HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 1387 Adult Day Care Centers
SPONSOR(S): Select Committee on Health Innovation, Silvers and others
TIED BILLS: IDEN./SIM. BILLS: SB 412
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Select Committee on Health Innovation 11 Y, 0 N, As CS Guzzo Calamas
2) Health Care Appropriations Subcommittee
3) Health & Human Services Committee
SUMMARY ANALYSIS
An adult day care center is a venue providing services (such as therapeutic programs, social and health
activities and services, leisure activities, self-care training, rest, nutritional services, respite care, etc.) to three
or more adults. Participants may utilize a variety of services offered during any part of a day totaling less than
24 hours.
Medicaid is the health care safety net for low-income Floridians. The Medicaid program is a medical assistance
program funded jointly between the state and federal governments. AHCA administers the Florida Medicaid
program authorized under Title XIX of the federal Social Security Act and Ch. 409, F.S. With the federal LTC
services waiver, current law requires AHCA to make payments for long-term care, including home and
community-based services, using the managed care model. Medicaid LTC plans must cover adult day care
services.
Medicaid LTC plans are also required to cover medically necessary non-emergency transportation services for
Medicaid eligible recipients who have no other means of transportation to a Medicaid covered service.
Payment for transportation services is included as part of the negotiated per-member/per-month capitated
payment the plan receives from AHCA. Under current law, managed care plans may subcontract for
transportation services, but are not required to contract with any specific provider. Current law does not
expressly authorize specific providers to provide transportation services.
HB 1387 authorizes adult day care centers to provide transportation services, with parameters, and requires
managed care plans to reimburse adult day care centers that provide transportation services to Medicaid
recipients at rates negotiated between the adult day care center and the managed care plan.
The bill establishes continuing education requirements for operators of adult day care centers. Spec ifically, the
bill requires each operator to annually complete a 8-hour continuing education course developed and offered
by the Florida Adult Day Services Association and approved by the Department of Elder Affairs.
The bill has an indeterminate fiscal impact on the state Medicaid program and no fiscal impact on local
government.
The bill provides an effective date of July 1, 2024.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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DATE: 2/2/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Adult Day Care Centers
An adult day care center is a venue where the owner-operator provides basic services (e.g.,
therapeutic programs of social and health activities and services, leisure activities, self-care training,
rest, nutritional services, respite care, etc.) to three or more persons who are at least 18 years of age.
Participants may utilize a variety of services offered during any part of a day totaling less than 24
hours.1 The owner-operator may organize the adult day care center as a for-profit or non-profit entity.2
Licensure
The Florida Agency for Health Care Administration (AHCA) regulates adult day care centers to develop,
establish, and enforce basis standards to assure that therapeutic social and health activities and
services are provided to adults experiencing functional impairments in a noninstitutional environment. 3
To operate in Florida, an adult day care center must be licensed by AHCA according to the Health Care
Licensing Procedures Act4 (Act).5 The Act provides a streamlined and consistent set of basic licensing
requirements for health care providers.6 The Act provides minimum licensure requirements, with which
applicants and licensees must comply to obtain and maintain a license. 7 The licensure fee for adult day
care centers must not exceed $150, and county-operated or municipally operated centers are exempt
from the licensure fee.8
In addition to the Act, current law sets additional licensure requirements specific to adult day care
centers. When an applicant first applies for licensure, he or she must furnish a description of the
physical and mental capacities and needs of the participants to the served and the availability,
frequency, and intensity of basic services and of supportive and optional services to be provided and
proof of adequately liability insurance coverage.9 Current law requires separate licenses for adult day
care centers located on separate premises even if the centers operate under the same management. 10
An adult day care center may not claim to be licensed or designated to provide specialized Alzheimer’s
services unless AHCA designates the adult day care center’s license as a “specialized Alzheimer’s
services adult day care center”.11 To obtain and maintain this special Alzheimer’s designation, the
owner, operator, and staff must possess prerequisite experience and educational credentials, receive
the training and supervision, and complete Level II background checks. 12 Amongst other requirements,
a specialized Alzheimer’s services adult day care center must care for each Alzheimer participant
according to an individualized care plan that accounts for cognitive deficits and personal needs. 13 The
Department of Elderly Affairs may adopt rules specific to these designated centers. 14 Notwithstanding
the tightly regulated environment of specialized Alzheimer’s services adult day care centers, current
1 Ss. 429.901(1), (3), F.S
2
S. 429.901(1), F.S.
3 Ss. 429.90, 429.903 F.S.
4 Ch. 408, Part II, F.S.; see also s. 408.801(1), F.S. (providing a short title).
5 S. 429.907(1), F.S.
6 S. 408.801(2), F.S.
7 See generally s. 408.810, F.S.
8 S. 429.907(3)-(4), F.S.
9 S. 429.909, F.S.
10 S. 429.907(2), F.S.
11 Ss. 429.917(2), 429.918(3), F.S.
12 Ss. 429.918(5)-(6), 429.919, F.S.
13 S. 429.918(4), F.S.
14 S. 429.918(12), F.S.
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law allows adult day care centers to serve persons experiencing Alzheimer’s as part of the general
population of participants at a non-designated center.15
Current law exempts three classes of facilities from adult day care center licensure. First, any facility,
institution, or other place operated by the federal government is exempt. Second, any freestanding,
Florida-licensed inpatient hospice facility that provides day care services exclusively to hospice patients
is exempt.16 Third, licensed assisted living facilities, licensed hospitals, and licensed nursing homes
that provide adult day care services are generally exempt; however, if a facility from this class holds
itself out to the public as an adult day care center, they must be licensed by AHCA as an adult day care
center.17
Enforcement Action
AHCA may deny, revoke, or suspend the licensure of an adult day care center when the owner,
operator, or an employee does any of the following acts: 18
An intentional or negligent act materially affecting the health or safety of center participants.
A violation of the standards or administrative rules governing adult day care centers.
Failure to comply with statutory background screening standards.
Failure to follow statutory criteria and procedures relating to the transportation, voluntary
admission, and involuntary examination of center participants.
Multiple or repeated violations.
Current law makes AHCA responsible for all investigations and inspections of adult day care centers. 19
AHCA may impose an immediate moratorium or emergency suspension on an adult care day center
provider when AHCA determines that a condition at the center presents a threat to the health, safety, or
welfare of a participant.20
AHCA may also impose an administrative fine for licensure violations. 21 Before AHCA assesses a fine,
AHCA must make a reasonable attempt to discuss with ownership each violation and may request a
corrective action plan so that the owner can demonstrate a good faith effort to remedy violations by an
AHCA-set deadline. Current law classifies an owner’s failure to comply with a corrective action plan or
to meet the deadline as a separate violation for each day the failure continues. In determining whether
to assess a fine, AHCA must consider the gravity of the violation, the actions taken by the owner or
operator to correct violations, any previous violations, and the financial benefit to the center of
committing or continuing the violation. AHCA may assess a maximum fine of $500 per violation, not to
exceed $5,000 in the aggregate. 22
If violations occur during the course of a licensure renewal or a change in ownership, AHCA may issue
a six-month conditional license to accompany an approved corrective action plan. 23
15 S. 429.918(11), F.S.
16 S. 429.905(1), F.S.
17 S. 429.905(2), F.S. Even if a facility from this class is not licensed as an adult day care center, AHCA must monitor these facilities
through regular inspections to ensure adequate space and sufficient staff.
18 S. 429.911(1)-(2), F.S.
19 S. 429.911(3), F.S.
20 Ss. 429.911(1); 408.814, F.S.
21 S. 429.911(1), F.S.
22 S. 429.913(1), F.S.
23 S. 429.915, F.S.
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Continuing Education Requirements
Current law does not require operators of adult day care centers to complete general training, however,
operators are required to complete training on Alzheimer’s disease and related disorders (ADRD).
Adult day care centers are required to provide basic written information to new employees, upon
beginning employment, about interacting with individuals with ADRD. 24 Adult day care centers are
required to ensure that all employees complete one hour of initial ADRD training within 30 days of
beginning employment.25 Employees adult day care centers who provide direct care to individuals with
ADRD are required to complete three hours of additional ADRD training within seven months of
beginning employment.26
Employees in adult day care centers that provide special care for individuals with ADRD, who have
regular contact with residents are required to complete three hours of ADRD training within three
months of beginning employment, and each employee who provides personal care must complete four
hours of ADRD training within six months of beginning employment. 27 Thereafter each employee who
provides personal care must participate in at least four hours of continuing education annually.28
Florida Medicaid
Medicaid is the health care safety net for low-income Floridians. The Medicaid program is a medical
assistance program funded jointly between the state and federal governments. The program provides
health care coverage for over 4.8 million low-income families and individuals, the elderly, and
individuals with disabilities in Florida, including 3.4 million recipients who receive their services through
a managed care plan.29
AHCA administers the Florida Medicaid program authorized under Title XIX of the federal Social
Security Act and Ch. 409, F.S. The AHCA administers the program through the managed care model, 30
under contracts with managed care plans in the 11 regions across the state. The program operates
under two separate federal Medicaid waivers: Section 1115 waiver for primary and acute care services
called the Managed Medical Assistance (MMA) program and Long-Term Care (LTC) services waiver
under Sections 1915(b) and (c) of the Social Security Act. 31
Subject to specific appropriations, AHCA must reimburse Medicaid providers of home-based and
community-based services rendered according to a federally approved waiver based on an established
or negotiated rate for each service.32 With the federal LTC services waiver, current law requires AHCA
to make payments for long-term care, including home and community-based services, using the
managed care model.33 Payment rates to plans participating in the long-term care managed care
program must reflect historic utilization and spending for covered services projected forward and
adjusted to reflect the level of care profile for enrollees in each plan. AHCA must adjust payments to
incentivize the increased utilization of home and community-based services.34
24 Ss. 429.917(1), F.S., and 430.525(4)(a), F.S.
25 Ss. 429.917(1), F.S., and 430.525(4)(b), F.S.
26
Ss. 429.917(1), F.S., and 430.525(4)(d), F.S.
27 Ss. 429.917(1), F.S., and 430.525(4)(e), F.S.
28 Id.
29 Agency for Health Care Administration, Comprehensive Medicaid Managed Care Enrollment Reports (December 31, 2023) available
at https://ahca.myflorida.com/medicaid/medicaid-finance-and-analytics/medicaid-data-analytics/medicaid-monthly-enrollment-report
(last visited January 31, 2024).
30 The vast majority of Medicaid enrollees receive services through the managed care model; those with limited benefits (such as the
family planning program) are not, and some populations (such as enrollees in the home and community-based waiver for persons with
developmental disabilities) may choose managed care or the fee -for-services model. S. 409.965, F.S.
31 S. 409.964, F.S.
32 S. 409.908(8), F.S.
33 S. 409.978(2), F.S.
34 S. 409.983(3), F.S.
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Medicaid LTC plans must cover adult day care services.35
Transportation Services
Long-term care plans are also required to cover both emergency and non-emergency transportation
services.36 Medicaid covers medically necessary non-emergency transportation services for Medicaid
eligible recipients who have no other means of transportation to a Medicaid covered service. 37 Payment
for transportation services is included as part of the negotiated per-member/per-month capitated
payment the plan receives from AHCA. Under current law, managed care plans may subcontract for
transportation services, but are not required to contract with any specific provider. Current law does not
expressly authorize specific providers to provide transportation services.
Effect of the Bill
Medicaid Transportation Services
HB 1387 authorizes adult day care centers to provide transportation services in the Medicaid managed
care program, with parameters. Adult day care centers may only provide transportation services to
enrollees receiving services at the adult day care center. Such transportation services are limited to
transporting clients of an adult day care facility to and from the adult day care center. The bill requires
managed care plans to reimburse adult day care centers that provide transportation services to
Medicaid recipients at rates negotiated between the adult day care center and the managed care plan.
Adult Day Care Center Licensure
The bill also establishes continuing education requirements for operators of adult day care c enters.
Specifically, the bill requires each operator to annually complete a 8-hour continuing education course
developed and offered by the Florida Adult Day Services Association and approved by the Department
of Elder Affairs (DOEA), or any other educational provider approved by DOEA.
The course must include training in the following subject areas:
One hour on compliance with the Agency for Health Care Administration;
One hour on Alzheimer's disease and related disorders;
One hour on the state comprehensive emergency management plan;
One hour on anti-fraud, abuse, and neglect;
One hour on nonemergency medical transportation;
One hour on daily management;
One hour on staff compliance with participant care standards; and
One hour on the Health Insurance Portability and Accountability Act.
The continuing education course may be offered in person or online. Upon completion of the online
course, an operator must pass a department-approved online examination with a minimum score of 80
percent. An operator attending an in-person course is exempt from the examination requirement. A
person who teaches an approved course of instruction, or lectures at any approved course, and who
attends the entire course shall qualify for the same number of classroom hours as a person who takes
and successfully completes such course. Credit is limited to the number of hours actually taught or
lectured unless the person attends the entire course.