The Florida Senate

430.705  Implementation of the long-term care community diversion pilot projects.--

(1)  In designing and implementing the community diversion pilot projects, the department shall work in consultation with the agency.

(2)  The department shall select projects whose design and providers demonstrate capacity to maximize the placement of participants in the least restrictive appropriate care setting. The department shall select providers that have a plan administrator who is dedicated to the diversion pilot project and project staff who perform the necessary project administrative functions, including data collection, reporting, and analysis. The department shall select providers that:

(a)  Are determined by the Department of Financial Services to:

1.  Meet surplus requirements specified in s. 641.225;

2.  Demonstrate the ability to comply with the standards for financial solvency specified in s. 641.285;

3.  Demonstrate the ability to provide for the prompt payment of claims as specified in s. 641.3155; and

4.  Demonstrate the ability to provide technology with the capability for data collection that meets the security requirements of the federal Health Insurance Portability and Accountability Act of 1996, 42 C.F.R. ss. 160 and 164.

(b)  Demonstrate the ability to contract with multiple providers that provide the same type of service.

(3)  The agency shall seek federal waivers necessary to place a cap on the number of diversion pilot project providers in each geographic area.

(4)  Pursuant to 42 C.F.R. s. 438.6(c), the agency, in consultation with the department, shall annually reevaluate and recertify the capitation rates for the diversion pilot projects. The agency, in consultation with the department, shall secure the utilization and cost data for Medicaid and Medicare beneficiaries served by the program which shall be used in developing rates for the diversion pilot projects.

(5)  In order to achieve rapid enrollment into the program and efficient diversion of applicants from nursing home care, the department and the agency shall allow enrollment of Medicaid beneficiaries on the date that eligibility for the community diversion pilot project is approved. The provider shall receive a prorated capitated rate for those enrollees who are enrolled after the first of each month.

(6)  The department shall provide to prospective participants a choice of participating in a community diversion pilot project or any other appropriate placement available. To the extent possible, individuals shall be allowed to choose their care providers, including long-term care service providers affiliated with an individual's religious faith or denomination.

(7)  The department shall enroll participants. Providers shall not directly enroll participants in community diversion pilot projects.

(8)  The department may require participants to contribute to their cost of care in an amount not to exceed the cost-sharing required of Medicaid-eligible nursing home residents.

(9)  Community diversion pilot projects must:

(a)  Provide services for participants that are of sufficient quality, quantity, type, and duration to prevent or delay nursing facility placement.

(b)  Integrate acute and long-term care services, and the funding sources for such services, as feasible.

(c)  Encourage individuals, families, and communities to plan for their long-term care needs.

(d)  Provide skilled and intermediate nursing facility care for participants who cannot be adequately cared for in noninstitutional settings.

History.--s. 5, ch. 97-87; s. 1, ch. 98-184; s. 12, ch. 2004-386.