Bill Text: FL S2506 | 2018 | Regular Session | Introduced


Bill Title: Health Care

Spectrum: Committee Bill

Status: (Introduced - Dead) 2018-03-10 - Died, not introduced [S2506 Detail]

Download: Florida-2018-S2506-Introduced.html
       Florida Senate - 2018                                    SB 2506
       
       
        
       By the Committee on Appropriations
       
       
       
       
       
       576-02708-18                                          20182506__
    1                        A bill to be entitled                      
    2         An act relating to health care; amending s. 381.915,
    3         F.S.; increasing the number of years that a cancer
    4         center may participate in Tier 3 of the Florida
    5         Consortium of National Cancer Institute Centers
    6         Program; increasing the number of years after
    7         qualification that a certain Tier 3 cancer center may
    8         pursue specified NCI designations; amending s.
    9         409.908, F.S.; removing the Agency for Health Care
   10         Administration’s authority to establish an alternative
   11         methodology to the DRG-based prospective payment
   12         system to set reimbursement rates for Class III
   13         psychiatric hospitals; revising parameters relating to
   14         the prospective payment methodology for the
   15         reimbursement of Medicaid providers to be implemented
   16         for rate setting purposes; requiring the agency to
   17         establish prospective payment reimbursement rates for
   18         nursing home services as provided in this act and in
   19         the General Appropriations Act; conforming provisions
   20         to changes made by the act; amending s. 409.9082,
   21         F.S.; authorizing the agency to seek certain remedies
   22         from any nursing home facility provider that fails to
   23         report its total number of resident days monthly,
   24         including the imposition of a specified fine; amending
   25         s. 409.9083, F.S.; authorizing the agency to seek
   26         certain remedies from any intermediate care facility
   27         for the developmentally disabled provider that fails
   28         to report its total number of resident days monthly,
   29         including the imposition of a specified fine; amending
   30         s. 409.909, F.S.; revising the definition of the term
   31         “qualifying institution” to include certain licensed
   32         substance abuse treatment facilities for purposes of
   33         the Statewide Medicaid Residency Program; amending s.
   34         409.968, F.S.; revising the rate-setting methodology
   35         used in the reimbursement of Class III psychiatric
   36         hospitals; amending s. 409.906, F.S.; conforming a
   37         cross-reference; requiring the agency to seek
   38         authorization from the federal Centers for Medicare
   39         and Medicaid Services to modify the period of
   40         retroactive Medicaid eligibility in a manner that
   41         ensures that the modification becomes effective by a
   42         certain date; requiring the agency to contract with a
   43         nonprofit organization in Miami-Dade County, which
   44         must meet certain requirements, to be a site for the
   45         Program for All-inclusive Care for the Elderly (PACE),
   46         subject to federal approval of the application site;
   47         requiring the nonprofit organization to provide PACE
   48         services to frail elders in Miami-Dade County;
   49         requiring the agency, in consultation with the
   50         Department of Elderly Affairs, to approve up to a
   51         certain number of initial enrollees in PACE at the new
   52         site, subject to an appropriation; providing effective
   53         dates.
   54          
   55  Be It Enacted by the Legislature of the State of Florida:
   56  
   57         Section 1. Paragraph (c) of subsection (4) of section
   58  381.915, Florida Statutes, is amended to read:
   59         381.915 Florida Consortium of National Cancer Institute
   60  Centers Program.—
   61         (4) Tier designations and corresponding weights within the
   62  Florida Consortium of National Cancer Institute Centers Program
   63  are as follows:
   64         (c) Tier 3: Florida-based cancer centers seeking
   65  designation as either a NCI-designated cancer center or NCI
   66  designated comprehensive cancer center, which shall be weighted
   67  at 1.0.
   68         1. A cancer center shall meet the following minimum
   69  criteria to be considered eligible for Tier 3 designation in any
   70  given fiscal year:
   71         a. Conducting cancer-related basic scientific research and
   72  cancer-related population scientific research;
   73         b. Offering and providing the full range of diagnostic and
   74  treatment services on site, as determined by the Commission on
   75  Cancer of the American College of Surgeons;
   76         c. Hosting or conducting cancer-related interventional
   77  clinical trials that are registered with the NCI’s Clinical
   78  Trials Reporting Program;
   79         d. Offering degree-granting programs or affiliating with
   80  universities through degree-granting programs accredited or
   81  approved by a nationally recognized agency and offered through
   82  the center or through the center in conjunction with another
   83  institution accredited by the Commission on Colleges of the
   84  Southern Association of Colleges and Schools;
   85         e. Providing training to clinical trainees, medical
   86  trainees accredited by the Accreditation Council for Graduate
   87  Medical Education or the American Osteopathic Association, and
   88  postdoctoral fellows recently awarded a doctorate degree; and
   89         f. Having more than $5 million in annual direct costs
   90  associated with their total NCI peer-reviewed grant funding.
   91         2. The General Appropriations Act or accompanying
   92  legislation may limit the number of cancer centers which shall
   93  receive Tier 3 designations or provide additional criteria for
   94  such designation.
   95         3. A cancer center’s participation in Tier 3 shall be
   96  limited to 6 5 years.
   97         4. A cancer center that qualifies as a designated Tier 3
   98  center under the criteria provided in subparagraph 1. by July 1,
   99  2014, is authorized to pursue NCI designation as a cancer center
  100  or a comprehensive cancer center for 6 5 years after
  101  qualification.
  102         Section 2. Paragraph (a) of subsection (1) of section
  103  409.908, Florida Statutes, is amended to read:
  104         409.908 Reimbursement of Medicaid providers.—Subject to
  105  specific appropriations, the agency shall reimburse Medicaid
  106  providers, in accordance with state and federal law, according
  107  to methodologies set forth in the rules of the agency and in
  108  policy manuals and handbooks incorporated by reference therein.
  109  These methodologies may include fee schedules, reimbursement
  110  methods based on cost reporting, negotiated fees, competitive
  111  bidding pursuant to s. 287.057, and other mechanisms the agency
  112  considers efficient and effective for purchasing services or
  113  goods on behalf of recipients. If a provider is reimbursed based
  114  on cost reporting and submits a cost report late and that cost
  115  report would have been used to set a lower reimbursement rate
  116  for a rate semester, then the provider’s rate for that semester
  117  shall be retroactively calculated using the new cost report, and
  118  full payment at the recalculated rate shall be effected
  119  retroactively. Medicare-granted extensions for filing cost
  120  reports, if applicable, shall also apply to Medicaid cost
  121  reports. Payment for Medicaid compensable services made on
  122  behalf of Medicaid eligible persons is subject to the
  123  availability of moneys and any limitations or directions
  124  provided for in the General Appropriations Act or chapter 216.
  125  Further, nothing in this section shall be construed to prevent
  126  or limit the agency from adjusting fees, reimbursement rates,
  127  lengths of stay, number of visits, or number of services, or
  128  making any other adjustments necessary to comply with the
  129  availability of moneys and any limitations or directions
  130  provided for in the General Appropriations Act, provided the
  131  adjustment is consistent with legislative intent.
  132         (1) Reimbursement to hospitals licensed under part I of
  133  chapter 395 must be made prospectively or on the basis of
  134  negotiation.
  135         (a) Reimbursement for inpatient care is limited as provided
  136  in s. 409.905(5), except as otherwise provided in this
  137  subsection.
  138         1. If authorized by the General Appropriations Act, the
  139  agency may modify reimbursement for specific types of services
  140  or diagnoses, recipient ages, and hospital provider types.
  141         2. The agency may establish an alternative methodology to
  142  the DRG-based prospective payment system to set reimbursement
  143  rates for:
  144         a. State-owned psychiatric hospitals.
  145         b. Newborn hearing screening services.
  146         c. Transplant services for which the agency has established
  147  a global fee.
  148         d. Recipients who have tuberculosis that is resistant to
  149  therapy who are in need of long-term, hospital-based treatment
  150  pursuant to s. 392.62.
  151         e. Class III psychiatric hospitals.
  152         3. The agency shall modify reimbursement according to other
  153  methodologies recognized in the General Appropriations Act.
  154  
  155  The agency may receive funds from state entities, including, but
  156  not limited to, the Department of Health, local governments, and
  157  other local political subdivisions, for the purpose of making
  158  special exception payments, including federal matching funds,
  159  through the Medicaid inpatient reimbursement methodologies.
  160  Funds received for this purpose shall be separately accounted
  161  for and may not be commingled with other state or local funds in
  162  any manner. The agency may certify all local governmental funds
  163  used as state match under Title XIX of the Social Security Act,
  164  to the extent and in the manner authorized under the General
  165  Appropriations Act and pursuant to an agreement between the
  166  agency and the local governmental entity. In order for the
  167  agency to certify such local governmental funds, a local
  168  governmental entity must submit a final, executed letter of
  169  agreement to the agency, which must be received by October 1 of
  170  each fiscal year and provide the total amount of local
  171  governmental funds authorized by the entity for that fiscal year
  172  under this paragraph, paragraph (b), or the General
  173  Appropriations Act. The local governmental entity shall use a
  174  certification form prescribed by the agency. At a minimum, the
  175  certification form must identify the amount being certified and
  176  describe the relationship between the certifying local
  177  governmental entity and the local health care provider. The
  178  agency shall prepare an annual statement of impact which
  179  documents the specific activities undertaken during the previous
  180  fiscal year pursuant to this paragraph, to be submitted to the
  181  Legislature annually by January 1.
  182         Section 3. Effective October 1, 2018, subsection (2) of
  183  section 409.908, Florida Statutes, as amended by section 8 of
  184  chapter 2017-129, Laws of Florida, is amended to read:
  185         Section 8. Effective October 1, 2018, subsection (2) of
  186  section 409.908, Florida Statutes, is amended to read:
  187         409.908 Reimbursement of Medicaid providers.—Subject to
  188  specific appropriations, the agency shall reimburse Medicaid
  189  providers, in accordance with state and federal law, according
  190  to methodologies set forth in the rules of the agency and in
  191  policy manuals and handbooks incorporated by reference therein.
  192  These methodologies may include fee schedules, reimbursement
  193  methods based on cost reporting, negotiated fees, competitive
  194  bidding pursuant to s. 287.057, and other mechanisms the agency
  195  considers efficient and effective for purchasing services or
  196  goods on behalf of recipients. If a provider is reimbursed based
  197  on cost reporting and submits a cost report late and that cost
  198  report would have been used to set a lower reimbursement rate
  199  for a rate semester, then the provider’s rate for that semester
  200  shall be retroactively calculated using the new cost report, and
  201  full payment at the recalculated rate shall be effected
  202  retroactively. Medicare-granted extensions for filing cost
  203  reports, if applicable, shall also apply to Medicaid cost
  204  reports. Payment for Medicaid compensable services made on
  205  behalf of Medicaid eligible persons is subject to the
  206  availability of moneys and any limitations or directions
  207  provided for in the General Appropriations Act or chapter 216.
  208  Further, nothing in this section shall be construed to prevent
  209  or limit the agency from adjusting fees, reimbursement rates,
  210  lengths of stay, number of visits, or number of services, or
  211  making any other adjustments necessary to comply with the
  212  availability of moneys and any limitations or directions
  213  provided for in the General Appropriations Act, provided the
  214  adjustment is consistent with legislative intent.
  215         (2)(a)1. Reimbursement to nursing homes licensed under part
  216  II of chapter 400 and state-owned-and-operated intermediate care
  217  facilities for the developmentally disabled licensed under part
  218  VIII of chapter 400 must be made prospectively.
  219         2. Unless otherwise limited or directed in the General
  220  Appropriations Act, reimbursement to hospitals licensed under
  221  part I of chapter 395 for the provision of swing-bed nursing
  222  home services must be made on the basis of the average statewide
  223  nursing home payment, and reimbursement to a hospital licensed
  224  under part I of chapter 395 for the provision of skilled nursing
  225  services must be made on the basis of the average nursing home
  226  payment for those services in the county in which the hospital
  227  is located. When a hospital is located in a county that does not
  228  have any community nursing homes, reimbursement shall be
  229  determined by averaging the nursing home payments in counties
  230  that surround the county in which the hospital is located.
  231  Reimbursement to hospitals, including Medicaid payment of
  232  Medicare copayments, for skilled nursing services shall be
  233  limited to 30 days, unless a prior authorization has been
  234  obtained from the agency. Medicaid reimbursement may be extended
  235  by the agency beyond 30 days, and approval must be based upon
  236  verification by the patient’s physician that the patient
  237  requires short-term rehabilitative and recuperative services
  238  only, in which case an extension of no more than 15 days may be
  239  approved. Reimbursement to a hospital licensed under part I of
  240  chapter 395 for the temporary provision of skilled nursing
  241  services to nursing home residents who have been displaced as
  242  the result of a natural disaster or other emergency may not
  243  exceed the average county nursing home payment for those
  244  services in the county in which the hospital is located and is
  245  limited to the period of time which the agency considers
  246  necessary for continued placement of the nursing home residents
  247  in the hospital.
  248         (b) Subject to any limitations or directions in the General
  249  Appropriations Act, the agency shall establish and implement a
  250  state Title XIX Long-Term Care Reimbursement Plan for nursing
  251  home care in order to provide care and services in conformance
  252  with the applicable state and federal laws, rules, regulations,
  253  and quality and safety standards and to ensure that individuals
  254  eligible for medical assistance have reasonable geographic
  255  access to such care.
  256         1. The agency shall amend the long-term care reimbursement
  257  plan and cost reporting system to create direct care and
  258  indirect care subcomponents of the patient care component of the
  259  per diem rate. These two subcomponents together shall equal the
  260  patient care component of the per diem rate. Separate prices
  261  shall be calculated for each patient care subcomponent,
  262  initially based on the September 2016 rate setting cost reports
  263  and subsequently based on the most recently audited cost report
  264  used during a rebasing year. The direct care subcomponent of the
  265  per diem rate for any providers still being reimbursed on a cost
  266  basis shall be limited by the cost-based class ceiling, and the
  267  indirect care subcomponent may be limited by the lower of the
  268  cost-based class ceiling, the target rate class ceiling, or the
  269  individual provider target. The ceilings and targets apply only
  270  to providers being reimbursed on a cost-based system. Effective
  271  October 1, 2018, a prospective payment methodology shall be
  272  implemented for rate setting purposes with the following
  273  parameters:
  274         a. Peer Groups, including:
  275         (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
  276  Counties; and
  277         (II) South-SMMC Regions 10-11, plus Palm Beach and
  278  Okeechobee Counties.
  279         b. Percentage of Median Costs based on the cost reports
  280  used for September 2016 rate setting:
  281         (I) Direct Care Costs....................105 100 percent.
  282         (II) Indirect Care Costs......................92 percent.
  283         (III) Operating Costs.........................86 percent.
  284         c. Floors:
  285         (I) Direct Care Component.....................95 percent.
  286         (II) Indirect Care Component................92.5 percent.
  287         (III) Operating Component...........................None.
  288         d. Pass-through PaymentsReal Estate and Personal Property
  289  Taxes and Property Insurance.
  290         e. Quality Incentive Program Payment Pool7.5 6 percent of
  291  September 2016 non-property related payments of included
  292  facilities.
  293         f. Quality Score Threshold to Quality for Quality Incentive
  294  Payment..................20th percentile of included facilities.
  295         g. Fair Rental Value System Payment Parameters:
  296         (I) Building Value per Square Foot based on 2018 RS Means.
  297         (II) Land Valuation...10 percent of Gross Building value.
  298         (III) Facility Square Footage......Actual Square Footage.
  299         (IV) Moveable Equipment Allowance.........$8,000 per bed.
  300         (V) Obsolescence Factor......................1.5 percent.
  301         (VI) Fair Rental Rate of Return................8 percent.
  302         (VII) Minimum Occupancy.......................90 percent.
  303         (VIII) Maximum Facility Age.....................40 years.
  304         (IX) Minimum Square Footage per Bed..................350.
  305         (X) Maximum Square Footage for Bed...................500.
  306         (XI) Minimum Cost of a renovation/replacements$500 per bed.
  307         h. Ventilator Supplemental payment of $200 per Medicaid day
  308  of 40,000 ventilator Medicaid days per fiscal year.
  309         2. The direct care subcomponent shall include salaries and
  310  benefits of direct care staff providing nursing services
  311  including registered nurses, licensed practical nurses, and
  312  certified nursing assistants who deliver care directly to
  313  residents in the nursing home facility, allowable therapy costs,
  314  and dietary costs. This excludes nursing administration, staff
  315  development, the staffing coordinator, and the administrative
  316  portion of the minimum data set and care plan coordinators. The
  317  direct care subcomponent also includes medically necessary
  318  dental care, vision care, hearing care, and podiatric care.
  319         3. All other patient care costs shall be included in the
  320  indirect care cost subcomponent of the patient care per diem
  321  rate, including complex medical equipment, medical supplies, and
  322  other allowable ancillary costs. Costs may not be allocated
  323  directly or indirectly to the direct care subcomponent from a
  324  home office or management company.
  325         4. On July 1 of each year, the agency shall report to the
  326  Legislature direct and indirect care costs, including average
  327  direct and indirect care costs per resident per facility and
  328  direct care and indirect care salaries and benefits per category
  329  of staff member per facility.
  330         5. Every fourth year, the agency shall rebase nursing home
  331  prospective payment rates to reflect changes in cost based on
  332  the most recently audited cost report for each participating
  333  provider.
  334         6. A direct care supplemental payment may be made to
  335  providers whose direct care hours per patient day are above the
  336  80th percentile and who provide Medicaid services to a larger
  337  percentage of Medicaid patients than the state average.
  338         7. For the period beginning on October 1, 2018, and ending
  339  on September 30, 2021, the agency shall reimburse providers the
  340  greater of their September 2016 cost-based rate or their
  341  prospective payment rate. Effective October 1, 2021, the agency
  342  shall reimburse providers the greater of 95 percent of their
  343  cost-based rate or their rebased prospective payment rate, using
  344  the most recently audited cost report for each facility. This
  345  subparagraph shall expire September 30, 2023.
  346         8. Pediatric, Florida Department of Veterans Affairs, and
  347  government-owned facilities are exempt from the pricing model
  348  established in this subsection and shall remain on a cost-based
  349  prospective payment system. Effective October 1, 2018, the
  350  agency shall set rates for all facilities remaining on a cost
  351  based prospective payment system using each facility’s most
  352  recently audited cost report, eliminating retroactive
  353  settlements.
  354  
  355  It is the intent of the Legislature that the reimbursement plan
  356  achieve the goal of providing access to health care for nursing
  357  home residents who require large amounts of care while
  358  encouraging diversion services as an alternative to nursing home
  359  care for residents who can be served within the community. The
  360  agency shall base the establishment of any maximum rate of
  361  payment, whether overall or component, on the available moneys
  362  as provided for in the General Appropriations Act. The agency
  363  may base the maximum rate of payment on the results of
  364  scientifically valid analysis and conclusions derived from
  365  objective statistical data pertinent to the particular maximum
  366  rate of payment.
  367         Section 4. Effective October 1, 2018, subsection (23) of
  368  section 409.908, Florida Statutes, is amended to read:
  369         409.908 Reimbursement of Medicaid providers.—Subject to
  370  specific appropriations, the agency shall reimburse Medicaid
  371  providers, in accordance with state and federal law, according
  372  to methodologies set forth in the rules of the agency and in
  373  policy manuals and handbooks incorporated by reference therein.
  374  These methodologies may include fee schedules, reimbursement
  375  methods based on cost reporting, negotiated fees, competitive
  376  bidding pursuant to s. 287.057, and other mechanisms the agency
  377  considers efficient and effective for purchasing services or
  378  goods on behalf of recipients. If a provider is reimbursed based
  379  on cost reporting and submits a cost report late and that cost
  380  report would have been used to set a lower reimbursement rate
  381  for a rate semester, then the provider’s rate for that semester
  382  shall be retroactively calculated using the new cost report, and
  383  full payment at the recalculated rate shall be effected
  384  retroactively. Medicare-granted extensions for filing cost
  385  reports, if applicable, shall also apply to Medicaid cost
  386  reports. Payment for Medicaid compensable services made on
  387  behalf of Medicaid eligible persons is subject to the
  388  availability of moneys and any limitations or directions
  389  provided for in the General Appropriations Act or chapter 216.
  390  Further, nothing in this section shall be construed to prevent
  391  or limit the agency from adjusting fees, reimbursement rates,
  392  lengths of stay, number of visits, or number of services, or
  393  making any other adjustments necessary to comply with the
  394  availability of moneys and any limitations or directions
  395  provided for in the General Appropriations Act, provided the
  396  adjustment is consistent with legislative intent.
  397         (23)(a) The agency shall establish rates at a level that
  398  ensures no increase in statewide expenditures resulting from a
  399  change in unit costs for county health departments effective
  400  July 1, 2011. Reimbursement rates shall be as provided in the
  401  General Appropriations Act.
  402         (b)1. Base rate reimbursement for inpatient services under
  403  a diagnosis-related group payment methodology shall be provided
  404  in the General Appropriations Act.
  405         2.(c) Base rate reimbursement for outpatient services under
  406  an enhanced ambulatory payment group methodology shall be
  407  provided in the General Appropriations Act.
  408         3. Prospective payment system reimbursement for nursing
  409  home services shall be as provided in subsection (2) and in the
  410  General Appropriations Act
  411         (d) This subsection applies to the following provider
  412  types:
  413         1. Nursing homes.
  414         2. County health departments.
  415         (e)The agency shall apply the effect of this subsection to
  416  the reimbursement rates for nursing home diversion programs.
  417         Section 5. Subsection (7) of section 409.9082, Florida
  418  Statutes, is amended to read:
  419         409.9082 Quality assessment on nursing home facility
  420  providers; exemptions; purpose; federal approval required;
  421  remedies.—
  422         (7) The agency may seek any of the following remedies for
  423  failure of any nursing home facility provider to report its
  424  total number of resident days monthly or to pay its assessment
  425  timely:
  426         (a) Withholding any medical assistance reimbursement
  427  payments until such time as the assessment amount is recovered;
  428         (b) Suspension or revocation of the nursing home facility
  429  license; and
  430         (c) Imposition of a fine of up to $1,000 per day for each
  431  offense delinquent payment, not to exceed the amount of the
  432  assessment.
  433         Section 6. Subsection (6) of section 409.9083, Florida
  434  Statutes, is amended to read:
  435         409.9083 Quality assessment on privately operated
  436  intermediate care facilities for the developmentally disabled;
  437  exemptions; purpose; federal approval required; remedies.—
  438         (6) The agency may seek any of the following remedies for
  439  failure of any ICF/DD provider to report its total number of
  440  resident days monthly or to timely pay its assessment:
  441         (a) Withholding any medical assistance reimbursement
  442  payments until the assessment amount is recovered.
  443         (b) Suspending or revoking the facility’s license.
  444         (c) Imposing a fine of up to $1,000 per day for each
  445  offense delinquent payment, not to exceed the amount of the
  446  assessment.
  447         Section 7. Paragraph (c) of subsection (2) of section
  448  409.909, Florida Statutes, is amended to read:
  449         409.909 Statewide Medicaid Residency Program.—
  450         (2) On or before September 15 of each year, the agency
  451  shall calculate an allocation fraction to be used for
  452  distributing funds to participating hospitals and to qualifying
  453  institutions as defined in paragraph (c). On or before the final
  454  business day of each quarter of a state fiscal year, the agency
  455  shall distribute to each participating hospital one-fourth of
  456  that hospital’s annual allocation calculated under subsection
  457  (4). The allocation fraction for each participating hospital is
  458  based on the hospital’s number of full-time equivalent residents
  459  and the amount of its Medicaid payments. As used in this
  460  section, the term:
  461         (c) “Qualifying institution” means a federally Qualified
  462  Health Center holding an Accreditation Council for Graduate
  463  Medical Education institutional accreditation or a substance
  464  abuse treatment facility licensed under chapter 397 which has
  465  housed residents and fellows since 2013.
  466         Section 8. Present subsections (4) and (5) of section
  467  409.968, Florida Statutes, are redesignated as subsections (5)
  468  and (6), respectively, and a new subsection (4) is added to that
  469  section, to read:
  470         409.968 Managed care plan payments.—
  471         (4) Reimbursement for Class III psychiatric hospitals is
  472  not defined by the agency’s inpatient hospital APR-DRG
  473  compensation methodology and must be established using the
  474  federal Centers for Medicare and Medicaid Services prospective
  475  payment system pricing methodology or be limited to compensation
  476  amounts agreed to by the plan and the hospital.
  477         Section 9. Paragraph (d) of subsection (13) of section
  478  409.906, Florida Statutes, is amended to read:
  479         409.906 Optional Medicaid services.—Subject to specific
  480  appropriations, the agency may make payments for services which
  481  are optional to the state under Title XIX of the Social Security
  482  Act and are furnished by Medicaid providers to recipients who
  483  are determined to be eligible on the dates on which the services
  484  were provided. Any optional service that is provided shall be
  485  provided only when medically necessary and in accordance with
  486  state and federal law. Optional services rendered by providers
  487  in mobile units to Medicaid recipients may be restricted or
  488  prohibited by the agency. Nothing in this section shall be
  489  construed to prevent or limit the agency from adjusting fees,
  490  reimbursement rates, lengths of stay, number of visits, or
  491  number of services, or making any other adjustments necessary to
  492  comply with the availability of moneys and any limitations or
  493  directions provided for in the General Appropriations Act or
  494  chapter 216. If necessary to safeguard the state’s systems of
  495  providing services to elderly and disabled persons and subject
  496  to the notice and review provisions of s. 216.177, the Governor
  497  may direct the Agency for Health Care Administration to amend
  498  the Medicaid state plan to delete the optional Medicaid service
  499  known as “Intermediate Care Facilities for the Developmentally
  500  Disabled.” Optional services may include:
  501         (13) HOME AND COMMUNITY-BASED SERVICES.—
  502         (d) The agency shall seek federal approval to pay for
  503  flexible services for persons with severe mental illness or
  504  substance use disorders, including, but not limited to,
  505  temporary housing assistance. Payments may be made as enhanced
  506  capitation rates or incentive payments to managed care plans
  507  that meet the requirements of s. 409.968(5) s. 409.968(4).
  508         Section 10. The Agency for Health Care Administration shall
  509  seek authorization from the federal Centers for Medicare and
  510  Medicaid Services to modify the period of retroactive Medicaid
  511  eligibility from 90 days to 30 days in a manner that ensures
  512  that the modification becomes effective on July 1, 2018.
  513         Section 11. Effective July 1, 2018, and subject to federal
  514  approval of the application to be a site for the Program of All
  515  inclusive Care for the Elderly (PACE), the Agency for Health
  516  Care Administration shall contract with an additional nonprofit
  517  organization to serve individuals and families in Miami-Dade
  518  County. The nonprofit organization must have a history of
  519  serving primarily the Hispanic population by providing primary
  520  care services, nutrition, meals, and adult day care to the
  521  senior population. The nonprofit organization shall leverage
  522  existing community-based care providers and health care
  523  organizations to provide PACE services to frail elders who
  524  reside in Miami-Dade County. The organization is exempt from the
  525  requirements of chapter 641, Florida Statutes. The agency, in
  526  consultation with the Department of Elderly Affairs and subject
  527  to an appropriation, shall approve up to 250 initial enrollees
  528  in the PACE site established by this organization to serve frail
  529  elders who reside in Miami-Dade County.
  530         Section 12. Except as expressly provided in this act, this
  531  act shall take effect upon becoming a law.

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