Bill Text: FL S2514 | 2017 | Regular Session | Enrolled


Bill Title: Health Care

Spectrum: Committee Bill

Status: (Passed) 2017-06-19 - Chapter No. 2017-129, companion bill(s) passed, see SB 2500 (Ch. 2017-70) [S2514 Detail]

Download: Florida-2017-S2514-Enrolled.html
       ENROLLED
       2017 Legislature                          SB 2514, 2nd Engrossed
       
       
       
       
       
       
                                                             20172514er
    1  
    2         An act relating to health care; amending s. 210.20,
    3         F.S.; providing that a specified percentage of the
    4         cigarette tax, up to a specified amount, be paid
    5         annually to the Florida Consortium of National Cancer
    6         Institute Centers Program, rather than the Sanford
    7         Burnham Medical Research Institute; requiring that the
    8         funds be used to advance cures for cancers afflicting
    9         pediatric populations through basic or applied
   10         research; amending s. 381.922, F.S.; revising the
   11         goals of the William G. “Bill” Bankhead, Jr., and
   12         David Coley Cancer Research Program to include
   13         identifying ways to increase pediatric enrollment in
   14         cancer clinical trials; establishing the Live Like
   15         Bella Initiative to advance progress toward curing
   16         pediatric cancer, subject to an appropriation;
   17         amending s. 394.9082, F.S.; revising the reporting
   18         requirements of the acute care services utilization
   19         database; requiring the Department of Children and
   20         Families to post certain data on its website; amending
   21         s. 395.602, F.S.; revising the definition of the term
   22         “rural hospital” to include a hospital classified as a
   23         sole community hospital, regardless of the number of
   24         licensed beds; amending s. 400.179, F.S.; providing
   25         that certain fees deposited into the Medicaid nursing
   26         home overpayment account in the Grants and Donations
   27         Trust Fund may be used by the agency for enhanced
   28         payments to nursing facilities as specified in the
   29         General Appropriations Act or other law; amending s.
   30         409.904, F.S.; authorizing the agency to make payments
   31         for medical assistance and related services on behalf
   32         of a person diagnosed with acquired immune deficiency
   33         syndrome who meets certain criteria, subject to the
   34         availability of moneys and specified limitations;
   35         amending s. 409.906, F.S.; deleting a provision
   36         relating to consolidation of waiver services to
   37         conform to changes made by the act; amending s.
   38         409.908, F.S.; revising requirements related to the
   39         long-term care reimbursement plan and cost reporting
   40         system; requiring the calculation of separate prices
   41         for each patient care subcomponent based on specified
   42         cost reports; providing that certain ceilings and
   43         targets apply only to providers being reimbursed on a
   44         cost-based system; requiring implementation of a
   45         prospective payment methodology for rate setting
   46         purposes; providing parameters; expanding the direct
   47         care subcomponent to include allowable therapy and
   48         dietary costs; specifying that allowable ancillary
   49         costs are included in the indirect care cost
   50         subcomponent; requiring that nursing home prospective
   51         payment rates be rebased at a specified interval;
   52         authorizing the payment of a direct care supplemental
   53         payment to certain providers; specifying the amount
   54         providers will be reimbursed for a specified period of
   55         time, which may be a cost-based rate or a prospective
   56         payment rate; providing for expiration of this
   57         reimbursement mechanism on a specified date; requiring
   58         the agency to reimburse providers on a cost-based rate
   59         or a rebased prospective payment rate, beginning on a
   60         specified date; requiring that Medicaid pay
   61         deductibles and coinsurance for certain X-ray services
   62         provided in an assisted living facility or in the
   63         patient’s home; deleting a provision relating to
   64         reimbursement rate parameters for certain Medicaid
   65         providers; authorizing the agency to receive funds
   66         from certain governmental entities for specified
   67         purposes; providing requirements for letters of
   68         agreement executed by a local governmental entity;
   69         amending s. 409.9082, F.S.; revising the uses of
   70         quality assessment and federal matching funds to
   71         include the partial funding of the quality incentive
   72         payment program for nursing facilities that exceed
   73         quality benchmarks; amending s. 409.909, F.S.;
   74         providing that the agency shall make payments and
   75         distribute funds to qualifying institutions in
   76         addition to hospitals under the Statewide Medicaid
   77         Residency Program; amending s. 409.911, F.S.; updating
   78         obsolete language; amending s. 409.9119, F.S.;
   79         revising criteria for the participation of hospitals
   80         in the disproportionate share program for specialty
   81         hospitals for children; amending s. 409.913, F.S.;
   82         removing a requirement that the agency provide each
   83         Medicaid recipient with an explanation of benefits;
   84         authorizing the agency to provide an explanation of
   85         benefits to a sample of Medicaid recipients or their
   86         representatives; amending s. 409.975, F.S.;
   87         authorizing, rather than requiring, a managed care
   88         plan to offer a network contract to certain medical
   89         equipment and supplies providers in the region;
   90         amending s. 409.979, F.S.; expanding eligibility for
   91         long-term care services to include hospital level of
   92         care for certain individuals diagnosed with cystic
   93         fibrosis; revising eligibility for certain Medicaid
   94         recipients in the long-term care managed care program;
   95         amending s. 409.983, F.S.; eliminating the requirement
   96         that the agency consider facility costs adjusted for
   97         inflation and other factors in the establishment of
   98         certain payment rates for nursing facilities; amending
   99         s. 409.901, F.S.; revising the definition of the term
  100         “third party”; amending s. 409.910, F.S.; revising
  101         provisions relating to responsibility for Medicaid
  102         payments in settlement proceedings; extending period
  103         of time for filing a claim of lien filed for purposes
  104         of third-party liability; extending the period of time
  105         within which the agency is authorized to pursue
  106         certain causes of action; revising procedures for a
  107         recipient to contest the amount payable to the agency
  108         when federal law limits reimbursement under certain
  109         circumstances; requiring certain entities responsible
  110         for payment of claims to provide certain records and
  111         information and respond to requests for payment of
  112         claims within a specified timeframe as a condition of
  113         doing business in the state; providing circumstances
  114         under which such parties are obligated to pay claims;
  115         deleting provisions relating to cooperative agreements
  116         between the agency, the Office of Insurance
  117         Regulation, and the Department of Revenue; requiring
  118         the agency to contract with a specified not-for-profit
  119         organization, a not-for-profit agency serving elders,
  120         and a not-for-profit hospice in Leon County to be a
  121         site for the Program for All-inclusive Care for the
  122         Elderly (PACE), subject to federal approval of the
  123         application site; authorizing PACE to serve eligible
  124         enrollees in Gadsden, Jefferson, Leon, and Wakulla
  125         Counties; requiring the agency, in consultation with
  126         the department, to approve a certain number of initial
  127         enrollees in PACE at the new site, subject to an
  128         appropriation; amending s. 17 of chapter 2011-61, Laws
  129         of Florida; requiring the agency, in consultation with
  130         the department, to approve a certain number of initial
  131         enrollees in PACE to serve frail elders who reside in
  132         certain counties; amending s. 29 of chapter 2016-65,
  133         Laws of Florida; requiring the agency, in consultation
  134         with the department, to approve a certain number of
  135         enrollees in the PACE established to serve frail
  136         elders who reside in Hospice Service Area 7C;
  137         requiring the agency, in consultation with the
  138         department, to approve a certain number of initial
  139         enrollees in PACE at the new site, subject to certain
  140         conditions; amending ss. 391.055, 393.0661, 409.968,
  141         427.0135, and 1011.70, F.S.; conforming cross
  142         references; providing appropriations; providing
  143         effective dates.
  144          
  145  Be It Enacted by the Legislature of the State of Florida:
  146  
  147         Section 1. Paragraph (c) of subsection (2) of section
  148  210.20, Florida Statutes, is amended to read:
  149         210.20 Employees and assistants; distribution of funds.—
  150         (2) As collections are received by the division from such
  151  cigarette taxes, it shall pay the same into a trust fund in the
  152  State Treasury designated “Cigarette Tax Collection Trust Fund”
  153  which shall be paid and distributed as follows:
  154         (c) Beginning July 1, 2017 2013, and continuing through
  155  June 30, 2033, the division shall from month to month certify to
  156  the Chief Financial Officer the amount derived from the
  157  cigarette tax imposed by s. 210.02, less the service charges
  158  provided for in s. 215.20 and less 0.9 percent of the amount
  159  derived from the cigarette tax imposed by s. 210.02, which shall
  160  be deposited into the Alcoholic Beverage and Tobacco Trust Fund,
  161  specifying an amount equal to 1 percent of the net collections,
  162  not to exceed $3 million annually, and that amount shall be
  163  deposited into the Biomedical Research Trust Fund in the
  164  Department of Health. These funds are appropriated annually in
  165  an amount not to exceed $3 million from the Biomedical Research
  166  Trust Fund for the advancement of cures for cancers afflicting
  167  pediatric populations through basic or applied research,
  168  including, but not limited to, clinical trials and nontoxic drug
  169  discovery. These funds are not included in the calculation for
  170  the distribution of funds pursuant to s. 381.915; however, these
  171  funds shall be distributed to cancer centers participating in
  172  the Florida Consortium of National Cancer Institute Centers
  173  Program in the same proportion as is allocated to each cancer
  174  center in accordance with s. 381.915 and are in addition to any
  175  funds distributed pursuant to that section Department of Health
  176  and the Sanford-Burnham Medical Research Institute to work in
  177  conjunction for the purpose of establishing activities and grant
  178  opportunities in relation to biomedical research.
  179         Section 2. Subsection (2) of section 381.922, Florida
  180  Statutes, is amended to read:
  181         381.922 William G. “Bill” Bankhead, Jr., and David Coley
  182  Cancer Research Program.—
  183         (2) The program shall provide grants for cancer research to
  184  further the search for cures for cancer.
  185         (a) Emphasis shall be given to the following goals, as
  186  those goals support the advancement of such cures:
  187         1. Efforts to significantly expand cancer research capacity
  188  in the state by:
  189         a. Identifying ways to attract new research talent and
  190  attendant national grant-producing researchers to cancer
  191  research facilities in this state;
  192         b. Implementing a peer-reviewed, competitive process to
  193  identify and fund the best proposals to expand cancer research
  194  institutes in this state;
  195         c. Funding through available resources for those proposals
  196  that demonstrate the greatest opportunity to attract federal
  197  research grants and private financial support;
  198         d. Encouraging the employment of bioinformatics in order to
  199  create a cancer informatics infrastructure that enhances
  200  information and resource exchange and integration through
  201  researchers working in diverse disciplines, to facilitate the
  202  full spectrum of cancer investigations;
  203         e. Facilitating the technical coordination, business
  204  development, and support of intellectual property as it relates
  205  to the advancement of cancer research; and
  206         f. Aiding in other multidisciplinary research-support
  207  activities as they inure to the advancement of cancer research.
  208         2. Efforts to improve both research and treatment through
  209  greater participation in clinical trials networks by:
  210         a. Identifying ways to increase pediatric and adult
  211  enrollment in cancer clinical trials;
  212         b. Supporting public and private professional education
  213  programs designed to increase the awareness and knowledge about
  214  cancer clinical trials;
  215         c. Providing tools to cancer patients and community-based
  216  oncologists to aid in the identification of cancer clinical
  217  trials available in the state; and
  218         d. Creating opportunities for the state’s academic cancer
  219  centers to collaborate with community-based oncologists in
  220  cancer clinical trials networks.
  221         3. Efforts to reduce the impact of cancer on disparate
  222  groups by:
  223         a. Identifying those cancers that disproportionately impact
  224  certain demographic groups; and
  225         b. Building collaborations designed to reduce health
  226  disparities as they relate to cancer.
  227         (b) Preference may be given to grant proposals that foster
  228  collaborations among institutions, researchers, and community
  229  practitioners, as such proposals support the advancement of
  230  cures through basic or applied research, including clinical
  231  trials involving cancer patients and related networks.
  232         (c) There is established within the program the Live Like
  233  Bella Initiative. The purpose of the initiative is to advance
  234  progress toward curing pediatric cancer by awarding grants
  235  through the peer-reviewed, competitive process established under
  236  subsection (3). This paragraph is subject to the annual
  237  appropriation of funds by the Legislature.
  238         Section 3. Paragraph (a) of subsection (10) of section
  239  394.9082, Florida Statutes, is republished, paragraph (b) of
  240  that subsection is amended, and paragraph (f) is added to that
  241  subsection, to read:
  242         394.9082 Behavioral health managing entities.—
  243         (10) ACUTE CARE SERVICES UTILIZATION DATABASE.—The
  244  department shall develop, implement, and maintain standards
  245  under which a managing entity shall collect utilization data
  246  from all public receiving facilities situated within its
  247  geographical service area and all detoxification and addictions
  248  receiving facilities under contract with the managing entity. As
  249  used in this subsection, the term “public receiving facility”
  250  means an entity that meets the licensure requirements of, and is
  251  designated by, the department to operate as a public receiving
  252  facility under s. 394.875 and that is operating as a licensed
  253  crisis stabilization unit.
  254         (a) The department shall develop standards and protocols to
  255  be used for data collection, storage, transmittal, and analysis.
  256  The standards and protocols shall allow for compatibility of
  257  data and data transmittal between public receiving facilities,
  258  detoxification facilities, addictions receiving facilities,
  259  managing entities, and the department for the implementation,
  260  and to meet the requirements, of this subsection.
  261         (b) A managing entity shall require providers specified in
  262  paragraph (a) to submit data, in real time or at least daily, to
  263  the managing entity for:
  264         1. All admissions and discharges of clients receiving
  265  public receiving facility services who qualify as indigent, as
  266  defined in s. 394.4787.
  267         2. All admissions and discharges of clients receiving
  268  substance abuse services in an addictions receiving facility or
  269  detoxification facility pursuant to parts IV and V of chapter
  270  397 who qualify as indigent.
  271         3. The current active census of total licensed and utilized
  272  beds, the number of beds purchased by the department, the number
  273  of clients qualifying as indigent occupying who occupy any of
  274  those beds, and the total number of unoccupied licensed beds,
  275  regardless of funding, and the number in excess of licensed
  276  capacity. Crisis units licensed for both adult and child use
  277  will report as a single unit.
  278         (f) The department shall post on its website, by facility,
  279  the data collected pursuant to this subsection and update such
  280  posting monthly.
  281         Section 4. Paragraph (e) of subsection (2) of section
  282  395.602, Florida Statutes, is amended to read:
  283         395.602 Rural hospitals.—
  284         (2) DEFINITIONS.—As used in this part, the term:
  285         (e) “Rural hospital” means an acute care hospital licensed
  286  under this chapter, having 100 or fewer licensed beds and an
  287  emergency room, which is:
  288         1. The sole provider within a county with a population
  289  density of up to 100 persons per square mile;
  290         2. An acute care hospital, in a county with a population
  291  density of up to 100 persons per square mile, which is at least
  292  30 minutes of travel time, on normally traveled roads under
  293  normal traffic conditions, from any other acute care hospital
  294  within the same county;
  295         3. A hospital supported by a tax district or subdistrict
  296  whose boundaries encompass a population of up to 100 persons per
  297  square mile;
  298         4. A hospital classified as a sole community hospital under
  299  42 C.F.R. s. 412.92, regardless of the number of which has up to
  300  175 licensed beds;
  301         5. A hospital with a service area that has a population of
  302  up to 100 persons per square mile. As used in this subparagraph,
  303  the term “service area” means the fewest number of zip codes
  304  that account for 75 percent of the hospital’s discharges for the
  305  most recent 5-year period, based on information available from
  306  the hospital inpatient discharge database in the Florida Center
  307  for Health Information and Transparency at the agency; or
  308         6. A hospital designated as a critical access hospital, as
  309  defined in s. 408.07.
  310  
  311  Population densities used in this paragraph must be based upon
  312  the most recently completed United States census. A hospital
  313  that received funds under s. 409.9116 for a quarter beginning no
  314  later than July 1, 2002, is deemed to have been and shall
  315  continue to be a rural hospital from that date through June 30,
  316  2021, if the hospital continues to have up to 100 licensed beds
  317  and an emergency room. An acute care hospital that has not
  318  previously been designated as a rural hospital and that meets
  319  the criteria of this paragraph shall be granted such designation
  320  upon application, including supporting documentation, to the
  321  agency. A hospital that was licensed as a rural hospital during
  322  the 2010-2011 or 2011-2012 fiscal year shall continue to be a
  323  rural hospital from the date of designation through June 30,
  324  2021, if the hospital continues to have up to 100 licensed beds
  325  and an emergency room.
  326         Section 5. Effective October 1, 2018, paragraph (d) of
  327  subsection (2) of section 400.179, Florida Statutes, is amended
  328  to read:
  329         400.179 Liability for Medicaid underpayments and
  330  overpayments.—
  331         (2) Because any transfer of a nursing facility may expose
  332  the fact that Medicaid may have underpaid or overpaid the
  333  transferor, and because in most instances, any such underpayment
  334  or overpayment can only be determined following a formal field
  335  audit, the liabilities for any such underpayments or
  336  overpayments shall be as follows:
  337         (d) Where the transfer involves a facility that has been
  338  leased by the transferor:
  339         1. The transferee shall, as a condition to being issued a
  340  license by the agency, acquire, maintain, and provide proof to
  341  the agency of a bond with a term of 30 months, renewable
  342  annually, in an amount not less than the total of 3 months’
  343  Medicaid payments to the facility computed on the basis of the
  344  preceding 12-month average Medicaid payments to the facility.
  345         2. A leasehold licensee may meet the requirements of
  346  subparagraph 1. by payment of a nonrefundable fee, paid at
  347  initial licensure, paid at the time of any subsequent change of
  348  ownership, and paid annually thereafter, in the amount of 1
  349  percent of the total of 3 months’ Medicaid payments to the
  350  facility computed on the basis of the preceding 12-month average
  351  Medicaid payments to the facility. If a preceding 12-month
  352  average is not available, projected Medicaid payments may be
  353  used. The fee shall be deposited into the Grants and Donations
  354  Trust Fund and shall be accounted for separately as a Medicaid
  355  nursing home overpayment account. These fees shall be used at
  356  the sole discretion of the agency to repay nursing home Medicaid
  357  overpayments or for enhanced payments to nursing facilities as
  358  specified in the General Appropriations Act or other law.
  359  Payment of this fee shall not release the licensee from any
  360  liability for any Medicaid overpayments, nor shall payment bar
  361  the agency from seeking to recoup overpayments from the licensee
  362  and any other liable party. As a condition of exercising this
  363  lease bond alternative, licensees paying this fee must maintain
  364  an existing lease bond through the end of the 30-month term
  365  period of that bond. The agency is herein granted specific
  366  authority to promulgate all rules pertaining to the
  367  administration and management of this account, including
  368  withdrawals from the account, subject to federal review and
  369  approval. This provision shall take effect upon becoming law and
  370  shall apply to any leasehold license application. The financial
  371  viability of the Medicaid nursing home overpayment account shall
  372  be determined by the agency through annual review of the account
  373  balance and the amount of total outstanding, unpaid Medicaid
  374  overpayments owing from leasehold licensees to the agency as
  375  determined by final agency audits. By March 31 of each year, the
  376  agency shall assess the cumulative fees collected under this
  377  subparagraph, minus any amounts used to repay nursing home
  378  Medicaid overpayments and amounts transferred to contribute to
  379  the General Revenue Fund pursuant to s. 215.20. If the net
  380  cumulative collections, minus amounts utilized to repay nursing
  381  home Medicaid overpayments, exceed $25 million, the provisions
  382  of this subparagraph shall not apply for the subsequent fiscal
  383  year.
  384         3. The leasehold licensee may meet the bond requirement
  385  through other arrangements acceptable to the agency. The agency
  386  is herein granted specific authority to promulgate rules
  387  pertaining to lease bond arrangements.
  388         4. All existing nursing facility licensees, operating the
  389  facility as a leasehold, shall acquire, maintain, and provide
  390  proof to the agency of the 30-month bond required in
  391  subparagraph 1., above, on and after July 1, 1993, for each
  392  license renewal.
  393         5. It shall be the responsibility of all nursing facility
  394  operators, operating the facility as a leasehold, to renew the
  395  30-month bond and to provide proof of such renewal to the agency
  396  annually.
  397         6. Any failure of the nursing facility operator to acquire,
  398  maintain, renew annually, or provide proof to the agency shall
  399  be grounds for the agency to deny, revoke, and suspend the
  400  facility license to operate such facility and to take any
  401  further action, including, but not limited to, enjoining the
  402  facility, asserting a moratorium pursuant to part II of chapter
  403  408, or applying for a receiver, deemed necessary to ensure
  404  compliance with this section and to safeguard and protect the
  405  health, safety, and welfare of the facility’s residents. A lease
  406  agreement required as a condition of bond financing or
  407  refinancing under s. 154.213 by a health facilities authority or
  408  required under s. 159.30 by a county or municipality is not a
  409  leasehold for purposes of this paragraph and is not subject to
  410  the bond requirement of this paragraph.
  411         Section 6. Subsection (11) is added to section 409.904,
  412  Florida Statutes, to read:
  413         409.904 Optional payments for eligible persons.—The agency
  414  may make payments for medical assistance and related services on
  415  behalf of the following persons who are determined to be
  416  eligible subject to the income, assets, and categorical
  417  eligibility tests set forth in federal and state law. Payment on
  418  behalf of these Medicaid eligible persons is subject to the
  419  availability of moneys and any limitations established by the
  420  General Appropriations Act or chapter 216.
  421         (11) Subject to federal waiver approval, a person diagnosed
  422  with acquired immune deficiency syndrome (AIDS) who has an AIDS
  423  related opportunistic infection and is at risk of
  424  hospitalization as determined by the agency and whose income is
  425  at or below 300 percent of the Federal Benefit Rate.
  426         Section 7. Paragraph (b) of subsection (13) of section
  427  409.906, Florida Statutes, is amended to read:
  428         409.906 Optional Medicaid services.—Subject to specific
  429  appropriations, the agency may make payments for services which
  430  are optional to the state under Title XIX of the Social Security
  431  Act and are furnished by Medicaid providers to recipients who
  432  are determined to be eligible on the dates on which the services
  433  were provided. Any optional service that is provided shall be
  434  provided only when medically necessary and in accordance with
  435  state and federal law. Optional services rendered by providers
  436  in mobile units to Medicaid recipients may be restricted or
  437  prohibited by the agency. Nothing in this section shall be
  438  construed to prevent or limit the agency from adjusting fees,
  439  reimbursement rates, lengths of stay, number of visits, or
  440  number of services, or making any other adjustments necessary to
  441  comply with the availability of moneys and any limitations or
  442  directions provided for in the General Appropriations Act or
  443  chapter 216. If necessary to safeguard the state’s systems of
  444  providing services to elderly and disabled persons and subject
  445  to the notice and review provisions of s. 216.177, the Governor
  446  may direct the Agency for Health Care Administration to amend
  447  the Medicaid state plan to delete the optional Medicaid service
  448  known as “Intermediate Care Facilities for the Developmentally
  449  Disabled.” Optional services may include:
  450         (13) HOME AND COMMUNITY-BASED SERVICES.—
  451         (b) The agency may consolidate types of services offered in
  452  the Aged and Disabled Waiver, the Channeling Waiver, the Project
  453  AIDS Care Waiver, and the Traumatic Brain and Spinal Cord Injury
  454  Waiver programs in order to group similar services under a
  455  single service, or continue a service upon evidence of the need
  456  for including a particular service type in a particular waiver.
  457  The agency is authorized to seek a Medicaid state plan amendment
  458  or federal waiver approval to implement this policy.
  459         Section 8. Effective October 1, 2018, subsection (2) of
  460  section 409.908, Florida Statutes, is amended to read:
  461         409.908 Reimbursement of Medicaid providers.—Subject to
  462  specific appropriations, the agency shall reimburse Medicaid
  463  providers, in accordance with state and federal law, according
  464  to methodologies set forth in the rules of the agency and in
  465  policy manuals and handbooks incorporated by reference therein.
  466  These methodologies may include fee schedules, reimbursement
  467  methods based on cost reporting, negotiated fees, competitive
  468  bidding pursuant to s. 287.057, and other mechanisms the agency
  469  considers efficient and effective for purchasing services or
  470  goods on behalf of recipients. If a provider is reimbursed based
  471  on cost reporting and submits a cost report late and that cost
  472  report would have been used to set a lower reimbursement rate
  473  for a rate semester, then the provider’s rate for that semester
  474  shall be retroactively calculated using the new cost report, and
  475  full payment at the recalculated rate shall be effected
  476  retroactively. Medicare-granted extensions for filing cost
  477  reports, if applicable, shall also apply to Medicaid cost
  478  reports. Payment for Medicaid compensable services made on
  479  behalf of Medicaid eligible persons is subject to the
  480  availability of moneys and any limitations or directions
  481  provided for in the General Appropriations Act or chapter 216.
  482  Further, nothing in this section shall be construed to prevent
  483  or limit the agency from adjusting fees, reimbursement rates,
  484  lengths of stay, number of visits, or number of services, or
  485  making any other adjustments necessary to comply with the
  486  availability of moneys and any limitations or directions
  487  provided for in the General Appropriations Act, provided the
  488  adjustment is consistent with legislative intent.
  489         (2)(a)1. Reimbursement to nursing homes licensed under part
  490  II of chapter 400 and state-owned-and-operated intermediate care
  491  facilities for the developmentally disabled licensed under part
  492  VIII of chapter 400 must be made prospectively.
  493         2. Unless otherwise limited or directed in the General
  494  Appropriations Act, reimbursement to hospitals licensed under
  495  part I of chapter 395 for the provision of swing-bed nursing
  496  home services must be made on the basis of the average statewide
  497  nursing home payment, and reimbursement to a hospital licensed
  498  under part I of chapter 395 for the provision of skilled nursing
  499  services must be made on the basis of the average nursing home
  500  payment for those services in the county in which the hospital
  501  is located. When a hospital is located in a county that does not
  502  have any community nursing homes, reimbursement shall be
  503  determined by averaging the nursing home payments in counties
  504  that surround the county in which the hospital is located.
  505  Reimbursement to hospitals, including Medicaid payment of
  506  Medicare copayments, for skilled nursing services shall be
  507  limited to 30 days, unless a prior authorization has been
  508  obtained from the agency. Medicaid reimbursement may be extended
  509  by the agency beyond 30 days, and approval must be based upon
  510  verification by the patient’s physician that the patient
  511  requires short-term rehabilitative and recuperative services
  512  only, in which case an extension of no more than 15 days may be
  513  approved. Reimbursement to a hospital licensed under part I of
  514  chapter 395 for the temporary provision of skilled nursing
  515  services to nursing home residents who have been displaced as
  516  the result of a natural disaster or other emergency may not
  517  exceed the average county nursing home payment for those
  518  services in the county in which the hospital is located and is
  519  limited to the period of time which the agency considers
  520  necessary for continued placement of the nursing home residents
  521  in the hospital.
  522         (b) Subject to any limitations or directions in the General
  523  Appropriations Act, the agency shall establish and implement a
  524  state Title XIX Long-Term Care Reimbursement Plan for nursing
  525  home care in order to provide care and services in conformance
  526  with the applicable state and federal laws, rules, regulations,
  527  and quality and safety standards and to ensure that individuals
  528  eligible for medical assistance have reasonable geographic
  529  access to such care.
  530         1. The agency shall amend the long-term care reimbursement
  531  plan and cost reporting system to create direct care and
  532  indirect care subcomponents of the patient care component of the
  533  per diem rate. These two subcomponents together shall equal the
  534  patient care component of the per diem rate. Separate prices
  535  cost-based ceilings shall be calculated for each patient care
  536  subcomponent, initially based on the September 2016 rate setting
  537  cost reports and subsequently based on the most recently audited
  538  cost report used during a rebasing year. The direct care
  539  subcomponent of the per diem rate for any providers still being
  540  reimbursed on a cost basis shall be limited by the cost-based
  541  class ceiling, and the indirect care subcomponent may be limited
  542  by the lower of the cost-based class ceiling, the target rate
  543  class ceiling, or the individual provider target. The ceilings
  544  and targets apply only to providers being reimbursed on a cost
  545  based system. Effective October 1, 2018, a prospective payment
  546  methodology shall be implemented for rate setting purposes with
  547  the following parameters:
  548         a.Peer Groups, including:
  549         (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee
  550  Counties; and
  551         (II) South-SMMC Regions 10-11, plus Palm Beach and
  552  Okeechobee Counties.
  553         b.Percentage of Median Costs based on the cost reports
  554  used for September 2016 rate setting:
  555         (I) Direct Care Costs........................100 percent.
  556         (II) Indirect Care Costs......................92 percent.
  557         (III) Operating Costs.........................86 percent.
  558         c.Floors:
  559         (I) Direct Care Component.....................95 percent.
  560         (II) Indirect Care Component................92.5 percent.
  561         (III) Operating Component...........................None.
  562         d.Pass-through PaymentsReal Estate and Personal Property
  563  Taxes and Property Insurance.
  564         e.Quality Incentive Program Payment Pool....6 percent of
  565  September 2016 non-property related payments of included
  566  facilities.
  567         f.Quality Score Threshold to Quality for Quality Incentive
  568  Payment..................20th percentile of included facilities.
  569         g.Fair Rental Value System Payment Parameters:
  570         (I) Building Value per Square Foot based on 2018 RS Means.
  571         (II) Land Valuation...10 percent of Gross Building value.
  572         (III) Facility Square Footage......Actual Square Footage.
  573         (IV) Moveable Equipment Allowance.........$8,000 per bed.
  574         (V) Obsolescence Factor......................1.5 percent.
  575         (VI) Fair Rental Rate of Return................8 percent.
  576         (VII) Minimum Occupancy.......................90 percent.
  577         (VIII) Maximum Facility Age.....................40 years.
  578         (IX) Minimum Square Footage per Bed..................350.
  579         (X) Maximum Square Footage for Bed...................500.
  580         (XI)Minimum Cost of a renovation/replacements$500 per bed.
  581         h.Ventilator Supplemental payment of $200 per Medicaid day
  582  of 40,000 ventilator Medicaid days per fiscal year.
  583         2. The direct care subcomponent shall include salaries and
  584  benefits of direct care staff providing nursing services
  585  including registered nurses, licensed practical nurses, and
  586  certified nursing assistants who deliver care directly to
  587  residents in the nursing home facility, allowable therapy costs,
  588  and dietary costs. This excludes nursing administration, staff
  589  development, the staffing coordinator, and the administrative
  590  portion of the minimum data set and care plan coordinators. The
  591  direct care subcomponent also includes medically necessary
  592  dental care, vision care, hearing care, and podiatric care.
  593         3. All other patient care costs shall be included in the
  594  indirect care cost subcomponent of the patient care per diem
  595  rate, including complex medical equipment, medical supplies, and
  596  other allowable ancillary costs. Costs may not be allocated
  597  directly or indirectly to the direct care subcomponent from a
  598  home office or management company.
  599         4. On July 1 of each year, the agency shall report to the
  600  Legislature direct and indirect care costs, including average
  601  direct and indirect care costs per resident per facility and
  602  direct care and indirect care salaries and benefits per category
  603  of staff member per facility.
  604         5. Every fourth year, the agency shall rebase nursing home
  605  prospective payment rates to reflect changes in cost based on
  606  the most recently audited cost report for each participating
  607  provider In order to offset the cost of general and professional
  608  liability insurance, the agency shall amend the plan to allow
  609  for interim rate adjustments to reflect increases in the cost of
  610  general or professional liability insurance for nursing homes.
  611  This provision shall be implemented to the extent existing
  612  appropriations are available.
  613         6. A direct care supplemental payment may be made to
  614  providers whose direct care hours per patient day are above the
  615  80th percentile and who provide Medicaid services to a larger
  616  percentage of Medicaid patients than the state average.
  617         7. For the period beginning on October 1, 2018, and ending
  618  on September 30, 2021, the agency shall reimburse providers the
  619  greater of their September 2016 cost-based rate or their
  620  prospective payment rate. Effective October 1, 2021, the agency
  621  shall reimburse providers the greater of 95 percent of their
  622  cost-based rate or their rebased prospective payment rate, using
  623  the most recently audited cost report for each facility. This
  624  subparagraph shall expire September 30, 2023.
  625         8. Pediatric, Florida Department of Veterans Affairs, and
  626  government-owned facilities are exempt from the pricing model
  627  established in this subsection and shall remain on a cost-based
  628  prospective payment system. Effective October 1, 2018, the
  629  agency shall set rates for all facilities remaining on a cost
  630  based prospective payment system using each facility’s most
  631  recently audited cost report, eliminating retroactive
  632  settlements.
  633  
  634  It is the intent of the Legislature that the reimbursement plan
  635  achieve the goal of providing access to health care for nursing
  636  home residents who require large amounts of care while
  637  encouraging diversion services as an alternative to nursing home
  638  care for residents who can be served within the community. The
  639  agency shall base the establishment of any maximum rate of
  640  payment, whether overall or component, on the available moneys
  641  as provided for in the General Appropriations Act. The agency
  642  may base the maximum rate of payment on the results of
  643  scientifically valid analysis and conclusions derived from
  644  objective statistical data pertinent to the particular maximum
  645  rate of payment.
  646         Section 9. Subsections (6) through (26) of section 409.908,
  647  Florida Statutes, are renumbered as subsections (5) through
  648  (25), respectively, present subsections (5), (14), and (24) are
  649  amended, and a new subsection (26) is added to that section, to
  650  read:
  651         409.908 Reimbursement of Medicaid providers.—Subject to
  652  specific appropriations, the agency shall reimburse Medicaid
  653  providers, in accordance with state and federal law, according
  654  to methodologies set forth in the rules of the agency and in
  655  policy manuals and handbooks incorporated by reference therein.
  656  These methodologies may include fee schedules, reimbursement
  657  methods based on cost reporting, negotiated fees, competitive
  658  bidding pursuant to s. 287.057, and other mechanisms the agency
  659  considers efficient and effective for purchasing services or
  660  goods on behalf of recipients. If a provider is reimbursed based
  661  on cost reporting and submits a cost report late and that cost
  662  report would have been used to set a lower reimbursement rate
  663  for a rate semester, then the provider’s rate for that semester
  664  shall be retroactively calculated using the new cost report, and
  665  full payment at the recalculated rate shall be effected
  666  retroactively. Medicare-granted extensions for filing cost
  667  reports, if applicable, shall also apply to Medicaid cost
  668  reports. Payment for Medicaid compensable services made on
  669  behalf of Medicaid eligible persons is subject to the
  670  availability of moneys and any limitations or directions
  671  provided for in the General Appropriations Act or chapter 216.
  672  Further, nothing in this section shall be construed to prevent
  673  or limit the agency from adjusting fees, reimbursement rates,
  674  lengths of stay, number of visits, or number of services, or
  675  making any other adjustments necessary to comply with the
  676  availability of moneys and any limitations or directions
  677  provided for in the General Appropriations Act, provided the
  678  adjustment is consistent with legislative intent.
  679         (5)An ambulatory surgical center shall be reimbursed the
  680  lesser of the amount billed by the provider or the Medicare
  681  established allowable amount for the facility.
  682         (13)(14) Medicare premiums for persons eligible for both
  683  Medicare and Medicaid coverage shall be paid at the rates
  684  established by Title XVIII of the Social Security Act. For
  685  Medicare services rendered to Medicaid-eligible persons,
  686  Medicaid shall pay Medicare deductibles and coinsurance as
  687  follows:
  688         (a) Medicaid’s financial obligation for deductibles and
  689  coinsurance payments shall be based on Medicare allowable fees,
  690  not on a provider’s billed charges.
  691         (b) Medicaid will pay no portion of Medicare deductibles
  692  and coinsurance when payment that Medicare has made for the
  693  service equals or exceeds what Medicaid would have paid if it
  694  had been the sole payor. The combined payment of Medicare and
  695  Medicaid shall not exceed the amount Medicaid would have paid
  696  had it been the sole payor. The Legislature finds that there has
  697  been confusion regarding the reimbursement for services rendered
  698  to dually eligible Medicare beneficiaries. Accordingly, the
  699  Legislature clarifies that it has always been the intent of the
  700  Legislature before and after 1991 that, in reimbursing in
  701  accordance with fees established by Title XVIII for premiums,
  702  deductibles, and coinsurance for Medicare services rendered by
  703  physicians to Medicaid eligible persons, physicians be
  704  reimbursed at the lesser of the amount billed by the physician
  705  or the Medicaid maximum allowable fee established by the Agency
  706  for Health Care Administration, as is permitted by federal law.
  707  It has never been the intent of the Legislature with regard to
  708  such services rendered by physicians that Medicaid be required
  709  to provide any payment for deductibles, coinsurance, or
  710  copayments for Medicare cost sharing, or any expenses incurred
  711  relating thereto, in excess of the payment amount provided for
  712  under the State Medicaid plan for such service. This payment
  713  methodology is applicable even in those situations in which the
  714  payment for Medicare cost sharing for a qualified Medicare
  715  beneficiary with respect to an item or service is reduced or
  716  eliminated. This expression of the Legislature is in
  717  clarification of existing law and shall apply to payment for,
  718  and with respect to provider agreements with respect to, items
  719  or services furnished on or after the effective date of this
  720  act. This paragraph applies to payment by Medicaid for items and
  721  services furnished before the effective date of this act if such
  722  payment is the subject of a lawsuit that is based on the
  723  provisions of this section, and that is pending as of, or is
  724  initiated after, the effective date of this act.
  725         (c) Notwithstanding paragraphs (a) and (b):
  726         1. Medicaid payments for Nursing Home Medicare part A
  727  coinsurance are limited to the Medicaid nursing home per diem
  728  rate less any amounts paid by Medicare, but only up to the
  729  amount of Medicare coinsurance. The Medicaid per diem rate shall
  730  be the rate in effect for the dates of service of the crossover
  731  claims and may not be subsequently adjusted due to subsequent
  732  per diem rate adjustments.
  733         2. Medicaid shall pay all deductibles and coinsurance for
  734  Medicare-eligible recipients receiving freestanding end stage
  735  renal dialysis center services.
  736         3. Medicaid payments for general and specialty hospital
  737  inpatient services are limited to the Medicare deductible and
  738  coinsurance per spell of illness. Medicaid payments for hospital
  739  Medicare Part A coinsurance shall be limited to the Medicaid
  740  hospital per diem rate less any amounts paid by Medicare, but
  741  only up to the amount of Medicare coinsurance. Medicaid payments
  742  for coinsurance shall be limited to the Medicaid per diem rate
  743  in effect for the dates of service of the crossover claims and
  744  may not be subsequently adjusted due to subsequent per diem
  745  adjustments.
  746         4. Medicaid shall pay all deductibles and coinsurance for
  747  Medicare emergency transportation services provided by
  748  ambulances licensed pursuant to chapter 401.
  749         5. Medicaid shall pay all deductibles and coinsurance for
  750  portable X-ray Medicare Part B services provided in a nursing
  751  home, in an assisted living facility, or in the patient’s home.
  752         (23)(24)(a) The agency shall establish rates at a level
  753  that ensures no increase in statewide expenditures resulting
  754  from a change in unit costs effective July 1, 2011.
  755  Reimbursement rates shall be as provided in the General
  756  Appropriations Act.
  757         (b) Base rate reimbursement for inpatient services under a
  758  diagnosis-related group payment methodology shall be provided in
  759  the General Appropriations Act.
  760         (c)Base rate reimbursement for outpatient services under
  761  an enhanced ambulatory payment group methodology shall be
  762  provided in the General Appropriations Act.
  763         (d)(c) This subsection applies to the following provider
  764  types:
  765         1.Inpatient hospitals.
  766         2.Outpatient hospitals.
  767         1.3. Nursing homes.
  768         2.4. County health departments.
  769         5.Prepaid health plans.
  770         (e)(d) The agency shall apply the effect of this subsection
  771  to the reimbursement rates for nursing home diversion programs.
  772         (26)The agency may receive funds from state entities,
  773  including, but not limited to, the Department of Health, local
  774  governments, and other local political subdivisions, for the
  775  purpose of making special exception payments, including federal
  776  matching funds. Funds received for this purpose shall be
  777  separately accounted for and may not be commingled with other
  778  state or local funds in any manner. The agency may certify all
  779  local governmental funds used as state match under Title XIX of
  780  the Social Security Act to the extent and in the manner
  781  authorized under the General Appropriations Act and pursuant to
  782  an agreement between the agency and the local governmental
  783  entity. In order for the agency to certify such local
  784  governmental funds, a local governmental entity must submit a
  785  final, executed letter of agreement to the agency, which must be
  786  received by October 1 of each fiscal year and provide the total
  787  amount of local governmental funds authorized by the entity for
  788  that fiscal year under the General Appropriations Act. The local
  789  governmental entity shall use a certification form prescribed by
  790  the agency. At a minimum, the certification form must identify
  791  the amount being certified and describe the relationship between
  792  the certifying local governmental entity and the local health
  793  care provider. Local governmental funds outlined in the letters
  794  of agreement must be received by the agency no later than
  795  October 31 of each fiscal year in which such funds are pledged,
  796  unless an alternative plan is specifically approved by the
  797  agency.
  798         Section 10. Effective October 1, 2018, subsection (4) of
  799  section 409.9082, Florida Statutes, is amended to read:
  800         409.9082 Quality assessment on nursing home facility
  801  providers; exemptions; purpose; federal approval required;
  802  remedies.—
  803         (4) The purpose of the nursing home facility quality
  804  assessment is to ensure continued quality of care. Collected
  805  assessment funds shall be used to obtain federal financial
  806  participation through the Medicaid program to make Medicaid
  807  payments for nursing home facility services up to the amount of
  808  nursing home facility Medicaid rates as calculated in accordance
  809  with the approved state Medicaid plan in effect on December 31,
  810  2007. The quality assessment and federal matching funds shall be
  811  used exclusively for the following purposes and in the following
  812  order of priority:
  813         (a) To reimburse the Medicaid share of the quality
  814  assessment as a pass-through, Medicaid-allowable cost;
  815         (b) To increase to each nursing home facility’s Medicaid
  816  rate, as needed, an amount that restores rate reductions
  817  effective on or after January 1, 2008, as provided in the
  818  General Appropriations Act; and
  819         (c) To partially fund the quality incentive payment program
  820  for nursing facilities that exceed quality benchmarks increase
  821  each nursing home facility’s Medicaid rate that accounts for the
  822  portion of the total assessment not included in paragraphs (a)
  823  and (b) which begins a phase-in to a pricing model for the
  824  operating cost component.
  825         Section 11. Section 409.909, Florida Statutes, is amended
  826  to read:
  827         409.909 Statewide Medicaid Residency Program.—
  828         (1) The Statewide Medicaid Residency Program is established
  829  to improve the quality of care and access to care for Medicaid
  830  recipients, expand graduate medical education on an equitable
  831  basis, and increase the supply of highly trained physicians
  832  statewide. The agency shall make payments to hospitals licensed
  833  under part I of chapter 395 and to qualifying institutions as
  834  defined in paragraph (2)(c) for graduate medical education
  835  associated with the Medicaid program. This system of payments is
  836  designed to generate federal matching funds under Medicaid and
  837  distribute the resulting funds to participating hospitals on a
  838  quarterly basis in each fiscal year for which an appropriation
  839  is made.
  840         (2) On or before September 15 of each year, the agency
  841  shall calculate an allocation fraction to be used for
  842  distributing funds to participating hospitals and to qualifying
  843  institutions as defined in paragraph (2)(c). On or before the
  844  final business day of each quarter of a state fiscal year, the
  845  agency shall distribute to each participating hospital one
  846  fourth of that hospital’s annual allocation calculated under
  847  subsection (4). The allocation fraction for each participating
  848  hospital is based on the hospital’s number of full-time
  849  equivalent residents and the amount of its Medicaid payments. As
  850  used in this section, the term:
  851         (a) “Full-time equivalent,” or “FTE,” means a resident who
  852  is in his or her residency period, with the initial residency
  853  period defined as the minimum number of years of training
  854  required before the resident may become eligible for board
  855  certification by the American Osteopathic Association Bureau of
  856  Osteopathic Specialists or the American Board of Medical
  857  Specialties in the specialty in which he or she first began
  858  training, not to exceed 5 years. The residency specialty is
  859  defined as reported using the current residency type codes in
  860  the Intern and Resident Information System (IRIS), required by
  861  Medicare. A resident training beyond the initial residency
  862  period is counted as 0.5 FTE, unless his or her chosen specialty
  863  is in primary care, in which case the resident is counted as 1.0
  864  FTE. For the purposes of this section, primary care specialties
  865  include:
  866         1. Family medicine;
  867         2. General internal medicine;
  868         3. General pediatrics;
  869         4. Preventive medicine;
  870         5. Geriatric medicine;
  871         6. Osteopathic general practice;
  872         7. Obstetrics and gynecology;
  873         8. Emergency medicine;
  874         9. General surgery; and
  875         10. Psychiatry.
  876         (b) “Medicaid payments” means the estimated total payments
  877  for reimbursing a hospital for direct inpatient services for the
  878  fiscal year in which the allocation fraction is calculated based
  879  on the hospital inpatient appropriation and the parameters for
  880  the inpatient diagnosis-related group base rate and the
  881  parameters for the outpatient enhanced ambulatory payment group
  882  rate, including applicable intergovernmental transfers,
  883  specified in the General Appropriations Act, as determined by
  884  the agency. Effective July 1, 2017, the term “Medicaid payments”
  885  means the estimated total payments for reimbursing a hospital
  886  and qualifying institutions as defined in paragraph (2)(c) for
  887  direct inpatient and outpatient services for the fiscal year in
  888  which the allocation fraction is calculated based on the
  889  hospital inpatient appropriation and outpatient appropriation
  890  and the parameters for the inpatient diagnosis-related group
  891  base rate and the parameters for the outpatient enhanced
  892  ambulatory payment group rate, including applicable
  893  intergovernmental transfers, specified in the General
  894  Appropriations Act, as determined by the agency.
  895         (c) “Qualifying institution” means a federally Qualified
  896  Health Center holding an Accreditation Council for Graduate
  897  Medical Education institutional accreditation.
  898         (d) “Resident” means a medical intern, fellow, or resident
  899  enrolled in a program accredited by the Accreditation Council
  900  for Graduate Medical Education, the American Association of
  901  Colleges of Osteopathic Medicine, or the American Osteopathic
  902  Association at the beginning of the state fiscal year during
  903  which the allocation fraction is calculated, as reported by the
  904  hospital to the agency.
  905         (3) The agency shall use the following formula to calculate
  906  a participating hospital’s and qualifying institution’s
  907  allocation fraction:
  908  
  909             HAF=[0.9 x (HFTE/TFTE)] + [0.1 x (HMP/TMP)]           
  910  
  911         Where:
  912         HAF=A hospital’s and qualifying institution’s allocation
  913  fraction.
  914         HFTE=A hospital’s and qualifying institution’s total number
  915  of FTE residents.
  916         TFTE=The total FTE residents for all participating
  917  hospitals and qualifying institutions.
  918         HMP=A hospital’s and qualifying institution’s Medicaid
  919  payments.
  920         TMP=The total Medicaid payments for all participating
  921  hospitals and qualifying institutions.
  922  
  923         (4) A hospital’s and qualifying institution’s annual
  924  allocation shall be calculated by multiplying the funds
  925  appropriated for the Statewide Medicaid Residency Program in the
  926  General Appropriations Act by that hospital’s and qualifying
  927  institution’s allocation fraction. If the calculation results in
  928  an annual allocation that exceeds two times the average per FTE
  929  resident amount for all hospitals and qualifying institutions,
  930  the hospital’s and qualifying institution’s annual allocation
  931  shall be reduced to a sum equaling no more than two times the
  932  average per FTE resident. The funds calculated for that hospital
  933  and qualifying institution in excess of two times the average
  934  per FTE resident amount for all hospitals and qualifying
  935  institutions shall be redistributed to participating hospitals
  936  and qualifying institutions whose annual allocation does not
  937  exceed two times the average per FTE resident amount for all
  938  hospitals and qualifying institutions, using the same
  939  methodology and payment schedule specified in this section.
  940         (5) The Graduate Medical Education Startup Bonus Program is
  941  established to provide resources for the education and training
  942  of physicians in specialties which are in a statewide supply
  943  and-demand deficit. Hospitals and qualifying institutions as
  944  defined in paragraph (2)(c) eligible for participation in
  945  subsection (1) are eligible to participate in the Graduate
  946  Medical Education Startup Bonus Program established under this
  947  subsection. Notwithstanding subsection (4) or an FTE’s residency
  948  period, and in any state fiscal year in which funds are
  949  appropriated for the startup bonus program, the agency shall
  950  allocate a $100,000 startup bonus for each newly created
  951  resident position that is authorized by the Accreditation
  952  Council for Graduate Medical Education or Osteopathic
  953  Postdoctoral Training Institution in an initial or established
  954  accredited training program that is in a physician specialty in
  955  statewide supply-and-demand deficit. In any year in which
  956  funding is not sufficient to provide $100,000 for each newly
  957  created resident position, funding shall be reduced pro rata
  958  across all newly created resident positions in physician
  959  specialties in statewide supply-and-demand deficit.
  960         (a) Hospitals and qualifying institutions as defined in
  961  paragraph (2)(c) applying for a startup bonus must submit to the
  962  agency by March 1 their Accreditation Council for Graduate
  963  Medical Education or Osteopathic Postdoctoral Training
  964  Institution approval validating the new resident positions
  965  approved on or after March 2 of the prior fiscal year through
  966  March 1 of the current fiscal year for the physician specialties
  967  identified in a statewide supply-and-demand deficit as provided
  968  in the current fiscal year’s General Appropriations Act. An
  969  applicant hospital or qualifying institution as defined in
  970  paragraph (2)(c) may validate a change in the number of
  971  residents by comparing the number in the prior period
  972  Accreditation Council for Graduate Medical Education or
  973  Osteopathic Postdoctoral Training Institution approval to the
  974  number in the current year.
  975         (b) Any unobligated startup bonus funds on April 15 of each
  976  fiscal year shall be proportionally allocated to hospitals and
  977  to qualifying institutions as defined in paragraph (2)(c)
  978  participating under subsection (3) for existing FTE residents in
  979  the physician specialties in statewide supply-and-demand
  980  deficit. This nonrecurring allocation shall be in addition to
  981  the funds allocated in subsection (4). Notwithstanding
  982  subsection (4), the allocation under this subsection may not
  983  exceed $100,000 per FTE resident.
  984         (c) For purposes of this subsection, physician specialties
  985  and subspecialties, both adult and pediatric, in statewide
  986  supply-and-demand deficit are those identified in the General
  987  Appropriations Act.
  988         (d) The agency shall distribute all funds authorized under
  989  the Graduate Medical Education Startup Bonus Program on or
  990  before the final business day of the fourth quarter of a state
  991  fiscal year.
  992         (6) Beginning in the 2015-2016 state fiscal year, the
  993  agency shall reconcile each participating hospital’s total
  994  number of FTE residents calculated for the state fiscal year 2
  995  years before with its most recently available Medicare cost
  996  reports covering the same time period. Reconciled FTE counts
  997  shall be prorated according to the portion of the state fiscal
  998  year covered by a Medicare cost report. Using the same
  999  definitions, methodology, and payment schedule specified in this
 1000  section, the reconciliation shall apply any differences in
 1001  annual allocations calculated under subsection (4) to the
 1002  current year’s annual allocations.
 1003         (7) The agency may adopt rules to administer this section.
 1004         Section 12. Paragraph (a) of subsection (2) of section
 1005  409.911, Florida Statutes, is amended, and paragraph (b) of that
 1006  subsection is republished, to read:
 1007         409.911 Disproportionate share program.—Subject to specific
 1008  allocations established within the General Appropriations Act
 1009  and any limitations established pursuant to chapter 216, the
 1010  agency shall distribute, pursuant to this section, moneys to
 1011  hospitals providing a disproportionate share of Medicaid or
 1012  charity care services by making quarterly Medicaid payments as
 1013  required. Notwithstanding the provisions of s. 409.915, counties
 1014  are exempt from contributing toward the cost of this special
 1015  reimbursement for hospitals serving a disproportionate share of
 1016  low-income patients.
 1017         (2) The Agency for Health Care Administration shall use the
 1018  following actual audited data to determine the Medicaid days and
 1019  charity care to be used in calculating the disproportionate
 1020  share payment:
 1021         (a) The average of the 2009, 2010, and 2011 2007, 2008, and
 1022  2009 audited disproportionate share data to determine each
 1023  hospital’s Medicaid days and charity care for the 2017-2018
 1024  2015-2016 state fiscal year.
 1025         (b) If the Agency for Health Care Administration does not
 1026  have the prescribed 3 years of audited disproportionate share
 1027  data as noted in paragraph (a) for a hospital, the agency shall
 1028  use the average of the years of the audited disproportionate
 1029  share data as noted in paragraph (a) which is available.
 1030         Section 13. Section 409.9119, Florida Statutes, is amended
 1031  to read:
 1032         409.9119 Disproportionate share program for specialty
 1033  hospitals for children.—In addition to the payments made under
 1034  s. 409.911, the Agency for Health Care Administration shall
 1035  develop and implement a system under which disproportionate
 1036  share payments are made to those hospitals that are separately
 1037  licensed by the state as specialty hospitals for children, have
 1038  a federal Centers for Medicare and Medicaid Services
 1039  certification number in the 3300-3399 range, have Medicaid days
 1040  that exceed 55 percent of their total days and Medicare days
 1041  that are less than 5 percent of their total days, and were
 1042  licensed on January 1, 2013 January 1, 2000, as specialty
 1043  hospitals for children. This system of payments must conform to
 1044  federal requirements and must distribute funds in each fiscal
 1045  year for which an appropriation is made by making quarterly
 1046  Medicaid payments. Notwithstanding s. 409.915, counties are
 1047  exempt from contributing toward the cost of this special
 1048  reimbursement for hospitals that serve a disproportionate share
 1049  of low-income patients. The agency may make disproportionate
 1050  share payments to specialty hospitals for children as provided
 1051  for in the General Appropriations Act.
 1052         (1) Unless specified in the General Appropriations Act, the
 1053  agency shall use the following formula to calculate the total
 1054  amount earned for hospitals that participate in the specialty
 1055  hospital for children disproportionate share program:
 1056  
 1057                        TAE = DSR x BMPD x MD                      
 1058  
 1059  Where:
 1060         TAE = total amount earned by a specialty hospital for
 1061  children.
 1062         DSR = disproportionate share rate.
 1063         BMPD = base Medicaid per diem.
 1064         MD = Medicaid days.
 1065  
 1066         (2) The agency shall calculate the total additional payment
 1067  for hospitals that participate in the specialty hospital for
 1068  children disproportionate share program as follows:
 1069  
 1070                       TAP = (TAE x TA) ÷ STAE                     
 1071  
 1072  Where:
 1073         TAP = total additional payment for a specialty hospital for
 1074  children.
 1075         TAE = total amount earned by a specialty hospital for
 1076  children.
 1077         TA = total appropriation for the specialty hospital for
 1078  children disproportionate share program.
 1079         STAE = sum of total amount earned by each hospital that
 1080  participates in the specialty hospital for children
 1081  disproportionate share program.
 1082  
 1083         (3) A hospital may not receive any payments under this
 1084  section until it achieves full compliance with the applicable
 1085  rules of the agency. A hospital that is not in compliance for
 1086  two or more consecutive quarters may not receive its share of
 1087  the funds. Any forfeited funds must be distributed to the
 1088  remaining participating specialty hospitals for children that
 1089  are in compliance.
 1090         (4) Notwithstanding any provision of this section to the
 1091  contrary, for the 2017-2018 2016-2017 state fiscal year, for
 1092  hospitals achieving full compliance under subsection (3), the
 1093  agency shall make disproportionate share payments to specialty
 1094  hospitals for children as provided in the 2017-2018 2016-2017
 1095  General Appropriations Act. This subsection expires July 1, 2018
 1096  2017.
 1097         Section 14. Subsection (36) of section 409.913, Florida
 1098  Statutes, is amended to read:
 1099         409.913 Oversight of the integrity of the Medicaid
 1100  program.—The agency shall operate a program to oversee the
 1101  activities of Florida Medicaid recipients, and providers and
 1102  their representatives, to ensure that fraudulent and abusive
 1103  behavior and neglect of recipients occur to the minimum extent
 1104  possible, and to recover overpayments and impose sanctions as
 1105  appropriate. Beginning January 1, 2003, and each year
 1106  thereafter, the agency and the Medicaid Fraud Control Unit of
 1107  the Department of Legal Affairs shall submit a joint report to
 1108  the Legislature documenting the effectiveness of the state’s
 1109  efforts to control Medicaid fraud and abuse and to recover
 1110  Medicaid overpayments during the previous fiscal year. The
 1111  report must describe the number of cases opened and investigated
 1112  each year; the sources of the cases opened; the disposition of
 1113  the cases closed each year; the amount of overpayments alleged
 1114  in preliminary and final audit letters; the number and amount of
 1115  fines or penalties imposed; any reductions in overpayment
 1116  amounts negotiated in settlement agreements or by other means;
 1117  the amount of final agency determinations of overpayments; the
 1118  amount deducted from federal claiming as a result of
 1119  overpayments; the amount of overpayments recovered each year;
 1120  the amount of cost of investigation recovered each year; the
 1121  average length of time to collect from the time the case was
 1122  opened until the overpayment is paid in full; the amount
 1123  determined as uncollectible and the portion of the uncollectible
 1124  amount subsequently reclaimed from the Federal Government; the
 1125  number of providers, by type, that are terminated from
 1126  participation in the Medicaid program as a result of fraud and
 1127  abuse; and all costs associated with discovering and prosecuting
 1128  cases of Medicaid overpayments and making recoveries in such
 1129  cases. The report must also document actions taken to prevent
 1130  overpayments and the number of providers prevented from
 1131  enrolling in or reenrolling in the Medicaid program as a result
 1132  of documented Medicaid fraud and abuse and must include policy
 1133  recommendations necessary to prevent or recover overpayments and
 1134  changes necessary to prevent and detect Medicaid fraud. All
 1135  policy recommendations in the report must include a detailed
 1136  fiscal analysis, including, but not limited to, implementation
 1137  costs, estimated savings to the Medicaid program, and the return
 1138  on investment. The agency must submit the policy recommendations
 1139  and fiscal analyses in the report to the appropriate estimating
 1140  conference, pursuant to s. 216.137, by February 15 of each year.
 1141  The agency and the Medicaid Fraud Control Unit of the Department
 1142  of Legal Affairs each must include detailed unit-specific
 1143  performance standards, benchmarks, and metrics in the report,
 1144  including projected cost savings to the state Medicaid program
 1145  during the following fiscal year.
 1146         (36) At least three times a year, The agency may shall
 1147  provide to a sample of each Medicaid recipients recipient or
 1148  their representatives through the distribution of explanations
 1149  his or her representative an explanation of benefits information
 1150  about services reimbursed by the Medicaid program for goods and
 1151  services to such recipients, including in the form of a letter
 1152  that is mailed to the most recent address of the recipient on
 1153  the record with the Department of Children and Families. The
 1154  explanation of benefits must include the patient’s name, the
 1155  name of the health care provider and the address of the location
 1156  where the service was provided, a description of all services
 1157  billed to Medicaid in terminology that should be understood by a
 1158  reasonable person, and information on how to report
 1159  inappropriate or incorrect billing to the agency or other law
 1160  enforcement entities for review or investigation. At least once
 1161  a year, the letter also must include information on how to
 1162  report criminal Medicaid fraud to, the Medicaid Fraud Control
 1163  Unit’s toll-free hotline number, and information about the
 1164  rewards available under s. 409.9203. The explanation of benefits
 1165  may not be mailed for Medicaid independent laboratory services
 1166  as described in s. 409.905(7) or for Medicaid certified match
 1167  services as described in ss. 409.9071 and 1011.70.
 1168         Section 15. Paragraph (e) of subsection (1) of section
 1169  409.975, Florida Statutes, is amended, to read:
 1170         409.975 Managed care plan accountability.—In addition to
 1171  the requirements of s. 409.967, plans and providers
 1172  participating in the managed medical assistance program shall
 1173  comply with the requirements of this section.
 1174         (1) PROVIDER NETWORKS.—Managed care plans must develop and
 1175  maintain provider networks that meet the medical needs of their
 1176  enrollees in accordance with standards established pursuant to
 1177  s. 409.967(2)(c). Except as provided in this section, managed
 1178  care plans may limit the providers in their networks based on
 1179  credentials, quality indicators, and price.
 1180         (e) Each managed care plan may must offer a network
 1181  contract to each home medical equipment and supplies provider in
 1182  the region which meets quality and fraud prevention and
 1183  detection standards established by the plan and which agrees to
 1184  accept the lowest price previously negotiated between the plan
 1185  and another such provider.
 1186         Section 16. Subsections (1) and (2) of section 409.979,
 1187  Florida Statutes, are amended to read:
 1188         409.979 Eligibility.—
 1189         (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid
 1190  recipients who meet all of the following criteria are eligible
 1191  to receive long-term care services and must receive long-term
 1192  care services by participating in the long-term care managed
 1193  care program. The recipient must be:
 1194         (a) Sixty-five years of age or older, or age 18 or older
 1195  and eligible for Medicaid by reason of a disability.
 1196         (b) Determined by the Comprehensive Assessment Review and
 1197  Evaluation for Long-Term Care Services (CARES) preadmission
 1198  screening program to require:
 1199         1. Nursing facility care as defined in s. 409.985(3); or
 1200         2. Hospital level of care, for individuals diagnosed with
 1201  cystic fibrosis.
 1202         (2) ENROLLMENT OFFERS.—Subject to the availability of
 1203  funds, the Department of Elderly Affairs shall make offers for
 1204  enrollment to eligible individuals based on a wait-list
 1205  prioritization. Before making enrollment offers, the agency and
 1206  the Department of Elderly Affairs shall determine that
 1207  sufficient funds exist to support additional enrollment into
 1208  plans.
 1209         (a) A Medicaid recipient enrolled in one of the following
 1210  Medicaid home and community-based services waiver programs who
 1211  meets the eligibility criteria established in subsection (1) is
 1212  eligible to participate in the long-term care managed care
 1213  program and must be transitioned into the long-term care managed
 1214  care program by January 1, 2018:
 1215         1. Traumatic Brain and Spinal Cord Injury Waiver.
 1216         2. Adult Cystic Fibrosis Waiver.
 1217         3. Project AIDS Care Waiver.
 1218         (b) The agency shall seek federal approval to terminate the
 1219  Traumatic Brain and Spinal Cord Injury Waiver, the Adult Cystic
 1220  Fibrosis Waiver, and the Project AIDS Care Waiver once all
 1221  eligible Medicaid recipients have transitioned into the long
 1222  term care managed care program.
 1223         Section 17. Effective October 1, 2018, subsection (6) of
 1224  section 409.983, Florida Statutes, is amended to read:
 1225         409.983 Long-term care managed care plan payment.—In
 1226  addition to the payment provisions of s. 409.968, the agency
 1227  shall provide payment to plans in the long-term care managed
 1228  care program pursuant to this section.
 1229         (6) The agency shall establish nursing-facility-specific
 1230  payment rates for each licensed nursing home based on facility
 1231  costs adjusted for inflation and other factors as authorized in
 1232  the General Appropriations Act. Payments to long-term care
 1233  managed care plans shall be reconciled, as necessary, to
 1234  reimburse actual payments to nursing facilities resulting from
 1235  changes in nursing home per diem rates, but may not be
 1236  reconciled to actual days experienced by the long-term care
 1237  managed care plans.
 1238         Section 18. Subsection (27) of section 409.901, Florida
 1239  Statutes, is amended to read:
 1240         409.901 Definitions; ss. 409.901-409.920.—As used in ss.
 1241  409.901-409.920, except as otherwise specifically provided, the
 1242  term:
 1243         (27) “Third party” means an individual, entity, or program,
 1244  excluding Medicaid, that is, may be, could be, should be, or has
 1245  been liable for all or part of the cost of medical services
 1246  related to any medical assistance covered by Medicaid. A third
 1247  party includes a third-party administrator; or a pharmacy
 1248  benefits manager; a health insurer; a self-insured plan; a group
 1249  health plan, as defined in s. 607(1) of the Employee Retirement
 1250  Income Security Act of 1974; a service benefit plan; a managed
 1251  care organization; liability insurance, including self
 1252  insurance; no-fault insurance; workers’ compensation laws or
 1253  plans; or other parties that are, by statute, contract, or
 1254  agreement, legally responsible for payment of a claim for a
 1255  health care item or service.
 1256         Section 19. Subsection (4), paragraph (c) of subsection
 1257  (6), paragraph (h) of subsection (11), subsection (16),
 1258  paragraph (b) of subsection (17), and subsection (20) of section
 1259  409.910, Florida Statutes, are amended to read:
 1260         409.910 Responsibility for payments on behalf of Medicaid
 1261  eligible persons when other parties are liable.—
 1262         (4) After the agency has provided medical assistance under
 1263  the Medicaid program, it shall seek recovery of reimbursement
 1264  from third-party benefits to the limit of legal liability and
 1265  for the full amount of third-party benefits, but not in excess
 1266  of the amount of medical assistance paid by Medicaid, as to:
 1267         (a) Claims for which the agency has a waiver pursuant to
 1268  federal law; or
 1269         (b) Situations in which the agency learns of the existence
 1270  of a liable third party or in which third-party benefits are
 1271  discovered or become available after medical assistance has been
 1272  provided by Medicaid.
 1273         (6) When the agency provides, pays for, or becomes liable
 1274  for medical care under the Medicaid program, it has the
 1275  following rights, as to which the agency may assert independent
 1276  principles of law, which shall nevertheless be construed
 1277  together to provide the greatest recovery from third-party
 1278  benefits:
 1279         (c) The agency is entitled to, and has, an automatic lien
 1280  for the full amount of medical assistance provided by Medicaid
 1281  to or on behalf of the recipient for medical care furnished as a
 1282  result of any covered injury or illness for which a third party
 1283  is or may be liable, upon the collateral, as defined in s.
 1284  409.901.
 1285         1. The lien attaches automatically when a recipient first
 1286  receives treatment for which the agency may be obligated to
 1287  provide medical assistance under the Medicaid program. The lien
 1288  is perfected automatically at the time of attachment.
 1289         2. The agency is authorized to file a verified claim of
 1290  lien. The claim of lien shall be signed by an authorized
 1291  employee of the agency, and shall be verified as to the
 1292  employee’s knowledge and belief. The claim of lien may be filed
 1293  and recorded with the clerk of the circuit court in the
 1294  recipient’s last known county of residence or in any county
 1295  deemed appropriate by the agency. The claim of lien, to the
 1296  extent known by the agency, shall contain:
 1297         a. The name and last known address of the person to whom
 1298  medical care was furnished.
 1299         b. The date of injury.
 1300         c. The period for which medical assistance was provided.
 1301         d. The amount of medical assistance provided or paid, or
 1302  for which Medicaid is otherwise liable.
 1303         e. The names and addresses of all persons claimed by the
 1304  recipient to be liable for the covered injuries or illness.
 1305         3. The filing of the claim of lien pursuant to this section
 1306  shall be notice thereof to all persons.
 1307         4. If the claim of lien is filed within 3 years 1 year
 1308  after the later of the date when the last item of medical care
 1309  relative to a specific covered injury or illness was paid, or
 1310  the date of discovery by the agency of the liability of any
 1311  third party, or the date of discovery of a cause of action
 1312  against a third party brought by a recipient or his or her legal
 1313  representative, record notice shall relate back to the time of
 1314  attachment of the lien.
 1315         5. If the claim of lien is filed after 3 years 1 year after
 1316  the later of the events specified in subparagraph 4., notice
 1317  shall be effective as of the date of filing.
 1318         6. Only one claim of lien need be filed to provide notice
 1319  as set forth in this paragraph and shall provide sufficient
 1320  notice as to any additional or after-paid amount of medical
 1321  assistance provided by Medicaid for any specific covered injury
 1322  or illness. The agency may, in its discretion, file additional,
 1323  amended, or substitute claims of lien at any time after the
 1324  initial filing, until the agency has been repaid the full amount
 1325  of medical assistance provided by Medicaid or otherwise has
 1326  released the liable parties and recipient.
 1327         7. No release or satisfaction of any cause of action, suit,
 1328  claim, counterclaim, demand, judgment, settlement, or settlement
 1329  agreement shall be valid or effectual as against a lien created
 1330  under this paragraph, unless the agency joins in the release or
 1331  satisfaction or executes a release of the lien. An acceptance of
 1332  a release or satisfaction of any cause of action, suit, claim,
 1333  counterclaim, demand, or judgment and any settlement of any of
 1334  the foregoing in the absence of a release or satisfaction of a
 1335  lien created under this paragraph shall prima facie constitute
 1336  an impairment of the lien, and the agency is entitled to recover
 1337  damages on account of such impairment. In an action on account
 1338  of impairment of a lien, the agency may recover from the person
 1339  accepting the release or satisfaction or making the settlement
 1340  the full amount of medical assistance provided by Medicaid.
 1341  Nothing in this section shall be construed as creating a lien or
 1342  other obligation on the part of an insurer which in good faith
 1343  has paid a claim pursuant to its contract without knowledge or
 1344  actual notice that the agency has provided medical assistance
 1345  for the recipient related to a particular covered injury or
 1346  illness. However, notice or knowledge that an insured is, or has
 1347  been a Medicaid recipient within 1 year from the date of service
 1348  for which a claim is being paid creates a duty to inquire on the
 1349  part of the insurer as to any injury or illness for which the
 1350  insurer intends or is otherwise required to pay benefits.
 1351         8. The lack of a properly filed claim of lien shall not
 1352  affect the agency’s assignment or subrogation rights provided in
 1353  this subsection, nor shall it affect the existence of the lien,
 1354  but only the effective date of notice as provided in
 1355  subparagraph 5.
 1356         9. The lien created by this paragraph is a first lien and
 1357  superior to the liens and charges of any provider, and shall
 1358  exist for a period of 7 years, if recorded, after the date of
 1359  recording; and shall exist for a period of 7 years after the
 1360  date of attachment, if not recorded. If recorded, the lien may
 1361  be extended for one additional period of 7 years by rerecording
 1362  the claim of lien within the 90-day period preceding the
 1363  expiration of the lien.
 1364         10. The clerk of the circuit court for each county in the
 1365  state shall endorse on a claim of lien filed under this
 1366  paragraph the date and hour of filing and shall record the claim
 1367  of lien in the official records of the county as for other
 1368  records received for filing. The clerk shall receive as his or
 1369  her fee for filing and recording any claim of lien or release of
 1370  lien under this paragraph the total sum of $2. Any fee required
 1371  to be paid by the agency shall not be required to be paid in
 1372  advance of filing and recording, but may be billed to the agency
 1373  after filing and recording of the claim of lien or release of
 1374  lien.
 1375         11. After satisfaction of any lien recorded under this
 1376  paragraph, the agency shall, within 60 days after satisfaction,
 1377  either file with the appropriate clerk of the circuit court or
 1378  mail to any appropriate party, or counsel representing such
 1379  party, if represented, a satisfaction of lien in a form
 1380  acceptable for filing in Florida.
 1381         (11) The agency may, as a matter of right, in order to
 1382  enforce its rights under this section, institute, intervene in,
 1383  or join any legal or administrative proceeding in its own name
 1384  in one or more of the following capacities: individually, as
 1385  subrogee of the recipient, as assignee of the recipient, or as
 1386  lienholder of the collateral.
 1387         (h) Except as otherwise provided in this section, actions
 1388  to enforce the rights of the agency under this section shall be
 1389  commenced within 6 5 years after the date a cause of action
 1390  accrues, with the period running from the later of the date of
 1391  discovery by the agency of a case filed by a recipient or his or
 1392  her legal representative, or of discovery of any judgment,
 1393  award, or settlement contemplated in this section, or of
 1394  discovery of facts giving rise to a cause of action under this
 1395  section. Nothing in this paragraph affects or prevents a
 1396  proceeding to enforce a lien during the existence of the lien as
 1397  set forth in subparagraph (6)(c)9.
 1398         (16) Any transfer or encumbrance of any right, title, or
 1399  interest to which the agency has a right pursuant to this
 1400  section, with the intent, likelihood, or practical effect of
 1401  defeating, hindering, or reducing reimbursement to recovery by
 1402  the agency for reimbursement of medical assistance provided by
 1403  Medicaid, shall be deemed to be a fraudulent conveyance, and
 1404  such transfer or encumbrance shall be void and of no effect
 1405  against the claim of the agency, unless the transfer was for
 1406  adequate consideration and the proceeds of the transfer are
 1407  reimbursed in full to the agency, but not in excess of the
 1408  amount of medical assistance provided by Medicaid.
 1409         (17)
 1410         (b) If federal law limits the agency to reimbursement from
 1411  the recovered medical expense damages, a recipient, or his or
 1412  her legal representative, may contest the amount designated as
 1413  recovered medical expense damages payable to the agency pursuant
 1414  to the formula specified in paragraph (11)(f) by filing a
 1415  petition under chapter 120 within 21 days after the date of
 1416  payment of funds to the agency or after the date of placing the
 1417  full amount of the third-party benefits in the trust account for
 1418  the benefit of the agency pursuant to paragraph (a). The
 1419  petition shall be filed with the Division of Administrative
 1420  Hearings. For purposes of chapter 120, the payment of funds to
 1421  the agency or the placement of the full amount of the third
 1422  party benefits in the trust account for the benefit of the
 1423  agency constitutes final agency action and notice thereof. Final
 1424  order authority for the proceedings specified in this subsection
 1425  rests with the Division of Administrative Hearings. This
 1426  procedure is the exclusive method for challenging the amount of
 1427  third-party benefits payable to the agency. In order to
 1428  successfully challenge the amount designated as recovered
 1429  medical expenses payable to the agency, the recipient must
 1430  prove, by clear and convincing evidence, that the a lesser
 1431  portion of the total recovery which should be allocated as
 1432  reimbursement for past and future medical expenses is less than
 1433  the amount calculated by the agency pursuant to the formula set
 1434  forth in paragraph (11)(f). Alternatively, the recipient must
 1435  prove by clear and convincing evidence or that Medicaid provided
 1436  a lesser amount of medical assistance than that asserted by the
 1437  agency.
 1438         (20)(a) Entities providing health insurance as defined in
 1439  s. 624.603, health maintenance organizations and prepaid health
 1440  clinics as defined in chapter 641, and, on behalf of their
 1441  clients, third-party administrators, and pharmacy benefits
 1442  managers, and any other third parties, as defined in s.
 1443  409.901(27), which are legally responsible for payment of a
 1444  claim for a health care item or service as a condition of doing
 1445  business in the state or providing coverage to residents of this
 1446  state, shall provide such records and information as are
 1447  necessary to accomplish the purpose of this section, unless such
 1448  requirement results in an unreasonable burden.
 1449         (b)An entity must respond to a request for payment with
 1450  payment on the claim, a written request for additional
 1451  information with which to process the claim, or a written reason
 1452  for denial of the claim within 90 working days after receipt of
 1453  written proof of loss or claim for payment for a health care
 1454  item or service provided to a Medicaid recipient who is covered
 1455  by the entity. Failure to pay or deny a claim within 140 days
 1456  after receipt of the claim creates an uncontestable obligation
 1457  to pay the claim.
 1458         (a)The director of the agency and the Director of the
 1459  Office of Insurance Regulation of the Financial Services
 1460  Commission shall enter into a cooperative agreement for
 1461  requesting and obtaining information necessary to effect the
 1462  purpose and objective of this section.
 1463         1.The agency shall request only that information necessary
 1464  to determine whether health insurance as defined pursuant to s.
 1465  624.603, or those health services provided pursuant to chapter
 1466  641, could be, should be, or have been claimed and paid with
 1467  respect to items of medical care and services furnished to any
 1468  person eligible for services under this section.
 1469         2.All information obtained pursuant to subparagraph 1. is
 1470  confidential and exempt from s. 119.07(1). The agency shall
 1471  provide the information obtained pursuant to subparagraph 1. to
 1472  the Department of Revenue for purposes of administering the
 1473  state Title IV-D program. The agency and the Department of
 1474  Revenue shall enter into a cooperative agreement for purposes of
 1475  implementing this requirement.
 1476         3.The cooperative agreement or rules adopted under this
 1477  subsection may include financial arrangements to reimburse the
 1478  reporting entities for reasonable costs or a portion thereof
 1479  incurred in furnishing the requested information. Neither the
 1480  cooperative agreement nor the rules shall require the automation
 1481  of manual processes to provide the requested information.
 1482         (b)The agency and the Financial Services Commission
 1483  jointly shall adopt rules for the development and administration
 1484  of the cooperative agreement. The rules shall include the
 1485  following:
 1486         1.A method for identifying those entities subject to
 1487  furnishing information under the cooperative agreement.
 1488         2.A method for furnishing requested information.
 1489         3.Procedures for requesting exemption from the cooperative
 1490  agreement based on an unreasonable burden to the reporting
 1491  entity.
 1492         Section 20. Notwithstanding section 27 of chapter 2016-65,
 1493  Laws of Florida, and subject to federal approval of the
 1494  application to be a site for the Program of All-inclusive Care
 1495  for the Elderly (PACE), the Agency for Health Care
 1496  Administration shall contract with a not-for-profit
 1497  organization, formed by a partnership with a not-for-profit
 1498  hospital, a not-for-profit agency serving elders, and a not-for
 1499  profit hospice in Leon County. The not-for-profit PACE shall
 1500  serve eligible PACE enrollees in Gadsden, Jefferson, Leon, and
 1501  Wakulla Counties. The Agency for Health Care Administration, in
 1502  consultation with the Department of Elderly Affairs and subject
 1503  to an appropriation, shall approve up to 300 initial enrollees
 1504  for the additional PACE site.
 1505         Section 21. Section 17 of chapter 2011-61, Laws of Florida,
 1506  is amended to read:
 1507         Section 17. Notwithstanding s. 430.707, Florida Statutes,
 1508  and subject to federal approval of the application to be a site
 1509  for the Program of All-inclusive Care for the Elderly, the
 1510  Agency for Health Care Administration shall contract with one
 1511  private health care organization, the sole member of which is a
 1512  private, not-for-profit corporation that owns and manages health
 1513  care organizations which provide comprehensive long-term care
 1514  services, including nursing home, assisted living, independent
 1515  housing, home care, adult day care, and care management, with a
 1516  board-certified, trained geriatrician as the medical director.
 1517  This organization shall provide these services to frail and
 1518  elderly persons who reside in Indian River, Martin, Okeechobee,
 1519  Palm Beach, and St. Lucie Counties County. The organization is
 1520  exempt from the requirements of chapter 641, Florida Statutes.
 1521  The agency, in consultation with the Department of Elderly
 1522  Affairs and subject to an appropriation, shall approve up to 150
 1523  initial enrollees who reside in Palm Beach County and up to 150
 1524  initial enrollees who reside in Martin County in the Program of
 1525  All-inclusive Care for the Elderly established by this
 1526  organization to serve elderly persons who reside in Palm Beach
 1527  County.
 1528         Section 22. Section 29 of chapter 2016-65, Laws of Florida,
 1529  is amended to read:
 1530         Section 29. Subject to federal approval of the application
 1531  to be a site for the Program of All-inclusive Care for the
 1532  Elderly (PACE), the Agency for Health Care Administration shall
 1533  contract with one private, not-for-profit hospice organization
 1534  located in Lake County which operates health care organizations
 1535  licensed in Hospice Areas 7B and 3E and which provides
 1536  comprehensive services, including hospice and palliative care,
 1537  to frail elders who reside in these service areas. The
 1538  organization is exempt from the requirements of chapter 641,
 1539  Florida Statutes. The agency, in consultation with the
 1540  Department of Elderly Affairs and subject to the appropriation
 1541  of funds by the Legislature, shall approve up to 150 initial
 1542  enrollees in the Program of All-inclusive Care for the Elderly
 1543  established by the organization to serve frail elders who reside
 1544  in Hospice Service Areas 7B and 3E. The agency, in consultation
 1545  with the department and subject to an appropriation, shall
 1546  approve up to 150 enrollees in the Program of All-inclusive Care
 1547  for the Elderly established by this organization to serve frail
 1548  elders who reside in Hospice Service Area 7C.
 1549         Section 23. Subsection (3) of section 391.055, Florida
 1550  Statutes, is amended to read:
 1551         391.055 Service delivery systems.—
 1552         (3) The Children’s Medical Services network may contract
 1553  with school districts participating in the certified school
 1554  match program pursuant to ss. 409.908(21) 409.908(22) and
 1555  1011.70 for the provision of school-based services, as provided
 1556  for in s. 409.9071, for Medicaid-eligible children who are
 1557  enrolled in the Children’s Medical Services network.
 1558         Section 24. Subsection (7) of section 393.0661, Florida
 1559  Statutes, is amended to read:
 1560         393.0661 Home and community-based services delivery system;
 1561  comprehensive redesign.—The Legislature finds that the home and
 1562  community-based services delivery system for persons with
 1563  developmental disabilities and the availability of appropriated
 1564  funds are two of the critical elements in making services
 1565  available. Therefore, it is the intent of the Legislature that
 1566  the Agency for Persons with Disabilities shall develop and
 1567  implement a comprehensive redesign of the system.
 1568         (7) The agency shall collect premiums or cost sharing
 1569  pursuant to s. 409.906(13)(c) 409.906(13)(d).
 1570         Section 25. Paragraph (a) of subsection (4) of section
 1571  409.968, Florida Statutes, is amended to read:
 1572         409.968 Managed care plan payments.—
 1573         (4)(a) Subject to a specific appropriation and federal
 1574  approval under s. 409.906(13)(d) 409.906(13)(e), the agency
 1575  shall establish a payment methodology to fund managed care plans
 1576  for flexible services for persons with severe mental illness and
 1577  substance use disorders, including, but not limited to,
 1578  temporary housing assistance. A managed care plan eligible for
 1579  these payments must do all of the following:
 1580         1. Participate as a specialty plan for severe mental
 1581  illness or substance use disorders or participate in counties
 1582  designated by the General Appropriations Act;
 1583         2. Include providers of behavioral health services pursuant
 1584  to chapters 394 and 397 in the managed care plan’s provider
 1585  network; and
 1586         3. Document a capability to provide housing assistance
 1587  through agreements with housing providers, relationships with
 1588  local housing coalitions, and other appropriate arrangements.
 1589         Section 26. Subsection (3) of section 427.0135, Florida
 1590  Statutes, is amended to read:
 1591         427.0135 Purchasing agencies; duties and responsibilities.
 1592  Each purchasing agency, in carrying out the policies and
 1593  procedures of the commission, shall:
 1594         (3) Not procure transportation disadvantaged services
 1595  without initially negotiating with the commission, as provided
 1596  in s. 287.057(3)(e)12., or unless otherwise authorized by
 1597  statute. If the purchasing agency, after consultation with the
 1598  commission, determines that it cannot reach mutually acceptable
 1599  contract terms with the commission, the purchasing agency may
 1600  contract for the same transportation services provided in a more
 1601  cost-effective manner and of comparable or higher quality and
 1602  standards. The Medicaid agency shall implement this subsection
 1603  in a manner consistent with s. 409.908(18) 409.908(19) and as
 1604  otherwise limited or directed by the General Appropriations Act.
 1605         Section 27. Subsections (1) and (5) of section 1011.70,
 1606  Florida Statutes, are amended to read:
 1607         1011.70 Medicaid certified school funding maximization.—
 1608         (1) Each school district, subject to the provisions of ss.
 1609  409.9071 and 409.908(21) 409.908(22) and this section, is
 1610  authorized to certify funds provided for a category of required
 1611  Medicaid services termed “school-based services,” which are
 1612  reimbursable under the federal Medicaid program. Such services
 1613  shall include, but not be limited to, physical, occupational,
 1614  and speech therapy services, behavioral health services, mental
 1615  health services, transportation services, Early Periodic
 1616  Screening, Diagnosis, and Treatment (EPSDT) administrative
 1617  outreach for the purpose of determining eligibility for
 1618  exceptional student education, and any other such services, for
 1619  the purpose of receiving federal Medicaid financial
 1620  participation. Certified school funding shall not be available
 1621  for the following services:
 1622         (a) Family planning.
 1623         (b) Immunizations.
 1624         (c) Prenatal care.
 1625         (5) Lab schools, as authorized under s. 1002.32, shall be
 1626  authorized to participate in the Medicaid certified school match
 1627  program on the same basis as school districts subject to the
 1628  provisions of subsections (1)-(4) and ss. 409.9071 and
 1629  409.908(21) 409.908(22).
 1630         Section 28. For the 2017-2018 fiscal year, $578,918,460 in
 1631  nonrecurring funds from the Grants and Donations Trust Fund and
 1632  $924,467,313 in nonrecurring funds from the Medical Care Trust
 1633  Fund are appropriated to the Agency for Health Care
 1634  Administration for the purpose of implementing a Low-Income Pool
 1635  Program. These funds shall be held in reserve. Subject to the
 1636  federal approval of the final terms and conditions of the Low
 1637  Income Pool, the Agency for Health Care Administration shall
 1638  submit a budget amendment requesting release of the funds held
 1639  in reserve pursuant to chapter 216, Florida Statutes. If the
 1640  chair and vice chair of the Legislative Budget Commission or the
 1641  President of the Senate and the Speaker of the House of
 1642  Representatives object in writing to a proposed amendment within
 1643  14 days after notification, the Governor shall void the action.
 1644  In addition to the proposed amendment, the agency must submit:
 1645  the Reimbursement and Funding Methodology Document, as specified
 1646  in the terms and conditions, which documents permissible Low
 1647  Income Pool expenditures; a proposed distribution model by
 1648  entity; and a proposed listing of entities contributing
 1649  Intergovernmental Transfers to support the state match required.
 1650  Low-Income Pool payments to providers under this section are
 1651  contingent upon the nonfederal share being provided through
 1652  intergovernmental transfers in the Grants and Donations Trust
 1653  Fund. In the event the funds are not available in the Grants and
 1654  Donations Trust Fund, the State of Florida is not obligated to
 1655  make payments under this section. This section expires July 1,
 1656  2018.
 1657         Section 29. For the 2017-2018 fiscal year, $94,414,800 in
 1658  nonrecurring funds from the Grants and Donations Trust Fund and
 1659  $151,585,200 in nonrecurring funds from the Medical Care Trust
 1660  Funds are appropriated to the Agency for Health Care
 1661  Administration to continue medical school faculty physician
 1662  supplemental payments. These funds shall be held in reserve.
 1663  These funds shall be used to continue supplemental payments for
 1664  services provided by doctors of medicine and osteopathy, as well
 1665  as other licensed health care practitioners acting under the
 1666  supervision of those doctors, who are employed by or under
 1667  contract with a medical school in Florida. These funds may also
 1668  be used for pass-through, sub-capitation, differential fee, or
 1669  directed lump sum payments for doctors of medicine and
 1670  osteopathy, as well as other licensed health care practitioners
 1671  acting under the supervision of those doctors, who are employed
 1672  by or under contract with a medical school in Florida. Subject
 1673  to federal approval to continue the supplemental and/or pass
 1674  through, sub-capitation, differential fee, or directed lump sum
 1675  payments, the Agency for Health Care Administration may submit a
 1676  budget amendment requesting release of the funds held in reserve
 1677  pursuant to the provisions of chapter 216, Florida Statutes. If
 1678  the chair and vice chair of the Legislative Budget Commission or
 1679  the President of the Senate and the Speaker of the House of
 1680  Representatives object in writing to a proposed amendment within
 1681  14 days following notification, the Governor shall void the
 1682  action. The amendment shall include the federal approvals, a
 1683  proposed distribution model by entity, and a proposed listing of
 1684  entities contributing Intergovernmental Transfers to support the
 1685  state match required. Payments to providers under this section
 1686  are contingent upon the nonfederal share being provided through
 1687  intergovernmental transfers in the Grants and Donations Trust
 1688  Fund. In the event the funds are not available in the Grants and
 1689  Donations Trust Fund, the State of Florida is not obligated to
 1690  make payments under this section. This section expires July 1,
 1691  2018.
 1692         Section 30. Except as otherwise expressly provided in this
 1693  act, this act shall take effect July 1, 2017.

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