September 30, 2020
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       ENROLLED
       2009 Legislature                   CS for SB 1658, 1st Engrossed
       
       
       
       
       
       
                                                             20091658er
    1  
    2         An act relating to health care; creating s. 395.7017,
    3         F.S.; authorizing the Agency for Health Care
    4         Administration to adopt rules related to the Public
    5         Medical Assistance Trust Fund; amending s. 409.815,
    6         F.S.; revising behavioral health services and dental
    7         services coverage under the Kidcare program; revising
    8         methods by which payments are made to federally
    9         qualified health centers and rural health clinics;
   10         amending s. 409.818, F.S.; revising the manner by
   11         which quality assurance and access standards are
   12         monitored in the Kidcare program; amending s. 409.904,
   13         F.S.; revising the expiration date of provisions
   14         authorizing the federal waiver for certain persons age
   15         65 and over or who have a disability; revising the
   16         expiration date of provisions authorizing a specified
   17         medically needy program; amending s. 409.905, F.S.;
   18         authorizing the Agency for Health Care Administration
   19         to require prior authorization of care based on
   20         utilization rates; requiring a home health agency to
   21         submit a plan of care and documentation of a
   22         recipient’s medical condition to the Agency for Health
   23         Care Administration when requesting prior
   24         authorization; prohibiting the Agency for Health Care
   25         Administration from paying for home health services
   26         unless specified requirements are satisfied; revising
   27         the criteria for adjusting a hospital’s inpatient per
   28         diem rate; amending s. 409.906, F.S., relating to
   29         optional Medicaid services; providing limitations on
   30         the provision of adult vision services; amending s.
   31         409.9082, F.S.; authorizing an exemption from the
   32         nursing home quality assessment to a nursing facility
   33         that has a certain number of indigent census days;
   34         revising the purposes of the use of quality assessment
   35         and federal matching funds; deleting an option for
   36         discontinuing the nursing home quality assessment;
   37         creating s. 409.9083, F.S.; providing definitions;
   38         providing for a quality assessment to be imposed upon
   39         privately operated intermediate care facility
   40         providers for the developmentally disabled; requiring
   41         the agency to calculate the quality assessment rate
   42         annually; providing requirements for reporting and
   43         collecting the assessment; specifying the purposes of
   44         the assessment and an order of priority; requiring
   45         that the agency seek federal authorization to
   46         implement the act; specifying circumstances requiring
   47         discontinuance of the quality assessment; authorizing
   48         the agency to impose certain penalties against
   49         providers that fail to pay the assessment; requiring
   50         the agency to adopt rules; providing for future
   51         repeal; amending s. 409.911, F.S.; updating the data
   52         to be used in calculating disproportionate share;
   53         providing a formula for payment of disproportionate
   54         share dollars to provider service network hospitals;
   55         amending s. 409.9112, F.S.; continuing the prohibition
   56         against distributing moneys under the perinatal
   57         intensive care centers disproportionate share program;
   58         amending s. 409.9113, F.S.; continuing authorization
   59         for the distribution of moneys to teaching hospitals
   60         under the disproportionate share program; amending s.
   61         409.9117, F.S.; continuing the prohibition against
   62         distributing moneys for the primary care
   63         disproportionate share program; amending s. 409.9119,
   64         F.S.; authorizing the agency to make disproportionate
   65         share payments to certain hospitals; amending s.
   66         409.912, F.S.; providing that the continuance of the
   67         integrated, fixed-payment delivery pilot program for
   68         certain elderly or dually eligible recipients is
   69         contingent upon an appropriation; providing that
   70         certain providers be paid in accordance with the
   71         appropriate fee schedule for services provided to
   72         eligible Medicaid recipients; authorizing the agency
   73         to seek waiver authority; amending s. 409.91211, F.S.;
   74         revising the timeline for phasing in financial risk
   75         for provider service networks; amending s. 409.9122,
   76         F.S.; revising and clarifying the procedure for a
   77         Medicaid recipient to change managed care plans or
   78         MediPass providers; amending s. 409.916, F.S.;
   79         requiring that quality assessment fees received from
   80         Medicaid providers be deposited into the Grants and
   81         Donations Trust Fund; amending s. 430.04, F.S.;
   82         requiring the Department of Elderly Affairs to
   83         administer all Medicaid waivers and programs relating
   84         to elders; amending s. 430.707, F.S.; requiring the
   85         agency, in consultation with the Department of Elderly
   86         Affairs, to accept and forward to the Centers for
   87         Medicare and Medicaid Services an application for
   88         expansion of a pilot project from an entity that
   89         provides certain benefits under a federal program;
   90         requiring the agency, in consultation with the
   91         Department of Elderly Affairs, to contract with a
   92         hospice organization to be a site for the Program of
   93         All-inclusive Care for the Elderly; directing the
   94         Agency for Health Care Administration to establish
   95         pilot projects in Miami-Dade County relating to home
   96         health services; providing an effective date.
   97  
   98  Be It Enacted by the Legislature of the State of Florida:
   99  
  100         Section 1. Section 395.7017, Florida Statutes, is created
  101  to read:
  102         395.7017 Rulemaking authority.—The agency may adopt rules
  103  pursuant to ss. 120.536 and 120.54 to implement the provisions
  104  of this part, which shall include the authority to define terms
  105  and determine the date of imposition and the determination of
  106  the process for determination, collection, and imposition of the
  107  Public Medical Assistance Trust Fund assessment and related
  108  fines.
  109         Section 2. Paragraphs (g) and (q) of subsection (2) of
  110  section 409.815, Florida Statutes, are amended, and paragraph
  111  (w) is added to that subsection, to read:
  112         409.815 Health benefits coverage; limitations.—
  113         (2) BENCHMARK BENEFITS.—In order for health benefits
  114  coverage to qualify for premium assistance payments for an
  115  eligible child under ss. 409.810-409.820, the health benefits
  116  coverage, except for coverage under Medicaid and Medikids, must
  117  include the following minimum benefits, as medically necessary.
  118         (g) Behavioral health services.—
  119         1. Mental health benefits include:
  120         a. Inpatient services, limited to not more than 30
  121  inpatient days per contract year for psychiatric admissions, or
  122  residential services in facilities licensed under s. 394.875(6)
  123  or s. 395.003 in lieu of inpatient psychiatric admissions;
  124  however, a minimum of 10 of the 30 days shall be available only
  125  for inpatient psychiatric services if when authorized by a
  126  physician; and
  127         b. Outpatient services, including outpatient visits for
  128  psychological or psychiatric evaluation, diagnosis, and
  129  treatment by a licensed mental health professional, limited to a
  130  maximum of 40 outpatient visits each contract year.
  131         2. Substance abuse services include:
  132         a. Inpatient services, limited to not more than 7 inpatient
  133  days per contract year for medical detoxification only and 30
  134  days of residential services; and
  135         b. Outpatient services, including evaluation, diagnosis,
  136  and treatment by a licensed practitioner, limited to a maximum
  137  of 40 outpatient visits per contract year.
  138  
  139  Effective October 1, 2009, covered services include inpatient
  140  and outpatient services for mental and nervous disorders as
  141  defined in the most recent edition of the Diagnostic and
  142  Statistical Manual of Mental Disorders published by the American
  143  Psychiatric Association. Such benefits include psychological or
  144  psychiatric evaluation, diagnosis, and treatment by a licensed
  145  mental health professional and inpatient, outpatient, and
  146  residential treatment of substance abuse disorders. Any benefit
  147  limitations, including duration of services, number of visits,
  148  or number of days for hospitalization or residential services,
  149  shall not be any less favorable than those for physical
  150  illnesses generally. The program may also implement appropriate
  151  financial incentives, peer review, utilization requirements, and
  152  other methods used for the management of benefits provided for
  153  other medical conditions in order to reduce service costs and
  154  utilization without compromising quality of care.
  155         (q) Dental services.Effective October 1, 2009, dental
  156  services shall be covered as required under federal law and may
  157  also include those dental benefits provided to children by the
  158  Florida Medicaid program under s. 409.906(6).
  159         (w) Reimbursement of federally qualified health centers and
  160  rural health clinics.—Effective October 1, 2009, payments for
  161  services provided to enrollees by federally qualified health
  162  centers and rural health clinics under this section shall be
  163  reimbursed using the Medicaid Prospective Payment System as
  164  provided for under s. 2107(e)(1)(D) of the Social Security Act.
  165  If such services are paid for by health insurers or health care
  166  providers under contract with the Florida Healthy Kids
  167  Corporation, such entities are responsible for this payment. The
  168  agency may seek any available federal grants to assist with this
  169  transition.
  170         Section 3. Paragraph (c) of subsection (3) of section
  171  409.818, Florida Statutes, is amended to read:
  172         409.818 Administration.—In order to implement ss. 409.810
  173  409.820, the following agencies shall have the following duties:
  174         (3) The Agency for Health Care Administration, under the
  175  authority granted in s. 409.914(1), shall:
  176         (c) Monitor compliance with quality assurance and access
  177  standards developed under s. 409.820 and in accordance with s.
  178  2103(f) of the Social Security Act, 42 U.S.C. 1397cc(f).
  179  
  180  The agency is designated the lead state agency for Title XXI of
  181  the Social Security Act for purposes of receipt of federal
  182  funds, for reporting purposes, and for ensuring compliance with
  183  federal and state regulations and rules.
  184         Section 4. Subsections (1) and (2) of section 409.904,
  185  Florida Statutes, are amended to read:
  186         409.904 Optional payments for eligible persons.—The agency
  187  may make payments for medical assistance and related services on
  188  behalf of the following persons who are determined to be
  189  eligible subject to the income, assets, and categorical
  190  eligibility tests set forth in federal and state law. Payment on
  191  behalf of these Medicaid eligible persons is subject to the
  192  availability of moneys and any limitations established by the
  193  General Appropriations Act or chapter 216.
  194         (1) Effective January 1, 2006, and Subject to federal
  195  waiver approval, a person who is age 65 or older or is
  196  determined to be disabled, whose income is at or below 88
  197  percent of the federal poverty level, whose assets do not exceed
  198  established limitations, and who is not eligible for Medicare
  199  or, if eligible for Medicare, is also eligible for and receiving
  200  Medicaid-covered institutional care services, hospice services,
  201  or home and community-based services. The agency shall seek
  202  federal authorization through a waiver to provide this coverage.
  203  This subsection expires December 31, 2010 June 30, 2009.
  204         (2)(a) A family, a pregnant woman, a child under age 21, a
  205  person age 65 or over, or a blind or disabled person, who would
  206  be eligible under any group listed in s. 409.903(1), (2), or
  207  (3), except that the income or assets of such family or person
  208  exceed established limitations. For a family or person in one of
  209  these coverage groups, medical expenses are deductible from
  210  income in accordance with federal requirements in order to make
  211  a determination of eligibility. A family or person eligible
  212  under the coverage known as the “medically needy,” is eligible
  213  to receive the same services as other Medicaid recipients, with
  214  the exception of services in skilled nursing facilities and
  215  intermediate care facilities for the developmentally disabled.
  216  This paragraph subsection expires December 31, 2010 June 30,
  217  2009.
  218         (b) Effective January 1, 2011 July 1, 2009, a pregnant
  219  woman or a child younger than 21 years of age who would be
  220  eligible under any group listed in s. 409.903, except that the
  221  income or assets of such group exceed established limitations.
  222  For a person in one of these coverage groups, medical expenses
  223  are deductible from income in accordance with federal
  224  requirements in order to make a determination of eligibility. A
  225  person eligible under the coverage known as the “medically
  226  needy” is eligible to receive the same services as other
  227  Medicaid recipients, with the exception of services in skilled
  228  nursing facilities and intermediate care facilities for the
  229  developmentally disabled.
  230         Section 5. Subsections (4) and (5) of section 409.905,
  231  Florida Statutes, are amended to read:
  232         409.905 Mandatory Medicaid services.—The agency may make
  233  payments for the following services, which are required of the
  234  state by Title XIX of the Social Security Act, furnished by
  235  Medicaid providers to recipients who are determined to be
  236  eligible on the dates on which the services were provided. Any
  237  service under this section shall be provided only when medically
  238  necessary and in accordance with state and federal law.
  239  Mandatory services rendered by providers in mobile units to
  240  Medicaid recipients may be restricted by the agency. Nothing in
  241  this section shall be construed to prevent or limit the agency
  242  from adjusting fees, reimbursement rates, lengths of stay,
  243  number of visits, number of services, or any other adjustments
  244  necessary to comply with the availability of moneys and any
  245  limitations or directions provided for in the General
  246  Appropriations Act or chapter 216.
  247         (4) HOME HEALTH CARE SERVICES.—The agency shall pay for
  248  nursing and home health aide services, supplies, appliances, and
  249  durable medical equipment, necessary to assist a recipient
  250  living at home. An entity that provides services pursuant to
  251  this subsection shall be licensed under part III of chapter 400.
  252  These services, equipment, and supplies, or reimbursement
  253  therefor, may be limited as provided in the General
  254  Appropriations Act and do not include services, equipment, or
  255  supplies provided to a person residing in a hospital or nursing
  256  facility.
  257         (a) In providing home health care services, the agency may
  258  require prior authorization of care based on diagnosis,
  259  utilization rates, or billing rates. The agency shall require
  260  prior authorization for visits for home health services that are
  261  not associated with a skilled nursing visit when the home health
  262  agency billing rates exceed the state average by 50 percent or
  263  more. The home health agency must submit the recipient’s plan of
  264  care and documentation that supports the recipient’s diagnosis
  265  to the agency when requesting prior authorization.
  266         (b) The agency shall implement a comprehensive utilization
  267  management program that requires prior authorization of all
  268  private duty nursing services, an individualized treatment plan
  269  that includes information about medication and treatment orders,
  270  treatment goals, methods of care to be used, and plans for care
  271  coordination by nurses and other health professionals. The
  272  utilization management program shall also include a process for
  273  periodically reviewing the ongoing use of private duty nursing
  274  services. The assessment of need shall be based on a child’s
  275  condition, family support and care supplements, a family’s
  276  ability to provide care, and a family’s and child’s schedule
  277  regarding work, school, sleep, and care for other family
  278  dependents. When implemented, the private duty nursing
  279  utilization management program shall replace the current
  280  authorization program used by the Agency for Health Care
  281  Administration and the Children’s Medical Services program of
  282  the Department of Health. The agency may competitively bid on a
  283  contract to select a qualified organization to provide
  284  utilization management of private duty nursing services. The
  285  agency is authorized to seek federal waivers to implement this
  286  initiative.
  287         (c) The agency may not pay for home health services unless
  288  the services are medically necessary and:
  289         1. The services are ordered by a physician.
  290         2. The written prescription for the services is signed and
  291  dated by the recipient’s physician before the development of a
  292  plan of care and before any request requiring prior
  293  authorization.
  294         3. The physician ordering the services is not employed,
  295  under contract with, or otherwise affiliated with the home
  296  health agency rendering the services. However, this subparagraph
  297  does not apply to a home health agency affiliated with a
  298  retirement community, of which the parent corporation or a
  299  related legal entity owns a rural health clinic certified under
  300  42 C.F.R. part 491, subpart A, ss. 1-11, a nursing home licensed
  301  under part II of chapter 400, or an apartment or single-family
  302  home for independent living. For purposes of this subparagraph,
  303  the agency may, on a case-by-case basis, provide an exception
  304  for medically fragile children who are younger than 21 years of
  305  age.
  306         4. The physician ordering the services has examined the
  307  recipient within the 30 days preceding the initial request for
  308  the services and biannually thereafter.
  309         5. The written prescription for the services includes the
  310  recipient’s acute or chronic medical condition or diagnosis, the
  311  home health service required, and, for skilled nursing services,
  312  the frequency and duration of the services.
  313         6. The national provider identifier, Medicaid
  314  identification number, or medical practitioner license number of
  315  the physician ordering the services is listed on the written
  316  prescription for the services, the claim for home health
  317  reimbursement, and the prior authorization request.
  318         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
  319  all covered services provided for the medical care and treatment
  320  of a recipient who is admitted as an inpatient by a licensed
  321  physician or dentist to a hospital licensed under part I of
  322  chapter 395. However, the agency shall limit the payment for
  323  inpatient hospital services for a Medicaid recipient 21 years of
  324  age or older to 45 days or the number of days necessary to
  325  comply with the General Appropriations Act.
  326         (c) The agency for Health Care Administration shall adjust
  327  a hospital’s current inpatient per diem rate to reflect the cost
  328  of serving the Medicaid population at that institution if:
  329         1. The hospital experiences an increase in Medicaid
  330  caseload by more than 25 percent in any year, primarily
  331  resulting from the closure of a hospital in the same service
  332  area occurring after July 1, 1995;
  333         2. The hospital’s Medicaid per diem rate is at least 25
  334  percent below the Medicaid per patient cost for that year; or
  335         3. The hospital is located in a county that has six five or
  336  fewer general acute care hospitals, began offering obstetrical
  337  services on or after September 1999, and has submitted a request
  338  in writing to the agency for a rate adjustment after July 1,
  339  2000, but before September 30, 2000, in which case such
  340  hospital’s Medicaid inpatient per diem rate shall be adjusted to
  341  cost, effective July 1, 2002.
  342  
  343  By No later than October 1 of each year, the agency must provide
  344  estimated costs for any adjustment in a hospital inpatient per
  345  diem rate pursuant to this paragraph to the Executive Office of
  346  the Governor, the House of Representatives General
  347  Appropriations Committee, and the Senate Appropriations
  348  Committee. Before the agency implements a change in a hospital’s
  349  inpatient per diem rate pursuant to this paragraph, the
  350  Legislature must have specifically appropriated sufficient funds
  351  in the General Appropriations Act to support the increase in
  352  cost as estimated by the agency.
  353         Section 6. Subsection (23) of section 409.906, Florida
  354  Statutes, is amended to read:
  355         409.906 Optional Medicaid services.—Subject to specific
  356  appropriations, the agency may make payments for services which
  357  are optional to the state under Title XIX of the Social Security
  358  Act and are furnished by Medicaid providers to recipients who
  359  are determined to be eligible on the dates on which the services
  360  were provided. Any optional service that is provided shall be
  361  provided only when medically necessary and in accordance with
  362  state and federal law. Optional services rendered by providers
  363  in mobile units to Medicaid recipients may be restricted or
  364  prohibited by the agency. Nothing in this section shall be
  365  construed to prevent or limit the agency from adjusting fees,
  366  reimbursement rates, lengths of stay, number of visits, or
  367  number of services, or making any other adjustments necessary to
  368  comply with the availability of moneys and any limitations or
  369  directions provided for in the General Appropriations Act or
  370  chapter 216. If necessary to safeguard the state’s systems of
  371  providing services to elderly and disabled persons and subject
  372  to the notice and review provisions of s. 216.177, the Governor
  373  may direct the Agency for Health Care Administration to amend
  374  the Medicaid state plan to delete the optional Medicaid service
  375  known as “Intermediate Care Facilities for the Developmentally
  376  Disabled.” Optional services may include:
  377         (23) VISUAL SERVICES.—The agency may pay for visual
  378  examinations, eyeglasses, and eyeglass repairs for a recipient
  379  if they are prescribed by a licensed physician specializing in
  380  diseases of the eye or by a licensed optometrist. Eyeglass
  381  frames Eyeglasses for adult recipients shall be limited to one
  382  pair two pairs per year per recipient every 2 years, except a
  383  second third pair may be provided during that period after prior
  384  authorization. Eyeglass lenses for adult recipients shall be
  385  limited to one pair per year except a second pair may be
  386  provided during that period after prior authorization.
  387         Section 7. Paragraph (d) is added to subsection (3) of
  388  section 409.9082, Florida Statutes, as created by section 1 of
  389  chapter 2009-4, Laws of Florida, and subsections (4) and (6) of
  390  that section are amended, to read:
  391         409.9082 Quality assessment on nursing home facility
  392  providers; exemptions; purpose; federal approval required;
  393  remedies.—
  394         (3)
  395         (d) Effective July 1, 2009, the agency may exempt from the
  396  quality assessment or apply a lower quality assessment rate to a
  397  qualified public, nonstate-owned or operated nursing home
  398  facility whose total annual indigent census days are greater
  399  than 25 percent of the facility’s total annual census days.
  400         (4) The purpose of the nursing home facility quality
  401  assessment is to ensure continued quality of care. Collected
  402  assessment funds shall be used to obtain federal financial
  403  participation through the Medicaid program to make Medicaid
  404  payments for nursing home facility services up to the amount of
  405  nursing home facility Medicaid rates as calculated in accordance
  406  with the approved state Medicaid plan in effect on December 31,
  407  2007. The quality assessment and federal matching funds shall be
  408  used exclusively for the following purposes and in the following
  409  order of priority:
  410         (a) To reimburse the Medicaid share of the quality
  411  assessment as a pass-through, Medicaid-allowable cost;
  412         (b) To increase to each nursing home facility’s Medicaid
  413  rate, as needed, an amount that restores the rate reductions
  414  implemented January 1, 2008, and January 1, 2009, and March 1,
  415  2009;
  416         (c) To increase to each nursing home facility’s Medicaid
  417  rate, as needed, an amount that restores any rate reductions for
  418  the 2009-2010 2008-2009 fiscal year; and
  419         (d) To increase each nursing home facility’s Medicaid rate
  420  that accounts for the portion of the total assessment not
  421  included in paragraphs (a)-(c) which begins a phase-in to a
  422  pricing model for the operating cost component.
  423         (6) The quality assessment shall terminate and the agency
  424  shall discontinue the imposition, assessment, and collection of
  425  the nursing facility quality assessment if any of the following
  426  occur:
  427         (a) the agency does not obtain necessary federal approval
  428  for the nursing home facility quality assessment or the payment
  429  rates required by subsection (4); or
  430         (b) The weighted average Medicaid rate paid to nursing home
  431  facilities is reduced below the weighted average Medicaid rate
  432  to nursing home facilities in effect on December 31, 2008, plus
  433  any future annual amount of the quality assessment and the
  434  applicable matching federal funds. Upon termination of the
  435  quality assessment, all collected assessment revenues, less any
  436  amounts expended by the agency, shall be returned on a pro rata
  437  basis to the nursing facilities that paid them.
  438         Section 8. Section 409.9083, Florida Statutes, is created
  439  to read:
  440         409.9083 Quality assessment on privately operated
  441  intermediate care facilities for the developmentally disabled;
  442  exemptions; purpose; federal approval required; remedies.—
  443         (1) As used in this section, the term:
  444         (a) “Intermediate care facility for the developmentally
  445  disabled” or “ICF/DD” means a privately operated intermediate
  446  care facility for the developmentally disabled licensed under
  447  part VIII of chapter 400.
  448         (b) “Net patient service revenue” means gross revenues from
  449  services provided to ICF/DD facility residents, less reductions
  450  from gross revenue resulting from an inability to collect
  451  payment of charges. Net patient service revenue excludes
  452  nonresident care revenues such as gain or loss on asset
  453  disposal, prior year revenue, donations, and physician billings,
  454  and all outpatient revenues. Reductions from gross revenue
  455  include bad debts; contractual adjustments; uncompensated care;
  456  administrative, courtesy, and policy discounts and adjustments;
  457  and other such revenue deductions.
  458         (c) “Resident day” means a calendar day of care provided to
  459  an ICF/DD facility resident, including the day of admission and
  460  excluding the day of discharge, except that, when admission and
  461  discharge occur on the same day, 1 day of care exists.
  462         (2) Effective October 1, 2009, there is imposed upon each
  463  intermediate care facility for the developmentally disabled a
  464  quality assessment. The aggregated amount of assessments for all
  465  ICF/DDs in a given year shall be an amount not exceeding the
  466  maximum percentage allowed under federal law of the total
  467  aggregate net patient service revenue of assessed facilities.
  468  The agency shall calculate the quality assessment rate annually
  469  on a per-resident-day basis as reported by the facilities. The
  470  per-resident-day assessment rate shall be uniform. Each facility
  471  shall report monthly to the agency its total number of resident
  472  days and shall remit an amount equal to the assessment rate
  473  times the reported number of days. The agency shall collect, and
  474  each facility shall pay, the quality assessment each month. The
  475  agency shall collect the assessment from facility providers no
  476  later than the 15th of the next succeeding calendar month. The
  477  agency shall notify providers of the quality assessment rate and
  478  provide a standardized form to complete and submit with
  479  payments. The collection of the quality assessment shall
  480  commence no sooner than 15 days after the agency’s initial
  481  payment to the facilities that implement the increased Medicaid
  482  rates containing the elements prescribed in subsection (3) and
  483  monthly thereafter. Intermediate care facilities for the
  484  developmentally disabled may increase their rates to incorporate
  485  the assessment but may not create a separate line-item charge
  486  for the purpose of passing through the assessment to residents.
  487         (3) The purpose of the facility quality assessment is to
  488  ensure continued quality of care. Collected assessment funds
  489  shall be used to obtain federal financial participation through
  490  the Medicaid program to make Medicaid payments for ICF/DD
  491  services up to the amount of the Medicaid rates for such
  492  facilities as calculated in accordance with the approved state
  493  Medicaid plan in effect on April 1, 2008. The quality assessment
  494  and federal matching funds shall be used exclusively for the
  495  following purposes and in the following order of priority to:
  496         (a) Reimburse the Medicaid share of the quality assessment
  497  as a pass-through, Medicaid-allowable cost.
  498         (b) Increase each privately operated ICF/DD Medicaid rate,
  499  as needed, by an amount that restores the rate reductions
  500  implemented on October 1, 2008.
  501         (c) Increase each ICF/DD Medicaid rate, as needed, by an
  502  amount that restores any rate reductions for the 2008-2009
  503  fiscal year and the 2009-2010 fiscal year.
  504         (d) Increase payments to such facilities to fund covered
  505  services to Medicaid beneficiaries.
  506         (4) The agency shall seek necessary federal approval in the
  507  form of state plan amendments in order to implement the
  508  provisions of this section.
  509         (5)(a) The quality assessment shall terminate and the
  510  agency shall discontinue the imposition, assessment, and
  511  collection of the quality assessment if the agency does not
  512  obtain necessary federal approval for the facility quality
  513  assessment or the payment rates required by subsection (3).
  514         (b) Upon termination of the quality assessment, all
  515  collected assessment revenues, less any amounts expended by the
  516  agency, shall be returned on a pro rata basis to the facilities
  517  that paid such assessments.
  518         (6) The agency may seek any of the following remedies for
  519  failure of any ICF/DD provider to timely pay its assessment:
  520         (a) Withholding any medical assistance reimbursement
  521  payments until the assessment amount is recovered.
  522         (b) Suspending or revoking the facility’s license.
  523         (c) Imposing a fine of up to $1,000 per day for each
  524  delinquent payment, not to exceed the amount of the assessment.
  525         (7) The agency shall adopt rules necessary to administer
  526  this section.
  527         (8) This section is repealed October 1, 2011.
  528         Section 9. Paragraph (a) of subsection (2) of section
  529  409.911, Florida Statutes, is amended, present subsections (5),
  530  (6), (7), (8), and (9) are renumbered as subsections (6), (7),
  531  (8), (9), and (10), respectively, and a new subsection (5) is
  532  added to that section, to read:
  533         409.911 Disproportionate share program.—Subject to specific
  534  allocations established within the General Appropriations Act
  535  and any limitations established pursuant to chapter 216, the
  536  agency shall distribute, pursuant to this section, moneys to
  537  hospitals providing a disproportionate share of Medicaid or
  538  charity care services by making quarterly Medicaid payments as
  539  required. Notwithstanding the provisions of s. 409.915, counties
  540  are exempt from contributing toward the cost of this special
  541  reimbursement for hospitals serving a disproportionate share of
  542  low-income patients.
  543         (2) The agency for Health Care Administration shall use the
  544  following actual audited data to determine the Medicaid days and
  545  charity care to be used in calculating the disproportionate
  546  share payment:
  547         (a) The average of the 2002, 2003, and 2004, and 2005
  548  audited disproportionate share data to determine each hospital’s
  549  Medicaid days and charity care for the 2009-2010 2008-2009 state
  550  fiscal year.
  551         (5) The following formula shall be used to pay
  552  disproportionate share dollars to provider service network (PSN)
  553  hospitals:
  554                 DSHP = TAAPSNH X (IHPSND X THPSND)                
  555         Where:
  556         DSHP = Disproportionate share hospital payments.
  557         TAAPSNH = Total amount available for PSN hospitals.
  558         IHPSND = Individual hospital PSN days.
  559         THPSND = Total of all hospital PSN days.
  560  
  561  For purposes of this paragraph, the PSN inpatient days shall be
  562  provided in the General Appropriations Act.
  563         Section 10. Section 409.9112, Florida Statutes, is amended
  564  to read:
  565         409.9112 Disproportionate share program for regional
  566  perinatal intensive care centers.—In addition to the payments
  567  made under s. 409.911, the agency for Health Care Administration
  568  shall design and implement a system for of making
  569  disproportionate share payments to those hospitals that
  570  participate in the regional perinatal intensive care center
  571  program established pursuant to chapter 383. The This system of
  572  payments must shall conform to with federal requirements and
  573  shall distribute funds in each fiscal year for which an
  574  appropriation is made by making quarterly Medicaid payments.
  575  Notwithstanding the provisions of s. 409.915, counties are
  576  exempt from contributing toward the cost of this special
  577  reimbursement for hospitals serving a disproportionate share of
  578  low-income patients. For the 2009-2010 state fiscal year 2008
  579  2009, the agency may shall not distribute moneys under the
  580  regional perinatal intensive care centers disproportionate share
  581  program.
  582         (1) The following formula shall be used by the agency to
  583  calculate the total amount earned for hospitals that participate
  584  in the regional perinatal intensive care center program:
  585                          TAE = HDSP/THDSP                         
  586  
  587         Where:
  588         TAE = total amount earned by a regional perinatal intensive
  589  care center.
  590         HDSP = the prior state fiscal year regional perinatal
  591  intensive care center disproportionate share payment to the
  592  individual hospital.
  593         THDSP = the prior state fiscal year total regional
  594  perinatal intensive care center disproportionate share payments
  595  to all hospitals.
  596         (2) The total additional payment for hospitals that
  597  participate in the regional perinatal intensive care center
  598  program shall be calculated by the agency as follows:
  599                           TAP = TAE x TA                          
  600  
  601         Where:
  602         TAP = total additional payment for a regional perinatal
  603  intensive care center.
  604         TAE = total amount earned by a regional perinatal intensive
  605  care center.
  606         TA = total appropriation for the regional perinatal
  607  intensive care center disproportionate share program.
  608         (3) In order to receive payments under this section, a
  609  hospital must be participating in the regional perinatal
  610  intensive care center program pursuant to chapter 383 and must
  611  meet the following additional requirements:
  612         (a) Agree to conform to all departmental and agency
  613  requirements to ensure high quality in the provision of
  614  services, including criteria adopted by departmental and agency
  615  rule concerning staffing ratios, medical records, standards of
  616  care, equipment, space, and such other standards and criteria as
  617  the department and agency deem appropriate as specified by rule.
  618         (b) Agree to provide information to the department and
  619  agency, in a form and manner to be prescribed by rule of the
  620  department and agency, concerning the care provided to all
  621  patients in neonatal intensive care centers and high-risk
  622  maternity care.
  623         (c) Agree to accept all patients for neonatal intensive
  624  care and high-risk maternity care, regardless of ability to pay,
  625  on a functional space-available basis.
  626         (d) Agree to develop arrangements with other maternity and
  627  neonatal care providers in the hospital’s region for the
  628  appropriate receipt and transfer of patients in need of
  629  specialized maternity and neonatal intensive care services.
  630         (e) Agree to establish and provide a developmental
  631  evaluation and services program for certain high-risk neonates,
  632  as prescribed and defined by rule of the department.
  633         (f) Agree to sponsor a program of continuing education in
  634  perinatal care for health care professionals within the region
  635  of the hospital, as specified by rule.
  636         (g) Agree to provide backup and referral services to the
  637  department’s county health departments and other low-income
  638  perinatal providers within the hospital’s region, including the
  639  development of written agreements between these organizations
  640  and the hospital.
  641         (h) Agree to arrange for transportation for high-risk
  642  obstetrical patients and neonates in need of transfer from the
  643  community to the hospital or from the hospital to another more
  644  appropriate facility.
  645         (4) Hospitals which fail to comply with any of the
  646  conditions in subsection (3) or the applicable rules of the
  647  department and agency may shall not receive any payments under
  648  this section until full compliance is achieved. A hospital which
  649  is not in compliance in two or more consecutive quarters may
  650  shall not receive its share of the funds. Any forfeited funds
  651  shall be distributed by the remaining participating regional
  652  perinatal intensive care center program hospitals.
  653         Section 11. Section 409.9113, Florida Statutes, is amended
  654  to read:
  655         409.9113 Disproportionate share program for teaching
  656  hospitals.—In addition to the payments made under ss. 409.911
  657  and 409.9112, the agency for Health Care Administration shall
  658  make disproportionate share payments to statutorily defined
  659  teaching hospitals for their increased costs associated with
  660  medical education programs and for tertiary health care services
  661  provided to the indigent. This system of payments must shall
  662  conform to with federal requirements and shall distribute funds
  663  in each fiscal year for which an appropriation is made by making
  664  quarterly Medicaid payments. Notwithstanding s. 409.915,
  665  counties are exempt from contributing toward the cost of this
  666  special reimbursement for hospitals serving a disproportionate
  667  share of low-income patients. For the 2009-2010 state fiscal
  668  year 2008-2009, the agency shall distribute the moneys provided
  669  in the General Appropriations Act to statutorily defined
  670  teaching hospitals and family practice teaching hospitals under
  671  the teaching hospital disproportionate share program. The funds
  672  provided for statutorily defined teaching hospitals shall be
  673  distributed in the same proportion as the state fiscal year
  674  2003-2004 teaching hospital disproportionate share funds were
  675  distributed or as otherwise provided in the General
  676  Appropriations Act. The funds provided for family practice
  677  teaching hospitals shall be distributed equally among family
  678  practice teaching hospitals.
  679         (1) On or before September 15 of each year, the agency for
  680  Health Care Administration shall calculate an allocation
  681  fraction to be used for distributing funds to state statutory
  682  teaching hospitals. Subsequent to the end of each quarter of the
  683  state fiscal year, the agency shall distribute to each statutory
  684  teaching hospital, as defined in s. 408.07, an amount determined
  685  by multiplying one-fourth of the funds appropriated for this
  686  purpose by the Legislature times such hospital’s allocation
  687  fraction. The allocation fraction for each such hospital shall
  688  be determined by the sum of the following three primary factors,
  689  divided by three. The primary factors are:
  690         (a) The number of nationally accredited graduate medical
  691  education programs offered by the hospital, including programs
  692  accredited by the Accreditation Council for Graduate Medical
  693  Education and the combined Internal Medicine and Pediatrics
  694  programs acceptable to both the American Board of Internal
  695  Medicine and the American Board of Pediatrics at the beginning
  696  of the state fiscal year preceding the date on which the
  697  allocation fraction is calculated. The numerical value of this
  698  factor is the fraction that the hospital represents of the total
  699  number of programs, where the total is computed for all state
  700  statutory teaching hospitals.
  701         (b) The number of full-time equivalent trainees in the
  702  hospital, which comprises two components:
  703         1. The number of trainees enrolled in nationally accredited
  704  graduate medical education programs, as defined in paragraph
  705  (a). Full-time equivalents are computed using the fraction of
  706  the year during which each trainee is primarily assigned to the
  707  given institution, over the state fiscal year preceding the date
  708  on which the allocation fraction is calculated. The numerical
  709  value of this factor is the fraction that the hospital
  710  represents of the total number of full-time equivalent trainees
  711  enrolled in accredited graduate programs, where the total is
  712  computed for all state statutory teaching hospitals.
  713         2. The number of medical students enrolled in accredited
  714  colleges of medicine and engaged in clinical activities,
  715  including required clinical clerkships and clinical electives.
  716  Full-time equivalents are computed using the fraction of the
  717  year during which each trainee is primarily assigned to the
  718  given institution, over the course of the state fiscal year
  719  preceding the date on which the allocation fraction is
  720  calculated. The numerical value of this factor is the fraction
  721  that the given hospital represents of the total number of full
  722  time equivalent students enrolled in accredited colleges of
  723  medicine, where the total is computed for all state statutory
  724  teaching hospitals.
  725  
  726  The primary factor for full-time equivalent trainees is computed
  727  as the sum of these two components, divided by two.
  728         (c) A service index that comprises three components:
  729         1. The Agency for Health Care Administration Service Index,
  730  computed by applying the standard Service Inventory Scores
  731  established by the agency for Health Care Administration to
  732  services offered by the given hospital, as reported on Worksheet
  733  A-2 for the last fiscal year reported to the agency before the
  734  date on which the allocation fraction is calculated. The
  735  numerical value of this factor is the fraction that the given
  736  hospital represents of the total Agency for Health Care
  737  Administration Service Index values, where the total is computed
  738  for all state statutory teaching hospitals.
  739         2. A volume-weighted service index, computed by applying
  740  the standard Service Inventory Scores established by the Agency
  741  for Health Care Administration to the volume of each service,
  742  expressed in terms of the standard units of measure reported on
  743  Worksheet A-2 for the last fiscal year reported to the agency
  744  before the date on which the allocation factor is calculated.
  745  The numerical value of this factor is the fraction that the
  746  given hospital represents of the total volume-weighted service
  747  index values, where the total is computed for all state
  748  statutory teaching hospitals.
  749         3. Total Medicaid payments to each hospital for direct
  750  inpatient and outpatient services during the fiscal year
  751  preceding the date on which the allocation factor is calculated.
  752  This includes payments made to each hospital for such services
  753  by Medicaid prepaid health plans, whether the plan was
  754  administered by the hospital or not. The numerical value of this
  755  factor is the fraction that each hospital represents of the
  756  total of such Medicaid payments, where the total is computed for
  757  all state statutory teaching hospitals.
  758  
  759  The primary factor for the service index is computed as the sum
  760  of these three components, divided by three.
  761         (2) By October 1 of each year, the agency shall use the
  762  following formula to calculate the maximum additional
  763  disproportionate share payment for statutorily defined teaching
  764  hospitals:
  765                           TAP = THAF x A                          
  766  
  767         Where:
  768         TAP = total additional payment.
  769         THAF = teaching hospital allocation factor.
  770         A = amount appropriated for a teaching hospital
  771  disproportionate share program.
  772         Section 12.  Section 409.9117, Florida Statutes, is amended
  773  to read:
  774         409.9117 Primary care disproportionate share program.—For
  775  the 2009-2010 state fiscal year 2008-2009, the agency shall not
  776  distribute moneys under the primary care disproportionate share
  777  program.
  778         (1) If federal funds are available for disproportionate
  779  share programs in addition to those otherwise provided by law,
  780  there shall be created a primary care disproportionate share
  781  program.
  782         (2) The following formula shall be used by the agency to
  783  calculate the total amount earned for hospitals that participate
  784  in the primary care disproportionate share program:
  785                          TAE = HDSP/THDSP                         
  786  
  787         Where:
  788         TAE = total amount earned by a hospital participating in
  789  the primary care disproportionate share program.
  790         HDSP = the prior state fiscal year primary care
  791  disproportionate share payment to the individual hospital.
  792         THDSP = the prior state fiscal year total primary care
  793  disproportionate share payments to all hospitals.
  794         (3) The total additional payment for hospitals that
  795  participate in the primary care disproportionate share program
  796  shall be calculated by the agency as follows:
  797                           TAP = TAE x TA                          
  798  
  799         Where:
  800         TAP = total additional payment for a primary care hospital.
  801         TAE = total amount earned by a primary care hospital.
  802         TA = total appropriation for the primary care
  803  disproportionate share program.
  804         (4) In the establishment and funding of this program, the
  805  agency shall use the following criteria in addition to those
  806  specified in s. 409.911, and payments may not be made to a
  807  hospital unless the hospital agrees to:
  808         (a) Cooperate with a Medicaid prepaid health plan, if one
  809  exists in the community.
  810         (b) Ensure the availability of primary and specialty care
  811  physicians to Medicaid recipients who are not enrolled in a
  812  prepaid capitated arrangement and who are in need of access to
  813  such physicians.
  814         (c) Coordinate and provide primary care services free of
  815  charge, except copayments, to all persons with incomes up to 100
  816  percent of the federal poverty level who are not otherwise
  817  covered by Medicaid or another program administered by a
  818  governmental entity, and to provide such services based on a
  819  sliding fee scale to all persons with incomes up to 200 percent
  820  of the federal poverty level who are not otherwise covered by
  821  Medicaid or another program administered by a governmental
  822  entity, except that eligibility may be limited to persons who
  823  reside within a more limited area, as agreed to by the agency
  824  and the hospital.
  825         (d) Contract with any federally qualified health center, if
  826  one exists within the agreed geopolitical boundaries, concerning
  827  the provision of primary care services, in order to guarantee
  828  delivery of services in a nonduplicative fashion, and to provide
  829  for referral arrangements, privileges, and admissions, as
  830  appropriate. The hospital shall agree to provide at an onsite or
  831  offsite facility primary care services within 24 hours to which
  832  all Medicaid recipients and persons eligible under this
  833  paragraph who do not require emergency room services are
  834  referred during normal daylight hours.
  835         (e) Cooperate with the agency, the county, and other
  836  entities to ensure the provision of certain public health
  837  services, case management, referral and acceptance of patients,
  838  and sharing of epidemiological data, as the agency and the
  839  hospital find mutually necessary and desirable to promote and
  840  protect the public health within the agreed geopolitical
  841  boundaries.
  842         (f) In cooperation with the county in which the hospital
  843  resides, develop a low-cost, outpatient, prepaid health care
  844  program to persons who are not eligible for the Medicaid
  845  program, and who reside within the area.
  846         (g) Provide inpatient services to residents within the area
  847  who are not eligible for Medicaid or Medicare, and who do not
  848  have private health insurance, regardless of ability to pay, on
  849  the basis of available space, except that hospitals may not be
  850  prevented nothing shall prevent the hospital from establishing
  851  bill collection programs based on ability to pay.
  852         (h) Work with the Florida Healthy Kids Corporation, the
  853  Florida Health Care Purchasing Cooperative, and business health
  854  coalitions, as appropriate, to develop a feasibility study and
  855  plan to provide a low-cost comprehensive health insurance plan
  856  to persons who reside within the area and who do not have access
  857  to such a plan.
  858         (i) Work with public health officials and other experts to
  859  provide community health education and prevention activities
  860  designed to promote healthy lifestyles and appropriate use of
  861  health services.
  862         (j) Work with the local health council to develop a plan
  863  for promoting access to affordable health care services for all
  864  persons who reside within the area, including, but not limited
  865  to, public health services, primary care services, inpatient
  866  services, and affordable health insurance generally.
  867  
  868  Any hospital that fails to comply with any of the provisions of
  869  this subsection, or any other contractual condition, may not
  870  receive payments under this section until full compliance is
  871  achieved.
  872         Section 13. Section 409.9119, Florida Statutes, is amended
  873  to read:
  874         409.9119 Disproportionate share program for specialty
  875  hospitals for children.—In addition to the payments made under
  876  s. 409.911, the Agency for Health Care Administration shall
  877  develop and implement a system under which disproportionate
  878  share payments are made to those hospitals that are licensed by
  879  the state as specialty hospitals for children and were licensed
  880  on January 1, 2000, as specialty hospitals for children. This
  881  system of payments must conform to federal requirements and must
  882  distribute funds in each fiscal year for which an appropriation
  883  is made by making quarterly Medicaid payments. Notwithstanding
  884  s. 409.915, counties are exempt from contributing toward the
  885  cost of this special reimbursement for hospitals that serve a
  886  disproportionate share of low-income patients. The agency may
  887  make disproportionate share payments to specialty hospitals for
  888  children as provided for Payments are subject to specific
  889  appropriations in the General Appropriations Act.
  890         (1) Unless specified in the General Appropriations Act, the
  891  agency shall use the following formula to calculate the total
  892  amount earned for hospitals that participate in the specialty
  893  hospital for children disproportionate share program:
  894                        TAE = DSR x BMPD x MD                      
  895  
  896  Where:
  897         TAE = total amount earned by a specialty hospital for
  898  children.
  899         DSR = disproportionate share rate.
  900         BMPD = base Medicaid per diem.
  901         MD = Medicaid days.
  902         (2) The agency shall calculate the total additional payment
  903  for hospitals that participate in the specialty hospital for
  904  children disproportionate share program as follows:
  905   TAP = TAE x TA(———————)STAE
  906  
  907  Where:
  908         TAP = total additional payment for a specialty hospital for
  909  children.
  910         TAE = total amount earned by a specialty hospital for
  911  children.
  912         TA = total appropriation for the specialty hospital for
  913  children disproportionate share program.
  914         STAE = sum of total amount earned by each hospital that
  915  participates in the specialty hospital for children
  916  disproportionate share program.
  917         (3) A hospital may not receive any payments under this
  918  section until it achieves full compliance with the applicable
  919  rules of the agency. A hospital that is not in compliance for
  920  two or more consecutive quarters may not receive its share of
  921  the funds. Any forfeited funds must be distributed to the
  922  remaining participating specialty hospitals for children that
  923  are in compliance.
  924         Section 14. Paragraph (g) is added to subsection (5) of
  925  section 409.912, Florida Statutes, and subsection (8) of that
  926  section, is amended to read:
  927         409.912 Cost-effective purchasing of health care.—The
  928  agency shall purchase goods and services for Medicaid recipients
  929  in the most cost-effective manner consistent with the delivery
  930  of quality medical care. To ensure that medical services are
  931  effectively utilized, the agency may, in any case, require a
  932  confirmation or second physician’s opinion of the correct
  933  diagnosis for purposes of authorizing future services under the
  934  Medicaid program. This section does not restrict access to
  935  emergency services or poststabilization care services as defined
  936  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  937  shall be rendered in a manner approved by the agency. The agency
  938  shall maximize the use of prepaid per capita and prepaid
  939  aggregate fixed-sum basis services when appropriate and other
  940  alternative service delivery and reimbursement methodologies,
  941  including competitive bidding pursuant to s. 287.057, designed
  942  to facilitate the cost-effective purchase of a case-managed
  943  continuum of care. The agency shall also require providers to
  944  minimize the exposure of recipients to the need for acute
  945  inpatient, custodial, and other institutional care and the
  946  inappropriate or unnecessary use of high-cost services. The
  947  agency shall contract with a vendor to monitor and evaluate the
  948  clinical practice patterns of providers in order to identify
  949  trends that are outside the normal practice patterns of a
  950  provider’s professional peers or the national guidelines of a
  951  provider’s professional association. The vendor must be able to
  952  provide information and counseling to a provider whose practice
  953  patterns are outside the norms, in consultation with the agency,
  954  to improve patient care and reduce inappropriate utilization.
  955  The agency may mandate prior authorization, drug therapy
  956  management, or disease management participation for certain
  957  populations of Medicaid beneficiaries, certain drug classes, or
  958  particular drugs to prevent fraud, abuse, overuse, and possible
  959  dangerous drug interactions. The Pharmaceutical and Therapeutics
  960  Committee shall make recommendations to the agency on drugs for
  961  which prior authorization is required. The agency shall inform
  962  the Pharmaceutical and Therapeutics Committee of its decisions
  963  regarding drugs subject to prior authorization. The agency is
  964  authorized to limit the entities it contracts with or enrolls as
  965  Medicaid providers by developing a provider network through
  966  provider credentialing. The agency may competitively bid single
  967  source-provider contracts if procurement of goods or services
  968  results in demonstrated cost savings to the state without
  969  limiting access to care. The agency may limit its network based
  970  on the assessment of beneficiary access to care, provider
  971  availability, provider quality standards, time and distance
  972  standards for access to care, the cultural competence of the
  973  provider network, demographic characteristics of Medicaid
  974  beneficiaries, practice and provider-to-beneficiary standards,
  975  appointment wait times, beneficiary use of services, provider
  976  turnover, provider profiling, provider licensure history,
  977  previous program integrity investigations and findings, peer
  978  review, provider Medicaid policy and billing compliance records,
  979  clinical and medical record audits, and other factors. Providers
  980  shall not be entitled to enrollment in the Medicaid provider
  981  network. The agency shall determine instances in which allowing
  982  Medicaid beneficiaries to purchase durable medical equipment and
  983  other goods is less expensive to the Medicaid program than long
  984  term rental of the equipment or goods. The agency may establish
  985  rules to facilitate purchases in lieu of long-term rentals in
  986  order to protect against fraud and abuse in the Medicaid program
  987  as defined in s. 409.913. The agency may seek federal waivers
  988  necessary to administer these policies.
  989         (5) The Agency for Health Care Administration, in
  990  partnership with the Department of Elderly Affairs, shall create
  991  an integrated, fixed-payment delivery program for Medicaid
  992  recipients who are 60 years of age or older or dually eligible
  993  for Medicare and Medicaid. The Agency for Health Care
  994  Administration shall implement the integrated program initially
  995  on a pilot basis in two areas of the state. The pilot areas
  996  shall be Area 7 and Area 11 of the Agency for Health Care
  997  Administration. Enrollment in the pilot areas shall be on a
  998  voluntary basis and in accordance with approved federal waivers
  999  and this section. The agency and its program contractors and
 1000  providers shall not enroll any individual in the integrated
 1001  program because the individual or the person legally responsible
 1002  for the individual fails to choose to enroll in the integrated
 1003  program. Enrollment in the integrated program shall be
 1004  exclusively by affirmative choice of the eligible individual or
 1005  by the person legally responsible for the individual. The
 1006  integrated program must transfer all Medicaid services for
 1007  eligible elderly individuals who choose to participate into an
 1008  integrated-care management model designed to serve Medicaid
 1009  recipients in the community. The integrated program must combine
 1010  all funding for Medicaid services provided to individuals who
 1011  are 60 years of age or older or dually eligible for Medicare and
 1012  Medicaid into the integrated program, including funds for
 1013  Medicaid home and community-based waiver services; all Medicaid
 1014  services authorized in ss. 409.905 and 409.906, excluding funds
 1015  for Medicaid nursing home services unless the agency is able to
 1016  demonstrate how the integration of the funds will improve
 1017  coordinated care for these services in a less costly manner; and
 1018  Medicare coinsurance and deductibles for persons dually eligible
 1019  for Medicaid and Medicare as prescribed in s. 409.908(13).
 1020         (g) The implementation of the integrated, fixed-payment
 1021  delivery program created under this subsection is subject to an
 1022  appropriation in the General Appropriations Act.
 1023         (8)(a) The agency may contract on a prepaid or fixed-sum
 1024  basis with an exclusive provider organization to provide health
 1025  care services to Medicaid recipients provided that the exclusive
 1026  provider organization meets applicable managed care plan
 1027  requirements in this section, ss. 409.9122, 409.9123, 409.9128,
 1028  and 627.6472, and other applicable provisions of law.
 1029         (b) For a period of no longer than 24 months after the
 1030  effective date of this paragraph, when a member of an exclusive
 1031  provider organization that is contracted by the agency to
 1032  provide health care services to Medicaid recipients in rural
 1033  areas without a health maintenance organization obtains services
 1034  from a provider that participates in the Medicaid program in
 1035  this state, the provider shall be paid in accordance with the
 1036  appropriate fee schedule for services provided to eligible
 1037  Medicaid recipients. The agency may seek waiver authority to
 1038  implement this paragraph.
 1039         Section 15. Paragraph (e) of subsection (3) and subsection
 1040  (12) of section 409.91211, Florida Statutes, are amended to
 1041  read:
 1042         409.91211 Medicaid managed care pilot program.—
 1043         (3) The agency shall have the following powers, duties, and
 1044  responsibilities with respect to the pilot program:
 1045         (e) To implement policies and guidelines for phasing in
 1046  financial risk for approved provider service networks that, for
 1047  purposes of this paragraph, include the Children’s Medical
 1048  Services Network, over a 5-year 3-year period. These policies
 1049  and guidelines must include an option for a provider service
 1050  network to be paid fee-for-service rates. For any provider
 1051  service network established in a managed care pilot area, the
 1052  option to be paid fee-for-service rates must shall include a
 1053  savings-settlement mechanism that is consistent with s.
 1054  409.912(44). This model must shall be converted to a risk
 1055  adjusted capitated rate by no later than the beginning of the
 1056  sixth fourth year of operation, and may be converted earlier at
 1057  the option of the provider service network. Federally qualified
 1058  health centers may be offered an opportunity to accept or
 1059  decline a contract to participate in any provider network for
 1060  prepaid primary care services.
 1061         (12) For purposes of this section, the term “capitated
 1062  managed care plan” includes health insurers authorized under
 1063  chapter 624, exclusive provider organizations authorized under
 1064  chapter 627, health maintenance organizations authorized under
 1065  chapter 641, the Children’s Medical Services Network under
 1066  chapter 391, and provider service networks that elect to be paid
 1067  fee-for-service for up to 5 3 years as authorized under this
 1068  section.
 1069         Section 16. Paragraph (e) of subsection (2) of section
 1070  409.9122, Florida Statutes, is amended to read:
 1071         409.9122 Mandatory Medicaid managed care enrollment;
 1072  programs and procedures.—
 1073         (2)
 1074         (e) Medicaid recipients who are already enrolled in a
 1075  managed care plan or MediPass shall be offered the opportunity
 1076  to change managed care plans or MediPass providers on a
 1077  staggered basis, as defined by the agency. All Medicaid
 1078  recipients shall have 30 days in which to make a choice of
 1079  managed care plans or MediPass providers. In counties that have
 1080  two or more managed care plans, a recipient already enrolled in
 1081  MediPass who fails to make a choice during the annual period
 1082  shall be assigned to a managed care plan if he or she is
 1083  eligible for enrollment in the managed care plan. The agency
 1084  shall apply for a state plan amendment or federal waiver
 1085  authority, if necessary, to implement the provisions of this
 1086  paragraph. All newly eligible Medicaid recipients shall have 30
 1087  days in which to make a choice of managed care plans or MediPass
 1088  providers. Those Medicaid recipients who do not make a choice
 1089  shall be assigned in accordance with paragraph (f). To
 1090  facilitate continuity of care, for a Medicaid recipient who is
 1091  also a recipient of Supplemental Security Income (SSI), prior to
 1092  assigning the SSI recipient to a managed care plan or MediPass,
 1093  the agency shall determine whether the SSI recipient has an
 1094  ongoing relationship with a MediPass provider or managed care
 1095  plan, and if so, the agency shall assign the SSI recipient to
 1096  that MediPass provider or managed care plan. If the SSI
 1097  recipient has an ongoing relationship with a managed care plan,
 1098  the agency shall assign the recipient to that managed care plan.
 1099  Those SSI recipients who do not have such a provider
 1100  relationship shall be assigned to a managed care plan or
 1101  MediPass provider in accordance with paragraph (f).
 1102         Section 17. Subsection (4) is added to section 409.916,
 1103  Florida Statutes, to read:
 1104         409.916 Grants and Donations Trust Fund.—
 1105         (4) Quality assessment fees received from Medicaid
 1106  providers shall be deposited into the Grants and Donations Trust
 1107  Fund and used for purposes established by law and the General
 1108  Appropriations Act.
 1109         Section 18. Subsection (18) is added to section 430.04,
 1110  Florida Statutes, to read:
 1111         430.04 Duties and responsibilities of the Department of
 1112  Elderly Affairs.—The Department of Elderly Affairs shall:
 1113         (18) Administer all Medicaid waivers and programs relating
 1114  to elders and their appropriations. The waivers include, but are
 1115  not limited to:
 1116         (a) The Alzheimer’s Dementia-Specific Medicaid Waiver as
 1117  established in s. 430.502(7), (8), and (9).
 1118         (b) The Assisted Living for the Frail Elderly Waiver.
 1119         (c) The Aged and Disabled Adult Waiver.
 1120         (d) The Adult Day Health Care Waiver.
 1121         (e) The Consumer Directed Care Plus Program as defined in
 1122  s. 409.221.
 1123         (f) The Program for All-inclusive Care for the Elderly.
 1124         (g) The Long-Term Care Community-Based Diversion Pilot
 1125  Project as described in s. 430.705.
 1126         (h) The Channeling Services Waiver for Frail Elders.
 1127         Section 19. Section 430.707, Florida Statutes, is amended
 1128  to read:
 1129         430.707 Contracts.—
 1130         (1) The department, in consultation with the agency, shall
 1131  select and contract with managed care organizations and, on a
 1132  prepaid basis, with other qualified providers as defined in s.
 1133  430.703(7) to provide long-term care within community diversion
 1134  pilot project areas. All providers shall report quarterly to the
 1135  department regarding the entity’s compliance with all the
 1136  financial and quality assurance requirements of the contract.
 1137         (2) The department, in consultation with the agency, may
 1138  contract with entities that which have submitted an application
 1139  as a community nursing home diversion project as of July 1,
 1140  1998, to provide benefits pursuant to the “Program of All
 1141  inclusive Care for the Elderly” as established in Pub. L. No.
 1142  105-33. For the purposes of this community nursing home
 1143  diversion project, such entities are shall be exempt from the
 1144  requirements of chapter 641, if the entity is a private,
 1145  nonprofit, superior-rated nursing home and if with at least 50
 1146  percent of its residents are eligible for Medicaid. The agency,
 1147  in consultation with the department, shall accept and forward to
 1148  the Centers for Medicare and Medicaid Services an application
 1149  for expansion of the pilot project from an entity that provides
 1150  benefits pursuant to the Program of All-inclusive Care for the
 1151  Elderly and that is in good standing with the agency, the
 1152  department, and the Centers for Medicare and Medicaid Services.
 1153         Section 20. Notwithstanding s. 430.707, Florida Statutes,
 1154  and subject to federal approval of the application to be a site
 1155  for the Program of All-inclusive Care for the Elderly, the
 1156  Agency for Health Care Administration shall contract with one
 1157  private, not-for-profit hospice organization located in
 1158  Hillsborough County, which provides comprehensive services,
 1159  including hospice care for frail and elderly persons. Such an
 1160  entity shall be exempt from the requirements of chapter 641,
 1161  Florida Statutes. The agency, in consultation with the
 1162  Department of Elderly Affairs and subject to an appropriation,
 1163  shall approve up to 100 initial enrollees in the Program of All
 1164  inclusive Care for the Elderly in Hillsborough County.
 1165         Section 21. The Agency for Health Care Administration shall
 1166  develop and implement a home health agency monitoring pilot
 1167  project in Miami-Dade County by January 1, 2010. The agency
 1168  shall contract with a vendor to verify the utilization and the
 1169  delivery of home health services and provide an electronic
 1170  billing interface for such services. The contract must require
 1171  the creation of a program to submit claims for the home health
 1172  services electronically. The program must verify visits for the
 1173  delivery of home health services telephonically using voice
 1174  biometrics. The agency may seek amendments to the Medicaid state
 1175  plan and waivers of federal law, as necessary, to implement the
 1176  pilot project. Notwithstanding s. 287.057(5)(f), Florida
 1177  Statutes, the agency must award the contract through the
 1178  competitive solicitation process. The agency shall submit a
 1179  report to the Governor, the President of the Senate, and the
 1180  Speaker of the House of Representatives evaluating the pilot
 1181  project by February 1, 2011.
 1182         Section 22. The Agency for Health Care Administration shall
 1183  implement a comprehensive care management pilot project in
 1184  Miami-Dade County for home health services by January 1, 2010,
 1185  which includes face-to-face assessments by a state-licensed
 1186  nurse, consultation with physicians ordering services to
 1187  substantiate the medical necessity for services, and on-site or
 1188  desk reviews of recipients’ medical records. The agency may
 1189  enter into a contract with a qualified organization to implement
 1190  the pilot project. The agency may seek amendments to the
 1191  Medicaid state plan and waivers of federal law, as necessary, to
 1192  implement the pilot project.
 1193         Section 23. This act shall take effect July 1, 2009.

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