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