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 65years. 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 65years 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. 151e. 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....................105100percent. 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 Pool7.56percent 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 provider412types:4131. Nursing homes.4142. County health departments.415(e)The agency shall apply the effect of this subsection to416the 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 offensedelinquent 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 offensedelinquent 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.