Bill Text: FL S2526 | 2022 | Regular Session | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health
Spectrum: Committee Bill
Status: (Passed) 2022-06-03 - Chapter No. 2022-150 [S2526 Detail]
Download: Florida-2022-S2526-Introduced.html
Bill Title: Health
Spectrum: Committee Bill
Status: (Passed) 2022-06-03 - Chapter No. 2022-150 [S2526 Detail]
Download: Florida-2022-S2526-Introduced.html
Florida Senate - 2022 SB 2526 By the Committee on Appropriations 576-02897-22 20222526__ 1 A bill to be entitled 2 An act relating to health; amending s. 210.201, F.S.; 3 providing an appropriation to the Board of Directors 4 of the H. Lee Moffitt Cancer Center and Research 5 Institute for a specified purpose; authorizing such 6 appropriation to be used to secure certain financing; 7 providing construction; amending s. 381.02035, F.S.; 8 authorizing pharmacists and wholesalers employed by or 9 under contract with forensic facilities managed by the 10 Agency for Persons with Disabilities to import 11 prescription drugs under the Canadian Prescription 12 Drug Importation Program for dispensing to clients in 13 such facilities; amending s. 394.9082, F.S.; requiring 14 that the Department of Children and Families’ 15 contracts with managing entities be made available on 16 the department’s website; requiring the department to 17 conduct a specified review of managing entities every 18 2 years; requiring the department to submit the review 19 to the Governor and the Legislature by a specified 20 date; requiring managing entities to provide notice to 21 providers before removing the provider from the 22 provider network; amending s. 408.062, F.S.; deleting 23 a requirement that the Agency for Health Care 24 Administration collect and publish on its website 25 certain data related to the retail prices of specified 26 prescribed medicines; amending s. 409.908, F.S.; 27 requiring the agency to base its rate of payments for 28 nursing home care in its Title XIX Long-Term Care 29 Reimbursement Plan in accordance with specified 30 minimum wage requirements; providing an effective 31 date. 32 33 Be It Enacted by the Legislature of the State of Florida: 34 35 Section 1. Section 210.201, Florida Statutes, is amended to 36 read: 37 210.201 H. Lee Moffitt Cancer Center and Research Institute 38 facilities; establishment; funding.— 39 (1) The Board of Directors of the H. Lee Moffitt Cancer 40 Center and Research Institute shall construct, furnish, and 41 equip, and shall covenant to complete, the cancer research and 42 clinical and related facilities of the H. Lee Moffitt Cancer 43 Center and Research Institute funded with proceeds from the 44 Cigarette Tax Collection Trust Fund pursuant to s. 210.20. 45 Moneys transferred to the Board of Directors of the H. Lee 46 Moffitt Cancer Center and Research Institute pursuant to s. 47 210.20 may be used to secure financing to pay costs related to 48 constructing, furnishing, equipping, operating, and maintaining 49 cancer research and clinical and related facilities; furnishing, 50 equipping, operating, and maintaining other leased or owned 51 properties; and paying costs incurred in connection with 52 purchasing, financing, operating, and maintaining such 53 equipment, facilities, and properties as provided in s. 210.20. 54 Such financing may include the issuance of tax-exempt bonds or 55 other forms of indebtedness by a local authority, municipality, 56 or county pursuant to parts II and III of chapter 159. Such 57 bonds shall not constitute state bonds for purposes of s. 11, 58 Art. VII of the State Constitution, but shall constitute bonds 59 of a“local agency,”as defined in s. 159.27(4). The cigarette 60 tax dollars pledged to facilities pursuant to s. 210.20 may be 61 replaced annually by the Legislature from tobacco litigation 62 settlement proceeds. 63 (2) Beginning in the 2022-2023 fiscal year, and annually 64 through the 2052-2053 fiscal year, the sum of $20 million is 65 appropriated and shall be transferred to the Board of Directors 66 of the H. Lee Moffitt Cancer Center and Research Institute for 67 construction and development of Moffitt’s Pasco County life 68 sciences park. Moneys transferred to the Board of Directors of 69 the H. Lee Moffitt Cancer Center and Research Institute pursuant 70 to this subsection may be used to secure financing to pay costs 71 related to the construction and development of Moffitt’s Pasco 72 County life sciences park. Such financing may include the 73 issuance of tax-exempt bonds or other forms of indebtedness by a 74 local authority, municipality, or county pursuant to parts II 75 and III of chapter 159. Such bonds shall not constitute state 76 bonds for purposes of s. 11, Art. VII of the State Constitution, 77 but shall constitute bonds of a local agency as defined in s. 78 159.27(4). 79 Section 2. Paragraph (f) is added to subsection (7) of 80 section 381.02035, Florida Statutes, to read: 81 381.02035 Canadian Prescription Drug Importation Program.— 82 (7) ELIGIBLE IMPORTERS.—The following entities may import 83 prescription drugs from an eligible Canadian supplier under the 84 program: 85 (f) A pharmacist or wholesaler employed by or under 86 contract with a forensic facility, as defined in s. 916.106, 87 that is managed by the Agency for Persons with Disabilities, for 88 dispensing to clients treated in such facility. 89 Section 3. Paragraph (i) of subsection (5) of section 90 394.9082, Florida Statutes, is amended, and paragraphs (k) and 91 (l) are added to subsection (4) of that section, to read: 92 394.9082 Behavioral health managing entities.— 93 (4) CONTRACT WITH MANAGING ENTITIES.— 94 (k) The department’s contracts with managing entities must 95 be made available in a publicly accessible format on the 96 department’s website. 97 (l) Every 2 years, the department shall conduct a 98 comprehensive, multiyear review of the revenues, expenditures, 99 and financial positions of managing entities covering the most 100 recent 2 consecutive fiscal years. The review must include a 101 comprehensive system-of-care analysis. The department shall 102 submit the review to the Governor, the President of the Senate, 103 and the Speaker of the House of Representatives by November 1 of 104 every other year, beginning in 2023. 105 (5) MANAGING ENTITY DUTIES.—A managing entity shall: 106 (i) Develop a comprehensive provider network of qualified 107 providers to deliver behavioral health services. The managing 108 entity is not required to competitively procure network 109 providers but shall publicize opportunities to join the provider 110 network and evaluate providers in the network to determine if 111 they may remain in the network. A managing entity must provide 112 notice to a provider before the provider is removed from the 113 network. The managing entity shall publish these processes on 114 its website. The managing entity shall ensure continuity of care 115 for clients if a provider ceases to provide a service or leaves 116 the network. 117 Section 4. Paragraph (h) of subsection (1) of section 118 408.062, Florida Statutes, is amended to read: 119 408.062 Research, analyses, studies, and reports.— 120 (1) The agency shall conduct research, analyses, and 121 studies relating to health care costs and access to and quality 122 of health care services as access and quality are affected by 123 changes in health care costs. Such research, analyses, and 124 studies shall include, but not be limited to: 125(h) The collection of a statistically valid sample of data126on the retail prices charged by pharmacies for the 300 most127frequently prescribed medicines from any pharmacy licensed by128this state. If the drug is available generically, price data129shall be reported for the generic drug and price data of a130brand-named drug for which the generic drug is the equivalent131shall be reported. The agency shall make available on its132Internet website for each pharmacy drug prices for a 30-day133supply at a standard dose. The data collected shall be reported134for each drug by pharmacy and by metropolitan statistical area135or region and updated monthly.136 Section 5. Subsection (2) of section 409.908, Florida 137 Statutes, is amended to read: 138 409.908 Reimbursement of Medicaid providers.—Subject to 139 specific appropriations, the agency shall reimburse Medicaid 140 providers, in accordance with state and federal law, according 141 to methodologies set forth in the rules of the agency and in 142 policy manuals and handbooks incorporated by reference therein. 143 These methodologies may include fee schedules, reimbursement 144 methods based on cost reporting, negotiated fees, competitive 145 bidding pursuant to s. 287.057, and other mechanisms the agency 146 considers efficient and effective for purchasing services or 147 goods on behalf of recipients. If a provider is reimbursed based 148 on cost reporting and submits a cost report late and that cost 149 report would have been used to set a lower reimbursement rate 150 for a rate semester, then the provider’s rate for that semester 151 shall be retroactively calculated using the new cost report, and 152 full payment at the recalculated rate shall be effected 153 retroactively. Medicare-granted extensions for filing cost 154 reports, if applicable, shall also apply to Medicaid cost 155 reports. Payment for Medicaid compensable services made on 156 behalf of Medicaid-eligible persons is subject to the 157 availability of moneys and any limitations or directions 158 provided for in the General Appropriations Act or chapter 216. 159 Further, nothing in this section shall be construed to prevent 160 or limit the agency from adjusting fees, reimbursement rates, 161 lengths of stay, number of visits, or number of services, or 162 making any other adjustments necessary to comply with the 163 availability of moneys and any limitations or directions 164 provided for in the General Appropriations Act, provided the 165 adjustment is consistent with legislative intent. 166 (2)(a)1. Reimbursement to nursing homes licensed under part 167 II of chapter 400 and state-owned-and-operated intermediate care 168 facilities for the developmentally disabled licensed under part 169 VIII of chapter 400 must be made prospectively. 170 2. Unless otherwise limited or directed in the General 171 Appropriations Act, reimbursement to hospitals licensed under 172 part I of chapter 395 for the provision of swing-bed nursing 173 home services must be made on the basis of the average statewide 174 nursing home payment, and reimbursement to a hospital licensed 175 under part I of chapter 395 for the provision of skilled nursing 176 services must be made on the basis of the average nursing home 177 payment for those services in the county in which the hospital 178 is located. When a hospital is located in a county that does not 179 have any community nursing homes, reimbursement shall be 180 determined by averaging the nursing home payments in counties 181 that surround the county in which the hospital is located. 182 Reimbursement to hospitals, including Medicaid payment of 183 Medicare copayments, for skilled nursing services shall be 184 limited to 30 days, unless a prior authorization has been 185 obtained from the agency. Medicaid reimbursement may be extended 186 by the agency beyond 30 days, and approval must be based upon 187 verification by the patient’s physician that the patient 188 requires short-term rehabilitative and recuperative services 189 only, in which case an extension of no more than 15 days may be 190 approved. Reimbursement to a hospital licensed under part I of 191 chapter 395 for the temporary provision of skilled nursing 192 services to nursing home residents who have been displaced as 193 the result of a natural disaster or other emergency may not 194 exceed the average county nursing home payment for those 195 services in the county in which the hospital is located and is 196 limited to the period of time which the agency considers 197 necessary for continued placement of the nursing home residents 198 in the hospital. 199 (b) Subject to any limitations or directions in the General 200 Appropriations Act, the agency shall establish and implement a 201 state Title XIX Long-Term Care Reimbursement Plan for nursing 202 home care in order to provide care and services in conformance 203 with the applicable state and federal laws, rules, regulations, 204 and quality and safety standards and to ensure that individuals 205 eligible for medical assistance have reasonable geographic 206 access to such care. 207 1. The agency shall amend the long-term care reimbursement 208 plan and cost reporting system to create direct care and 209 indirect care subcomponents of the patient care component of the 210 per diem rate. These two subcomponents together shall equal the 211 patient care component of the per diem rate. Separate prices 212 shall be calculated for each patient care subcomponent, 213 initially based on the September 2016 rate setting cost reports 214 and subsequently based on the most recently audited cost report 215 used during a rebasing year. The direct care subcomponent of the 216 per diem rate for any providers still being reimbursed on a cost 217 basis shall be limited by the cost-based class ceiling, and the 218 indirect care subcomponent may be limited by the lower of the 219 cost-based class ceiling, the target rate class ceiling, or the 220 individual provider target. The ceilings and targets apply only 221 to providers being reimbursed on a cost-based system. Effective 222 October 1, 2018, a prospective payment methodology shall be 223 implemented for rate setting purposes with the following 224 parameters: 225 a. Peer Groups, including: 226 (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee 227 Counties; and 228 (II) South-SMMC Regions 10-11, plus Palm Beach and 229 Okeechobee Counties. 230 b. Percentage of Median Costs based on the cost reports 231 used for September 2016 rate setting: 232 (I) Direct Care Costs........................100 percent. 233 (II) Indirect Care Costs......................92 percent. 234 (III) Operating Costs.........................86 percent. 235 c. Floors: 236 (I) Direct Care Component.....................95 percent. 237 (II) Indirect Care Component................92.5 percent. 238 (III) Operating Component...........................None. 239 d. Pass-through Payments..................Real Estate and 240 ...............................................Personal Property 241 ...................................Taxes and Property Insurance. 242 e. Quality Incentive Program Payment 243 Pool......................................6 percent of September 244 .......................................2016 non-property related 245 ................................payments of included facilities. 246 f. Quality Score Threshold to Quality for Quality Incentive 247 Payment..................20th percentile of included facilities. 248 g. Fair Rental Value System Payment Parameters: 249 (I) Building Value per Square Foot based on 2018 RS Means. 250 (II) Land Valuation...10 percent of Gross Building value. 251 (III) Facility Square Footage......Actual Square Footage. 252 (IV) Moveable Equipment Allowance.........$8,000 per bed. 253 (V) Obsolescence Factor......................1.5 percent. 254 (VI) Fair Rental Rate of Return................8 percent. 255 (VII) Minimum Occupancy.......................90 percent. 256 (VIII) Maximum Facility Age.....................40 years. 257 (IX) Minimum Square Footage per Bed..................350. 258 (X) Maximum Square Footage for Bed...................500. 259 (XI) Minimum Cost of a renovation/replacements$500 per bed. 260 h. Ventilator Supplemental payment of $200 per Medicaid day 261 of 40,000 ventilator Medicaid days per fiscal year. 262 2. The direct care subcomponent shall include salaries and 263 benefits of direct care staff providing nursing services 264 including registered nurses, licensed practical nurses, and 265 certified nursing assistants who deliver care directly to 266 residents in the nursing home facility, allowable therapy costs, 267 and dietary costs. This excludes nursing administration, staff 268 development, the staffing coordinator, and the administrative 269 portion of the minimum data set and care plan coordinators. The 270 direct care subcomponent also includes medically necessary 271 dental care, vision care, hearing care, and podiatric care. 272 3. All other patient care costs shall be included in the 273 indirect care cost subcomponent of the patient care per diem 274 rate, including complex medical equipment, medical supplies, and 275 other allowable ancillary costs. Costs may not be allocated 276 directly or indirectly to the direct care subcomponent from a 277 home office or management company. 278 4. On July 1 of each year, the agency shall report to the 279 Legislature direct and indirect care costs, including average 280 direct and indirect care costs per resident per facility and 281 direct care and indirect care salaries and benefits per category 282 of staff member per facility. 283 5. Every fourth year, the agency shall rebase nursing home 284 prospective payment rates to reflect changes in cost based on 285 the most recently audited cost report for each participating 286 provider. 287 6. A direct care supplemental payment may be made to 288 providers whose direct care hours per patient day are above the 289 80th percentile and who provide Medicaid services to a larger 290 percentage of Medicaid patients than the state average. 291 7. For the period beginning on October 1, 2018, and ending 292 on September 30, 2021, the agency shall reimburse providers the 293 greater of their September 2016 cost-based rate or their 294 prospective payment rate. Effective October 1, 2021, the agency 295 shall reimburse providers the greater of 95 percent of their 296 cost-based rate or their rebased prospective payment rate, using 297 the most recently audited cost report for each facility. This 298 subparagraph shall expire September 30, 2023. 299 8. Pediatric, Florida Department of Veterans Affairs, and 300 government-owned facilities are exempt from the pricing model 301 established in this subsection and shall remain on a cost-based 302 prospective payment system. Effective October 1, 2018, the 303 agency shall set rates for all facilities remaining on a cost 304 based prospective payment system using each facility’s most 305 recently audited cost report, eliminating retroactive 306 settlements. 307 308 It is the intent of the Legislature that the reimbursement plan 309 achieve the goal of providing access to health care for nursing 310 home residents who require large amounts of care while 311 encouraging diversion services as an alternative to nursing home 312 care for residents who can be served within the community. The 313 agency shall base the establishment of any maximum rate of 314 payment, whether overall or component, on the available moneys 315 as provided for in the General Appropriations Act. The agency 316 may base the maximum rate of payment on the results of 317 scientifically valid analysis and conclusions derived from 318 objective statistical data pertinent to the particular maximum 319 rate of payment. The agency shall base the rates of payments in 320 accordance with the minimum wage requirements as provided in the 321 General Appropriations Act. 322 Section 6. This act shall take effect July 1, 2022.