal approval of an application
807 to be a provider of the Program of All-inclusive Care for the
808 Elderly (PACE), the Agency for Health Care Administration shall
809 contract with a private organization that has demonstrated the
810 ability to operate PACE centers in more than one state and that
811 serves more than 500 eligible PACE participants, to provide PACE
812 services to frail and elderly persons who reside in
813 Hillsborough, Hernando, or Pasco Counties. The organization is
814 exempt from the requirements of chapter 641, Florida Statutes.
815 The agency, in consultation with the Department of Elderly
816 Affairs and subject to the appropriation of funds by the
817 Legislature, shall approve up to 500 initial enrollees in the
818 PACE program established by the organization to serve frail and
819 elderly persons who reside in Hillsborough, Hernando, or Pasco
820 Counties.
821 Section 19. Subject to federal approval of an application
822 to be a provider of the Program of All-inclusive Care for the
823 Elderly (PACE), the Agency for Health Care Administration shall
824 contract with a private organization that has demonstrated the
825 ability to service high-risk, frail elderly residents in either
826 nursing homes or in the community in Florida through its
827 operation of long-term care facilities, as well as approved
828 special needs plans for institutionalized Medicare residents.
829 This organization shall provide these services to frail and
830 elderly persons who reside in Broward County. The organization
831 is exempt from the requirements of chapter 641, Florida
832 Statutes. The agency, in consultation with the Department of
833 Elderly Affairs and subject to the appropriation of funds by the
834 Legislature, shall approve up to 300 initial enrollees in the
835 PACE program established by the organization to serve frail and
836 elderly persons who reside in Broward County.
837 Section 20. Subject to federal approval, a current Program
838 of All-inclusive Care for the Elderly (PACE) organization that
839 is authorized to provide PACE services in Northeast Florida and
840 that is granted authority under section 28 of Chapter 2016-65,
841 Laws of Florida, for up to 300 enrollee slots to serve frail and
842 elderly persons residing in Baker, Clay, Duval, Nassau, and St.
843 Johns Counties, may also use those PACE slots for enrollees
844 residing in Alachua and Putnam Counties, subject to a contract
845 amendment with the Agency for Health Care Administration.
846 Section 21. The Program of All-inclusive Care for the
847 Elderly (PACE) organization that is authorized as of July 1,
848 2021 to provide PACE services for up to 150 enrollee slots to
849 serve frail and elderly persons residing in Hospice Service
850 Areas 7B (Orange and Osceola Counties) and 3E (Lake and Sumter
851 Counties), as previously authorized by section 29 of Chapter
852 2016-65, Laws of Florida, and the PACE organization that is
853 authorized as of July 1, 2021 to provide PACE services for up to
854 150 initial enrollee slots to serve frail and elderly persons
855 who reside in Hospice Services Area 7C (Seminole County), as
856 previously authorized by section 22 of Chapter 2017-129, Laws of
857 Florida, may be consolidated. With the consolidation, the PACE
858 organization that has demonstrated the ability to operate PACE
859 centers in more than one state and that serves more than 500
860 eligible PACE participants is authorized to provide PACE
861 services for up to 300 initial enrollee slots to serve frail and
862 elderly persons who reside in Orange, Osceola, Lake, Sumter, or
863 Seminole Counties.
864 Section 22. Subject to federal approval, a private
865 organization that owns and manages a health care organization
866 that provides comprehensive long-term care services, including
867 acute care services, independent living through federally
868 approved affordable housing, and care management, and has
869 demonstrated the ability to operate Program of All-inclusive
870 Care for the Elderly (PACE) centers in more than one state is
871 authorized to provide PACE services to frail and elderly persons
872 who reside in Seminole, Volusia, or Flagler Counties. The
873 organization is exempt from the requirements of chapter 641,
874 Florida Statutes. The agency, in consultation with the
875 Department of Elderly Affairs, and subject to an appropriation,
876 shall approve up to 500 initial enrollee slots to serve frail
877 and elderly persons residing in Seminole, Volusia, or Flagler
878 Counties.
879 Section 23. Subject to federal approval of the application
880 to be a site for the Program of All-inclusive Care for the
881 Elderly (PACE), the Agency for Health Care Administration shall
882 contract with one public hospital system operating in the
883 northern two-thirds of Broward County to provide comprehensive
884 services to frail and elderly persons residing in the northern
885 two-thirds of Broward County. The public hospital system is
886 exempt from the requirements of chapter 641, Florida Statutes.
887 The agency, in consultation with the Department of Elderly
888 Affairs, and subject to an appropriation, shall approve up to
889 200 initial enrollee slots in the PACE program established by
890 the public hospital system to serve frail and elderly persons
891 residing in the northern two-thirds of Broward County.
892 Section 24. This act shall take effect July 1, 2021.