May 26, 2019
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       Florida Senate - 2010                      CS for CS for SB 1464
       
       
       
       By the Policy and Steering Committee on Ways and Means; the
       Committee on Health and Human Services Appropriations; and
       Senator Peaden
       
       
       576-03794A-10                                         20101464c2
    1                        A bill to be entitled                      
    2         An act relating to the Agency for Health Care
    3         Administration; amending s. 395.701, F.S.; increasing
    4         the assessments imposed on hospital inpatient and
    5         outpatient services and deposited into the Public
    6         Medical Assistance Trust Fund; amending s. 400.141,
    7         F.S.; conforming a cross-reference to changes made by
    8         the act; amending s. 400.23, F.S.; providing
    9         flexibility for nursing home facilities with respect
   10         to meeting minimum staffing requirements; amending s.
   11         409.906, F.S.; requiring the Agency for Health Care
   12         Administration, in consultation with the Department of
   13         Elderly Affairs, to phase out certain specified
   14         programs and to transfer the Medicaid waiver
   15         recipients to other appropriate home and community
   16         based service programs; prohibiting certain programs
   17         from accepting new members after a specified date;
   18         requiring community-based providers to assist in the
   19         transition of enrollees and cease provision of certain
   20         waiver services by a specified date; amending s.
   21         409.9082, F.S.; revising requirements for the use of
   22         funds from nursing home quality assessments and
   23         federal matching funds; amending s. 409.9083, F.S.;
   24         revising requirements for the use of funds from
   25         quality assessments on privately operated intermediate
   26         care facility providers for the developmentally
   27         disabled and federal matching funds; amending s.
   28         409.911, F.S.; continuing the requirements for
   29         calculating the disproportionate share funds for
   30         provider service network hospitals; amending s.
   31         409.9112, F.S.; continuing the prohibition against
   32         distributing moneys under the perinatal intensive care
   33         centers disproportionate share program; amending s.
   34         409.9113, F.S.; continuing authorization for the
   35         distribution of moneys to teaching hospitals under the
   36         disproportionate share program; amending s. 409.9117,
   37         F.S.; continuing the prohibition against distributing
   38         moneys for the primary care disproportionate share
   39         program; requiring each Medicaid managed care plan and
   40         provider service network to include in its provider
   41         network any pharmacy that is located in a rural county
   42         and willing to accept the reimbursement terms and
   43         conditions established by the managed care plan or
   44         provider service agreement; providing a contingent
   45         effective date.
   46  
   47  Be It Enacted by the Legislature of the State of Florida:
   48  
   49         Section 1. Subsection (2) of section 395.701, Florida
   50  Statutes, is amended to read:
   51         395.701 Annual assessments on net operating revenues for
   52  inpatient and outpatient services to fund public medical
   53  assistance; administrative fines for failure to pay assessments
   54  when due; exemption.—
   55         (2)(a) There is imposed upon each hospital an assessment in
   56  an amount equal to 2 1.5 percent of the annual net operating
   57  revenue for inpatient services for each hospital, such revenue
   58  to be determined by the agency, based on the actual experience
   59  of the hospital as reported to the agency. Within 6 months after
   60  the end of each hospital fiscal year, the agency shall certify
   61  the amount of the assessment for each hospital. The assessment
   62  shall be payable to and collected by the agency in equal
   63  quarterly amounts, on or before the first day of each calendar
   64  quarter, beginning with the first full calendar quarter that
   65  occurs after the agency certifies the amount of the assessment
   66  for each hospital. All moneys collected pursuant to this
   67  subsection shall be deposited into the Public Medical Assistance
   68  Trust Fund.
   69         (b) There is imposed upon each hospital an assessment in an
   70  amount equal to 1.5 1 percent of the annual net operating
   71  revenue for outpatient services for each hospital, such revenue
   72  to be determined by the agency, based on the actual experience
   73  of the hospital as reported to the agency. While prior year
   74  report worksheets may be reconciled to the hospital’s audited
   75  financial statements, no additional audited financial components
   76  may be required for the purposes of determining the amount of
   77  the assessment imposed pursuant to this section other than those
   78  in effect on July 1, 2000. Within 6 months after the end of each
   79  hospital fiscal year, the agency shall certify the amount of the
   80  assessment for each hospital. The assessment shall be payable to
   81  and collected by the agency in equal quarterly amounts, on or
   82  before the first day of each calendar quarter, beginning with
   83  the first full calendar quarter that occurs after the agency
   84  certifies the amount of the assessment for each hospital. All
   85  moneys collected pursuant to this subsection shall be deposited
   86  into the Public Medical Assistance Trust Fund.
   87         Section 2. Paragraph (o) of subsection (1) of section
   88  400.141, Florida Statutes, is amended to read:
   89         400.141 Administration and management of nursing home
   90  facilities.—
   91         (1) Every licensed facility shall comply with all
   92  applicable standards and rules of the agency and shall:
   93         (o)1. Submit semiannually to the agency, or more frequently
   94  if requested by the agency, information regarding facility
   95  staff-to-resident ratios, staff turnover, and staff stability,
   96  including information regarding certified nursing assistants,
   97  licensed nurses, the director of nursing, and the facility
   98  administrator. For purposes of this reporting:
   99         a. Staff-to-resident ratios must be reported in the
  100  categories specified in s. 400.23(3)(a) and applicable rules.
  101  The ratio must be reported as an average for the most recent
  102  calendar quarter.
  103         b. Staff turnover must be reported for the most recent 12
  104  month period ending on the last workday of the most recent
  105  calendar quarter prior to the date the information is submitted.
  106  The turnover rate must be computed quarterly, with the annual
  107  rate being the cumulative sum of the quarterly rates. The
  108  turnover rate is the total number of terminations or separations
  109  experienced during the quarter, excluding any employee
  110  terminated during a probationary period of 3 months or less,
  111  divided by the total number of staff employed at the end of the
  112  period for which the rate is computed, and expressed as a
  113  percentage.
  114         c. The formula for determining staff stability is the total
  115  number of employees that have been employed for more than 12
  116  months, divided by the total number of employees employed at the
  117  end of the most recent calendar quarter, and expressed as a
  118  percentage.
  119         d. A nursing facility that has failed to comply with state
  120  minimum-staffing requirements for 2 consecutive days is
  121  prohibited from accepting new admissions until the facility has
  122  achieved the minimum-staffing requirements for a period of 6
  123  consecutive days. For the purposes of this sub-subparagraph, any
  124  person who was a resident of the facility and was absent from
  125  the facility for the purpose of receiving medical care at a
  126  separate location or was on a leave of absence is not considered
  127  a new admission. Failure to impose such an admissions moratorium
  128  constitutes a class II deficiency.
  129         e. A nursing facility which does not have a conditional
  130  license may be cited for failure to comply with the standards in
  131  s. 400.23(3)(a)1.b. and c. s. 400.23(3)(a)1.a. only if it has
  132  failed to meet those standards on 2 consecutive days or if it
  133  has failed to meet at least 97 percent of those standards on any
  134  one day.
  135         f. A facility which has a conditional license must be in
  136  compliance with the standards in s. 400.23(3)(a) at all times.
  137         2. This paragraph does not limit the agency’s ability to
  138  impose a deficiency or take other actions if a facility does not
  139  have enough staff to meet the residents’ needs.
  140         Section 3. Paragraph (a) of subsection (3) of section
  141  400.23, Florida Statutes, is amended to read:
  142         400.23 Rules; evaluation and deficiencies; licensure
  143  status.—
  144         (3)(a)1. The agency shall adopt rules providing minimum
  145  staffing requirements for nursing homes. These requirements
  146  shall include, for each nursing home facility:
  147         a.A minimum weekly average of certified nursing assistant
  148  and licensed nursing staffing combined of 3.9 hours of direct
  149  care per resident per day. As used in this sub-subparagraph, a
  150  week is defined as Sunday through Saturday.
  151         b.A minimum certified nursing assistant staffing of 2.7
  152  hours of direct care per resident per day. A facility may not
  153  staff below one certified nursing assistant per 20 residents.
  154         c.A minimum licensed nursing staffing of 1.0 hour of
  155  direct care per resident per day. A facility may not staff below
  156  one licensed nurse per 40 residents.
  157         a.A minimum certified nursing assistant staffing of 2.6
  158  hours of direct care per resident per day beginning January 1,
  159  2003, and increasing to 2.7 hours of direct care per resident
  160  per day beginning January 1, 2007. Beginning January 1, 2002, no
  161  facility shall staff below one certified nursing assistant per
  162  20 residents, and a minimum licensed nursing staffing of 1.0
  163  hour of direct care per resident per day but never below one
  164  licensed nurse per 40 residents.
  165         b.Beginning January 1, 2007, a minimum weekly average
  166  certified nursing assistant staffing of 2.9 hours of direct care
  167  per resident per day. For the purpose of this sub-subparagraph,
  168  a week is defined as Sunday through Saturday.
  169         2. Nursing assistants employed under s. 400.211(2) may be
  170  included in computing the staffing ratio for certified nursing
  171  assistants only if their job responsibilities include only
  172  nursing-assistant-related duties.
  173         3. Each nursing home must document compliance with staffing
  174  standards as required under this paragraph and post daily the
  175  names of staff on duty for the benefit of facility residents and
  176  the public.
  177         4. The agency shall recognize the use of licensed nurses
  178  for compliance with minimum staffing requirements for certified
  179  nursing assistants, provided that the facility otherwise meets
  180  the minimum staffing requirements for licensed nurses and that
  181  the licensed nurses are performing the duties of a certified
  182  nursing assistant. Unless otherwise approved by the agency,
  183  licensed nurses counted toward the minimum staffing requirements
  184  for certified nursing assistants must exclusively perform the
  185  duties of a certified nursing assistant for the entire shift and
  186  not also be counted toward the minimum staffing requirements for
  187  licensed nurses. If the agency approved a facility’s request to
  188  use a licensed nurse to perform both licensed nursing and
  189  certified nursing assistant duties, the facility must allocate
  190  the amount of staff time specifically spent on certified nursing
  191  assistant duties for the purpose of documenting compliance with
  192  minimum staffing requirements for certified and licensed nursing
  193  staff. In no event may the hours of a licensed nurse with dual
  194  job responsibilities be counted twice.
  195         Section 4. Paragraph (d) is added to subsection (13) of
  196  section 409.906, Florida Statutes, to read:
  197         409.906 Optional Medicaid services.—Subject to specific
  198  appropriations, the agency may make payments for services which
  199  are optional to the state under Title XIX of the Social Security
  200  Act and are furnished by Medicaid providers to recipients who
  201  are determined to be eligible on the dates on which the services
  202  were provided. Any optional service that is provided shall be
  203  provided only when medically necessary and in accordance with
  204  state and federal law. Optional services rendered by providers
  205  in mobile units to Medicaid recipients may be restricted or
  206  prohibited by the agency. Nothing in this section shall be
  207  construed to prevent or limit the agency from adjusting fees,
  208  reimbursement rates, lengths of stay, number of visits, or
  209  number of services, or making any other adjustments necessary to
  210  comply with the availability of moneys and any limitations or
  211  directions provided for in the General Appropriations Act or
  212  chapter 216. If necessary to safeguard the state’s systems of
  213  providing services to elderly and disabled persons and subject
  214  to the notice and review provisions of s. 216.177, the Governor
  215  may direct the Agency for Health Care Administration to amend
  216  the Medicaid state plan to delete the optional Medicaid service
  217  known as “Intermediate Care Facilities for the Developmentally
  218  Disabled.” Optional services may include:
  219         (13) HOME AND COMMUNITY-BASED SERVICES.—
  220         (d)The agency, in consultation with the Department of
  221  Elderly Affairs, shall phase out the adult day health care and
  222  Channeling Services waiver programs and transfer existing waiver
  223  enrollees to other appropriate home and community-based service
  224  programs. Effective July 1, 2010, the adult day health care, and
  225  Channeling Services waiver programs shall cease to enroll new
  226  members. Existing enrollees in the adult day health care and
  227  Channeling Services programs shall receive counseling regarding
  228  available options and shall be offered an alternative home and
  229  community-based services program based on eligibility and
  230  personal choice. Each enrollee in the waiver program shall
  231  continue to receive home and community-based services without
  232  interruption in the enrollee’s program of choice. The providers
  233  of the adult day health care and Channeling Services waiver
  234  programs, in consultation with the area agencies on aging, shall
  235  assist in the transition of enrollees. Provision of adult day
  236  health care and Channeling Services waiver services shall cease
  237  by December 31, 2010. The agency may seek federal waiver
  238  approval to administer this change.
  239         Section 5. Subsections (4) and (6) of section 409.9082,
  240  Florida Statutes, are amended to read:
  241         409.9082 Quality assessment on nursing home facility
  242  providers; exemptions; purpose; federal approval required;
  243  remedies.—
  244         (4) The purpose of the nursing home facility quality
  245  assessment is to ensure continued quality of care. Collected
  246  assessment funds shall be used to obtain federal financial
  247  participation through the Medicaid program to make Medicaid
  248  payments for nursing home facility services up to the amount of
  249  nursing home facility Medicaid rates as calculated in accordance
  250  with the approved state Medicaid plan in effect on December 31,
  251  2007. The quality assessment and federal matching funds shall be
  252  used exclusively for the following purposes and in the following
  253  order of priority:
  254         (a) To reimburse the Medicaid share of the quality
  255  assessment as a pass-through, Medicaid-allowable cost;
  256         (b) To increase to each nursing home facility’s Medicaid
  257  rate, as needed, up to an amount that restores the rate
  258  reductions implemented January 1, 2008; January 1, 2009; and
  259  March 1, 2009; and July 1, 2009;
  260         (c) To increase to each nursing home facility’s Medicaid
  261  rate, as needed, up to an amount that restores any rate
  262  reductions for the 2010-2011 2009-2010 fiscal year; and
  263         (d) To increase each nursing home facility’s Medicaid rate
  264  that accounts for the portion of the total assessment not
  265  included in paragraphs (a)-(c) which begins a phase-in to a
  266  pricing model for the operating cost component.
  267         (6) The quality assessment shall terminate and the agency
  268  shall discontinue the imposition, assessment, and collection of
  269  the nursing facility quality assessment if the agency does not
  270  obtain necessary federal approval for the nursing home facility
  271  quality assessment or the payment rates required by subsection
  272  (4). Upon termination, all collected assessment revenues, less
  273  any amounts expended by the agency, shall be returned on a pro
  274  rata basis to the nursing facilities that paid them.
  275         Section 6. Subsections (3) and (5) of section 409.9083,
  276  Florida Statutes, are amended to read:
  277         409.9083 Quality assessment on privately operated
  278  intermediate care facilities for the developmentally disabled;
  279  exemptions; purpose; federal approval required; remedies.—
  280         (3) The purpose of the facility quality assessment is to
  281  ensure continued quality of care. Collected assessment funds
  282  shall be used to obtain federal financial participation through
  283  the Medicaid program to make Medicaid payments for ICF/DD
  284  services up to the amount of the Medicaid rates for such
  285  facilities as calculated in accordance with the approved state
  286  Medicaid plan in effect on April 1, 2008. The quality assessment
  287  and federal matching funds shall be used exclusively for the
  288  following purposes and in the following order of priority to:
  289         (a) Reimburse the Medicaid share of the quality assessment
  290  as a pass-through, Medicaid-allowable cost.
  291         (b) Increase each privately operated ICF/DD Medicaid rate,
  292  as needed, by an amount that restores the rate reductions
  293  implemented on October 1, 2008.
  294         (c) Increase each ICF/DD Medicaid rate, as needed, by an
  295  amount that restores any rate reductions for the 2008-2009
  296  fiscal year, and the 2009-2010 fiscal year, and the 2010-2011
  297  fiscal year.
  298         (d) Increase payments to such facilities to fund covered
  299  services to Medicaid beneficiaries.
  300         (5)(a) The quality assessment shall terminate and the
  301  agency shall discontinue the imposition, assessment, and
  302  collection of the quality assessment if the agency does not
  303  obtain necessary federal approval for the facility quality
  304  assessment or the payment rates required by subsection (3).
  305         (b) Upon termination of the quality assessment, all
  306  collected assessment revenues, less any amounts expended by the
  307  agency, shall be returned on a pro rata basis to the facilities
  308  that paid such assessments.
  309         Section 7. Paragraph (a) of subsection (2) of section
  310  409.911, Florida Statutes, is amended to read:
  311         409.911 Disproportionate share program.—Subject to specific
  312  allocations established within the General Appropriations Act
  313  and any limitations established pursuant to chapter 216, the
  314  agency shall distribute, pursuant to this section, moneys to
  315  hospitals providing a disproportionate share of Medicaid or
  316  charity care services by making quarterly Medicaid payments as
  317  required. Notwithstanding the provisions of s. 409.915, counties
  318  are exempt from contributing toward the cost of this special
  319  reimbursement for hospitals serving a disproportionate share of
  320  low-income patients.
  321         (2) The Agency for Health Care Administration shall use the
  322  following actual audited data to determine the Medicaid days and
  323  charity care to be used in calculating the disproportionate
  324  share payment:
  325         (a) The average of the 2003, 2004, and 2005 audited
  326  disproportionate share data to determine each hospital’s
  327  Medicaid days and charity care for the 2010-2011 2009-2010 state
  328  fiscal year.
  329         Section 8. Section 409.9112, Florida Statutes, is amended
  330  to read:
  331         409.9112 Disproportionate share program for regional
  332  perinatal intensive care centers.—In addition to the payments
  333  made under s. 409.911, the agency shall design and implement a
  334  system for making disproportionate share payments to those
  335  hospitals that participate in the regional perinatal intensive
  336  care center program established pursuant to chapter 383. The
  337  system of payments must conform to federal requirements and
  338  distribute funds in each fiscal year for which an appropriation
  339  is made by making quarterly Medicaid payments. Notwithstanding
  340  s. 409.915, counties are exempt from contributing toward the
  341  cost of this special reimbursement for hospitals serving a
  342  disproportionate share of low-income patients. For the 2010-2011
  343  2009-2010 state fiscal year, the agency may not distribute
  344  moneys under the regional perinatal intensive care centers
  345  disproportionate share program.
  346         (1) The following formula shall be used by the agency to
  347  calculate the total amount earned for hospitals that participate
  348  in the regional perinatal intensive care center program:
  349                          TAE = HDSP/THDSP                         
  350  
  351  Where:
  352         TAE = total amount earned by a regional perinatal intensive
  353  care center.
  354         HDSP = the prior state fiscal year regional perinatal
  355  intensive care center disproportionate share payment to the
  356  individual hospital.
  357         THDSP = the prior state fiscal year total regional
  358  perinatal intensive care center disproportionate share payments
  359  to all hospitals.
  360         (2) The total additional payment for hospitals that
  361  participate in the regional perinatal intensive care center
  362  program shall be calculated by the agency as follows:
  363                           TAP = TAE x TA                          
  364  
  365  Where:
  366         TAP = total additional payment for a regional perinatal
  367  intensive care center.
  368         TAE = total amount earned by a regional perinatal intensive
  369  care center.
  370         TA = total appropriation for the regional perinatal
  371  intensive care center disproportionate share program.
  372         (3) In order to receive payments under this section, a
  373  hospital must be participating in the regional perinatal
  374  intensive care center program pursuant to chapter 383 and must
  375  meet the following additional requirements:
  376         (a) Agree to conform to all departmental and agency
  377  requirements to ensure high quality in the provision of
  378  services, including criteria adopted by departmental and agency
  379  rule concerning staffing ratios, medical records, standards of
  380  care, equipment, space, and such other standards and criteria as
  381  the department and agency deem appropriate as specified by rule.
  382         (b) Agree to provide information to the department and
  383  agency, in a form and manner to be prescribed by rule of the
  384  department and agency, concerning the care provided to all
  385  patients in neonatal intensive care centers and high-risk
  386  maternity care.
  387         (c) Agree to accept all patients for neonatal intensive
  388  care and high-risk maternity care, regardless of ability to pay,
  389  on a functional space-available basis.
  390         (d) Agree to develop arrangements with other maternity and
  391  neonatal care providers in the hospital’s region for the
  392  appropriate receipt and transfer of patients in need of
  393  specialized maternity and neonatal intensive care services.
  394         (e) Agree to establish and provide a developmental
  395  evaluation and services program for certain high-risk neonates,
  396  as prescribed and defined by rule of the department.
  397         (f) Agree to sponsor a program of continuing education in
  398  perinatal care for health care professionals within the region
  399  of the hospital, as specified by rule.
  400         (g) Agree to provide backup and referral services to the
  401  county health departments and other low-income perinatal
  402  providers within the hospital’s region, including the
  403  development of written agreements between these organizations
  404  and the hospital.
  405         (h) Agree to arrange for transportation for high-risk
  406  obstetrical patients and neonates in need of transfer from the
  407  community to the hospital or from the hospital to another more
  408  appropriate facility.
  409         (4) Hospitals which fail to comply with any of the
  410  conditions in subsection (3) or the applicable rules of the
  411  department and agency may not receive any payments under this
  412  section until full compliance is achieved. A hospital which is
  413  not in compliance in two or more consecutive quarters may not
  414  receive its share of the funds. Any forfeited funds shall be
  415  distributed by the remaining participating regional perinatal
  416  intensive care center program hospitals.
  417         Section 9. Section 409.9113, Florida Statutes, is amended
  418  to read:
  419         409.9113 Disproportionate share program for teaching
  420  hospitals.—In addition to the payments made under ss. 409.911
  421  and 409.9112, the agency shall make disproportionate share
  422  payments to statutorily defined teaching hospitals for their
  423  increased costs associated with medical education programs and
  424  for tertiary health care services provided to the indigent. This
  425  system of payments must conform to federal requirements and
  426  distribute funds in each fiscal year for which an appropriation
  427  is made by making quarterly Medicaid payments. Notwithstanding
  428  s. 409.915, counties are exempt from contributing toward the
  429  cost of this special reimbursement for hospitals serving a
  430  disproportionate share of low-income patients. For the 2010-2011
  431  2009-2010 state fiscal year, the agency shall distribute the
  432  moneys provided in the General Appropriations Act to statutorily
  433  defined teaching hospitals and family practice teaching
  434  hospitals under the teaching hospital disproportionate share
  435  program. The funds provided for statutorily defined teaching
  436  hospitals shall be distributed in the same proportion as the
  437  state fiscal year 2003-2004 teaching hospital disproportionate
  438  share funds were distributed or as otherwise provided in the
  439  General Appropriations Act. The funds provided for family
  440  practice teaching hospitals shall be distributed equally among
  441  family practice teaching hospitals.
  442         (1) On or before September 15 of each year, the agency
  443  shall calculate an allocation fraction to be used for
  444  distributing funds to state statutory teaching hospitals.
  445  Subsequent to the end of each quarter of the state fiscal year,
  446  the agency shall distribute to each statutory teaching hospital,
  447  as defined in s. 408.07, an amount determined by multiplying
  448  one-fourth of the funds appropriated for this purpose by the
  449  Legislature times such hospital’s allocation fraction. The
  450  allocation fraction for each such hospital shall be determined
  451  by the sum of the following three primary factors, divided by
  452  three:
  453         (a) The number of nationally accredited graduate medical
  454  education programs offered by the hospital, including programs
  455  accredited by the Accreditation Council for Graduate Medical
  456  Education and the combined Internal Medicine and Pediatrics
  457  programs acceptable to both the American Board of Internal
  458  Medicine and the American Board of Pediatrics at the beginning
  459  of the state fiscal year preceding the date on which the
  460  allocation fraction is calculated. The numerical value of this
  461  factor is the fraction that the hospital represents of the total
  462  number of programs, where the total is computed for all state
  463  statutory teaching hospitals.
  464         (b) The number of full-time equivalent trainees in the
  465  hospital, which comprises two components:
  466         1. The number of trainees enrolled in nationally accredited
  467  graduate medical education programs, as defined in paragraph
  468  (a). Full-time equivalents are computed using the fraction of
  469  the year during which each trainee is primarily assigned to the
  470  given institution, over the state fiscal year preceding the date
  471  on which the allocation fraction is calculated. The numerical
  472  value of this factor is the fraction that the hospital
  473  represents of the total number of full-time equivalent trainees
  474  enrolled in accredited graduate programs, where the total is
  475  computed for all state statutory teaching hospitals.
  476         2. The number of medical students enrolled in accredited
  477  colleges of medicine and engaged in clinical activities,
  478  including required clinical clerkships and clinical electives.
  479  Full-time equivalents are computed using the fraction of the
  480  year during which each trainee is primarily assigned to the
  481  given institution, over the course of the state fiscal year
  482  preceding the date on which the allocation fraction is
  483  calculated. The numerical value of this factor is the fraction
  484  that the given hospital represents of the total number of full
  485  time equivalent students enrolled in accredited colleges of
  486  medicine, where the total is computed for all state statutory
  487  teaching hospitals.
  488  
  489  The primary factor for full-time equivalent trainees is computed
  490  as the sum of these two components, divided by two.
  491         (c) A service index that comprises three components:
  492         1. The Agency for Health Care Administration Service Index,
  493  computed by applying the standard Service Inventory Scores
  494  established by the agency to services offered by the given
  495  hospital, as reported on Worksheet A-2 for the last fiscal year
  496  reported to the agency before the date on which the allocation
  497  fraction is calculated. The numerical value of this factor is
  498  the fraction that the given hospital represents of the total
  499  Agency for Health Care Administration Service Index values,
  500  where the total is computed for all state statutory teaching
  501  hospitals.
  502         2. A volume-weighted service index, computed by applying
  503  the standard Service Inventory Scores established by the Agency
  504  for Health Care Administration to the volume of each service,
  505  expressed in terms of the standard units of measure reported on
  506  Worksheet A-2 for the last fiscal year reported to the agency
  507  before the date on which the allocation factor is calculated.
  508  The numerical value of this factor is the fraction that the
  509  given hospital represents of the total volume-weighted service
  510  index values, where the total is computed for all state
  511  statutory teaching hospitals.
  512         3. Total Medicaid payments to each hospital for direct
  513  inpatient and outpatient services during the fiscal year
  514  preceding the date on which the allocation factor is calculated.
  515  This includes payments made to each hospital for such services
  516  by Medicaid prepaid health plans, whether the plan was
  517  administered by the hospital or not. The numerical value of this
  518  factor is the fraction that each hospital represents of the
  519  total of such Medicaid payments, where the total is computed for
  520  all state statutory teaching hospitals.
  521  
  522  The primary factor for the service index is computed as the sum
  523  of these three components, divided by three.
  524         (2) By October 1 of each year, the agency shall use the
  525  following formula to calculate the maximum additional
  526  disproportionate share payment for statutorily defined teaching
  527  hospitals:
  528                           TAP = THAF x A                          
  529  
  530  Where:
  531         TAP = total additional payment.
  532         THAF = teaching hospital allocation factor.
  533         A = amount appropriated for a teaching hospital
  534  disproportionate share program.
  535         Section 10. Section 409.9117, Florida Statutes, is amended
  536  to read:
  537         409.9117 Primary care disproportionate share program.—For
  538  the 2010-2011 2009-2010 state fiscal year, the agency shall not
  539  distribute moneys under the primary care disproportionate share
  540  program.
  541         (1) If federal funds are available for disproportionate
  542  share programs in addition to those otherwise provided by law,
  543  there shall be created a primary care disproportionate share
  544  program.
  545         (2) The following formula shall be used by the agency to
  546  calculate the total amount earned for hospitals that participate
  547  in the primary care disproportionate share program:
  548                          TAE = HDSP/THDSP                         
  549  
  550  Where:
  551         TAE = total amount earned by a hospital participating in
  552  the primary care disproportionate share program.
  553         HDSP = the prior state fiscal year primary care
  554  disproportionate share payment to the individual hospital.
  555         THDSP = the prior state fiscal year total primary care
  556  disproportionate share payments to all hospitals.
  557         (3) The total additional payment for hospitals that
  558  participate in the primary care disproportionate share program
  559  shall be calculated by the agency as follows:
  560                           TAP = TAE x TA                          
  561  
  562  Where:
  563         TAP = total additional payment for a primary care hospital.
  564         TAE = total amount earned by a primary care hospital.
  565         TA = total appropriation for the primary care
  566  disproportionate share program.
  567         (4) In the establishment and funding of this program, the
  568  agency shall use the following criteria in addition to those
  569  specified in s. 409.911, and payments may not be made to a
  570  hospital unless the hospital agrees to:
  571         (a) Cooperate with a Medicaid prepaid health plan, if one
  572  exists in the community.
  573         (b) Ensure the availability of primary and specialty care
  574  physicians to Medicaid recipients who are not enrolled in a
  575  prepaid capitated arrangement and who are in need of access to
  576  such physicians.
  577         (c) Coordinate and provide primary care services free of
  578  charge, except copayments, to all persons with incomes up to 100
  579  percent of the federal poverty level who are not otherwise
  580  covered by Medicaid or another program administered by a
  581  governmental entity, and to provide such services based on a
  582  sliding fee scale to all persons with incomes up to 200 percent
  583  of the federal poverty level who are not otherwise covered by
  584  Medicaid or another program administered by a governmental
  585  entity, except that eligibility may be limited to persons who
  586  reside within a more limited area, as agreed to by the agency
  587  and the hospital.
  588         (d) Contract with any federally qualified health center, if
  589  one exists within the agreed geopolitical boundaries, concerning
  590  the provision of primary care services, in order to guarantee
  591  delivery of services in a nonduplicative fashion, and to provide
  592  for referral arrangements, privileges, and admissions, as
  593  appropriate. The hospital shall agree to provide at an onsite or
  594  offsite facility primary care services within 24 hours to which
  595  all Medicaid recipients and persons eligible under this
  596  paragraph who do not require emergency room services are
  597  referred during normal daylight hours.
  598         (e) Cooperate with the agency, the county, and other
  599  entities to ensure the provision of certain public health
  600  services, case management, referral and acceptance of patients,
  601  and sharing of epidemiological data, as the agency and the
  602  hospital find mutually necessary and desirable to promote and
  603  protect the public health within the agreed geopolitical
  604  boundaries.
  605         (f) In cooperation with the county in which the hospital
  606  resides, develop a low-cost, outpatient, prepaid health care
  607  program to persons who are not eligible for the Medicaid
  608  program, and who reside within the area.
  609         (g) Provide inpatient services to residents within the area
  610  who are not eligible for Medicaid or Medicare, and who do not
  611  have private health insurance, regardless of ability to pay, on
  612  the basis of available space, except that hospitals may not be
  613  prevented from establishing bill collection programs based on
  614  ability to pay.
  615         (h) Work with the Florida Healthy Kids Corporation, the
  616  Florida Health Care Purchasing Cooperative, and business health
  617  coalitions, as appropriate, to develop a feasibility study and
  618  plan to provide a low-cost comprehensive health insurance plan
  619  to persons who reside within the area and who do not have access
  620  to such a plan.
  621         (i) Work with public health officials and other experts to
  622  provide community health education and prevention activities
  623  designed to promote healthy lifestyles and appropriate use of
  624  health services.
  625         (j) Work with the local health council to develop a plan
  626  for promoting access to affordable health care services for all
  627  persons who reside within the area, including, but not limited
  628  to, public health services, primary care services, inpatient
  629  services, and affordable health insurance generally.
  630  
  631  Any hospital that fails to comply with any of the provisions of
  632  this subsection, or any other contractual condition, may not
  633  receive payments under this section until full compliance is
  634  achieved.
  635         Section 11. Notwithstanding any other provision of law,
  636  each Medicaid managed care plan and provider service network
  637  shall include in its provider network any pharmacy that is
  638  licensed under chapter 465, Florida Statutes, located in a rural
  639  county, and willing to accept the reimbursement terms and
  640  conditions established by the Medicaid managed care plan or the
  641  provider service agreement. As used in this section, a rural
  642  county means a county that has a population of fewer than
  643  200,000 residents, based upon the 2000 official census.
  644         Section 12. This act shall take effect July 1, 2010;
  645  however, the amendments made by section 1 of this act do not
  646  take effect if federal law extends the enhanced Federal Medicaid
  647  Assistance Percentage rate, as provided under the American
  648  Reinvestment and Recovery Act (Pub. L. No. 111-5), from December
  649  31, 2010, through June 30, 2011.

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