Florida Senate - 2025                       CS for CS for SB 170
       
       
        
       By the Appropriations Committee on Health and Human Services;
       the Committee on Health Policy; and Senator Burton
       
       
       
       
       603-02910-25                                           2025170c2
    1                        A bill to be entitled                      
    2         An act relating to the quality of care in nursing
    3         homes; reviving, reenacting, and amending s. 400.0225,
    4         F.S., relating to consumer satisfaction surveys;
    5         requiring the Agency for Health Care Administration to
    6         develop user-friendly consumer satisfaction surveys
    7         for nursing home facilities; specifying requirements
    8         for the surveys; authorizing family members,
    9         guardians, and other resident designees to assist the
   10         resident in completing the survey; prohibiting
   11         employees and volunteers of the facility or of a
   12         corporation or business entity with an ownership
   13         interest in the facility from attempting to influence
   14         a resident’s responses to the survey; requiring the
   15         agency to specify certain protocols for administration
   16         of the survey; requiring the agency to publish on its
   17         website aggregated survey data in a manner that allows
   18         for comparison between nursing home facilities;
   19         amending s. 400.141, F.S.; requiring medical directors
   20         of nursing home facilities to obtain, or to be in the
   21         process of obtaining, certain qualifications by a
   22         specified date; requiring the agency to include such
   23         medical director’s name on each nursing home
   24         facility’s online provider profile; requiring nursing
   25         home facilities to conduct biennial patient safety
   26         culture surveys; specifying requirements for
   27         administration of such surveys; requiring nursing home
   28         facilities to submit the results of such surveys
   29         biennially to the agency in a format specified by
   30         agency rule; authorizing nursing home facilities to
   31         develop an internal action plan between surveys to
   32         identify measures for improvement of the survey and
   33         submit such plan to the agency; amending s. 400.191,
   34         F.S.; requiring the agency to include the results from
   35         specified consumer satisfaction surveys as part of the
   36         Nursing Home Guide on its website; amending s.
   37         408.051, F.S.; requiring nursing home facilities that
   38         maintain certain electronic health records to make
   39         available certain data to the agency’s Florida Health
   40         Information Exchange program for a specified purpose;
   41         authorizing the agency to adopt rules; amending s.
   42         408.061, F.S.; exempting nursing homes operated by
   43         state agencies from certain financial reporting
   44         requirements; requiring the agency to impose
   45         administrative fines against nursing homes and home
   46         offices of nursing homes for failing to comply with
   47         certain reporting requirements; defining the term
   48         “violation”; providing construction; requiring the
   49         agency to adopt rules; providing requirements for such
   50         rules; amending s. 408.08, F.S.; prohibiting nursing
   51         homes subject to certain administrative fines from
   52         being fined under a specified provision for the same
   53         violation; amending s. 409.908, F.S.; requiring the
   54         agency to revise its methodology for calculating
   55         Quality Incentive Program payments; providing
   56         requirements for such revision; requiring the agency
   57         to submit an annual report to the Governor and the
   58         Legislature on payments made under the Quality
   59         Incentive Program; specifying requirements for the
   60         report; requiring the agency to contract with a third
   61         party vendor to conduct a comprehensive study of
   62         nursing home quality incentive programs in other
   63         states; providing minimum requirements for the report;
   64         requiring the agency to submit a final report on the
   65         study to the Governor and the Legislature by a
   66         specified date; providing an effective date.
   67          
   68  Be It Enacted by the Legislature of the State of Florida:
   69  
   70         Section 1. Notwithstanding the repeal of section 400.0225,
   71  Florida Statutes, in section 14 of chapter 2001-377, Laws of
   72  Florida, that section is revived, reenacted, and amended to
   73  read:
   74         400.0225 Consumer satisfaction surveys.—
   75         (1) The agency shall develop user-friendly consumer
   76  satisfaction surveys to capture resident and family member
   77  satisfaction with care provided by nursing home facilities. The
   78  consumer satisfaction surveys must be based on a core set of
   79  consumer satisfaction questions to allow for consistent
   80  measurement and must be administered annually to a random sample
   81  of long-stay and short-stay residents of each facility and their
   82  family members. The survey tool must be based on an agency
   83  validated survey instrument whose measures have received an
   84  endorsement by the National Quality Forum.
   85         (2)Family members, guardians, or other resident designees
   86  may assist a resident in completing the consumer satisfaction
   87  survey.
   88         (3)Employees and volunteers of the nursing home facility
   89  or of a corporation or business entity with an ownership
   90  interest in the nursing home facility are prohibited from
   91  attempting to influence a resident’s responses to the consumer
   92  satisfaction survey.
   93         (4)The agency shall specify the protocols for conducting
   94  the consumer satisfaction surveys, ensuring survey validity,
   95  reporting survey results, and protecting the identity of
   96  individual respondents. The agency shall make aggregated survey
   97  data available to consumers on the agency’s website pursuant to
   98  s. 400.191(2)(a)15. in a manner that allows for comparison
   99  between nursing home facilities, or its contractor, in
  100  consultation with the nursing home industry and consumer
  101  representatives, shall develop an easy-to-use consumer
  102  satisfaction survey, shall ensure that every nursing facility
  103  licensed pursuant to this part participates in assessing
  104  consumer satisfaction, and shall establish procedures to ensure
  105  that, at least annually, a representative sample of residents of
  106  each facility is selected to participate in the survey. The
  107  sample shall be of sufficient size to allow comparisons between
  108  and among facilities. Family members, guardians, or other
  109  resident designees may assist the resident in completing the
  110  survey. Employees and volunteers of the nursing facility or of a
  111  corporation or business entity with an ownership interest in the
  112  facility are prohibited from assisting a resident with or
  113  attempting to influence a resident’s responses to the consumer
  114  satisfaction survey. The agency, or its contractor, shall survey
  115  family members, guardians, or other resident designees. The
  116  agency, or its contractor, shall specify the protocol for
  117  conducting and reporting the consumer satisfaction surveys.
  118  Reports of consumer satisfaction surveys shall protect the
  119  identity of individual respondents. The agency shall contract
  120  for consumer satisfaction surveys and report the results of
  121  those surveys in the consumer information materials prepared and
  122  distributed by the agency.
  123         (5) The agency may adopt rules as necessary to implement
  124  administer this section.
  125         Section 2. Paragraph (b) of subsection (1) of section
  126  400.141, Florida Statutes, is amended, and paragraph (x) is
  127  added to that subsection, to read:
  128         400.141 Administration and management of nursing home
  129  facilities.—
  130         (1) Every licensed facility shall comply with all
  131  applicable standards and rules of the agency and shall:
  132         (b) Appoint a medical director licensed pursuant to chapter
  133  458 or chapter 459. By January 1, 2026, the medical director of
  134  each nursing home facility must obtain designation as a
  135  certified medical director by the American Medical Directors
  136  Association, hold a similar credential bestowed by an
  137  organization recognized by the agency, or be in the process of
  138  seeking such designation or credentialing, according to
  139  parameters adopted by agency rule. The agency shall include the
  140  name of each nursing home facility’s medical director on the
  141  facility’s provider profile published by the agency on its
  142  website. The agency may establish by rule more specific criteria
  143  for the appointment of a medical director.
  144         (x) Conduct, at least biennially, a patient safety culture
  145  survey using the applicable Survey on Patient Safety Culture
  146  developed by the federal Agency for Healthcare Research and
  147  Quality. Each facility shall conduct the survey anonymously to
  148  encourage completion of the survey by staff working in or
  149  employed by the facility. A facility may contract with a third
  150  party to administer the survey. Each facility shall biennially
  151  submit the survey data to the agency in a format specified by
  152  agency rule, which must include the survey participation rate.
  153  Each facility may develop an internal action plan between
  154  conducting surveys to identify measures to improve the survey
  155  and submit such plan to the agency.
  156         Section 3. Paragraph (a) of subsection (2) of section
  157  400.191, Florida Statutes, is amended to read:
  158         400.191 Availability, distribution, and posting of reports
  159  and records.—
  160         (2) The agency shall publish the Nursing Home Guide
  161  quarterly in electronic form to assist consumers and their
  162  families in comparing and evaluating nursing home facilities.
  163         (a) The agency shall provide an Internet site which must
  164  shall include at least the following information either directly
  165  or indirectly through a link to another established site or
  166  sites of the agency’s choosing:
  167         1. A section entitled “Have you considered programs that
  168  provide alternatives to nursing home care?” which must shall be
  169  the first section of the Nursing Home Guide and must which shall
  170  prominently display information about available alternatives to
  171  nursing homes and how to obtain additional information regarding
  172  these alternatives. The Nursing Home Guide must shall explain
  173  that this state offers alternative programs that allow permit
  174  qualified elderly persons to stay in their homes instead of
  175  being placed in nursing homes and must shall encourage
  176  interested persons to call the Comprehensive Assessment Review
  177  and Evaluation for Long-Term Care Services (CARES) Program to
  178  inquire as to whether if they qualify. The Nursing Home Guide
  179  must shall list available home and community-based programs and
  180  must which shall clearly state the services that are provided,
  181  including and indicate whether nursing home services are covered
  182  under those programs when necessary included if needed.
  183         2. A list by name and address of all nursing home
  184  facilities in this state, including any prior name by which a
  185  facility was known during the previous 24-month period.
  186         3. Whether such nursing home facilities are proprietary or
  187  nonproprietary.
  188         4. The current owner of the facility’s license and the year
  189  that that entity became the owner of the license.
  190         5. The name of the owner or owners of each facility and
  191  whether the facility is affiliated with a company or other
  192  organization owning or managing more than one nursing facility
  193  in this state.
  194         6. The total number of beds in each facility and the most
  195  recently available occupancy levels.
  196         7. The number of private and semiprivate rooms in each
  197  facility.
  198         8. The religious affiliation, if any, of each facility.
  199         9. The languages spoken by the administrator and staff of
  200  each facility.
  201         10. Whether or not each facility accepts Medicare or
  202  Medicaid recipients or insurance, health maintenance
  203  organization, United States Department of Veterans Affairs,
  204  CHAMPUS program, or workers’ compensation coverage.
  205         11. Recreational and other programs available at each
  206  facility.
  207         12. Special care units or programs offered at each
  208  facility.
  209         13. Whether the facility is a part of a retirement
  210  community that offers other services pursuant to part III of
  211  this chapter or part I or part III of chapter 429.
  212         14. Survey and deficiency information, including all
  213  federal and state recertification, licensure, revisit, and
  214  complaint survey information, for each facility. For
  215  noncertified nursing homes, state survey and deficiency
  216  information, including licensure, revisit, and complaint survey
  217  information, shall be provided.
  218         15. The results of consumer satisfaction surveys conducted
  219  pursuant to s. 400.0225.
  220         Section 4. Present subsections (6) and (7) of section
  221  408.051, Florida Statutes, are redesignated as subsections (7)
  222  and (8), respectively, and a new subsection (6) is added to that
  223  section, to read:
  224         408.051 Florida Electronic Health Records Exchange Act.—
  225         (6) NURSING HOME DATA.—A nursing home facility as defined
  226  in s. 400.021 which maintains certified electronic health record
  227  technology shall make available all admission, transfer, and
  228  discharge data to the agency’s Florida Health Information
  229  Exchange program for the purpose of supporting public health
  230  data registries and patient care coordination. The agency may
  231  adopt rules to implement this subsection.
  232         Section 5. Present subsections (7) through (15) of section
  233  408.061, Florida Statutes, are redesignated as subsections (8)
  234  through (16), respectively, a new subsection (7) is added to
  235  that section, and subsections (5) and (6) of that section are
  236  amended, to read:
  237         408.061 Data collection; uniform systems of financial
  238  reporting; information relating to physician charges;
  239  confidential information; immunity.—
  240         (5) Within 120 days after the end of its fiscal year, each
  241  nursing home as defined in s. 408.07, excluding nursing homes
  242  operated by state agencies, shall file with the agency, on forms
  243  adopted by the agency and based on the uniform system of
  244  financial reporting, its actual financial experience for that
  245  fiscal year, including expenditures, revenues, and statistical
  246  measures. Such data may be based on internal financial reports
  247  that are certified to be complete and accurate by the chief
  248  financial officer of the nursing home. However, a nursing home’s
  249  actual financial experience shall be its audited actual
  250  experience. This audited actual experience must include the
  251  fiscal year-end balance sheet, income statement, statement of
  252  cash flow, and statement of retained earnings and must be
  253  submitted to the agency in addition to the information filed in
  254  the uniform system of financial reporting. The financial
  255  statements must tie to the information submitted in the uniform
  256  system of financial reporting, and a crosswalk must be submitted
  257  along with the financial statements.
  258         (6) Within 120 days after the end of its fiscal year, the
  259  home office of each nursing home as defined in s. 408.07,
  260  excluding nursing homes operated by state agencies, shall file
  261  with the agency, on forms adopted by the agency and based on the
  262  uniform system of financial reporting, its actual financial
  263  experience for that fiscal year, including expenditures,
  264  revenues, and statistical measures. Such data may be based on
  265  internal financial reports that are certified to be complete and
  266  accurate by the chief financial officer of the nursing home.
  267  However, the home office’s actual financial experience shall be
  268  its audited actual experience. This audited actual experience
  269  must include the fiscal year-end balance sheet, income
  270  statement, statement of cash flow, and statement of retained
  271  earnings and must be submitted to the agency in addition to the
  272  information filed in the uniform system of financial reporting.
  273  The financial statements must tie to the information submitted
  274  in the uniform system of financial reporting, and a crosswalk
  275  must be submitted along with the audited financial statements.
  276         (7)(a)Beginning January 1, 2026, the agency shall impose
  277  an administrative fine of $10,000 per violation against a
  278  nursing home or home office that fails to comply with subsection
  279  (5) or subsection (6), as applicable. For purposes of this
  280  paragraph, the term “violation” means failing to file the
  281  financial report required by subsection (5) or subsection (6),
  282  as applicable, on or before the report’s due date. Failing to
  283  file the report during any subsequent 10-day period occurring
  284  after the due date constitutes a separate violation until the
  285  report has been submitted.
  286         (b) The agency shall adopt rules to implement this
  287  subsection. The rules must include provisions for a nursing home
  288  or home office to present factors in mitigation of the
  289  imposition of the fine’s full dollar amount. The agency may
  290  determine not to impose the fine’s full dollar amount upon a
  291  showing that the full fine is inappropriate under the
  292  circumstances.
  293         Section 6. Subsection (2) of section 408.08, Florida
  294  Statutes, is amended to read:
  295         408.08 Inspections and audits; violations; penalties;
  296  fines; enforcement.—
  297         (2) Any health care facility that refuses to file a report,
  298  fails to timely file a report, files a false report, or files an
  299  incomplete report and upon notification fails to timely file a
  300  complete report required under s. 408.061; that violates this
  301  section, s. 408.061, or s. 408.20, or rule adopted thereunder;
  302  or that fails to provide documents or records requested by the
  303  agency under this chapter shall be punished by a fine not
  304  exceeding $1,000 per day for each day in violation, to be
  305  imposed and collected by the agency. Pursuant to rules adopted
  306  by the agency, the agency may, upon a showing of good cause,
  307  grant a one-time extension of any deadline for a health care
  308  facility to timely file a report as required by this section, s.
  309  408.061, or s. 408.20. A facility fined under s. 408.061(7) may
  310  not be additionally fined under this subsection for the same
  311  violation.
  312         Section 7. Paragraph (b) of subsection (2) of section
  313  409.908, Florida Statutes, is amended to read:
  314         409.908 Reimbursement of Medicaid providers.—Subject to
  315  specific appropriations, the agency shall reimburse Medicaid
  316  providers, in accordance with state and federal law, according
  317  to methodologies set forth in the rules of the agency and in
  318  policy manuals and handbooks incorporated by reference therein.
  319  These methodologies may include fee schedules, reimbursement
  320  methods based on cost reporting, negotiated fees, competitive
  321  bidding pursuant to s. 287.057, and other mechanisms the agency
  322  considers efficient and effective for purchasing services or
  323  goods on behalf of recipients. If a provider is reimbursed based
  324  on cost reporting and submits a cost report late and that cost
  325  report would have been used to set a lower reimbursement rate
  326  for a rate semester, then the provider’s rate for that semester
  327  shall be retroactively calculated using the new cost report, and
  328  full payment at the recalculated rate shall be effected
  329  retroactively. Medicare-granted extensions for filing cost
  330  reports, if applicable, shall also apply to Medicaid cost
  331  reports. Payment for Medicaid compensable services made on
  332  behalf of Medicaid-eligible persons is subject to the
  333  availability of moneys and any limitations or directions
  334  provided for in the General Appropriations Act or chapter 216.
  335  Further, nothing in this section shall be construed to prevent
  336  or limit the agency from adjusting fees, reimbursement rates,
  337  lengths of stay, number of visits, or number of services, or
  338  making any other adjustments necessary to comply with the
  339  availability of moneys and any limitations or directions
  340  provided for in the General Appropriations Act, provided the
  341  adjustment is consistent with legislative intent.
  342         (2)
  343         (b) Subject to any limitations or directions in the General
  344  Appropriations Act, the agency shall establish and implement a
  345  state Title XIX Long-Term Care Reimbursement Plan for nursing
  346  home care in order to provide care and services in conformance
  347  with the applicable state and federal laws, rules, regulations,
  348  and quality and safety standards and to ensure that individuals
  349  eligible for medical assistance have reasonable geographic
  350  access to such care.
  351         1. The agency shall amend the long-term care reimbursement
  352  plan and cost reporting system to create direct care and
  353  indirect care subcomponents of the patient care component of the
  354  per diem rate. These two subcomponents together shall equal the
  355  patient care component of the per diem rate. Separate prices
  356  shall be calculated for each patient care subcomponent,
  357  initially based on the September 2016 rate setting cost reports
  358  and subsequently based on the most recently audited cost report
  359  used during a rebasing year. The direct care subcomponent of the
  360  per diem rate for any providers still being reimbursed on a cost
  361  basis shall be limited by the cost-based class ceiling, and the
  362  indirect care subcomponent may be limited by the lower of the
  363  cost-based class ceiling, the target rate class ceiling, or the
  364  individual provider target. The ceilings and targets apply only
  365  to providers being reimbursed on a cost-based system. Effective
  366  October 1, 2018, a prospective payment methodology shall be
  367  implemented for rate setting purposes with the following
  368  parameters:
  369         a. Peer Groups, including:
  370         (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
  371  Counties; and
  372         (II) South-SMMC Regions 10-11, plus Palm Beach and
  373  Okeechobee Counties.
  374         b. Percentage of Median Costs based on the cost reports
  375  used for September 2016 rate setting:
  376         (I) Direct Care Costs........................100 percent.
  377         (II) Indirect Care Costs......................92 percent.
  378         (III) Operating Costs.........................86 percent.
  379         c. Floors:
  380         (I) Direct Care Component.....................95 percent.
  381         (II) Indirect Care Component................92.5 percent.
  382         (III) Operating Component...........................None.
  383         d. Pass-through Payments..................Real Estate and
  384  ...............................................Personal Property
  385  ...................................Taxes and Property Insurance.
  386         e. Quality Incentive Program Payment
  387  Pool.....................................10 percent of September
  388  .......................................2016 non-property related
  389  ................................payments of included facilities.
  390         f. Quality Score Threshold to Qualify Quality for Quality
  391  Incentive Payment...........................................20th
  392  ..............................percentile of included facilities.
  393         g. Fair Rental Value System Payment Parameters:
  394         (I) Building Value per Square Foot based on 2018 RS Means.
  395         (II) Land Valuation...10 percent of Gross Building value.
  396         (III) Facility Square Footage......Actual Square Footage.
  397         (IV) Movable Equipment Allowance..........$8,000 per bed.
  398         (V) Obsolescence Factor......................1.5 percent.
  399         (VI) Fair Rental Rate of Return................8 percent.
  400         (VII) Minimum Occupancy.......................90 percent.
  401         (VIII) Maximum Facility Age.....................40 years.
  402         (IX) Minimum Square Footage per Bed..................350.
  403         (X) Maximum Square Footage for Bed...................500.
  404         (XI) Minimum Cost of a renovation/replacements$500 per bed.
  405         h. Ventilator Supplemental payment of $200 per Medicaid day
  406  of 40,000 ventilator Medicaid days per fiscal year.
  407         2. The agency shall revise its methodology for calculating
  408  Quality Incentive Program payments to include the results of
  409  consumer satisfaction surveys conducted pursuant to s. 400.0225
  410  as a measure of nursing home quality. The agency shall so revise
  411  the methodology after the surveys have been in effect for an
  412  amount of time the agency deems sufficient for statistical and
  413  scientific validity as a meaningful quality measure that may be
  414  incorporated into the methodology.
  415         3. The direct care subcomponent shall include salaries and
  416  benefits of direct care staff providing nursing services
  417  including registered nurses, licensed practical nurses, and
  418  certified nursing assistants who deliver care directly to
  419  residents in the nursing home facility, allowable therapy costs,
  420  and dietary costs. This excludes nursing administration, staff
  421  development, the staffing coordinator, and the administrative
  422  portion of the minimum data set and care plan coordinators. The
  423  direct care subcomponent also includes medically necessary
  424  dental care, vision care, hearing care, and podiatric care.
  425         4.3. All other patient care costs shall be included in the
  426  indirect care cost subcomponent of the patient care per diem
  427  rate, including complex medical equipment, medical supplies, and
  428  other allowable ancillary costs. Costs may not be allocated
  429  directly or indirectly to the direct care subcomponent from a
  430  home office or management company.
  431         5.4. On July 1 of each year, the agency shall report to the
  432  Legislature direct and indirect care costs, including average
  433  direct and indirect care costs per resident per facility and
  434  direct care and indirect care salaries and benefits per category
  435  of staff member per facility.
  436         6.5. Every fourth year, the agency shall rebase nursing
  437  home prospective payment rates to reflect changes in cost based
  438  on the most recently audited cost report for each participating
  439  provider.
  440         7.6. A direct care supplemental payment may be made to
  441  providers whose direct care hours per patient day are above the
  442  80th percentile and who provide Medicaid services to a larger
  443  percentage of Medicaid patients than the state average.
  444         8.7. Pediatric, Florida Department of Veterans Affairs, and
  445  government-owned facilities are exempt from the pricing model
  446  established in this subsection and shall remain on a cost-based
  447  prospective payment system. Effective October 1, 2018, the
  448  agency shall set rates for all facilities remaining on a cost
  449  based prospective payment system using each facility’s most
  450  recently audited cost report, eliminating retroactive
  451  settlements.
  452         9.By October 1, 2025, and each year thereafter, the agency
  453  shall submit to the Governor, the President of the Senate, and
  454  the Speaker of the House of Representatives a report on each
  455  Quality Incentive Program payment made pursuant to sub
  456  subparagraph 1.e. The report must, at a minimum, include all of
  457  the following information:
  458         a.The name of each facility that received a Quality
  459  Incentive Program payment and the dollar amount of such payment
  460  each facility received.
  461         b.The total number of quality incentive metric points
  462  awarded by the agency to each facility and the number of points
  463  awarded by the agency for each individual quality metric
  464  measured.
  465         c.An examination of any trends in the improvement of the
  466  quality of care provided to nursing home residents which may be
  467  attributable to incentive payments received under the Quality
  468  Incentive Program. The agency shall include examination of
  469  trends both for the program as a whole as well as for each
  470  individual quality metric used by the agency to award program
  471  payments.
  472  
  473  It is the intent of the Legislature that the reimbursement plan
  474  achieve the goal of providing access to health care for nursing
  475  home residents who require large amounts of care while
  476  encouraging diversion services as an alternative to nursing home
  477  care for residents who can be served within the community. The
  478  agency shall base the establishment of any maximum rate of
  479  payment, whether overall or component, on the available moneys
  480  as provided for in the General Appropriations Act. The agency
  481  may base the maximum rate of payment on the results of
  482  scientifically valid analysis and conclusions derived from
  483  objective statistical data pertinent to the particular maximum
  484  rate of payment. The agency shall base the rates of payments in
  485  accordance with the minimum wage requirements as provided in the
  486  General Appropriations Act.
  487         Section 8. (1)To support and enhance quality outcomes in
  488  Florida’s nursing homes, the Agency for Health Care
  489  Administration shall contract with a third-party vendor to
  490  conduct a comprehensive study of nursing home quality incentive
  491  programs in other states.
  492         (a)At a minimum, the study must include a detailed
  493  analysis of quality incentive programs implemented in each of
  494  the states examined, identify components of such programs which
  495  have demonstrably improved nursing home quality outcomes, and
  496  provide recommendations to modify or enhance this state’s
  497  existing Medicaid Quality Incentive Program based on its
  498  historical performance and trends since it was first
  499  implemented.
  500         (b)The study must also include:
  501         1.An in-depth review of emerging and existing technologies
  502  applicable to nursing home care and an analysis of how their
  503  adoption in this state could improve quality of care and
  504  operational efficiency; and
  505         2.An examination of other states’ Medicaid add-on payment
  506  structures related to the provision of ventilator care,
  507  bariatric services, and behavioral health services.
  508         (2)The agency shall submit a final report on the study,
  509  including findings and actionable recommendations, to the
  510  Governor, the President of the Senate, and the Speaker of the
  511  House of Representatives by December 1, 2025.
  512         Section 9. This act shall take effect July 1, 2025.