Bill Amendment: FL S0844 | 2013 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Medicaid
Status: 2013-04-29 - Laid on Table, companion bill(s) passed, see CS/CS/HB 939 (Ch. 2013-150), SB 1520 (Ch. 2013-48) [S0844 Detail]
Download: Florida-2013-S0844-Health_Policy_Committee_Amendment_861804.html
Bill Title: Medicaid
Status: 2013-04-29 - Laid on Table, companion bill(s) passed, see CS/CS/HB 939 (Ch. 2013-150), SB 1520 (Ch. 2013-48) [S0844 Detail]
Download: Florida-2013-S0844-Health_Policy_Committee_Amendment_861804.html
Florida Senate - 2013 COMMITTEE AMENDMENT Bill No. SB 844 Barcode 861804 LEGISLATIVE ACTION Senate . House Comm: RCS . 03/07/2013 . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Health Policy (Grimsley) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete lines 201 - 655 4 and insert: 5 (8)(a)Each provider, or each principal of the provider if 6 the provider is a corporation, partnership, association, or 7 other entity, seeking to participate in the Medicaid program 8 must submit a complete set of his or her fingerprints to the 9 agency for the purpose of conducting a criminal history record 10 check. Principals of the provider include any officer, director, 11 billing agent, managing employee, or affiliated person, or any 12 partner or shareholder who has an ownership interest equal to 5 13 percent or more in the provider. However, for a hospital 14 licensed under chapter 395 or a nursing home licensed under 15 chapter 400, principals of the provider are those who meet the 16 definition of a controlling interest under s. 408.803. A 17 director of a not-for-profit corporation or organization is not 18 a principal for purposes of a background investigationas19 required by this section if the director: serves solely in a 20 voluntary capacity for the corporation or organization, does not 21 regularly take part in the day-to-day operational decisions of 22 the corporation or organization, receives no remuneration from 23 the not-for-profit corporation or organization for his or her 24 service on the board of directors, has no financial interest in 25 the not-for-profit corporation or organization, and has no 26 family members with a financial interest in the not-for-profit 27 corporation or organization; and if the director submits an 28 affidavit, under penalty of perjury, to this effect to the 29 agency and the not-for-profit corporation or organization 30 submits an affidavit, under penalty of perjury, to this effect 31 to the agency as part of the corporation’s or organization’s 32 Medicaid provider agreement application. Notwithstanding the 33 above, the agency may require a background check for any person 34 reasonably suspected by the agency to have been convicted of a 35 crime. 36 (a) This subsection does not apply to: 371. A hospital licensed under chapter 395;382. A nursing home licensed under chapter 400;393. A hospice licensed under chapter 400;404. An assisted living facility licensed under chapter 429;41 1.5.A unit of local government, except that requirements 42 of this subsection apply to nongovernmental providers and 43 entities contracting with the local government to provide 44 Medicaid services. The actual cost of the state and national 45 criminal history record checks must be borne by the 46 nongovernmental provider or entity; or 47 2.6.Any business that derives more than 50 percent of its 48 revenue from the sale of goods to the final consumer, and the 49 business or its controlling parent is required to file a form 50 10-K or other similar statement with the Securities and Exchange 51 Commission or has a net worth of $50 million or more. 52 (b) Background screening shall be conducted in accordance 53 with chapter 435 and s. 408.809. The cost of the state and 54 national criminal record check shall be borne by the provider. 55(c) Proof of compliance with the requirements of level 256screening under chapter 435 conducted within 12 months before57the date the Medicaid provider application is submitted to the58agency fulfills the requirements of this subsection.59 Section 2. Subsections (9), (13), (15), (16), (21), (22), 60 (25), (28), (30) and (31) of section 409.913, Florida Statutes, 61 are amended to read: 62 409.913 Oversight of the integrity of the Medicaid 63 program.—The agency shall operate a program to oversee the 64 activities of Florida Medicaid recipients, and providers and 65 their representatives, to ensure that fraudulent and abusive 66 behavior and neglect of recipients occur to the minimum extent 67 possible, and to recover overpayments and impose sanctions as 68 appropriate. Beginning January 1, 2003, and each year 69 thereafter, the agency and the Medicaid Fraud Control Unit of 70 the Department of Legal Affairs shall submit a joint report to 71 the Legislature documenting the effectiveness of the state’s 72 efforts to control Medicaid fraud and abuse and to recover 73 Medicaid overpayments during the previous fiscal year. The 74 report must describe the number of cases opened and investigated 75 each year; the sources of the cases opened; the disposition of 76 the cases closed each year; the amount of overpayments alleged 77 in preliminary and final audit letters; the number and amount of 78 fines or penalties imposed; any reductions in overpayment 79 amounts negotiated in settlement agreements or by other means; 80 the amount of final agency determinations of overpayments; the 81 amount deducted from federal claiming as a result of 82 overpayments; the amount of overpayments recovered each year; 83 the amount of cost of investigation recovered each year; the 84 average length of time to collect from the time the case was 85 opened until the overpayment is paid in full; the amount 86 determined as uncollectible and the portion of the uncollectible 87 amount subsequently reclaimed from the Federal Government; the 88 number of providers, by type, that are terminated from 89 participation in the Medicaid program as a result of fraud and 90 abuse; and all costs associated with discovering and prosecuting 91 cases of Medicaid overpayments and making recoveries in such 92 cases. The report must also document actions taken to prevent 93 overpayments and the number of providers prevented from 94 enrolling in or reenrolling in the Medicaid program as a result 95 of documented Medicaid fraud and abuse and must include policy 96 recommendations necessary to prevent or recover overpayments and 97 changes necessary to prevent and detect Medicaid fraud. All 98 policy recommendations in the report must include a detailed 99 fiscal analysis, including, but not limited to, implementation 100 costs, estimated savings to the Medicaid program, and the return 101 on investment. The agency must submit the policy recommendations 102 and fiscal analyses in the report to the appropriate estimating 103 conference, pursuant to s. 216.137, by February 15 of each year. 104 The agency and the Medicaid Fraud Control Unit of the Department 105 of Legal Affairs each must include detailed unit-specific 106 performance standards, benchmarks, and metrics in the report, 107 including projected cost savings to the state Medicaid program 108 during the following fiscal year. 109 (9) A Medicaid provider shall retain medical, professional, 110 financial, and business records pertaining to services and goods 111 furnished to a Medicaid recipient and billed to Medicaid for 6a112period of 5years after the date of furnishing such services or 113 goods. The agency may investigate, review, or analyze such 114 records, which must be made available during normal business 115 hours. However, 24-hour notice must be provided if patient 116 treatment would be disrupted. The provider must keepis117responsible for furnishing to the agency, and keepingthe agency 118 informed of the location of, the provider’s Medicaid-related 119 records. The authority of the agency to obtain Medicaid-related 120 records from a provider is neither curtailed nor limited during 121 a period of litigation between the agency and the provider. 122 (13) The agency shallimmediatelyterminate participation 123 of a Medicaid provider in the Medicaid program and may seek 124 civil remedies or impose other administrative sanctions against 125 a Medicaid provider, if the provider or any principal, officer, 126 director, agent, managing employee, or affiliated person of the 127 provider, or any partner or shareholder having an ownership 128 interest in the provider equal to 5 percent or greater, has been 129 convicted of a criminal offense under federal law or the law of 130 any state relating to the practice of the provider’s profession, 131 or a criminal offense listed under s. 409.907(10), s. 132 408.809(4), or s. 435.04(2)has been:133(a) Convicted of a criminal offense related to the delivery134of any health care goods or services, including the performance135of management or administrative functions relating to the136delivery of health care goods or services;137(b) Convicted of a criminal offense under federal law or138the law of any state relating to the practice of the provider’s139profession; or140(c) Found by a court of competent jurisdiction to have141neglected or physically abused a patient in connection with the142delivery of health care goods or services. If the agency 143 determines that theaprovider did not participate or acquiesce 144 in theanoffensespecified in paragraph (a), paragraph (b), or145paragraph (c),termination will not be imposed. If the agency 146 effects a termination under this subsection, the agency shall 147 take final agency actionissue an immediate final order pursuant148to s.120.569(2)(n). 149 (15) The agency shall seek a remedy provided by law, 150 including, but not limited to, any remedy provided in 151 subsections (13) and (16) and s. 812.035, if: 152 (a) The provider’s license has not been renewed, or has 153 been revoked, suspended, or terminated, for cause, by the 154 licensing agency of any state; 155 (b) The provider has failed to make available or has 156 refused access to Medicaid-related records to an auditor, 157 investigator, or other authorized employee or agent of the 158 agency, the Attorney General, a state attorney, or the Federal 159 Government; 160 (c) The provider has not furnished or has failed to make 161 available such Medicaid-related records as the agency has found 162 necessary to determine whether Medicaid payments are or were due 163 and the amounts thereof; 164 (d) The provider has failed to maintain medical records 165 made at the time of service, or prior to service if prior 166 authorization is required, demonstrating the necessity and 167 appropriateness of the goods or services rendered; 168 (e) The provider is not in compliance with provisions of 169 Medicaid provider publications that have been adopted by 170 reference as rules in the Florida Administrative Code; with 171 provisions of state or federal laws, rules, or regulations; with 172 provisions of the provider agreement between the agency and the 173 provider; or with certifications found on claim forms or on 174 transmittal forms for electronically submitted claims that are 175 submitted by the provider or authorized representative, as such 176 provisions apply to the Medicaid program; 177 (f) The provider or person who ordered, authorized, or 178 prescribed the care, services, or supplies has furnished, or 179 ordered or authorized the furnishing of, goods or services to a 180 recipient which are inappropriate, unnecessary, excessive, or 181 harmful to the recipient or are of inferior quality; 182 (g) The provider has demonstrated a pattern of failure to 183 provide goods or services that are medically necessary; 184 (h) The provider or an authorized representative of the 185 provider, or a person who ordered, authorized, or prescribed the 186 goods or services, has submitted or caused to be submitted false 187 or a pattern of erroneous Medicaid claims; 188 (i) The provider or an authorized representative of the 189 provider, or a person who has ordered, authorized, or prescribed 190 the goods or services, has submitted or caused to be submitted a 191 Medicaid provider enrollment application, a request for prior 192 authorization for Medicaid services, a drug exception request, 193 or a Medicaid cost report that contains materially false or 194 incorrect information; 195 (j) The provider or an authorized representative of the 196 provider has collected from or billed a recipient or a 197 recipient’s responsible party improperly for amounts that should 198 not have been so collected or billed by reason of the provider’s 199 billing the Medicaid program for the same service; 200 (k) The provider or an authorized representative of the 201 provider has included in a cost report costs that are not 202 allowable under a Florida Title XIX reimbursement plan,after 203 the provider or authorized representative had been advised in an 204 audit exit conference or audit report that the costs were not 205 allowable; 206 (l) The provider is charged by information or indictment 207 with fraudulent billing practices or an offense referenced in 208 subsection (13). The sanction applied for this reason is limited 209 to suspension of the provider’s participation in the Medicaid 210 program for the duration of the indictment unless the provider 211 is found guilty pursuant to the information or indictment; 212 (m) The provider or a person whohasordered, authorized, 213 or prescribed the goods or services is found liable for 214 negligent practice resulting in death or injury to the 215 provider’s patient; 216 (n) The provider fails to demonstrate that it had available 217 during a specific audit or review period sufficient quantities 218 of goods, or sufficient time in the case of services, to support 219 the provider’s billings to the Medicaid program; 220 (o) The provider has failed to comply with the notice and 221 reporting requirements of s. 409.907; 222 (p) The agency has received reliable information of patient 223 abuse or neglect or of any act prohibited by s. 409.920; or 224 (q) The provider has failed to comply with an agreed-upon 225 repayment schedule. 226 227 A provider is subject to sanctions for violations of this 228 subsection as the result of actions or inactions of the 229 provider, or actions or inactions of any principal, officer, 230 director, agent, managing employee, or affiliated person of the 231 provider, or any partner or shareholder having an ownership 232 interest in the provider equal to 5 percent or greater, in which 233 the provider participated or acquiesced. 234 (16) The agency shall impose any of the following sanctions 235 or disincentives on a provider or a person for any of the acts 236 described in subsection (15): 237 (a) Suspension for a specific period of time of not more 238 than 1 year. Suspension precludesshall precludeparticipation 239 in the Medicaid program, which includes any action that results 240 in a claim for payment to the Medicaid program foras a result241offurnishing, supervising a person who is furnishing, or 242 causing a person to furnish goods or services. 243 (b) Termination for a specific period of time rangingof244 from more than 1 year to 20 years. Termination precludesshall245precludeparticipation in the Medicaid program, which includes 246 any action that results in a claim for payment to the Medicaid 247 program foras a result offurnishing, supervising a person who 248 is furnishing, or causing a person to furnish goods or services. 249 (c) Imposition of a fine of up to $5,000 for each 250 violation. Each day that an ongoing violation continues, such as 251 refusing to furnish Medicaid-related records or refusing access 252 to records, is considered, for the purposes of this section, to253bea separate violation. Each instance of improper billing of a 254 Medicaid recipient; each instance of including an unallowable 255 cost on a hospital or nursing home Medicaid cost report after 256 the provider or authorized representative has been advised in an 257 audit exit conference or previous audit report of the cost 258 unallowability; each instance of furnishing a Medicaid recipient 259 goods or professional services that are inappropriate or of 260 inferior quality as determined by competent peer judgment; each 261 instance of knowingly submitting a materially false or erroneous 262 Medicaid provider enrollment application, request for prior 263 authorization for Medicaid services, drug exception request, or 264 cost report; each instance of inappropriate prescribing of drugs 265 for a Medicaid recipient as determined by competent peer 266 judgment; and each false or erroneous Medicaid claim leading to 267 an overpayment to a provider is considered, for the purposes of268this section, to bea separate violation. 269 (d) Immediate suspension, if the agency has received 270 information of patient abuse or neglect or of any act prohibited 271 by s. 409.920. Upon suspension, the agency must issue an 272 immediate final order under s. 120.569(2)(n). 273 (e) A fine, not to exceed $10,000, for a violation of 274 paragraph (15)(i). 275 (f) Imposition of liens against provider assets, including, 276 but not limited to, financial assets and real property, not to 277 exceed the amount of fines or recoveries sought, upon entry of 278 an order determining that such moneys are due or recoverable. 279 (g) Prepayment reviews of claims for a specified period of 280 time. 281 (h) Comprehensive followup reviews of providers every 6 282 months to ensure that they are billing Medicaid correctly. 283 (i) Corrective-action plans thatwouldremain in effectfor284providersfor up to 3 years and that arewould bemonitored by 285 the agency every 6 months while in effect. 286 (j) Other remedies as permitted by law to effect the 287 recovery of a fine or overpayment. 288 289 If a provider voluntarily relinquishes its Medicaid provider 290 number or an associated license, or allows the associated 291 licensure to expire after receiving written notice that the 292 agency is conducting, or has conducted, an audit, survey, 293 inspection, or investigation and that a sanction of suspension 294 or termination will or would be imposed for noncompliance 295 discovered as a result of the audit, survey, inspection, or 296 investigation, the agency shall impose the sanction of 297 termination for cause against the provider. The Secretary of 298 Health Care Administration may make a determination that 299 imposition of a sanction or disincentive is not in the best 300 interest of the Medicaid program, in which case a sanction or 301 disincentive mayshallnot be imposed. 302 (21) When making a determination that an overpayment has 303 occurred, the agency shall prepare and issue an audit report to 304 the provider showing the calculation of overpayments. The 305 agency’s determination must be based solely upon information 306 available to it before issuance of the audit report and, in the 307 case of documentation obtained to substantiate claims for 308 Medicaid reimbursement, based solely upon contemporaneous 309 records. 310 (22) The audit report, supported by agency work papers, 311 showing an overpayment to a provider constitutes evidence of the 312 overpayment. A provider may not present or elicit testimony,313eitheron direct examination or cross-examination in any court 314 or administrative proceeding, regarding the purchase or 315 acquisition by any means of drugs, goods, or supplies; sales or 316 divestment by any means of drugs, goods, or supplies; or 317 inventory of drugs, goods, or supplies, unless such acquisition, 318 sales, divestment, or inventory is documented by written 319 invoices, written inventory records, or other competent written 320 documentary evidence maintained in the normal course of the 321 provider’s business. A provider may not present records to 322 contest an overpayment or sanction unless such records are 323 contemporaneous and, if requested during the audit process, were 324 furnished to the agency or its agent upon request or were 325 furnished within 30 days after the provider received the final 326 audit report. This limitation does not apply to Medicaid cost 327 report audits. Notwithstanding the applicable rules of 328 discovery, all documentation tothat willbe offered as evidence 329 at an administrative hearing on a Medicaid overpayment or an 330 administrative sanction must be exchanged by all parties at 331 least 14 days before the administrative hearing ormustbe 332 excluded from consideration. 333 (25)(a) The agency shall withhold Medicaid payments, in 334 whole or in part, to a provider upon receipt of reliable 335 evidence that the circumstances giving rise to the need for a 336 withholding of payments involve fraud, willful 337 misrepresentation, or abuse under the Medicaid program, or a 338 crime committed while rendering goods or services to Medicaid 339 recipients. If it is determined that fraud, willful 340 misrepresentation, abuse, or a crime did not occur, the payments 341 withheld must be paid to the provider within 14 days after such 342 determinationwith interest at the rate of 10 percent a year.343Any money withheld in accordance with this paragraph shall be344placed in a suspended account, readily accessible to the agency,345so that any payment ultimately due the provider shall be made346within 14 days. 347 (b) The agency shall deny payment, or require repayment, if 348 the goods or services were furnished, supervised, or caused to 349 be furnished by a person who has been suspended or terminated 350 from the Medicaid program or Medicare program by the Federal 351 Government or any state. 352 (c) Overpayments owed to the agency bear interest at the 353 rate of 10 percent per year from the date of determination of 354 the overpayment by the agency, and payment arrangements must be 355 made within 30 days after the date of the final order, which is 356 not subject to further appeal, and all appeals have been 357 exhaustedat the conclusion of legal proceedings.A provider who358does not enter into or adhere to an agreed-upon repayment359schedule may be terminated by the agency for nonpayment or360partial payment.361 (d) The agency, upon entry of a final agency order, a 362 judgment or order of a court of competent jurisdiction, or a 363 stipulation or settlement, may collect the moneys owed by all 364 means allowable by law, including, but not limited to, notifying 365 any fiscal intermediary of Medicare benefits that the state has 366 a superior right of payment. Upon receipt of such written 367 notification, the Medicare fiscal intermediary shall remit to 368 the state the sum claimed. 369 (e) The agency may institute amnesty programs to allow 370 Medicaid providers the opportunity to voluntarily repay 371 overpayments. The agency may adopt rules to administer such 372 programs. 373 (28) Venue for all Medicaid program integrityoverpayment374 cases liesshall liein Leon County, at the discretion of the 375 agency. 376 377 ================= T I T L E A M E N D M E N T ================ 378 And the title is amended as follows: 379 Delete lines 13 - 21 380 and insert: 381 409.913, F.S.; increasing the number of years a