November 14, 2019
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HB 5301

1
A bill to be entitled
2An act relating to Medicaid services; amending s. 400.141,
3F.S.; conforming a cross-reference to changes made by the
4act; amending s. 400.179, F.S.; revising requirements for
5nursing home lease bond alternative fees; amending s.
6400.23, F.S.; providing for flexibility in how to meet the
7minimum staffing requirements for nursing home facilities;
8amending s. 409.904, F.S.; revising the expiration date of
9provisions authorizing the federal waiver for certain
10persons age 65 and over or who have a disability; revising
11the expiration date of provisions authorizing a specified
12medically needy program; amending s. 409.905, F.S.;
13authorizing the Agency for Health Care Administration to
14develop and implement a program to reduce hospital
15readmissions for a certain population in certain areas of
16the state; amending s. 409.907, F.S.; authorizing the
17agency to enroll entities as Medicare crossover-only
18providers for payment and claims processing purposes only;
19specifying requirements for Medicare crossover-only
20agreements; amending s. 409.908, F.S.; providing penalties
21for providers that fail to report suspension or
22disenrollment from Medicare within a specified time;
23amending s. 409.9082, F.S.; revising the purpose of the
24use of the nursing home facility quality assessment and
25federal matching funds; amending s. 409.9083, F.S.;
26revising the purpose of the use of the privately operated
27intermediate care facilities for the developmentally
28disabled quality assessment and federal matching funds;
29amending s. 409.911, F.S.; continuing the audited data
30specified for use in calculating disproportionate share;
31revising the formula used to pay disproportionate share
32dollars to provider service network hospitals; amending s.
33409.9112, F.S.; continuing the prohibition against
34distributing moneys under the perinatal intensive care
35centers disproportionate share program; amending s.
36409.9113, F.S.; continuing authorization for the
37distribution of moneys to teaching hospitals under the
38disproportionate share program; amending s. 409.9117,
39F.S.; continuing the prohibition against distributing
40moneys under the primary care disproportionate share
41program; authorizing the agency to contract with an
42organization to provide certain benefits under a federal
43program in Polk, Highlands, Hardee, and Hillsborough
44Counties; providing an exemption from ch. 641, F.S., for
45the organization; authorizing, subject to appropriation,
46enrollment slots for the Program of All-inclusive Care for
47the Elderly in Polk, Highlands, and Hardee Counties;
48authorizing the agency, subject to appropriation and
49federal approval of an expansion application, to contract
50with an Organized Health Care Delivery System in Miami-
51Dade County to provide certain benefits under a federal
52program; providing an exemption from ch. 641, F.S., for
53the Organized Health Care Delivery System; authorizing,
54subject to appropriation, enrollment slots for the Program
55of All-inclusive Care for the Elderly in Southwest Miami-
56Dade County; providing an effective date.
57
58Be It Enacted by the Legislature of the State of Florida:
59
60     Section 1.  Paragraph (o) of subsection (1) of section
61400.141, Florida Statutes, is amended to read:
62     400.141  Administration and management of nursing home
63facilities.-
64     (1)  Every licensed facility shall comply with all
65applicable standards and rules of the agency and shall:
66     (o)1.  Submit semiannually to the agency, or more
67frequently if requested by the agency, information regarding
68facility staff-to-resident ratios, staff turnover, and staff
69stability, including information regarding certified nursing
70assistants, licensed nurses, the director of nursing, and the
71facility administrator. For purposes of this reporting:
72     a.  Staff-to-resident ratios must be reported in the
73categories specified in s. 400.23(3)(a) and applicable rules.
74The ratio must be reported as an average for the most recent
75calendar quarter.
76     b.  Staff turnover must be reported for the most recent 12-
77month period ending on the last workday of the most recent
78calendar quarter prior to the date the information is submitted.
79The turnover rate must be computed quarterly, with the annual
80rate being the cumulative sum of the quarterly rates. The
81turnover rate is the total number of terminations or separations
82experienced during the quarter, excluding any employee
83terminated during a probationary period of 3 months or less,
84divided by the total number of staff employed at the end of the
85period for which the rate is computed, and expressed as a
86percentage.
87     c.  The formula for determining staff stability is the
88total number of employees that have been employed for more than
8912 months, divided by the total number of employees employed at
90the end of the most recent calendar quarter, and expressed as a
91percentage.
92     d.  A nursing facility that has failed to comply with state
93minimum-staffing requirements for 2 consecutive days is
94prohibited from accepting new admissions until the facility has
95achieved the minimum-staffing requirements for a period of 6
96consecutive days. For the purposes of this sub-subparagraph, any
97person who was a resident of the facility and was absent from
98the facility for the purpose of receiving medical care at a
99separate location or was on a leave of absence is not considered
100a new admission. Failure to impose such an admissions moratorium
101constitutes a class II deficiency.
102     e.  A nursing facility which does not have a conditional
103license may be cited for failure to comply with the standards in
104s. 400.23(3)(a)1.b. and c. s. 400.23(3)(a)1.a. only if it has
105failed to meet those standards on 2 consecutive days or if it
106has failed to meet at least 97 percent of those standards on any
107one day.
108     f.  A facility which has a conditional license must be in
109compliance with the standards in s. 400.23(3)(a) at all times.
110     2.  This paragraph does not limit the agency's ability to
111impose a deficiency or take other actions if a facility does not
112have enough staff to meet the residents' needs.
113     Section 2.  Paragraph (d) of subsection (2) of section
114400.179, Florida Statutes, is amended to read:
115     400.179  Liability for Medicaid underpayments and
116overpayments.-
117     (2)  Because any transfer of a nursing facility may expose
118the fact that Medicaid may have underpaid or overpaid the
119transferor, and because in most instances, any such underpayment
120or overpayment can only be determined following a formal field
121audit, the liabilities for any such underpayments or
122overpayments shall be as follows:
123     (d)  Where the transfer involves a facility that has been
124leased by the transferor:
125     1.  The transferee shall, as a condition to being issued a
126license by the agency, acquire, maintain, and provide proof to
127the agency of a bond with a term of 30 months, renewable
128annually, in an amount not less than the total of 3 months'
129Medicaid payments to the facility computed on the basis of the
130preceding 12-month average Medicaid payments to the facility.
131     2.  A leasehold licensee may meet the requirements of
132subparagraph 1. by payment of a nonrefundable fee, paid at
133initial licensure, paid at the time of any subsequent change of
134ownership, and paid annually thereafter, in the amount of 1
135percent of the total of 3 months' Medicaid payments to the
136facility computed on the basis of the preceding 12-month average
137Medicaid payments to the facility. If a preceding 12-month
138average is not available, projected Medicaid payments may be
139used. The fee shall be deposited into the Grants and Donations
140Trust Fund and shall be accounted for separately as a Medicaid
141nursing home overpayment account. These fees shall be used at
142the sole discretion of the agency to repay nursing home Medicaid
143overpayments. Payment of this fee shall not release the licensee
144from any liability for any Medicaid overpayments, nor shall
145payment bar the agency from seeking to recoup overpayments from
146the licensee and any other liable party. As a condition of
147exercising this lease bond alternative, licensees paying this
148fee must maintain an existing lease bond through the end of the
14930-month term period of that bond. The agency is herein granted
150specific authority to promulgate all rules pertaining to the
151administration and management of this account, including
152withdrawals from the account, subject to federal review and
153approval. This provision shall take effect upon becoming law and
154shall apply to any leasehold license application. The financial
155viability of the Medicaid nursing home overpayment account shall
156be determined by the agency through annual review of the account
157balance and the amount of total outstanding, unpaid Medicaid
158overpayments owing from leasehold licensees to the agency as
159determined by final agency audits. By March 31 of each year, the
160agency shall assess the cumulative fees collected under this
161subparagraph, minus any amounts used to repay nursing home
162Medicaid overpayments and amounts transferred to contribute to
163the General Revenue Fund pursuant to s. 215.20. If the net
164cumulative collections, minus amounts utilized to repay nursing
165home Medicaid overpayments, exceed $25 million, the provisions
166of this subparagraph shall not apply for the subsequent fiscal
167year.
168     3.  The leasehold licensee may meet the bond requirement
169through other arrangements acceptable to the agency. The agency
170is herein granted specific authority to promulgate rules
171pertaining to lease bond arrangements.
172     4.  All existing nursing facility licensees, operating the
173facility as a leasehold, shall acquire, maintain, and provide
174proof to the agency of the 30-month bond required in
175subparagraph 1., above, on and after July 1, 1993, for each
176license renewal.
177     5.  It shall be the responsibility of all nursing facility
178operators, operating the facility as a leasehold, to renew the
17930-month bond and to provide proof of such renewal to the agency
180annually.
181     6.  Any failure of the nursing facility operator to
182acquire, maintain, renew annually, or provide proof to the
183agency shall be grounds for the agency to deny, revoke, and
184suspend the facility license to operate such facility and to
185take any further action, including, but not limited to,
186enjoining the facility, asserting a moratorium pursuant to part
187II of chapter 408, or applying for a receiver, deemed necessary
188to ensure compliance with this section and to safeguard and
189protect the health, safety, and welfare of the facility's
190residents. A lease agreement required as a condition of bond
191financing or refinancing under s. 154.213 by a health facilities
192authority or required under s. 159.30 by a county or
193municipality is not a leasehold for purposes of this paragraph
194and is not subject to the bond requirement of this paragraph.
195     Section 3.  Paragraph (a) of subsection (3) of section
196400.23, Florida Statutes, is amended to read:
197     400.23  Rules; evaluation and deficiencies; licensure
198status.-
199     (3)(a)1.  The agency shall adopt rules providing minimum
200staffing requirements for nursing homes. These requirements
201shall include, for each nursing home facility:
202     a.  A minimum weekly average of certified nursing assistant
203and licensed nursing staffing combined of 3.9 hours of direct
204care per resident per day. As used in this sub-subparagraph, a
205week is defined as Sunday through Saturday.
206     b.  A minimum certified nursing assistant staffing of 2.7
207hours of direct care per resident per day. A facility may not
208staff below one certified nursing assistant per 20 residents.
209     c.  A minimum licensed nursing staffing of 1.0 hour of
210direct care per resident per day. A facility may not staff below
211one licensed nurse per 40 residents.
212     a.  A minimum certified nursing assistant staffing of 2.6
213hours of direct care per resident per day beginning January 1,
2142003, and increasing to 2.7 hours of direct care per resident
215per day beginning January 1, 2007. Beginning January 1, 2002, no
216facility shall staff below one certified nursing assistant per
21720 residents, and a minimum licensed nursing staffing of 1.0
218hour of direct care per resident per day but never below one
219licensed nurse per 40 residents.
220     b.  Beginning January 1, 2007, a minimum weekly average
221certified nursing assistant staffing of 2.9 hours of direct care
222per resident per day. For the purpose of this sub-subparagraph,
223a week is defined as Sunday through Saturday.
224     2.  Nursing assistants employed under s. 400.211(2) may be
225included in computing the staffing ratio for certified nursing
226assistants only if their job responsibilities include only
227nursing-assistant-related duties.
228     3.  Each nursing home must document compliance with
229staffing standards as required under this paragraph and post
230daily the names of staff on duty for the benefit of facility
231residents and the public.
232     4.  The agency shall recognize the use of licensed nurses
233for compliance with minimum staffing requirements for certified
234nursing assistants, provided that the facility otherwise meets
235the minimum staffing requirements for licensed nurses and that
236the licensed nurses are performing the duties of a certified
237nursing assistant. Unless otherwise approved by the agency,
238licensed nurses counted toward the minimum staffing requirements
239for certified nursing assistants must exclusively perform the
240duties of a certified nursing assistant for the entire shift and
241not also be counted toward the minimum staffing requirements for
242licensed nurses. If the agency approved a facility's request to
243use a licensed nurse to perform both licensed nursing and
244certified nursing assistant duties, the facility must allocate
245the amount of staff time specifically spent on certified nursing
246assistant duties for the purpose of documenting compliance with
247minimum staffing requirements for certified and licensed nursing
248staff. In no event may the hours of a licensed nurse with dual
249job responsibilities be counted twice.
250     Section 4.  Subsections (1) and (2) of section 409.904,
251Florida Statutes, are amended to read:
252     409.904  Optional payments for eligible persons.-The agency
253may make payments for medical assistance and related services on
254behalf of the following persons who are determined to be
255eligible subject to the income, assets, and categorical
256eligibility tests set forth in federal and state law. Payment on
257behalf of these Medicaid eligible persons is subject to the
258availability of moneys and any limitations established by the
259General Appropriations Act or chapter 216.
260     (1)  Effective January 1, 2006, and subject to federal
261waiver approval, a person who is age 65 or older or is
262determined to be disabled, whose income is at or below 88
263percent of the federal poverty level, whose assets do not exceed
264established limitations, and who is not eligible for Medicare
265or, if eligible for Medicare, is also eligible for and receiving
266Medicaid-covered institutional care services, hospice services,
267or home and community-based services. The agency shall seek
268federal authorization through a waiver to provide this coverage.
269This subsection expires June 30, 2011 December 31, 2010.
270     (2)(a)  A family, a pregnant woman, a child under age 21, a
271person age 65 or over, or a blind or disabled person, who would
272be eligible under any group listed in s. 409.903(1), (2), or
273(3), except that the income or assets of such family or person
274exceed established limitations. For a family or person in one of
275these coverage groups, medical expenses are deductible from
276income in accordance with federal requirements in order to make
277a determination of eligibility. A family or person eligible
278under the coverage known as the "medically needy," is eligible
279to receive the same services as other Medicaid recipients, with
280the exception of services in skilled nursing facilities and
281intermediate care facilities for the developmentally disabled.
282This paragraph expires June 30, 2011 December 31, 2010.
283     (b)  Effective July 1, 2011 January 1, 2011, a pregnant
284woman or a child younger than 21 years of age who would be
285eligible under any group listed in s. 409.903, except that the
286income or assets of such group exceed established limitations.
287For a person in one of these coverage groups, medical expenses
288are deductible from income in accordance with federal
289requirements in order to make a determination of eligibility. A
290person eligible under the coverage known as the "medically
291needy" is eligible to receive the same services as other
292Medicaid recipients, with the exception of services in skilled
293nursing facilities and intermediate care facilities for the
294developmentally disabled.
295     Section 5.  Paragraph (f) is added to subsection (5) of
296section 409.905, Florida Statutes, to read:
297     409.905  Mandatory Medicaid services.-The agency may make
298payments for the following services, which are required of the
299state by Title XIX of the Social Security Act, furnished by
300Medicaid providers to recipients who are determined to be
301eligible on the dates on which the services were provided. Any
302service under this section shall be provided only when medically
303necessary and in accordance with state and federal law.
304Mandatory services rendered by providers in mobile units to
305Medicaid recipients may be restricted by the agency. Nothing in
306this section shall be construed to prevent or limit the agency
307from adjusting fees, reimbursement rates, lengths of stay,
308number of visits, number of services, or any other adjustments
309necessary to comply with the availability of moneys and any
310limitations or directions provided for in the General
311Appropriations Act or chapter 216.
312     (5)  HOSPITAL INPATIENT SERVICES.-The agency shall pay for
313all covered services provided for the medical care and treatment
314of a recipient who is admitted as an inpatient by a licensed
315physician or dentist to a hospital licensed under part I of
316chapter 395. However, the agency shall limit the payment for
317inpatient hospital services for a Medicaid recipient 21 years of
318age or older to 45 days or the number of days necessary to
319comply with the General Appropriations Act.
320     (f)  The agency may develop and implement a program to
321reduce the number of hospital readmissions among the non-
322Medicare population eligible in areas 9, 10, and 11.
323     Section 6.  Paragraphs (d) and (e) are added to subsection
324(5) of section 409.907, Florida Statutes, to read:
325     409.907  Medicaid provider agreements.-The agency may make
326payments for medical assistance and related services rendered to
327Medicaid recipients only to an individual or entity who has a
328provider agreement in effect with the agency, who is performing
329services or supplying goods in accordance with federal, state,
330and local law, and who agrees that no person shall, on the
331grounds of handicap, race, color, or national origin, or for any
332other reason, be subjected to discrimination under any program
333or activity for which the provider receives payment from the
334agency.
335     (5)  The agency:
336     (d)  May enroll entities as Medicare crossover-only
337providers for payment and claims processing purposes only. The
338provider agreement shall:
339     1.  Require that the provider be able to demonstrate to the
340satisfaction of the agency that the provider is an eligible
341Medicare provider and has a current provider agreement in place
342with the Centers for Medicare and Medicaid Services.
343     2.  Require the provider to notify the agency immediately
344in writing upon being suspended or disenrolled as a Medicare
345provider. If the provider does not provide such notification
346within 5 business days after suspension or disenrollment,
347sanctions may be imposed pursuant to this chapter and the
348provider may be required to return funds paid to the provider
349during the period of time that the provider was suspended or
350disenrolled as a Medicare provider.
351     3.  Require that all records pertaining to health care
352services provided to each of the provider's recipients be kept
353for a minimum of 6 years. The agreement shall also require that
354records and any information relating to payments claimed by the
355provider for services under the agreement be delivered to the
356agency or the Office of the Attorney General Medicaid Fraud
357Control Unit when requested. If a provider does not provide such
358records and information when requested, sanctions may be imposed
359pursuant to this chapter.
360     4.  Disclose that the agreement is for the purposes of
361paying and processing Medicare crossover claims only.
362
363This paragraph pertains solely to Medicare crossover-only
364providers. In order to become a standard Medicaid provider, the
365requirements of this section and applicable rules must be met.
366     (e)  Providers that are required to post a surety bond as
367part of the Medicaid enrollment process are excluded for
368enrollment under paragraph (d).
369     Section 7.  Subsection (24) is added to section 409.908,
370Florida Statutes, to read:
371     409.908  Reimbursement of Medicaid providers.-Subject to
372specific appropriations, the agency shall reimburse Medicaid
373providers, in accordance with state and federal law, according
374to methodologies set forth in the rules of the agency and in
375policy manuals and handbooks incorporated by reference therein.
376These methodologies may include fee schedules, reimbursement
377methods based on cost reporting, negotiated fees, competitive
378bidding pursuant to s. 287.057, and other mechanisms the agency
379considers efficient and effective for purchasing services or
380goods on behalf of recipients. If a provider is reimbursed based
381on cost reporting and submits a cost report late and that cost
382report would have been used to set a lower reimbursement rate
383for a rate semester, then the provider's rate for that semester
384shall be retroactively calculated using the new cost report, and
385full payment at the recalculated rate shall be effected
386retroactively. Medicare-granted extensions for filing cost
387reports, if applicable, shall also apply to Medicaid cost
388reports. Payment for Medicaid compensable services made on
389behalf of Medicaid eligible persons is subject to the
390availability of moneys and any limitations or directions
391provided for in the General Appropriations Act or chapter 216.
392Further, nothing in this section shall be construed to prevent
393or limit the agency from adjusting fees, reimbursement rates,
394lengths of stay, number of visits, or number of services, or
395making any other adjustments necessary to comply with the
396availability of moneys and any limitations or directions
397provided for in the General Appropriations Act, provided the
398adjustment is consistent with legislative intent.
399     (24)  If a provider fails to notify the agency within 5
400business days after suspension or disenrollment from Medicare,
401sanctions may be imposed pursuant to this chapter and the
402provider may be required to return funds paid to the provider
403during the period of time that the provider was suspended or
404disenrolled as a Medicare provider.
405     Section 8.  Subsection (4) of section 409.9082, Florida
406Statutes, is amended to read:
407     409.9082  Quality assessment on nursing home facility
408providers; exemptions; purpose; federal approval required;
409remedies.-
410     (4)  The purpose of the nursing home facility quality
411assessment is to ensure continued quality of care. Collected
412assessment funds shall be used to obtain federal financial
413participation through the Medicaid program to make Medicaid
414payments for nursing home facility services up to the amount of
415nursing home facility Medicaid rates as calculated in accordance
416with the approved state Medicaid plan in effect on December 31,
4172007. The quality assessment and federal matching funds shall be
418used exclusively for the following purposes and in the following
419order of priority:
420     (a)  To reimburse the Medicaid share of the quality
421assessment as a pass-through, Medicaid-allowable cost;
422     (b)  To increase to each nursing home facility's Medicaid
423rate, as needed, an amount that restores the rate reductions
424effective on or after implemented January 1, 2008, as provided
425in the General Appropriations Act; January 1, 2009; and March 1,
4262009; and
427     (c)  To increase to each nursing home facility's Medicaid
428rate, as needed, an amount that restores any rate reductions for
429the 2009-2010 fiscal year; and
430     (c)(d)  To increase each nursing home facility's Medicaid
431rate that accounts for the portion of the total assessment not
432included in paragraphs (a) and (b) (a)-(c) which begins a phase-
433in to a pricing model for the operating cost component.
434     Section 9.  Subsection (3) of section 409.9083, Florida
435Statutes, is amended to read:
436     409.9083  Quality assessment on privately operated
437intermediate care facilities for the developmentally disabled;
438exemptions; purpose; federal approval required; remedies.-
439     (3)  The purpose of the facility quality assessment is to
440ensure continued quality of care. Collected assessment funds
441shall be used to obtain federal financial participation through
442the Medicaid program to make Medicaid payments for ICF/DD
443services up to the amount of the Medicaid rates for such
444facilities as calculated in accordance with the approved state
445Medicaid plan in effect on April 1, 2008. The quality assessment
446and federal matching funds shall be used exclusively for the
447following purposes and in the following order of priority to:
448     (a)  Reimburse the Medicaid share of the quality assessment
449as a pass-through, Medicaid-allowable cost.
450     (b)  Increase each privately operated ICF/DD Medicaid rate,
451as needed, by an amount that restores the rate reductions
452effective on or after implemented on October 1, 2008, as
453provided in the General Appropriations Act.
454     (c)  Increase each ICF/DD Medicaid rate, as needed, by an
455amount that restores any rate reductions for the 2008-2009
456fiscal year and the 2009-2010 fiscal year.
457     (c)(d)  Increase payments to such facilities to fund
458covered services to Medicaid beneficiaries.
459     Section 10.  Paragraph (a) of subsection (2) and subsection
460(5) of section 409.911, Florida Statutes, are amended to read:
461     409.911  Disproportionate share program.-Subject to
462specific allocations established within the General
463Appropriations Act and any limitations established pursuant to
464chapter 216, the agency shall distribute, pursuant to this
465section, moneys to hospitals providing a disproportionate share
466of Medicaid or charity care services by making quarterly
467Medicaid payments as required. Notwithstanding the provisions of
468s. 409.915, counties are exempt from contributing toward the
469cost of this special reimbursement for hospitals serving a
470disproportionate share of low-income patients.
471     (2)  The Agency for Health Care Administration shall use
472the following actual audited data to determine the Medicaid days
473and charity care to be used in calculating the disproportionate
474share payment:
475     (a)  The average of the 2003, 2004, and 2005 audited
476disproportionate share data to determine each hospital's
477Medicaid days and charity care for the 2010-2011 2009-2010 state
478fiscal year.
479     (5)  The following formula shall be used to pay
480disproportionate share dollars to provider service network (PSN)
481hospitals:
482
DSHP = TAAPSNH x (IHPSND/THPSND IHPSND x THPSND)
483Where:
484     DSHP = Disproportionate share hospital payments.
485     TAAPSNH = Total amount available for PSN hospitals.
486     IHPSND = Individual hospital PSN days.
487     THPSND = Total of all hospital PSN days.
488For purposes of this subsection, the PSN inpatient days shall be
489provided in the General Appropriations Act.
490     Section 11.  Section 409.9112, Florida Statutes, is amended
491to read:
492     409.9112  Disproportionate share program for regional
493perinatal intensive care centers.-In addition to the payments
494made under s. 409.911, the agency shall design and implement a
495system for making disproportionate share payments to those
496hospitals that participate in the regional perinatal intensive
497care center program established pursuant to chapter 383. The
498system of payments must conform to federal requirements and
499distribute funds in each fiscal year for which an appropriation
500is made by making quarterly Medicaid payments. Notwithstanding
501s. 409.915, counties are exempt from contributing toward the
502cost of this special reimbursement for hospitals serving a
503disproportionate share of low-income patients. For the 2010-2011
5042009-2010 state fiscal year, the agency may not distribute
505moneys under the regional perinatal intensive care centers
506disproportionate share program.
507     (1)  The following formula shall be used by the agency to
508calculate the total amount earned for hospitals that participate
509in the regional perinatal intensive care center program:
510
TAE = HDSP/THDSP
511Where:
512     TAE = total amount earned by a regional perinatal intensive
513care center.
514     HDSP = the prior state fiscal year regional perinatal
515intensive care center disproportionate share payment to the
516individual hospital.
517     THDSP = the prior state fiscal year total regional
518perinatal intensive care center disproportionate share payments
519to all hospitals.
520     (2)  The total additional payment for hospitals that
521participate in the regional perinatal intensive care center
522program shall be calculated by the agency as follows:
523
TAP = TAE x TA
524Where:
525     TAP = total additional payment for a regional perinatal
526intensive care center.
527     TAE = total amount earned by a regional perinatal intensive
528care center.
529     TA = total appropriation for the regional perinatal
530intensive care center disproportionate share program.
531     (3)  In order to receive payments under this section, a
532hospital must be participating in the regional perinatal
533intensive care center program pursuant to chapter 383 and must
534meet the following additional requirements:
535     (a)  Agree to conform to all departmental and agency
536requirements to ensure high quality in the provision of
537services, including criteria adopted by departmental and agency
538rule concerning staffing ratios, medical records, standards of
539care, equipment, space, and such other standards and criteria as
540the department and agency deem appropriate as specified by rule.
541     (b)  Agree to provide information to the department and
542agency, in a form and manner to be prescribed by rule of the
543department and agency, concerning the care provided to all
544patients in neonatal intensive care centers and high-risk
545maternity care.
546     (c)  Agree to accept all patients for neonatal intensive
547care and high-risk maternity care, regardless of ability to pay,
548on a functional space-available basis.
549     (d)  Agree to develop arrangements with other maternity and
550neonatal care providers in the hospital's region for the
551appropriate receipt and transfer of patients in need of
552specialized maternity and neonatal intensive care services.
553     (e)  Agree to establish and provide a developmental
554evaluation and services program for certain high-risk neonates,
555as prescribed and defined by rule of the department.
556     (f)  Agree to sponsor a program of continuing education in
557perinatal care for health care professionals within the region
558of the hospital, as specified by rule.
559     (g)  Agree to provide backup and referral services to the
560county health departments and other low-income perinatal
561providers within the hospital's region, including the
562development of written agreements between these organizations
563and the hospital.
564     (h)  Agree to arrange for transportation for high-risk
565obstetrical patients and neonates in need of transfer from the
566community to the hospital or from the hospital to another more
567appropriate facility.
568     (4)  Hospitals which fail to comply with any of the
569conditions in subsection (3) or the applicable rules of the
570department and agency may not receive any payments under this
571section until full compliance is achieved. A hospital which is
572not in compliance in two or more consecutive quarters may not
573receive its share of the funds. Any forfeited funds shall be
574distributed by the remaining participating regional perinatal
575intensive care center program hospitals.
576     Section 12.  Section 409.9113, Florida Statutes, is amended
577to read:
578     409.9113  Disproportionate share program for teaching
579hospitals.-In addition to the payments made under ss. 409.911
580and 409.9112, the agency shall make disproportionate share
581payments to statutorily defined teaching hospitals for their
582increased costs associated with medical education programs and
583for tertiary health care services provided to the indigent. This
584system of payments must conform to federal requirements and
585distribute funds in each fiscal year for which an appropriation
586is made by making quarterly Medicaid payments. Notwithstanding
587s. 409.915, counties are exempt from contributing toward the
588cost of this special reimbursement for hospitals serving a
589disproportionate share of low-income patients. For the 2010-2011
5902009-2010 state fiscal year, the agency shall distribute the
591moneys provided in the General Appropriations Act to statutorily
592defined teaching hospitals and family practice teaching
593hospitals under the teaching hospital disproportionate share
594program. The funds provided for statutorily defined teaching
595hospitals shall be distributed in the same proportion as the
596state fiscal year 2003-2004 teaching hospital disproportionate
597share funds were distributed or as otherwise provided in the
598General Appropriations Act. The funds provided for family
599practice teaching hospitals shall be distributed equally among
600family practice teaching hospitals.
601     (1)  On or before September 15 of each year, the agency
602shall calculate an allocation fraction to be used for
603distributing funds to state statutory teaching hospitals.
604Subsequent to the end of each quarter of the state fiscal year,
605the agency shall distribute to each statutory teaching hospital,
606as defined in s. 408.07, an amount determined by multiplying
607one-fourth of the funds appropriated for this purpose by the
608Legislature times such hospital's allocation fraction. The
609allocation fraction for each such hospital shall be determined
610by the sum of the following three primary factors, divided by
611three:
612     (a)  The number of nationally accredited graduate medical
613education programs offered by the hospital, including programs
614accredited by the Accreditation Council for Graduate Medical
615Education and the combined Internal Medicine and Pediatrics
616programs acceptable to both the American Board of Internal
617Medicine and the American Board of Pediatrics at the beginning
618of the state fiscal year preceding the date on which the
619allocation fraction is calculated. The numerical value of this
620factor is the fraction that the hospital represents of the total
621number of programs, where the total is computed for all state
622statutory teaching hospitals.
623     (b)  The number of full-time equivalent trainees in the
624hospital, which comprises two components:
625     1.  The number of trainees enrolled in nationally
626accredited graduate medical education programs, as defined in
627paragraph (a). Full-time equivalents are computed using the
628fraction of the year during which each trainee is primarily
629assigned to the given institution, over the state fiscal year
630preceding the date on which the allocation fraction is
631calculated. The numerical value of this factor is the fraction
632that the hospital represents of the total number of full-time
633equivalent trainees enrolled in accredited graduate programs,
634where the total is computed for all state statutory teaching
635hospitals.
636     2.  The number of medical students enrolled in accredited
637colleges of medicine and engaged in clinical activities,
638including required clinical clerkships and clinical electives.
639Full-time equivalents are computed using the fraction of the
640year during which each trainee is primarily assigned to the
641given institution, over the course of the state fiscal year
642preceding the date on which the allocation fraction is
643calculated. The numerical value of this factor is the fraction
644that the given hospital represents of the total number of full-
645time equivalent students enrolled in accredited colleges of
646medicine, where the total is computed for all state statutory
647teaching hospitals.
648
649The primary factor for full-time equivalent trainees is computed
650as the sum of these two components, divided by two.
651     (c)  A service index that comprises three components:
652     1.  The Agency for Health Care Administration Service
653Index, computed by applying the standard Service Inventory
654Scores established by the agency to services offered by the
655given hospital, as reported on Worksheet A-2 for the last fiscal
656year reported to the agency before the date on which the
657allocation fraction is calculated. The numerical value of this
658factor is the fraction that the given hospital represents of the
659total Agency for Health Care Administration Service Index
660values, where the total is computed for all state statutory
661teaching hospitals.
662     2.  A volume-weighted service index, computed by applying
663the standard Service Inventory Scores established by the Agency
664for Health Care Administration to the volume of each service,
665expressed in terms of the standard units of measure reported on
666Worksheet A-2 for the last fiscal year reported to the agency
667before the date on which the allocation factor is calculated.
668The numerical value of this factor is the fraction that the
669given hospital represents of the total volume-weighted service
670index values, where the total is computed for all state
671statutory teaching hospitals.
672     3.  Total Medicaid payments to each hospital for direct
673inpatient and outpatient services during the fiscal year
674preceding the date on which the allocation factor is calculated.
675This includes payments made to each hospital for such services
676by Medicaid prepaid health plans, whether the plan was
677administered by the hospital or not. The numerical value of this
678factor is the fraction that each hospital represents of the
679total of such Medicaid payments, where the total is computed for
680all state statutory teaching hospitals.
681
682The primary factor for the service index is computed as the sum
683of these three components, divided by three.
684     (2)  By October 1 of each year, the agency shall use the
685following formula to calculate the maximum additional
686disproportionate share payment for statutorily defined teaching
687hospitals:
688
TAP = THAF x A
689Where:
690     TAP = total additional payment.
691     THAF = teaching hospital allocation factor.
692     A = amount appropriated for a teaching hospital
693disproportionate share program.
694     Section 13.  Section 409.9117, Florida Statutes, is amended
695to read:
696     409.9117  Primary care disproportionate share program.-For
697the 2010-2011 2009-2010 state fiscal year, the agency shall not
698distribute moneys under the primary care disproportionate share
699program.
700     (1)  If federal funds are available for disproportionate
701share programs in addition to those otherwise provided by law,
702there shall be created a primary care disproportionate share
703program.
704     (2)  The following formula shall be used by the agency to
705calculate the total amount earned for hospitals that participate
706in the primary care disproportionate share program:
707
TAE = HDSP/THDSP
708Where:
709     TAE = total amount earned by a hospital participating in
710the primary care disproportionate share program.
711     HDSP = the prior state fiscal year primary care
712disproportionate share payment to the individual hospital.
713     THDSP = the prior state fiscal year total primary care
714disproportionate share payments to all hospitals.
715     (3)  The total additional payment for hospitals that
716participate in the primary care disproportionate share program
717shall be calculated by the agency as follows:
718
TAP = TAE x TA
719Where:
720     TAP = total additional payment for a primary care hospital.
721     TAE = total amount earned by a primary care hospital.
722     TA = total appropriation for the primary care
723disproportionate share program.
724     (4)  In the establishment and funding of this program, the
725agency shall use the following criteria in addition to those
726specified in s. 409.911, and payments may not be made to a
727hospital unless the hospital agrees to:
728     (a)  Cooperate with a Medicaid prepaid health plan, if one
729exists in the community.
730     (b)  Ensure the availability of primary and specialty care
731physicians to Medicaid recipients who are not enrolled in a
732prepaid capitated arrangement and who are in need of access to
733such physicians.
734     (c)  Coordinate and provide primary care services free of
735charge, except copayments, to all persons with incomes up to 100
736percent of the federal poverty level who are not otherwise
737covered by Medicaid or another program administered by a
738governmental entity, and to provide such services based on a
739sliding fee scale to all persons with incomes up to 200 percent
740of the federal poverty level who are not otherwise covered by
741Medicaid or another program administered by a governmental
742entity, except that eligibility may be limited to persons who
743reside within a more limited area, as agreed to by the agency
744and the hospital.
745     (d)  Contract with any federally qualified health center,
746if one exists within the agreed geopolitical boundaries,
747concerning the provision of primary care services, in order to
748guarantee delivery of services in a nonduplicative fashion, and
749to provide for referral arrangements, privileges, and
750admissions, as appropriate. The hospital shall agree to provide
751at an onsite or offsite facility primary care services within 24
752hours to which all Medicaid recipients and persons eligible
753under this paragraph who do not require emergency room services
754are referred during normal daylight hours.
755     (e)  Cooperate with the agency, the county, and other
756entities to ensure the provision of certain public health
757services, case management, referral and acceptance of patients,
758and sharing of epidemiological data, as the agency and the
759hospital find mutually necessary and desirable to promote and
760protect the public health within the agreed geopolitical
761boundaries.
762     (f)  In cooperation with the county in which the hospital
763resides, develop a low-cost, outpatient, prepaid health care
764program to persons who are not eligible for the Medicaid
765program, and who reside within the area.
766     (g)  Provide inpatient services to residents within the
767area who are not eligible for Medicaid or Medicare, and who do
768not have private health insurance, regardless of ability to pay,
769on the basis of available space, except that hospitals may not
770be prevented from establishing bill collection programs based on
771ability to pay.
772     (h)  Work with the Florida Healthy Kids Corporation, the
773Florida Health Care Purchasing Cooperative, and business health
774coalitions, as appropriate, to develop a feasibility study and
775plan to provide a low-cost comprehensive health insurance plan
776to persons who reside within the area and who do not have access
777to such a plan.
778     (i)  Work with public health officials and other experts to
779provide community health education and prevention activities
780designed to promote healthy lifestyles and appropriate use of
781health services.
782     (j)  Work with the local health council to develop a plan
783for promoting access to affordable health care services for all
784persons who reside within the area, including, but not limited
785to, public health services, primary care services, inpatient
786services, and affordable health insurance generally.
787
788Any hospital that fails to comply with any of the provisions of
789this subsection, or any other contractual condition, may not
790receive payments under this section until full compliance is
791achieved.
792     Section 14.  Notwithstanding s. 430.707, Florida Statutes,
793and subject to federal approval of the application to be a site
794for the Program of All-inclusive Care for the Elderly, the
795Agency for Health Care Administration shall contract with one
796private health care organization, the sole member of which is a
797private, not-for-profit corporation that owns and manages health
798care organizations which provide comprehensive services,
799including hospice and palliative care services, to frail and
800elderly persons who reside in Polk, Highlands, Hardee, and
801Hillsborough Counties. Such an entity shall be exempt from the
802requirements of chapter 641, Florida Statutes. The agency, in
803consultation with the Department of Elderly Affairs and subject
804to appropriation, shall approve up to 150 initial enrollees in
805the Program of All-inclusive Care for the Elderly established by
806this organization to serve persons in Polk, Highlands, and
807Hardee Counties.
808     Section 15.  Notwithstanding s. 430.707, Florida Statutes,
809and subject to federal approval of an application for expansion
810to a new site, the Agency for Health Care Administration shall
811contract with an Organized Health Care Delivery System (OHCDS)
812in Miami-Dade County that currently offers benefits pursuant to
813the Program of All-inclusive Care for the Elderly to provide
814comprehensive services to frail and elderly persons residing in
815Southwest Miami-Dade County. Such an entity shall be exempt from
816the requirements of chapter 641, Florida Statutes. The agency,
817in consultation with the Department of Elderly Affairs and
818subject to appropriation, shall approve up to 50 initial
819enrollees in the Program of All-inclusive Care for the Elderly
820established by this organization to serve persons in Southwest
821Miami-Dade County.
822     Section 16.  This act shall take effect July 1, 2010.


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