ENROLLED
       2021 Legislature                          SB 2518, 1st Engrossed
       
       
       
       
       
       
                                                             20212518er
    1  
    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.