Florida Senate - 2022 SB 1596
By Senator Gibson
6-00881C-22 20221596__
1 A bill to be entitled
2 An act relating to nursing home accountability;
3 amending s. 400.141, F.S.; requiring licensed nursing
4 home facilities to comply with certain rules adopted
5 by the Agency for Health Care Administration;
6 requiring the agency to adopt rules establishing a
7 medical loss ratio for the disposition of Medicaid
8 revenue in excess of expenses for nursing home
9 facilities; providing the method of calculating the
10 medical loss ratio; requiring nursing home facilities
11 to pay any excess Medicaid revenue to the agency by a
12 specified date under certain circumstances; providing
13 for the collection of such payments; requiring the
14 agency to use refunds of excess Medicaid revenue to
15 fund certain initiatives; requiring nursing home
16 facilities to limit their use of excess Medicaid
17 revenue for management salaries and limit rates paid
18 for contracted staffing and services; prohibiting
19 nursing home facilities from using more than a
20 specified percentage of Medicaid funding on executive
21 and managerial salaries; prohibiting nursing home
22 facilities from contracting with certain management
23 companies for staffing or services at a rate exceeding
24 a specified percentage; providing an exception;
25 requiring each nursing home facility to post certain
26 maximum rates charged at the facility on its Internet
27 website and update the rates annually; requiring each
28 nursing home facility to post a list of its owners on
29 its Internet website and submit such list to the
30 agency, to be posted on the agency’s website;
31 requiring nursing home facilities to update the list
32 within a specified timeframe; requiring each nursing
33 home facility to post summaries of certain contracts
34 and agreements on its Internet website within a
35 specified timeframe; requiring the agency to adopt
36 rules; amending s. 408.061, F.S.; specifying that a
37 nursing home’s or its home office’s actual financial
38 experience is its audited actual experience for
39 purposes of financial reporting; providing an
40 effective date.
41
42 Be It Enacted by the Legislature of the State of Florida:
43
44 Section 1. Paragraphs (x), (y), and (z) are added to
45 subsection (1) of section 400.141, Florida Statutes, to read:
46 400.141 Administration and management of nursing home
47 facilities.—
48 (1) Every licensed facility shall comply with all
49 applicable standards and rules of the agency and shall:
50 (x) Comply with rules adopted by the agency which establish
51 a medical loss ratio for the disposition of revenue in excess of
52 expenses for nursing home facilities.
53 1. The agency shall adopt rules requiring that a minimum of
54 75 percent of the total Medicaid revenue of a nursing home
55 facility be spent on costs related to patient care, 55 percent
56 of which must be spent on direct care, as defined by agency
57 rule. Patient care costs are calculated by combining direct care
58 and indirect care costs pursuant to agency rule.
59 2. If a nursing home facility fails to spend at least 75
60 percent of its total Medicaid revenue on patient care costs as
61 defined by agency rule, the nursing home facility must pay such
62 excess revenue to the agency by January 1 of the following
63 fiscal year. The agency shall collect such payments by any
64 method it deems necessary, including, but not limited to,
65 deductions or offsets from payments made under the Medicaid
66 program. Refunds of excess Medicaid revenue collected by the
67 agency shall be used to fund initiatives that improve the
68 quality of care or quality of life for residents of nursing home
69 facilities. Such initiatives may include, but need not be
70 limited to, surveillance and inspection activities; activities
71 designed to improve the quality, performance, and compliance of
72 poorly performing nursing home facilities; training and
73 education for facility staff; and activities to encourage
74 resident and consumer involvement in initiatives to improve the
75 quality of care or quality of life for residents of nursing home
76 facilities.
77 (y) Limit the use of excess Medicaid revenue for management
78 salaries and limit rates paid for contracted staffing or
79 services so as not to exceed the current market rates for such
80 staffing and services.
81 1. A nursing home facility may not use more than 15 percent
82 of its total expenses funded through the Medicaid program for
83 executive or managerial salaries.
84 2. A nursing home facility may not contract for staffing or
85 services with any management company that has an ownership
86 interest in the facility at a rate exceeding 10 percent of that
87 for the facility’s in-house staffing or service costs, unless an
88 emergency has been declared as determined by the agency or as
89 defined by agency rule.
90
91 The agency shall adopt rules to implement this paragraph.
92 (z) Post on its Internet website, and update annually, the
93 maximum rates to be charged for the use of facilities and the
94 provision of services, including the rates for services paid
95 through public and private payor sources.
96 1. A nursing home facility shall post on its Internet
97 website a list of all facility owners and submit such list to
98 the agency for posting on the agency’s Internet website. Such
99 list must be updated within 30 days after any change is made to
100 the list.
101 2. A nursing home facility shall also post on its Internet
102 website a summary of any contract or agreement entered into by
103 the facility for the provision of goods or services in which the
104 facility has an ownership interest in the contracted company and
105 pays for such goods or services using any portion of Medicaid
106 funds. Such summaries must be posted within 30 days after such
107 contract or agreement is executed.
108
109 The agency shall adopt rules to implement this paragraph.
110 Section 2. Subsections (5) and (6) of section 408.061,
111 Florida Statutes, are amended to read:
112 408.061 Data collection; uniform systems of financial
113 reporting; information relating to physician charges;
114 confidential information; immunity.—
115 (5) Within 120 days after the end of its fiscal year, each
116 nursing home as defined in s. 408.07 shall file with the agency,
117 on forms adopted by the agency and based on the uniform system
118 of financial reporting, its actual financial experience for that
119 fiscal year, including expenditures, revenues, and statistical
120 measures. Such data may be based on internal financial reports
121 that are certified to be complete and accurate by the chief
122 financial officer of the nursing home. A nursing home’s actual
123 financial experience shall be its audited actual experience.
124 This audited actual experience must include the fiscal year-end
125 balance sheet, income statement, statement of cash flow, and
126 statement of retained earnings and must be submitted to the
127 agency in addition to the information filed in the uniform
128 system of financial reporting. The financial statements must tie
129 to the information submitted in the uniform system of financial
130 reporting, and a crosswalk must be submitted along with the
131 financial statements.
132 (6) Within 120 days after the end of its fiscal year, the
133 home office of each nursing home as defined in s. 408.07 shall
134 file with the agency, on forms adopted by the agency and based
135 on the uniform system of financial reporting, its actual
136 financial experience for that fiscal year, including
137 expenditures, revenues, and statistical measures. Such data may
138 be based on internal financial reports that are certified to be
139 complete and accurate by the chief financial officer of the
140 nursing home. The actual financial experience of the home office
141 of a nursing home shall be its audited actual experience. This
142 audited actual experience must include the fiscal year-end
143 balance sheet, income statement, statement of cash flow, and
144 statement of retained earnings and must be submitted to the
145 agency in addition to the information filed in the uniform
146 system of financial reporting. The financial statements must tie
147 to the information submitted in the uniform system of financial
148 reporting, and a crosswalk must be submitted along with the
149 audited financial statements.
150 Section 3. This act shall take effect October 1, 2022.