Bill Text: FL S7056 | 2016 | Regular Session | Comm Sub
Bill Title: Long-term Care Managed Care Prioritization
Spectrum: Committee Bill
Status: (Introduced - Dead) 2016-03-08 - Laid on Table, companion bill(s) passed, see CS/HB 1335 (Ch. 2016-147) [S7056 Detail]
Download: Florida-2016-S7056-Comm_Sub.html
Florida Senate - 2016 CS for SB 7056 By the Committees on Appropriations; and Health Policy 576-04801-16 20167056c1 1 A bill to be entitled 2 An act relating to long-term care managed care 3 prioritization; amending s. 409.962, F.S.; defining 4 terms; amending s. 409.979, F.S.; requiring the 5 Department of Elderly Affairs to maintain a statewide 6 wait list for enrollment for home and community-based 7 services through the Medicaid long-term care managed 8 care program; requiring the department to prioritize 9 individuals for potential enrollment using a frailty 10 based screening tool that provides a priority score; 11 providing for determinations regarding offers of 12 enrollment; requiring screening and certain 13 rescreening by Aging Resource Center personnel of 14 individuals requesting long-term care services from 15 the program; requiring the department to adopt by rule 16 a screening tool; requiring the department to make a 17 specified methodology available on its website; 18 requiring the department to notify applicants if they 19 are placed on the wait list; requiring the department 20 to conduct prerelease assessments upon notification by 21 the agency of available capacity; authorizing certain 22 individuals to enroll in the long-term care managed 23 care program; authorizing the department to terminate 24 an individual from the wait list under certain 25 circumstances; providing for priority enrollment for 26 home and community-based services; authorizing the 27 department and the Agency for Health Care 28 Administration to adopt rules; deleting obsolete 29 language; providing an effective date. 30 31 Be It Enacted by the Legislature of the State of Florida: 32 33 Section 1. Present subsections (4) through (13) of section 34 409.962, Florida Statutes, are redesignated as subsections (5) 35 through (14), respectively, present subsection (14) of that 36 section is redesignated as subsection (18), and new subsection 37 (4) and subsections (15), (16), and (17) are added to that 38 section, to read: 39 409.962 Definitions.—As used in this part, except as 40 otherwise specifically provided, the term: 41 (4) “Authorized representative” means an individual who has 42 the legal authority to make decisions on behalf of a Medicaid 43 recipient or potential Medicaid recipient in matters related to 44 the managed care plan or the screening or eligibility process. 45 (15) “Rescreening” means the use of a screening tool to 46 conduct annual screenings or screenings due to a significant 47 change which determine an individual’s placement and 48 continuation on the wait list. 49 (16) “Screening” means the use of an information-collection 50 tool to determine a priority score for placement on the wait 51 list. 52 (17) “Significant change” means change in an individual’s 53 health status after an accident or illness; an actual or 54 anticipated change in the individual’s living situation; a 55 change in the caregiver relationship; loss of or damage to the 56 individual’s home or deterioration of his or her home 57 environment; or loss of the individual’s spouse or caregiver. 58 Section 2. Section 409.979, Florida Statutes, is amended to 59 read: 60 409.979 Eligibility.— 61 (1) PREREQUISITE CRITERIA FOR ELIGIBILITY.—Medicaid 62 recipients who meet all of the following criteria are eligible 63 to receive long-term care services and must receive long-term 64 care services by participating in the long-term care managed 65 care program. The recipient must be: 66 (a) Sixty-five years of age or older, or age 18 or older 67 and eligible for Medicaid by reason of a disability. 68 (b) Determined by the Comprehensive Assessment Review and 69 Evaluation for Long-Term Care Services (CARES) preadmission 70 screening program to require nursing facility care as defined in 71 s. 409.985(3). 72 (2) ENROLLMENT OFFERS.—Medicaid recipients who, on the date73long-term care managed care plans become available in their74region, reside in a nursing home facility or are enrolled in one75of the following long-term care Medicaid waiver programs are76eligible to participate in the long-term care managed care77program for up to 12 months without being reevaluated for their78need for nursing facility care as defined in s. 409.985(3):79(a) The Assisted Living for the Frail Elderly Waiver.80(b) The Aged and Disabled Adult Waiver.81(c) The Consumer-Directed Care Plus Program as described in82s. 409.221.83(d) The Program of All-inclusive Care for the Elderly.84(e) The Channeling Services Waiver for Frail Elders.85(3)Subject to availability of funds, the Department of 86 Elderly Affairs shall make offers for enrollment to eligible 87 individuals based on a wait-list prioritizationand subject to88availability of funds. Before making enrollment offers, the 89 agency and the Department of Elderly Affairsdepartmentshall 90 determine that sufficient funds exist to support additional 91 enrollment into plans. 92 (3) WAIT LIST, RELEASE, AND OFFER PROCESS.—The Department 93 of Elderly Affairs shall maintain a statewide wait list for 94 enrollment for home and community-based services through the 95 long-term care managed care program. 96 (a) The Department of Elderly Affairs shall prioritize 97 individuals for potential enrollment for home and community 98 based services through the long-term care managed care program 99 using a frailty-based screening tool that results in a priority 100 score. The priority score is used to set an order for releasing 101 individuals from the wait list for potential enrollment in the 102 long-term care managed care program. If capacity is limited for 103 individuals with identical priority scores, the individual with 104 the oldest date of placement on the wait list shall receive 105 priority for release. 106 1. Pursuant to s. 430.2053, Aging Resource Center personnel 107 certified by the Department of Elderly Affairs shall perform the 108 screening for each individual requesting enrollment for home and 109 community-based services through the long-term care managed care 110 program. The Department of Elderly Affairs shall request that 111 the individual or the individual’s authorized representative 112 provide alternate names and their contact information. 113 2. The individual requesting the long-term care services, 114 or the individual’s authorized representative, must participate 115 in an initial screening or rescreening for placement on the wait 116 list. The screening or rescreening must be completed in its 117 entirety before placement on the wait list. 118 3. Pursuant to s. 430.2053, Aging Resource Center personnel 119 shall administer rescreening annually or upon notification of a 120 significant change in an individual’s circumstances. 121 4. The Department of Elderly Affairs shall adopt by rule a 122 screening tool that generates the priority score, and shall make 123 publicly available on its website the specific methodology used 124 to calculate an individual’s priority score. 125 (b) Upon completion of the screening or rescreening 126 process, the Department of Elderly Affairs shall notify the 127 individual or the individual’s authorized representative that 128 the individual has been placed on the wait list. 129 (c) If the Department of Elderly Affairs is unable to 130 contact the individual or the individual’s authorized 131 representative to schedule an initial screening or rescreening, 132 and documents the action steps to do so, it shall send a letter 133 to the last documented address of the individual or the 134 individual’s authorized representative. The letter must advise 135 the individual or his or her authorized representative that he 136 or she must contact the Department of Elderly Affairs within 30 137 calendar days after the date of the notice to schedule a 138 screening or rescreening and must notify the individual that 139 failure to complete the screening or rescreening will result in 140 his or her termination from the screening process and the wait 141 list. 142 (d) After notification by the agency of available capacity, 143 the CARES program shall conduct a prerelease assessment. The 144 Department of Elderly Affairs shall release individuals from the 145 wait list based on the priority scoring process and prerelease 146 assessment results. Upon release, individuals who meet all 147 eligibility criteria may enroll in the long-term care managed 148 care program. 149 (e) The Department of Elderly Affairs may terminate an 150 individual’s inclusion on the wait list if the individual: 151 1. Does not have a current priority score due to the 152 individual’s action or inaction; 153 2. Requests to be removed from the wait list; 154 3. Does not keep an appointment to complete the rescreening 155 without scheduling another appointment and has not responded to 156 three documented contact attempts by the Department of Elderly 157 Affairs; 158 4. Receives an offer to begin the eligibility determination 159 process for the long-term care managed care program; or 160 5. Begins receiving services through the long-term care 161 managed care program. 162 163 An individual whose inclusion on the wait list is terminated 164 must initiate a new request for placement on the wait list, and 165 any previous priority considerations must be disregarded. 166 (f) Notwithstanding this subsection, the following 167 individuals are afforded priority enrollment for home and 168 community-based services through the long-term care managed care 169 program and do not have to complete the screening or wait-list 170 process if all other long-term care managed care program 171 eligibility requirements are met: 172 1. Individuals who are 18, 19, or 20 years of age who have 173 chronic debilitating diseases or conditions of one or more 174 physiological or organ systems which generally make the 175 individual dependent upon 24-hour-per-day medical, nursing, or 176 health supervision or intervention. 177 2. Nursing facility residents requesting to transition into 178 the community who have resided in a Florida-licensed skilled 179 nursing facility for at least 60 consecutive days. 180 3. Individuals referred by the department’s adult 181 protective services program as high risk and placed in an 182 assisted living facility temporarily funded by the department. 183 (g) The Department of Elderly Affairs and the agency may 184 adopt rules to implement this subsection. 185 Section 3. This act shall take effect July 1, 2016.