Bill Text: FL S2526 | 2022 | Regular Session | Engrossed
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-Engrossed.html
Bill Title: Health
Spectrum: Committee Bill
Status: (Passed) 2022-06-03 - Chapter No. 2022-150 [S2526 Detail]
Download: Florida-2022-S2526-Engrossed.html
SB 2526 First Engrossed 20222526e1 1 A bill to be entitled 2 An act relating to health; amending s. 17.41, F.S.; 3 providing that the Department of Financial Services 4 Tobacco Settlement Clearing Trust Fund shall be 5 referred to as the “Lawton Chiles Trust Fund”; 6 amending s. 210.201, F.S.; providing an appropriation 7 to the Board of Directors of the H. Lee Moffitt Cancer 8 Center and Research Institute for a specified purpose; 9 authorizing such appropriation to be used to secure 10 certain financing; providing construction; amending s. 11 381.02035, F.S.; authorizing pharmacists and 12 wholesalers employed by or under contract with 13 forensic facilities managed by the Agency for Persons 14 with Disabilities to import prescription drugs under 15 the Canadian Prescription Drug Importation Program for 16 dispensing to clients in such facilities; amending s. 17 381.915, F.S.; renaming the Florida Consortium of 18 National Cancer Institute Centers Program as the 19 “Casey DeSantis Cancer Research Program”; revising a 20 short title; amending s. 394.9082, F.S.; requiring 21 that the Department of Children and Families’ 22 contracts with managing entities be made available on 23 the department’s website; requiring the department to 24 conduct a specified review of managing entities every 25 2 years; requiring the department to submit the review 26 to the Governor and the Legislature by a specified 27 date; requiring managing entities to provide notice to 28 providers before removing the provider from the 29 provider network; amending s. 409.814, F.S.; providing 30 for continued Title XXI-funded coverage for certain 31 enrollees beyond 19 years of age under certain 32 circumstances; providing for eligibility; amending s. 33 409.908, F.S.; requiring the agency to base its rate 34 of payments for nursing home care in its Title XIX 35 Long-Term Care Reimbursement Plan in accordance with 36 specified minimum wage requirements; amending ss. 37 20.435, 210.20, and 409.816, F.S.; conforming 38 provisions to changes made by the act; providing an 39 effective date. 40 41 Be It Enacted by the Legislature of the State of Florida: 42 43 Section 1. Subsection (1) of section 17.41, Florida 44 Statutes, is amended to read: 45 17.41 Department of Financial Services Tobacco Settlement 46 Clearing Trust Fund.— 47 (1) The Department of Financial Services Tobacco Settlement 48 Clearing Trust Fund, which shall be referred to as the “Lawton 49 Chiles Trust Fund,” is created within that department. 50 Section 2. Section 210.201, Florida Statutes, is amended to 51 read: 52 210.201 H. Lee Moffitt Cancer Center and Research Institute 53 facilities; establishment; funding.— 54 (1) The Board of Directors of the H. Lee Moffitt Cancer 55 Center and Research Institute shall construct, furnish, and 56 equip, and shall covenant to complete, the cancer research and 57 clinical and related facilities of the H. Lee Moffitt Cancer 58 Center and Research Institute funded with proceeds from the 59 Cigarette Tax Collection Trust Fund pursuant to s. 210.20. 60 Moneys transferred to the Board of Directors of the H. Lee 61 Moffitt Cancer Center and Research Institute pursuant to s. 62 210.20 may be used to secure financing to pay costs related to 63 constructing, furnishing, equipping, operating, and maintaining 64 cancer research and clinical and related facilities; furnishing, 65 equipping, operating, and maintaining other leased or owned 66 properties; and paying costs incurred in connection with 67 purchasing, financing, operating, and maintaining such 68 equipment, facilities, and properties as provided in s. 210.20. 69 Such financing may include the issuance of tax-exempt bonds or 70 other forms of indebtedness by a local authority, municipality, 71 or county pursuant to parts II and III of chapter 159. Such 72 bonds shall not constitute state bonds for purposes of s. 11, 73 Art. VII of the State Constitution, but shall constitute bonds 74 of a“local agency,”as defined in s. 159.27(4). The cigarette 75 tax dollars pledged to facilities pursuant to s. 210.20 may be 76 replaced annually by the Legislature from tobacco litigation 77 settlement proceeds. 78 (2) Beginning in the 2022-2023 fiscal year, and annually 79 through the 2052-2053 fiscal year, the sum of $20 million is 80 appropriated and shall be transferred to the Board of Directors 81 of the H. Lee Moffitt Cancer Center and Research Institute for 82 construction and development of Moffitt’s Pasco County life 83 sciences park. Moneys transferred to the Board of Directors of 84 the H. Lee Moffitt Cancer Center and Research Institute pursuant 85 to this subsection may be used to secure financing to pay costs 86 related to the construction and development of Moffitt’s Pasco 87 County life sciences park. Such financing may include the 88 issuance of tax-exempt bonds or other forms of indebtedness by a 89 local authority, municipality, or county pursuant to parts II 90 and III of chapter 159. Such bonds shall not constitute state 91 bonds for purposes of s. 11, Art. VII of the State Constitution, 92 but shall constitute bonds of a local agency as defined in s. 93 159.27(4). 94 Section 3. Paragraph (f) is added to subsection (7) of 95 section 381.02035, Florida Statutes, to read: 96 381.02035 Canadian Prescription Drug Importation Program.— 97 (7) ELIGIBLE IMPORTERS.—The following entities may import 98 prescription drugs from an eligible Canadian supplier under the 99 program: 100 (f) A pharmacist or wholesaler employed by or under 101 contract with a forensic facility, as defined in s. 916.106, 102 that is managed by the Agency for Persons with Disabilities, for 103 dispensing to clients treated in such facility. 104 Section 4. Section 381.915, Florida Statutes, is amended to 105 read: 106 381.915 Casey DeSantis Cancer ResearchFlorida Consortium107of National Cancer Institute CentersProgram.— 108 (1) This section may be cited as the “Casey DeSantis Cancer 109 ResearchFlorida NCI Cancer CentersAct.” 110 (2) The Casey DeSantis Cancer ResearchFlorida Consortium111of National Cancer Institute CentersProgram is established to 112 enhance the quality and competitiveness of cancer care in this 113 state, further a statewide biomedical research strategy directly 114 responsive to the health needs of Florida’s citizens, and 115 capitalize on the potential educational opportunities available 116 to its students. The department shall make payments to Florida 117 based cancer centers recognized by the National Cancer Institute 118 (NCI) at the National Institutes of Health as NCI-designated 119 cancer centers or NCI-designated comprehensive cancer centers, 120 and cancer centers working toward achieving NCI designation. The 121 department shall distribute funds to participating cancer 122 centers on a quarterly basis during each fiscal year for which 123 an appropriation is made. 124 (3) On or before September 15 of each year, the department 125 shall calculate an allocation fraction to be used for 126 distributing funds to participating cancer centers. On or before 127 the final business day of each quarter of the state fiscal year, 128 the department shall distribute to each participating cancer 129 center one-fourth of that cancer center’s annual allocation 130 calculated under subsection (6). The allocation fraction for 131 each participating cancer center is based on the cancer center’s 132 tier-designated weight under subsection (4) multiplied by each 133 of the following allocation factors: number of reportable cases, 134 peer-review costs, and biomedical education and training. As 135 used in this section, the term: 136 (a) “Biomedical education and training” means instruction 137 that is offered to a student who is enrolled in a biomedical 138 research program at an affiliated university as a medical 139 student or a student in a master’s or doctoral degree program, 140 or who is a resident physician trainee or postdoctoral trainee 141 in such program. An affiliated university biomedical research 142 program must be accredited or approved by a nationally 143 recognized agency and offered through an institution accredited 144 by the Commission on Colleges of the Southern Association of 145 Colleges and Schools. Full-time equivalency for trainees shall 146 be prorated for training received in oncologic sciences and 147 oncologic medicine. 148 (b) “Cancer center” means a freestanding center, a center 149 situated within an academic institution, or a formal research 150 based consortium under centralized leadership that has achieved 151 NCI designation or is prepared to achieve NCI designation by 152 July 1, 2019. 153 (c) “Florida-based” means that a cancer center’s actual or 154 sought designated status is or would be recognized by the NCI as 155 primarily located in Florida and not in another state. 156 (d) “Peer-review costs” means the total annual direct costs 157 for peer-reviewed cancer-related research projects, consistent 158 with reporting guidelines provided by the NCI, for the most 159 recent annual reporting period available. 160 (e) “Reportable cases” means cases of cancer in which a 161 cancer center is involved in the diagnosis, evaluation of the 162 diagnosis, evaluation of the extent of cancer spread at the time 163 of diagnosis, or administration of all or any part of the first 164 course of therapy for the most recent annual reporting period 165 available. Cases relating to patients enrolled in institutional 166 or investigator-initiated interventional clinical trials shall 167 be weighted at 1.2 relative to other cases weighted at 1.0. 168 Determination of institutional or investigator-initiated 169 interventional clinical trials must be consistent with reporting 170 guidelines provided by the NCI. 171 (4) Tier designations and corresponding weights within the 172 Casey DeSantis Cancer ResearchFlorida Consortium of National173Cancer Institute CentersProgram are as follows: 174 (a) Tier 1: Florida-based NCI-designated comprehensive 175 cancer centers, which shall be weighted at 1.5. 176 (b) Tier 2: Florida-based NCI-designated cancer centers, 177 which shall be weighted at 1.25. 178 (c) Tier 3: Florida-based cancer centers seeking 179 designation as either a NCI-designated cancer center or NCI 180 designated comprehensive cancer center, which shall be weighted 181 at 1.0. 182 1. A cancer center shall meet the following minimum 183 criteria to be considered eligible for Tier 3 designation in any 184 given fiscal year: 185 a. Conducting cancer-related basic scientific research and 186 cancer-related population scientific research; 187 b. Offering and providing the full range of diagnostic and 188 treatment services on site, as determined by the Commission on 189 Cancer of the American College of Surgeons; 190 c. Hosting or conducting cancer-related interventional 191 clinical trials that are registered with the NCI’s Clinical 192 Trials Reporting Program; 193 d. Offering degree-granting programs or affiliating with 194 universities through degree-granting programs accredited or 195 approved by a nationally recognized agency and offered through 196 the center or through the center in conjunction with another 197 institution accredited by the Commission on Colleges of the 198 Southern Association of Colleges and Schools; 199 e. Providing training to clinical trainees, medical 200 trainees accredited by the Accreditation Council for Graduate 201 Medical Education or the American Osteopathic Association, and 202 postdoctoral fellows recently awarded a doctorate degree; and 203 f. Having more than $5 million in annual direct costs 204 associated with their total NCI peer-reviewed grant funding. 205 2. The General Appropriations Act or accompanying 206 legislation may limit the number of cancer centers which shall 207 receive Tier 3 designations or provide additional criteria for 208 such designation. 209 3. A cancer center’s participation in Tier 3 may not extend 210 beyond June 30, 2024. 211 4. A cancer center that qualifies as a designated Tier 3 212 center under the criteria provided in subparagraph 1. by July 1, 213 2014, is authorized to pursue NCI designation as a cancer center 214 or a comprehensive cancer center until June 30, 2024. 215 (5) The department shall use the following formula to 216 calculate a participating cancer center’s allocation fraction: 217 218 CAF=[0.4x(CRC÷TCRC)]+[0.3x(CPC÷TCPC)]+[0.3x(CBE÷TCBE)] 219 220 Where: 221 CAF=A cancer center’s allocation fraction. 222 CRC=A cancer center’s tier-weighted reportable cases. 223 TCRC=The total tier-weighted reportable cases for all 224 cancer centers. 225 CPC=A cancer center’s tier-weighted peer-review costs. 226 TCPC=The total tier-weighted peer-review costs for all 227 cancer centers. 228 CBE=A cancer center’s tier-weighted biomedical education 229 and training. 230 TCBE=The total tier-weighted biomedical education and 231 training for all cancer centers. 232 233 (6) A cancer center’s annual allocation shall be calculated 234 by multiplying the funds appropriated for the Casey DeSantis 235 Cancer ResearchFlorida Consortium of National Cancer Institute236CentersProgram in the General Appropriations Act by that cancer 237 center’s allocation fraction. If the calculation results in an 238 annual allocation that is less than $16 million, that cancer 239 center’s annual allocation shall be increased to a sum equaling 240 $16 million, with the additional funds being provided 241 proportionally from the annual allocations calculated for the 242 other participating cancer centers. 243 (7) Beginning July 1, 2017, and every 3 years thereafter, 244 the department, in conjunction with participating cancer 245 centers, shall submit a report to the Cancer Control and 246 Research Advisory Council on specific metrics relating to cancer 247 mortality and external funding for cancer-related research in 248 the state. If a cancer center does not endorse this report or 249 produce an equivalent independent report, the cancer center 250 shall be suspended from the program for 1 year. The report must 251 include: 252 (a) An analysis of trending age-adjusted cancer mortality 253 rates in the state, which must include, at a minimum, overall 254 age-adjusted mortality rates for cancer statewide and age 255 adjusted mortality rates by age group, geographic region, and 256 type of cancer, which must include, at a minimum: 257 1. Lung cancer. 258 2. Pancreatic cancer. 259 3. Sarcoma. 260 4. Melanoma. 261 5. Leukemia and myelodysplastic syndromes. 262 6. Brain cancer. 263 (b) Identification of trends in overall federal funding, 264 broken down by institutional source, for cancer-related research 265 in the state. 266 (c) A list and narrative description of collaborative 267 grants and interinstitutional collaboration among participating 268 cancer centers, a comparison of collaborative grants in 269 proportion to the grant totals for each cancer center, a 270 catalogue of retreats and progress seed grants using state 271 funds, and targets for collaboration in the future and reports 272 on progress regarding such targets where appropriate. 273 (8) This section is subject to annual appropriation by the 274 Legislature. 275 (9) The department may adopt rules to administer this 276 section. 277 Section 5. Paragraph (i) of subsection (5) of section 278 394.9082, Florida Statutes, is amended, and paragraphs (k) and 279 (l) are added to subsection (4) of that section, to read: 280 394.9082 Behavioral health managing entities.— 281 (4) CONTRACT WITH MANAGING ENTITIES.— 282 (k) The department’s contracts with managing entities must 283 be made available in a publicly accessible format on the 284 department’s website. 285 (l) Every 2 years, the department shall conduct a 286 comprehensive, multiyear review of the revenues, expenditures, 287 and financial positions of managing entities covering the most 288 recent 2 consecutive fiscal years. The review must include a 289 comprehensive system-of-care analysis. The department shall 290 submit the review to the Governor, the President of the Senate, 291 and the Speaker of the House of Representatives by November 1 of 292 every other year, beginning in 2023. 293 (5) MANAGING ENTITY DUTIES.—A managing entity shall: 294 (i) Develop a comprehensive provider network of qualified 295 providers to deliver behavioral health services. The managing 296 entity is not required to competitively procure network 297 providers but shall publicize opportunities to join the provider 298 network and evaluate providers in the network to determine if 299 they may remain in the network. A managing entity must provide 300 notice to a provider before the provider is removed from the 301 network. The managing entity shall publish these processes on 302 its website. The managing entity shall ensure continuity of care 303 for clients if a provider ceases to provide a service or leaves 304 the network. 305 Section 6. Present subsections (4) through (11) of section 306 409.814, Florida Statutes, are redesignated as subsections (5) 307 through (12), respectively, a new subsection (4) is added to 308 that section, and present subsections (5), (6), and (10) are 309 amended, to read: 310 409.814 Eligibility.—A child who has not reached 19 years 311 of age whose family income is equal to or below 200 percent of 312 the federal poverty level is eligible for the Florida Kidcare 313 program as provided in this section. If an enrolled individual 314 is determined to be ineligible for coverage, he or she must be 315 immediately disenrolled from the respective Florida Kidcare 316 program component. 317 (4) A Title XXI-funded child who reaches 19 years of age is 318 eligible for continued Title XXI-funded coverage for the 319 duration of a pregnancy and the postpartum period consisting of 320 the 12-month period beginning on the last day of a pregnancy, if 321 such pregnancy or postpartum period begins prior to the child 322 reaching 19 years of age, and if the child is ineligible for 323 Medicaid. 324 (6)(5)A child who is otherwise eligible for the Florida 325 Kidcare program and who has a preexisting condition that 326 prevents coverage under another insurance plan as described in 327 paragraph (5)(a)(4)(a)which would have disqualified the child 328 for the Florida Kidcare program if the child were able to enroll 329 in the plan is eligible for Florida Kidcare coverage when 330 enrollment is possible. 331 (7)(6)A child whose family income is above 200 percent of 332 the federal poverty level or a child who is excluded under the 333 provisions of subsection (5)(4)may participate in the Florida 334 Kidcare program as provided in s. 409.8132 or, if the child is 335 ineligible for Medikids by reason of age, in the Florida Healthy 336 Kids program, subject to the following: 337 (a) The family is not eligible for premium assistance 338 payments and must pay the full cost of the premium, including 339 any administrative costs. 340 (b) The board of directors of the Florida Healthy Kids 341 Corporation may offer a reduced benefit package to these 342 children in order to limit program costs for such families. 343 (11)(10)Subject to paragraph (5)(a)(4)(a), the Florida 344 Kidcare program shall withhold benefits from an enrollee if the 345 program obtains evidence that the enrollee is no longer 346 eligible, submitted incorrect or fraudulent information in order 347 to establish eligibility, or failed to provide verification of 348 eligibility. The applicant or enrollee shall be notified that 349 because of such evidence program benefits will be withheld 350 unless the applicant or enrollee contacts a designated 351 representative of the program by a specified date, which must be 352 within 10 working days after the date of notice, to discuss and 353 resolve the matter. The program shall make every effort to 354 resolve the matter within a timeframe that will not cause 355 benefits to be withheld from an eligible enrollee. 356 Section 7. Subsection (2) of section 409.908, Florida 357 Statutes, is amended to read: 358 409.908 Reimbursement of Medicaid providers.—Subject to 359 specific appropriations, the agency shall reimburse Medicaid 360 providers, in accordance with state and federal law, according 361 to methodologies set forth in the rules of the agency and in 362 policy manuals and handbooks incorporated by reference therein. 363 These methodologies may include fee schedules, reimbursement 364 methods based on cost reporting, negotiated fees, competitive 365 bidding pursuant to s. 287.057, and other mechanisms the agency 366 considers efficient and effective for purchasing services or 367 goods on behalf of recipients. If a provider is reimbursed based 368 on cost reporting and submits a cost report late and that cost 369 report would have been used to set a lower reimbursement rate 370 for a rate semester, then the provider’s rate for that semester 371 shall be retroactively calculated using the new cost report, and 372 full payment at the recalculated rate shall be effected 373 retroactively. Medicare-granted extensions for filing cost 374 reports, if applicable, shall also apply to Medicaid cost 375 reports. Payment for Medicaid compensable services made on 376 behalf of Medicaid-eligible persons is subject to the 377 availability of moneys and any limitations or directions 378 provided for in the General Appropriations Act or chapter 216. 379 Further, nothing in this section shall be construed to prevent 380 or limit the agency from adjusting fees, reimbursement rates, 381 lengths of stay, number of visits, or number of services, or 382 making any other adjustments necessary to comply with the 383 availability of moneys and any limitations or directions 384 provided for in the General Appropriations Act, provided the 385 adjustment is consistent with legislative intent. 386 (2)(a)1. Reimbursement to nursing homes licensed under part 387 II of chapter 400 and state-owned-and-operated intermediate care 388 facilities for the developmentally disabled licensed under part 389 VIII of chapter 400 must be made prospectively. 390 2. Unless otherwise limited or directed in the General 391 Appropriations Act, reimbursement to hospitals licensed under 392 part I of chapter 395 for the provision of swing-bed nursing 393 home services must be made on the basis of the average statewide 394 nursing home payment, and reimbursement to a hospital licensed 395 under part I of chapter 395 for the provision of skilled nursing 396 services must be made on the basis of the average nursing home 397 payment for those services in the county in which the hospital 398 is located. When a hospital is located in a county that does not 399 have any community nursing homes, reimbursement shall be 400 determined by averaging the nursing home payments in counties 401 that surround the county in which the hospital is located. 402 Reimbursement to hospitals, including Medicaid payment of 403 Medicare copayments, for skilled nursing services shall be 404 limited to 30 days, unless a prior authorization has been 405 obtained from the agency. Medicaid reimbursement may be extended 406 by the agency beyond 30 days, and approval must be based upon 407 verification by the patient’s physician that the patient 408 requires short-term rehabilitative and recuperative services 409 only, in which case an extension of no more than 15 days may be 410 approved. Reimbursement to a hospital licensed under part I of 411 chapter 395 for the temporary provision of skilled nursing 412 services to nursing home residents who have been displaced as 413 the result of a natural disaster or other emergency may not 414 exceed the average county nursing home payment for those 415 services in the county in which the hospital is located and is 416 limited to the period of time which the agency considers 417 necessary for continued placement of the nursing home residents 418 in the hospital. 419 (b) Subject to any limitations or directions in the General 420 Appropriations Act, the agency shall establish and implement a 421 state Title XIX Long-Term Care Reimbursement Plan for nursing 422 home care in order to provide care and services in conformance 423 with the applicable state and federal laws, rules, regulations, 424 and quality and safety standards and to ensure that individuals 425 eligible for medical assistance have reasonable geographic 426 access to such care. 427 1. The agency shall amend the long-term care reimbursement 428 plan and cost reporting system to create direct care and 429 indirect care subcomponents of the patient care component of the 430 per diem rate. These two subcomponents together shall equal the 431 patient care component of the per diem rate. Separate prices 432 shall be calculated for each patient care subcomponent, 433 initially based on the September 2016 rate setting cost reports 434 and subsequently based on the most recently audited cost report 435 used during a rebasing year. The direct care subcomponent of the 436 per diem rate for any providers still being reimbursed on a cost 437 basis shall be limited by the cost-based class ceiling, and the 438 indirect care subcomponent may be limited by the lower of the 439 cost-based class ceiling, the target rate class ceiling, or the 440 individual provider target. The ceilings and targets apply only 441 to providers being reimbursed on a cost-based system. Effective 442 October 1, 2018, a prospective payment methodology shall be 443 implemented for rate setting purposes with the following 444 parameters: 445 a. Peer Groups, including: 446 (I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee 447 Counties; and 448 (II) South-SMMC Regions 10-11, plus Palm Beach and 449 Okeechobee Counties. 450 b. Percentage of Median Costs based on the cost reports 451 used for September 2016 rate setting: 452 (I) Direct Care Costs........................100 percent. 453 (II) Indirect Care Costs......................92 percent. 454 (III) Operating Costs.........................86 percent. 455 c. Floors: 456 (I) Direct Care Component.....................95 percent. 457 (II) Indirect Care Component................92.5 percent. 458 (III) Operating Component...........................None. 459 d. Pass-through Payments..................Real Estate and 460 ...............................................Personal Property 461 ...................................Taxes and Property Insurance. 462 e. Quality Incentive Program Payment 463 Pool......................................6 percent of September 464 .......................................2016 non-property related 465 ................................payments of included facilities. 466 f. Quality Score Threshold to Quality for Quality Incentive 467 Payment..................20th percentile of included facilities. 468 g. Fair Rental Value System Payment Parameters: 469 (I) Building Value per Square Foot based on 2018 RS Means. 470 (II) Land Valuation...10 percent of Gross Building value. 471 (III) Facility Square Footage......Actual Square Footage. 472 (IV) Moveable Equipment Allowance.........$8,000 per bed. 473 (V) Obsolescence Factor......................1.5 percent. 474 (VI) Fair Rental Rate of Return................8 percent. 475 (VII) Minimum Occupancy.......................90 percent. 476 (VIII) Maximum Facility Age.....................40 years. 477 (IX) Minimum Square Footage per Bed..................350. 478 (X) Maximum Square Footage for Bed...................500. 479 (XI) Minimum Cost of a renovation/replacements$500 per bed. 480 h. Ventilator Supplemental payment of $200 per Medicaid day 481 of 40,000 ventilator Medicaid days per fiscal year. 482 2. The direct care subcomponent shall include salaries and 483 benefits of direct care staff providing nursing services 484 including registered nurses, licensed practical nurses, and 485 certified nursing assistants who deliver care directly to 486 residents in the nursing home facility, allowable therapy costs, 487 and dietary costs. This excludes nursing administration, staff 488 development, the staffing coordinator, and the administrative 489 portion of the minimum data set and care plan coordinators. The 490 direct care subcomponent also includes medically necessary 491 dental care, vision care, hearing care, and podiatric care. 492 3. All other patient care costs shall be included in the 493 indirect care cost subcomponent of the patient care per diem 494 rate, including complex medical equipment, medical supplies, and 495 other allowable ancillary costs. Costs may not be allocated 496 directly or indirectly to the direct care subcomponent from a 497 home office or management company. 498 4. On July 1 of each year, the agency shall report to the 499 Legislature direct and indirect care costs, including average 500 direct and indirect care costs per resident per facility and 501 direct care and indirect care salaries and benefits per category 502 of staff member per facility. 503 5. Every fourth year, the agency shall rebase nursing home 504 prospective payment rates to reflect changes in cost based on 505 the most recently audited cost report for each participating 506 provider. 507 6. A direct care supplemental payment may be made to 508 providers whose direct care hours per patient day are above the 509 80th percentile and who provide Medicaid services to a larger 510 percentage of Medicaid patients than the state average. 511 7. For the period beginning on October 1, 2018, and ending 512 on September 30, 2021, the agency shall reimburse providers the 513 greater of their September 2016 cost-based rate or their 514 prospective payment rate. Effective October 1, 2021, the agency 515 shall reimburse providers the greater of 95 percent of their 516 cost-based rate or their rebased prospective payment rate, using 517 the most recently audited cost report for each facility. This 518 subparagraph shall expire September 30, 2023. 519 8. Pediatric, Florida Department of Veterans Affairs, and 520 government-owned facilities are exempt from the pricing model 521 established in this subsection and shall remain on a cost-based 522 prospective payment system. Effective October 1, 2018, the 523 agency shall set rates for all facilities remaining on a cost 524 based prospective payment system using each facility’s most 525 recently audited cost report, eliminating retroactive 526 settlements. 527 528 It is the intent of the Legislature that the reimbursement plan 529 achieve the goal of providing access to health care for nursing 530 home residents who require large amounts of care while 531 encouraging diversion services as an alternative to nursing home 532 care for residents who can be served within the community. The 533 agency shall base the establishment of any maximum rate of 534 payment, whether overall or component, on the available moneys 535 as provided for in the General Appropriations Act. The agency 536 may base the maximum rate of payment on the results of 537 scientifically valid analysis and conclusions derived from 538 objective statistical data pertinent to the particular maximum 539 rate of payment. The agency shall base the rates of payments in 540 accordance with the minimum wage requirements as provided in the 541 General Appropriations Act. 542 Section 8. Paragraph (a) of subsection (7) of section 543 20.435, Florida Statutes, is amended to read: 544 20.435 Department of Health; trust funds.—The following 545 trust funds shall be administered by the Department of Health: 546 (7) Biomedical Research Trust Fund. 547 (a) Funds to be credited to the trust fund shall consist of 548 funds appropriated by the Legislature. Funds shall be used for 549 the purposes of the James and Esther King Biomedical Research 550 Program, the Casey DeSantis Cancer ResearchFlorida Consortium551of National Cancer Institute CentersProgram, and the William G. 552 “Bill” Bankhead, Jr., and David Coley Cancer Research Program as 553 specified in ss. 215.5602, 288.955, 381.915, and 381.922. The 554 trust fund is exempt from the service charges imposed by s. 555 215.20. 556 Section 9. Paragraph (c) of subsection (2) of section 557 210.20, Florida Statutes, is amended to read: 558 210.20 Employees and assistants; distribution of funds.— 559 (2) As collections are received by the division from such 560 cigarette taxes, it shall pay the same into a trust fund in the 561 State Treasury designated “Cigarette Tax Collection Trust Fund” 562 which shall be paid and distributed as follows: 563 (c) Beginning July 1, 2017, and continuing through June 30, 564 2033, the division shall from month to month certify to the 565 Chief Financial Officer the amount derived from the cigarette 566 tax imposed by s. 210.02, less the service charges provided for 567 in s. 215.20 and less 0.9 percent of the amount derived from the 568 cigarette tax imposed by s. 210.02, which shall be deposited 569 into the Alcoholic Beverage and Tobacco Trust Fund, specifying 570 an amount equal to 1 percent of the net collections, not to 571 exceed $3 million annually, and that amount shall be deposited 572 into the Biomedical Research Trust Fund in the Department of 573 Health. These funds are appropriated annually from the 574 Biomedical Research Trust Fund for the advancement of cures for 575 cancers afflicting pediatric populations through basic or 576 applied research, including, but not limited to, clinical trials 577 and nontoxic drug discovery. These funds are not included in the 578 calculation for the distribution of funds pursuant to s. 579 381.915; however, these funds shall be distributed to cancer 580 centers participating in the Casey DeSantis Cancer Research 581Florida Consortium of National Cancer Institute CentersProgram 582 in the same proportion as is allocated to each cancer center in 583 accordance with s. 381.915 and are in addition to any funds 584 distributed pursuant to that section. 585 Section 10. Subsection (3) of section 409.816, Florida 586 Statutes, is amended to read: 587 409.816 Limitations on premiums and cost sharing.—The 588 following limitations on premiums and cost sharing are 589 established for the program. 590 (3) Enrollees in families with a family income above 150 591 percent of the federal poverty level who are not receiving 592 coverage under the Medicaid program or who are not eligible 593 under s. 409.814(7)s. 409.814(6)may be required to pay 594 enrollment fees, premiums, copayments, deductibles, coinsurance, 595 or similar charges on a sliding scale related to income, except 596 that the total annual aggregate cost sharing with respect to all 597 children in a family may not exceed 5 percent of the family’s 598 income. However, copayments, deductibles, coinsurance, or 599 similar charges may not be imposed for preventive services, 600 including well-baby and well-child care, age-appropriate 601 immunizations, and routine hearing and vision screenings. 602 Section 11. This act shall take effect July 1, 2022.