Florida Senate - 2025 COMMITTEE AMENDMENT
Bill No. CS for SB 170
Ì2558703Î255870
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
03/28/2025 .
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The Appropriations Committee on Health and Human Services
(Burton) recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete lines 224 - 430
4 and insert:
5 through (16), respectively, a new subsection (7) is added to
6 that section, and subsections (5) and (6) of that section are
7 amended, to read:
8 408.061 Data collection; uniform systems of financial
9 reporting; information relating to physician charges;
10 confidential information; immunity.—
11 (5) Within 120 days after the end of its fiscal year, each
12 nursing home as defined in s. 408.07, excluding nursing homes
13 operated by state agencies, shall file with the agency, on forms
14 adopted by the agency and based on the uniform system of
15 financial reporting, its actual financial experience for that
16 fiscal year, including expenditures, revenues, and statistical
17 measures. Such data may be based on internal financial reports
18 that are certified to be complete and accurate by the chief
19 financial officer of the nursing home. However, a nursing home’s
20 actual financial experience shall be its audited actual
21 experience. This audited actual experience must include the
22 fiscal year-end balance sheet, income statement, statement of
23 cash flow, and statement of retained earnings and must be
24 submitted to the agency in addition to the information filed in
25 the uniform system of financial reporting. The financial
26 statements must tie to the information submitted in the uniform
27 system of financial reporting, and a crosswalk must be submitted
28 along with the financial statements.
29 (6) Within 120 days after the end of its fiscal year, the
30 home office of each nursing home as defined in s. 408.07,
31 excluding nursing homes operated by state agencies, shall file
32 with the agency, on forms adopted by the agency and based on the
33 uniform system of financial reporting, its actual financial
34 experience for that fiscal year, including expenditures,
35 revenues, and statistical measures. Such data may be based on
36 internal financial reports that are certified to be complete and
37 accurate by the chief financial officer of the nursing home.
38 However, the home office’s actual financial experience shall be
39 its audited actual experience. This audited actual experience
40 must include the fiscal year-end balance sheet, income
41 statement, statement of cash flow, and statement of retained
42 earnings and must be submitted to the agency in addition to the
43 information filed in the uniform system of financial reporting.
44 The financial statements must tie to the information submitted
45 in the uniform system of financial reporting, and a crosswalk
46 must be submitted along with the audited financial statements.
47 (7)(a) Beginning January 1, 2026, the agency shall impose
48 an administrative fine of $10,000 per violation against a
49 nursing home or home office that fails to comply with subsection
50 (5) or subsection (6), as applicable. For purposes of this
51 paragraph, the term “violation” means failing to file the
52 financial report required by subsection (5) or subsection (6),
53 as applicable, on or before the report’s due date. Failing to
54 file the report during any subsequent 10-day period occurring
55 after the due date constitutes a separate violation until the
56 report has been submitted.
57 (b) The agency shall adopt rules to implement this
58 subsection. The rules must include provisions for a nursing home
59 or home office to present factors in mitigation of the
60 imposition of the fine’s full dollar amount. The agency may
61 determine not to impose the fine’s full dollar amount upon a
62 showing that the full fine is inappropriate under the
63 circumstances.
64 Section 6. Subsection (2) of section 408.08, Florida
65 Statutes, is amended to read:
66 408.08 Inspections and audits; violations; penalties;
67 fines; enforcement.—
68 (2) Any health care facility that refuses to file a report,
69 fails to timely file a report, files a false report, or files an
70 incomplete report and upon notification fails to timely file a
71 complete report required under s. 408.061; that violates this
72 section, s. 408.061, or s. 408.20, or rule adopted thereunder;
73 or that fails to provide documents or records requested by the
74 agency under this chapter shall be punished by a fine not
75 exceeding $1,000 per day for each day in violation, to be
76 imposed and collected by the agency. Pursuant to rules adopted
77 by the agency, the agency may, upon a showing of good cause,
78 grant a one-time extension of any deadline for a health care
79 facility to timely file a report as required by this section, s.
80 408.061, or s. 408.20. A facility fined under s. 408.061(7) may
81 not be additionally fined under this subsection for the same
82 violation.
83 Section 7. Paragraph (b) of subsection (2) of section
84 409.908, Florida Statutes, is amended to read:
85 409.908 Reimbursement of Medicaid providers.—Subject to
86 specific appropriations, the agency shall reimburse Medicaid
87 providers, in accordance with state and federal law, according
88 to methodologies set forth in the rules of the agency and in
89 policy manuals and handbooks incorporated by reference therein.
90 These methodologies may include fee schedules, reimbursement
91 methods based on cost reporting, negotiated fees, competitive
92 bidding pursuant to s. 287.057, and other mechanisms the agency
93 considers efficient and effective for purchasing services or
94 goods on behalf of recipients. If a provider is reimbursed based
95 on cost reporting and submits a cost report late and that cost
96 report would have been used to set a lower reimbursement rate
97 for a rate semester, then the provider’s rate for that semester
98 shall be retroactively calculated using the new cost report, and
99 full payment at the recalculated rate shall be effected
100 retroactively. Medicare-granted extensions for filing cost
101 reports, if applicable, shall also apply to Medicaid cost
102 reports. Payment for Medicaid compensable services made on
103 behalf of Medicaid-eligible persons is subject to the
104 availability of moneys and any limitations or directions
105 provided for in the General Appropriations Act or chapter 216.
106 Further, nothing in this section shall be construed to prevent
107 or limit the agency from adjusting fees, reimbursement rates,
108 lengths of stay, number of visits, or number of services, or
109 making any other adjustments necessary to comply with the
110 availability of moneys and any limitations or directions
111 provided for in the General Appropriations Act, provided the
112 adjustment is consistent with legislative intent.
113 (2)
114 (b) Subject to any limitations or directions in the General
115 Appropriations Act, the agency shall establish and implement a
116 state Title XIX Long-Term Care Reimbursement Plan for nursing
117 home care in order to provide care and services in conformance
118 with the applicable state and federal laws, rules, regulations,
119 and quality and safety standards and to ensure that individuals
120 eligible for medical assistance have reasonable geographic
121 access to such care.
122 1. The agency shall amend the long-term care reimbursement
123 plan and cost reporting system to create direct care and
124 indirect care subcomponents of the patient care component of the
125 per diem rate. These two subcomponents together shall equal the
126 patient care component of the per diem rate. Separate prices
127 shall be calculated for each patient care subcomponent,
128 initially based on the September 2016 rate setting cost reports
129 and subsequently based on the most recently audited cost report
130 used during a rebasing year. The direct care subcomponent of the
131 per diem rate for any providers still being reimbursed on a cost
132 basis shall be limited by the cost-based class ceiling, and the
133 indirect care subcomponent may be limited by the lower of the
134 cost-based class ceiling, the target rate class ceiling, or the
135 individual provider target. The ceilings and targets apply only
136 to providers being reimbursed on a cost-based system. Effective
137 October 1, 2018, a prospective payment methodology shall be
138 implemented for rate setting purposes with the following
139 parameters:
140 a. Peer Groups, including:
141 (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
142 Counties; and
143 (II) South-SMMC Regions 10-11, plus Palm Beach and
144 Okeechobee Counties.
145 b. Percentage of Median Costs based on the cost reports
146 used for September 2016 rate setting:
147 (I) Direct Care Costs........................100 percent.
148 (II) Indirect Care Costs......................92 percent.
149 (III) Operating Costs.........................86 percent.
150 c. Floors:
151 (I) Direct Care Component.....................95 percent.
152 (II) Indirect Care Component................92.5 percent.
153 (III) Operating Component...........................None.
154 d. Pass-through Payments..................Real Estate and
155 ...............................................Personal Property
156 ...................................Taxes and Property Insurance.
157 e. Quality Incentive Program Payment
158 Pool.....................................10 percent of September
159 .......................................2016 non-property related
160 ................................payments of included facilities.
161 f. Quality Score Threshold to Qualify Quality for Quality
162 Incentive Payment...........................................20th
163 ..............................percentile of included facilities.
164 g. Fair Rental Value System Payment Parameters:
165 (I) Building Value per Square Foot based on 2018 RS Means.
166 (II) Land Valuation...10 percent of Gross Building value.
167 (III) Facility Square Footage......Actual Square Footage.
168 (IV) Movable Equipment Allowance..........$8,000 per bed.
169 (V) Obsolescence Factor......................1.5 percent.
170 (VI) Fair Rental Rate of Return................8 percent.
171 (VII) Minimum Occupancy.......................90 percent.
172 (VIII) Maximum Facility Age.....................40 years.
173 (IX) Minimum Square Footage per Bed..................350.
174 (X) Maximum Square Footage for Bed...................500.
175 (XI) Minimum Cost of a renovation/replacements$500 per bed.
176 h. Ventilator Supplemental payment of $200 per Medicaid day
177 of 40,000 ventilator Medicaid days per fiscal year.
178 2. The agency shall revise its methodology for calculating
179 Quality Incentive Program payments to include the results of
180 consumer satisfaction surveys conducted pursuant to s. 400.0225
181 as a measure of nursing home quality. The agency shall so revise
182 the methodology after the surveys have been in effect for an
183 amount of time the agency deems sufficient for statistical and
184 scientific validity as a meaningful quality measure that may be
185 incorporated into the methodology.
186 3. The direct care subcomponent shall include salaries and
187 benefits of direct care staff providing nursing services
188 including registered nurses, licensed practical nurses, and
189 certified nursing assistants who deliver care directly to
190 residents in the nursing home facility, allowable therapy costs,
191 and dietary costs. This excludes nursing administration, staff
192 development, the staffing coordinator, and the administrative
193 portion of the minimum data set and care plan coordinators. The
194 direct care subcomponent also includes medically necessary
195 dental care, vision care, hearing care, and podiatric care.
196 4.3. All other patient care costs shall be included in the
197 indirect care cost subcomponent of the patient care per diem
198 rate, including complex medical equipment, medical supplies, and
199 other allowable ancillary costs. Costs may not be allocated
200 directly or indirectly to the direct care subcomponent from a
201 home office or management company.
202 5.4. On July 1 of each year, the agency shall report to the
203 Legislature direct and indirect care costs, including average
204 direct and indirect care costs per resident per facility and
205 direct care and indirect care salaries and benefits per category
206 of staff member per facility.
207 6.5. Every fourth year, the agency shall rebase nursing
208 home prospective payment rates to reflect changes in cost based
209 on the most recently audited cost report for each participating
210 provider.
211 7.6. A direct care supplemental payment may be made to
212 providers whose direct care hours per patient day are above the
213 80th percentile and who provide Medicaid services to a larger
214 percentage of Medicaid patients than the state average.
215 8.7. Pediatric, Florida Department of Veterans Affairs, and
216 government-owned facilities are exempt from the pricing model
217 established in this subsection and shall remain on a cost-based
218 prospective payment system. Effective October 1, 2018, the
219 agency shall set rates for all facilities remaining on a cost
220 based prospective payment system using each facility’s most
221 recently audited cost report, eliminating retroactive
222 settlements.
223 9. By October 1, 2025, and each year thereafter, the agency
224 shall submit to the Governor, the President of the Senate, and
225 the Speaker of the House of Representatives a report on each
226 Quality Incentive Program payment made pursuant to sub
227 subparagraph 1.e. The report must, at a minimum, include all of
228 the following information:
229 a. The name of each facility that received a Quality
230 Incentive Program payment and the dollar amount of such payment
231 each facility received.
232 b. The total number of quality incentive metric points
233 awarded by the agency to each facility and the number of points
234 awarded by the agency for each individual quality metric
235 measured.
236 c. An examination of any trends in the improvement of the
237 quality of care provided to nursing home residents which may be
238 attributable to incentive payments received under the Quality
239 Incentive Program. The agency shall include examination of
240 trends both for the program as a whole as well as for each
241 individual quality metric used by the agency to award program
242 payments.
243
244 It is the intent of the Legislature that the reimbursement plan
245 achieve the goal of providing access to health care for nursing
246 home residents who require large amounts of care while
247 encouraging diversion services as an alternative to nursing home
248 care for residents who can be served within the community. The
249 agency shall base the establishment of any maximum rate of
250 payment, whether overall or component, on the available moneys
251 as provided for in the General Appropriations Act. The agency
252 may base the maximum rate of payment on the results of
253 scientifically valid analysis and conclusions derived from
254 objective statistical data pertinent to the particular maximum
255 rate of payment. The agency shall base the rates of payments in
256 accordance with the minimum wage requirements as provided in the
257 General Appropriations Act.
258 Section 8. (1) To support and enhance quality outcomes in
259 Florida’s nursing homes, the Agency for Health Care
260 Administration shall contract with a third-party vendor to
261 conduct a comprehensive study of nursing home quality incentive
262 programs in other states.
263 (a) At a minimum, the study must include a detailed
264 analysis of quality incentive programs implemented in each of
265 the states examined, identify components of such programs which
266 have demonstrably improved nursing home quality outcomes, and
267 provide recommendations to modify or enhance this state’s
268 existing Medicaid Quality Incentive Program based on its
269 historical performance and trends since it was first
270 implemented.
271 (b) The study must also include:
272 1. An in-depth review of emerging and existing technologies
273 applicable to nursing home care and an analysis of how their
274 adoption in this state could improve quality of care and
275 operational efficiency; and
276 2. An examination of other states’ Medicaid add-on payment
277 structures related to the provision of ventilator care,
278 bariatric services, and behavioral health services.
279 (2) The agency shall submit a final report on the study,
280 including findings and actionable recommendations, to the
281 Governor, the President of the Senate, and the Speaker of the
282 House of Representatives by December 1, 2025.
283
284 ================= T I T L E A M E N D M E N T ================
285 And the title is amended as follows:
286 Delete lines 42 - 55
287 and insert:
288 408.061, F.S.; exempting nursing homes operated by
289 state agencies from certain financial reporting
290 requirements; requiring the agency to impose
291 administrative fines against nursing homes and home
292 offices of nursing homes for failing to comply with
293 certain reporting requirements; defining the term
294 “violation”; providing construction; requiring the
295 agency to adopt rules; providing requirements for such
296 rules; amending s. 408.08, F.S.; prohibiting nursing
297 homes subject to certain administrative fines from
298 being fined under a specified provision for the same
299 violation; amending s. 409.908, F.S.; requiring the
300 agency to revise its methodology for calculating
301 Quality Incentive Program payments; providing
302 requirements for such revision; requiring the agency
303 to submit an annual report to the Governor and the
304 Legislature on payments made under the Quality
305 Incentive Program; specifying requirements for the
306 report; requiring the agency to contract with a third
307 party vendor to conduct a comprehensive study of
308 nursing home quality incentive programs in other
309 states; providing minimum requirements for the report;
310 requiring the agency to submit a final report on the
311 study to the Governor and the Legislature by a
312 specified date; providing an effective