Senate Bill 2526 (2022) — Filed
SB 2526
Florida Bills
Florida Senate - 2022 SB 2526 By the Committee on Appropriations 576-02897-22 20222526__ Page 1 of 12 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1
An act relating to health; amending s. 210.201, F.S.; 2 providing an appropriation to the Board of Directors 3 of the H.
Lee Moffitt Cancer Center and Research 4 Institute for a specified purpose; authorizing such 5 appropriation to be used to secure certain financing; 6 providing construction; amending s. 381.02035, F.S.; 7 authorizing pharmacists and wholesalers employed by or 8 under contract with forensic facilities managed by the 9 Agency for Persons with Disabilities to import 10 prescription drugs under the Canadian Prescription 11 Drug Importation Program for dispensing to clients in 12 such facilities; amending s. 394.9082, F.S.; requiring 13 that the Department of Children and Families’ 14 contracts with managing entities be made available on 15 the department’s website; requiring the department to 16 conduct a specified review of managing entities every 17 2 years; requiring the department to submit the review 18 to the Governor and the Legislature by a specified 19 date; requiring managing entities to provide notice to 20 providers before removing the provider from the 21 provider network; amending s. 408.062, F.S.; deleting 22 a requirement that the Agency for Health Care 23 Administration collect and publish on its website 24 certain data related to the retail prices of specified 25 prescribed medicines; amending s. 409.908, F.S.; 26 requiring the agency to base its rate of payments for 27 nursing home care in its Title XIX Long-Term Care 28 Reimbursement Plan in accordance with specified 29
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 2 of 12 CODING: Words stricken are deletions; words underlined are additions. minimum wage requirements; providing an effective 30 date. 31 32 Be It Enacted by the Legislature of the State of Florida: 33 34
Section
Section 210.201, Florida Statutes, is amended to 35 read: 36 210.201 H. Lee Moffitt Cancer Center and Research Institute 37 facilities; establishment; funding.— 38
(1) The Board of Directors of the H. Lee Moffitt Cancer 39 Center and Research Institute shall construct, furnish, and 40 equip, and shall covenant to complete, the cancer research and 41 clinical and related facilities of the H. Lee Moffitt Cancer 42 Center and Research Institute funded with proceeds from the 43 Cigarette Tax Collection Trust Fund pursuant to s. 210.20. 44 Moneys transferred to the Board of Directors of the H.
Lee 45 Moffitt Cancer Center and Research Institute pursuant to s. 46 210.20 may be used to secure financing to pay costs related to 47 constructing, furnishing, equipping, operating, and maintaining 48 cancer research and clinical and related facilities; furnishing, 49 equipping, operating, and maintaining other lea sed or owned 50 properties; and paying costs incurred in connection with 51 purchasing, financing, operating, and maintaining such 52 equipment, facilities, and properties as provided in s. 210.20. 53 Such financing may include the issuance of tax-exempt bonds or 54 other forms of indebtedness by a local authority, municipality, 55 or county pursuant to parts II and III of
chapter 159. Such 56 bonds shall not constitute state bonds for purposes of s. 11, 57 Art. VII of the State Constitution, but shall constitute bonds 58
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 3 of 12 CODING: Words stricken are deletions; words underlined are additions. of a “local agency,” as defined in s. 159.27(4). The cigarette 59 tax dollars pledged to facilities pursuant to s. 210.20 may be 60 replaced annually by the Legislature from tobacco litigation 61 settlement proceeds. 62
(2) Beginning in the 2022-2023 fiscal year, and annually 63 through the 2052-2053 fiscal year, the sum of $20 million is 64 appropriated and shall be transferred to the Board of Directors 65 of the H. Lee Moffitt Cancer Center and Research Institute for 66 construction and development of Moffitt’s Pasco County life 67 sciences park. Moneys transferred to the Board of Directors of 68 the H. Lee Moffitt Cancer Center and Research Institute pursuant 69 to this subsection may be used to secure financing to pay costs 70 related to the construction and development of Moffitt’s Pasco 71 County life sciences park.
Such financing may include the 72 issuance of tax-exempt bonds or other forms of indebtedness by a 73 local authority, municipality, or county pursuant to parts II 74 and III of
chapter 159. Such bonds shall not constitute state 75 bonds for purposes of s. 11, Art. VII of the State Constitution, 76 but shall constitute bonds of a local agency as defined in s. 77 159.27(4). 78
Section 2. Paragraph (
f) is added to subsection (7) of 79
section 381.02035, Florida Statutes, to read: 80 381.02035 Canadian Prescription Drug Importation Program.— 81
(7) ELIGIBLE IMPORTERS.—The following entities may import 82 prescription drugs from an eligible Canadian supplier under the 83 program: 84 (
f) A pharmacist or wholesaler employed by or under 85 contract with a forensic facility, as defined in s. 916.106, 86 that is managed by the Agency for Persons with Disabilities, for 87
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 4 of 12 CODING: Words stricken are deletions; words underlined are additions. dispensing to clients treated in such facility. 88
Section 3. Paragraph (
i) of subsection (5) of
section 89 394.9082, Florida Statutes, is amended, and paragraphs (
k) and 90 (
l) are added to subsection (4) of that section, to read: 91 394.9082 Behavioral health managing entities.— 92
(4) CONTRACT WITH MANAGING ENTITIES.— 93 (
k) The department’s contracts with managing entities must 94 be made available in a publicly accessible format on the 95 department’s website. 96 (
l) Every 2 years, the department shall conduct a 97 comprehensive, multiyear review of the revenues, expenditures, 98 and financial positions of managing entities covering the most 99 recent 2 consecutive fiscal years. The review must include a 100 comprehensive system-of-care analysis. The department shall 101 submit the review to the Governor, the President of the Senate, 102 and the Speaker of the House of Representatives by November 1 of 103 every other year, beginning in 2023. 104
(5) MANAGING ENTITY DUTIES.—A managing entity shall: 105 (
i) Develop a comprehensive provider network of qualified 106 providers to deliver behavioral health services. The managing 107 entity is not required to competitively procure network 108 providers but shall publicize opportunities to join the p rovider 109 network and evaluate providers in the network to determine if 110 they may remain in the network. A managing entity must provide 111 notice to a provider before the provider is removed from the 112 network. The managing entity shall publish these processes on 113 its website. The managing entity shall ensure continuity of care 114 for clients if a provider ceases to provide a service or leaves 115 the network. 116
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 5 of 12 CODING: Words stricken are deletions; words underlined are additions.
Section 4. Paragraph (
h) of subsection (1) of
section 117 408.062, Florida Statutes, is amended to read: 118 408.062 Research, analyses, studies, and reports.— 119
(1) The agency shall conduct research, analyses, and 120 studies relating to health care costs and access to and quality 121 of health care services as access and quality are affected by 122 changes in health care costs. Such research, analyses, and 123 studies shall include, but not be limited to: 124 (
h) The collection of a statistically valid sample of data 125 on the retail prices charged by pharmacies for the 300 most 126 frequently prescribed medicines from any pharmacy licensed by 127 this state. If the drug is available generically, price data 128 shall be reported for the generic drug and price data of a 129 brand-named drug for which the generic drug is the equivalent 130 shall be reported. The agency shall make available on its 131 Internet website for each pharmacy drug prices for a 30-day 132 supply at a standard dose. The data collected shall be reported 133 for each drug by pharmacy and by metropolitan statistical area 134 or region and updated monthly. 135
Section 5. Subsection (2) of
section 409.908, Florida 136 Statutes, is amended to read: 137 409.908 Reimbursement of Medicaid providers.—Subject to 138 specific appropriations, the agency shall reimburse Medicaid 139 providers, in accordance with state and federal law, according 140 to methodologies set forth in the rules of the agen cy and in 141 policy manuals and handbooks incorporated by reference therein. 142 These methodologies may include fee schedules, reimbursement 143 methods based on cost reporting, negotiated fees, competitive 144 bidding pursuant to s. 287.057, and other mechanisms the ag ency 145
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 6 of 12 CODING: Words stricken are deletions; words underlined are additions. considers efficient and effective for purchasing services or 146 goods on behalf of recipients. If a provider is reimbursed based 147 on cost reporting and submits a cost report late and that cost 148 report would have been used to set a lower reimbursement rate 149 for a rate semester, then the provider’s rate for that semester 150 shall be retroactively calculated using the new cost report, and 151 full payment at the recalculated rate shall be effected 152 retroactively.
Medicare-granted extensions for filing cost 153 reports, if applicable, shall also apply to Medicaid cost 154 reports. Payment for Medicaid compensable services made on 155 behalf of Medicaid-eligible persons is subject to the 156 availability of moneys and any limitations or directions 157 provided for in the General Appropriations Act or
chapter 216. 158 Further, nothing in this
section shall be construed to prevent 159 or limit the agency from adjusting fees, reimbursement rates, 160 lengths of stay, number of visits, or number of services, or 161 making any other adjustments necessary to compl y with the 162 availability of moneys and any limitations or directions 163 provided for in the General Appropriations Act, provided the 164 adjustment is consistent with legislative intent. 165 (2)(a)1. Reimbursement to nursing homes licensed under
part 166 II of
chapter 400 and state-owned-and-operated intermediate care 167 facilities for the developmentally disabled licensed under
part 168 VIII of
chapter 400 must be made prospectively. 169 2. Unless otherwise limited or directed in the General 170 Appropriations Act, reimbursement to hospitals licensed under 171
part I of
chapter 395 for the provision of swing -bed nursing 172 home services must be made on the basis of the average statewide 173 nursing home payment, and reimbursement to a hospital licensed 174
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 7 of 12 CODING: Words stricken are deletions; words underlined are additions. under
part I of
chapter 395 for the provision of skilled nursing 175 services must be made on the basis of the average nursing home 176 payment for those services in the county in which the hospital 177 is located.
When a hospital is located in a county that does not 178 have any community nursing homes, reimbursement shall be 179 determined by averaging the nursing home payments in counties 180 that surround the county in which the hospital is located. 181 Reimbursement to hospitals, including Medicaid payment of 182 Medicare copayments, for skilled nursing services shall be 183 limited to 30 days, unless a prior authorization has been 184 obtained from the agency.
Medicaid reimbursement may be extended 185 by the agency beyond 30 days, and approval must be based upon 186 verification by the patient’s physician that the patient 187 requires short-term rehabilitative and recuperative services 188 only, in which case an extension of no more than 15 days may be 189 approved. Reimbursement to a hospital licensed under
part I of 190
chapter 395 for the temporary provision of skilled nursing 191 services to nursing home residents who have been displaced as 192 the result of a natural disaster or other emergency may not 193 exceed the average county nursing home payment for those 194 services in the county in which the hospital is located and is 195 limited to the period of time which the agency considers 196 necessary for continued placement of the nursing home residents 197 in the hospital. 198 (
b) Subject to any limitations or directions in the General 199 Appropriations Act, the agency shall establish and implement a 200 state Title XIX Long-Term Care Reimbursement Plan for nursing 201 home care in order to provide care and services in conformance 202 with the applicable state and federal laws, rules, regulations, 203
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 8 of 12 CODING: Words stricken are deletions; words underlined are additions. and quality and safety standards and to ensure that individuals 204 eligible for medical assistance have reasonable geographic 205 access to such care. 206 1. The agency shall amend the long-term care reimbursement 207 plan and cost reporting system to create direct care and 208 indirect care subcomponents of the patient care component of the 209 per diem rate. These two subcomponents together shall equal the 210 patient care component of the per diem rate.
Separate prices 211 shall be calculated for each patient care subcomponent, 212 initially based on the September 2016 rate setting cost reports 213 and subsequently based on the most recently audi ted cost report 214 used during a rebasing year. The direct care subcomponent of the 215 per diem rate for any providers still being reimbursed on a cost 216 basis shall be limited by the cost-based class ceiling, and the 217 indirect care subcomponent may be limited by the lower of the 218 cost-based class ceiling, the target rate class ceiling, or the 219 individual provider target.
The ceilings and targets apply only 220 to providers being reimbursed on a cost-based system. Effective 221 October 1, 2018, a prospective payment methodolo gy shall be 222 implemented for rate setting purposes with the following 223 parameters: 224 a. Peer Groups, including: 225 (
I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee 226 Counties; and 227 (II) South-SMMC Regions 10-11, plus Palm Beach and 228 Okeechobee Counties. 229 b. Percentage of Median Costs based on the cost reports 230 used for September 2016 rate setting: 231 (
I) Direct Care Costs...........................100 percent. 232
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 9 of 12 CODING: Words stricken are deletions; words underlined are additions. (II) Indirect Care Costs.........................92 percent. 233 (III) Operating Costs............................86 percent. 234 c. Floors: 235 (
I) Direct Care Component........................95 percent. 236 (II) Indirect Care Component...................92.5 percent. 237 (III) Operating Component..............................None. 238 d. Pass-through Payments.....................Real Estate and 239 ................................................Personal Property 240 ....................................Taxes and Property Insurance. 241 e.
Quality Incentive Program Payment 242 Pool.......................................6 percent of September 243 ........................................2016 non-property related 244 .................................payments of included facilities. 245 f. Quality Score Threshold to Quality for Quality Incentive 246 Payment...................20th percentile of included facilities. 247 g. Fair Rental Value System Payment Parameters: 248 (
I) Building Value per Square Foot based on 2018 RS Means. 249 (II) Land Valuation......10 percent of Gross Building value. 250 (III) Facility Square Footage.........Actual Square Footage. 251 (IV) Moveable Equipment Allowance............$8,000 per bed. 252 (
V) Obsolescence Factor.........................1.5 percent. 253 (VI) Fair Rental Rate of Return...................8 percent. 254 (VII) Minimum Occupancy..........................90 percent. 255 (VIII) Maximum Facility Age........................40 years. 256 (IX) Minimum Square Footage per Bed.....................350. 257 (
X) Maximum Square Footage for Bed......................500. 258 (XI) Minimum Cost of a renovation/replacements.$500 per bed. 259 h. Ventilator Supplemental payment of $200 per Medicaid day 260 of 40,000 ventilator Medicaid days per fiscal year. 261
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 10 of 12 CODING: Words stricken are deletions; words underlined are additions. 2. The direct care subcomponent shall include salaries and 262 benefits of direct care staff providing nursing services 263 including registered nurses, licensed practical nurses, and 264 certified nursing assistants who deliver care directly to 265 residents in the nursing home facility, allowable therapy costs, 266 and dietary costs.
This excludes nursing administration, staff 267 development, the staffing coordinator, and the administrative 268 portion of the minimum data set and care plan coordinators. The 269 direct care subcomponent also includes medically necessary 270 dental care, vision care, hearing care, and podiatric care. 271 3. All other patient care costs shall be included in the 272 indirect care cost subcomponent of the patient care per die m 273 rate, including complex medical equipment, medical supplies, and 274 other allowable ancillary costs.
Costs may not be allocated 275 directly or indirectly to the direct care subcomponent from a 276 home office or management company. 277 4. On July 1 of each year, the agency shall report to the 278 Legislature direct and indirect care costs, including average 279 direct and indirect care costs per resident per facility and 280 direct care and indirect care salaries and benefits per category 281 of staff member per facility. 282 5.
Every fourth year, the agency shall rebase nursing home 283 prospective payment rates to reflect changes in cost based on 284 the most recently audited cost report for each participating 285 provider. 286 6. A direct care supplemental payment may be made to 287 providers whose direct care hours per patient day are above the 288 80th percentile and who provide Medicaid services to a larger 289 percentage of Medicaid patients than the state average. 290
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 11 of 12 CODING: Words stricken are deletions; words underlined are additions. 7. For the period beginning on October 1, 2018, and ending 291 on September 30, 2021, the agency shall reimburse providers the 292 greater of their September 2016 cost-based rate or their 293 prospective payment rate. Effective October 1, 2021, the agency 294 shall reimburse providers the greater of 95 percent of their 295 cost-based rate or their rebased prospective payment rate, using 296 the most recently audited cost report for each facility.
This 297 subparagraph shall expire September 30, 2023. 298 8. Pediatric, Florida Department of Veterans Affairs, and 299 government-owned facilities are exempt from the pricing model 300 established in this subsection and shall remain on a cost-based 301 prospective payment system.
Effective October 1, 2018, the 302 agency shall set rates for all facilities remaining on a cost -303 based prospective payment system using each facility’s most 304 recently audited cost report, eliminating retroactive 305 settlements. 306 307 It is the intent of the Legislature that the reimbursement plan 308 achieve the goal of providing access to health care for nursing 309 home residents who require large amounts of care while 310 encouraging diversion services as an alternative to nursing home 311 care for residents who can be served within the community.
The 312 agency shall base the establishment of any maximum rate of 313 payment, whether overall or component, on the available moneys 314 as provided for in the General Appropriations Act. The agency 315 may base the maximum rate of payment on the results of 316 scientifically valid analysis and conclusions derived from 317 objective statistical data pertinent to the particular maximum 318 rate of payment. The agency shall base the rates of payments in 319
Florida Senate - 2022 SB 2526 576-02897-22 20222526__ Page 12 of 12 CODING: Words stricken are deletions; words underlined are additions. accordance with the minimum wage requirements as provided in the 320 General Appropriations Act. 321