F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 5201 2021
1 A bill to be entitled
2 An act relating to health care; amending s. 296.37,
3 F.S.; revising the threshold dollar amount relating to
4 a requirement that a resident of a certain health care
5 facility contribute to his or her maintenance and
6 support; reenacting s. 400.179, F.S., relating to
7 specified fees collected by the Agency for Health Care
8 Administration from certain nursing homes to maintain
9 the lease bond alternative; amending s. 408.061, F.S.;
10 requiring nursing homes and their home offices to
11 annually submit to the agency audited financial data
12 and certain other information within a specified
13 timeframe using a certain uniform system of financial
14 reporting; amending s. 408.07, F.S.; providing
15 definitions; amending s. 409.903, F.S.; extending the
16 postpartum Medicaid eligibility period for pregnant
17 women; amending s. 409.904, F.S.; revising a date
18 relating to a requirement that the agency make
19 payments for Medicaid-covered services retroactive for
20 a specified period for certain eligible persons;
21 abrogating the future expiration of certain
22 provisions; reenacting s. 409.908, F.S., relating to
23 the agency's implementation of a state Title XIX Long-
24 Term Care Reimbursement Plan for nursing home care,
25 the reimbursement of Medicaid providers, and Low
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26 Income Pool Program payments; amending s. 409.975,
27 F.S.; conforming a cross-reference; reenacting s.
28 624.91, F.S., relating to a requirement that the
29 Florida Healthy Kids Corporation validate the medical
30 loss ratio and calculate a refund amount for insurers
31 and providers of health care services who meet certain
32 criteria; amending s. 1011.52, F.S.; conforming a
33 cross-reference; providing an effective date.
34
35 Be It Enacted by the Legislature of the State of Florida:
36
37 Section 1. Subsection (1) of section 296.37, Florida
38 Statutes, is amended to read:
39 296.37 Residents; contribution to support.—
40 (1) Every resident of the home who receives a pension,
41 compensation, or gratuity from the United States Government, or
42 income from any other source of more than $130 $105 per month,
43 shall contribute to his or her maintenance and support while a
44 resident of the home in accordance with a schedule of payment
45 determined by the administrator and approved by the director.
46 The total amount of such contributions shall be to the fullest
47 extent possible but shall not exceed the actual cost of
48 operating and maintaining the home.
49 Section 2. Notwithstanding the expiration date in section
50 51 of chapter 2020-114, Laws of Florida, paragraph (d) of
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51 subsection (2) of section 400.179, Florida Statutes, is
52 reenacted to read:
53 400.179 Liability for Medicaid underpayments and
54 overpayments.—
55 (2) Because any transfer of a nursing facility may expose
56 the fact that Medicaid may have underpaid or overpaid the
57 transferor, and because in most instances, any such underpayment
58 or overpayment can only be determined following a formal field
59 audit, the liabilities for any such underpayments or
60 overpayments shall be as follows:
61 (d) Where the transfer involves a facility that has been
62 leased by the transferor:
63 1. The transferee shall, as a condition to being issued a
64 license by the agency, acquire, maintain, and provide proof to
65 the agency of a bond with a term of 30 months, renewable
66 annually, in an amount not less than the total of 3 months'
67 Medicaid payments to the facility computed on the basis of the
68 preceding 12-month average Medicaid payments to the facility.
69 2. A leasehold licensee may meet the requirements of
70 subparagraph 1. by payment of a nonrefundable fee, paid at
71 initial licensure, paid at the time of any subsequent change of
72 ownership, and paid annually thereafter, in the amount of 1
73 percent of the total of 3 months' Medicaid payments to the
74 facility computed on the basis of the preceding 12-month average
75 Medicaid payments to the facility. If a preceding 12-month
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76 average is not available, projected Medicaid payments may be
77 used. The fee shall be deposited into the Grants and Donations
78 Trust Fund and shall be accounted for separately as a Medicaid
79 nursing home overpayment account. These fees shall be used at
80 the sole discretion of the agency to repay nursing home Medicaid
81 overpayments or for enhanced payments to nursing facilities as
82 specified in the General Appropriations Act or other law.
83 Payment of this fee shall not release the licensee from any
84 liability for any Medicaid overpayments, nor shall payment bar
85 the agency from seeking to recoup overpayments from the licensee
86 and any other liable party. As a condition of exercising this
87 lease bond alternative, licensees paying this fee must maintain
88 an existing lease bond through the end of the 30-month term
89 period of that bond. The agency is herein granted specific
90 authority to promulgate all rules pertaining to the
91 administration and management of this account, including
92 withdrawals from the account, subject to federal review and
93 approval. This provision shall take effect upon becoming law and
94 shall apply to any leasehold license application. The financial
95 viability of the Medicaid nursing home overpayment account shall
96 be determined by the agency through annual review of the account
97 balance and the amount of total outstanding, unpaid Medicaid
98 overpayments owing from leasehold licensees to the agency as
99 determined by final agency audits. By March 31 of each year, the
100 agency shall assess the cumulative fees collected under this
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101 subparagraph, minus any amounts used to repay nursing home
102 Medicaid overpayments and amounts transferred to contribute to
103 the General Revenue Fund pursuant to s. 215.20. If the net
104 cumulative collections, minus amounts utilized to repay nursing
105 home Medicaid overpayments, exceed $10 million, the provisions
106 of this subparagraph shall not apply for the subsequent fiscal
107 year.
108 3. The leasehold licensee may meet the bond requirement
109 through other arrangements acceptable to the agency. The agency
110 is herein granted specific authority to promulgate rules
111 pertaining to lease bond arrangements.
112 4. All existing nursing facility licensees, operating the
113 facility as a leasehold, shall acquire, maintain, and provide
114 proof to the agency of the 30-month bond required in
115 subparagraph 1., above, on and after July 1, 1993, for each
116 license renewal.
117 5. It shall be the responsibility of all nursing facility
118 operators, operating the facility as a leasehold, to renew the
119 30-month bond and to provide proof of such renewal to the agency
120 annually.
121 6. Any failure of the nursing facility operator to
122 acquire, maintain, renew annually, or provide proof to the
123 agency shall be grounds for the agency to deny, revoke, and
124 suspend the facility license to operate such facility and to
125 take any further action, including, but not limited to,
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126 enjoining the facility, asserting a moratorium pursuant to part
127 II of chapter 408, or applying for a receiver, deemed necessary
128 to ensure compliance with this section and to safeguard and
129 protect the health, safety, and welfare of the facility's
130 residents. A lease agreement required as a condition of bond
131 financing or refinancing under s. 154.213 by a health facilities
132 authority or required under s. 159.30 by a county or
133 municipality is not a leasehold for purposes of this paragraph
134 and is not subject to the bond requirement of this paragraph.
135 Section 3. Subsections (5) through (13) of section
136 408.061, Florida Statutes, are renumbered as subsections (7)
137 through (15), respectively, subsection (4) is amended, and new
138 subsections (5) and (6) are added to that section, to read:
139 408.061 Data collection; uniform systems of financial
140 reporting; information relating to physician charges;
141 confidential information; immunity.—
142 (4) Within 120 days after the end of its fiscal year, each
143 health care facility, excluding continuing care facilities, and
144 hospitals operated by state agencies, and nursing homes as those
145 terms are defined in s. 408.07, shall file with the agency, on
146 forms adopted by the agency and based on the uniform system of
147 financial reporting, its actual financial experience for that
148 fiscal year, including expenditures, revenues, and statistical
149 measures. Such data may be based on internal financial reports
150 which are certified to be complete and accurate by the provider.
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151 However, hospitals' actual financial experience shall be their
152 audited actual experience. Every nursing home shall submit to
153 the agency, in a format designated by the agency, a statistical
154 profile of the nursing home residents. The agency, in
155 conjunction with the Department of Elderly Affairs and the
156 Department of Health, shall review these statistical profiles
157 and develop recommendations for the types of residents who might
158 more appropriately be placed in their homes or other
159 noninstitutional settings.
160 (5) Within 120 days after the end of its fiscal year, each
161 nursing home as defined in s. 408.07 shall file with the agency,
162 on forms adopted by the agency and based on the uniform system
163 of financial reporting, its actual financial experience for that
164 fiscal year, including expenditures, revenues, and statistical
165 measures. Such data may be based on internal financial reports
166 which are certified to be complete and accurate by the chief
167 financial officer of the nursing home. However, the nursing
168 home's actual financial experience shall be its audited actual
169 financial experience, as audited by an independent certified
170 public accountant. This audited actual experience shall include
171 the fiscal year-end balance sheet, income statement, statement
172 of cash flow, and statement of retained earnings and shall be
173 submitted to the agency in addition to the information filed in
174 the uniform system of financial reporting. The nursing home
175 shall provide all necessary records for the independent
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176 certified public accountant to form an opinion and complete an
177 accurate audit report. The independent certified public
178 accountant's opinion and audit report shall accompany the
179 financial statements submitted to the agency. The audited
180 financial statements shall tie to the information submitted in
181 the uniform system of financial reporting and a crosswalk shall
182 be submitted along with the audited financial statements.
183 (6) Within 120 days after the end of its fiscal year, the
184 home office of each nursing home as defined in s. 408.07 shall
185 file with the agency, on forms adopted by the agency and based
186 on the uniform system of financial reporting, its actual
187 financial experience for that fiscal year, including
188 expenditures, revenues, and statistical measures. Such data may
189 be based on internal financial reports which are certified to be
190 complete and accurate by the chief financial officer of the
191 nursing home. However, the home office's actual financial
192 experience shall be its audited actual financial experience, as
193 audited by an independent certified public accountant. This
194 audited actual experience shall include the fiscal year-end
195 balance sheet, income statement, statement of cash flow, and
196 statement of retained earnings and shall be submitted to the
197 agency in addition to the information filed in the uniform
198 system of financial reporting. The home office shall provide all
199 necessary records for the independent certified public
200 accountant to form an opinion and complete an accurate audit
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201 report. The independent certified public accountant's opinion
202 and audit report shall accompany the financial statements
203 submitted to the agency. The audited financial statements shall
204 tie to the information submitted in the uniform system of
205 financial reporting and a crosswalk shall be submitted along
206 with the audited financial statements.
207 Section 4. Subsections (19) through (27) of section
208 408.07, Florida Statutes, are renumbered as subsections (20)
209 through (28), respectively, and subsecti