HB 1237 2022
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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
A bill to be entitled 1
An act relating to nursing home accountability; 2
amending s. 400.141, F.S.; requiring licensed nursing 3
home facilities to comply with certain rules adopted 4
by the Agency for Health Care Administration; 5
requiring the agency to adopt rules establishing a 6
medical loss ratio for the disposition of Medicaid 7
revenue in excess of expenses for nursing home 8
facilities; providing the method of calculating the 9
medical loss ratio; requiring that a nursing home 10
facility pay any excess Medicaid revenue to the agency 11
by a specified date under certain circumstances; 12
requiring the agency to collect such payments; 13
authorizing the use of refunds of excess Medicaid 14
revenue to fund initiatives that improve the quality 15
of care or quality of life for nursing home facility 16
residents; requiring a nursing home facility to limit 17
the use of excess Medicaid revenues for management 18
salaries and for contracted staff or contracted 19
services; prohibiting a nursing home facility from 20
using more than a specified percentage of its total 21
expenses funded through the Medicaid program for 22
certain salaries; prohibiting a nursing home facility 23
from contracting with certain management companies for 24
staffing or services; providing an exception; 25
HB 1237 2022
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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
requiring a nursing home facility to post specified 26
information on its Internet website and update such 27
information annually; requiring a nursing home 28
facility to post a certain list on its Internet 29
website and submit such list to the agency; requiring 30
that such list be updated within a specified 31
timeframe; requiring a nursing home facility to post 32
summaries of certain contracts or agreements on its 33
Internet website within a specified timeframe; 34
requiring the agency t o adopt rules; amending s. 35
408.061, F.S.; requiring nursing homes and their home 36
offices to annually file with the agency their audited 37
actual experience for purposes of financial reporting; 38
providing an effective date. 39
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Be It Enacted by the Legislatur e of the State of Florida: 41
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Section 1. Paragraphs (x), (y), and (z) are added to 43
subsection (1) of section 400.141, Florida Statutes, to read: 44
400.141 Administration and management of nursing home 45
facilities.— 46
(1) Every licensed facility shall comp ly with all 47
applicable standards and rules of the agency and shall: 48
(x) Comply with rules adopted by the agency which 49
establish a medical loss ratio for the disposition of revenue in 50
HB 1237 2022
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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
excess of expenses for nursing home facilities. 51
1. The agency shall a dopt rules requiring that a minimum 52
of 75 percent of the total Medicaid revenue of a nursing home 53
facility be spent on costs related to patient care, of which 55 54
percent must be spent on direct care, as defined by agency rule. 55
Patient care costs are calcul ated by combining direct care and 56
indirect care costs pursuant to agency rule. 57
2. If any nursing home facility fails to spend at least 75 58
percent of its total Medicaid revenue on patient care costs as 59
defined by agency rule, the nursing home facility mus t pay such 60
excess revenue to the agency by January 1 of the following 61
fiscal year. The agency shall collect such payments by any 62
method it deems necessary, including, but not limited to, 63
deductions or offsets from payments made under the Medicaid 64
program. Refunds of excess Medicaid revenue collected by the 65
agency shall be used to fund initiatives that improve the 66
quality of care or quality of life for residents of nursing home 67
facilities. Such initiatives may include, but need not be 68
limited to, surveillanc e and inspection activities; activities 69
designed to improve the quality, performance, and compliance of 70
poorly performing nursing home facilities; training and 71
education for facility staff; and activities to encourage 72
resident and consumer involvement in i nitiatives to improve the 73
quality of care or quality of life for residents of facilities. 74
(y) Limit the use of excess Medicaid revenues for 75
HB 1237 2022
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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
management salaries and for contracted staff or contracted 76
services that are provided at a cost that exceeds the c urrent 77
market rates for such services. 78
1. A nursing home facility may not use more than 15 79
percent of its total expenses funded through the Medicaid 80
program for executive or managerial salaries. 81
2. A nursing home facility may not contract for staffing 82
or services with any management company that has an ownership 83
interest in the facility at a rate exceeding 10 percent of the 84
facility's in-house staffing or service costs, unless an 85
emergency has been declared as determined by the agency or as 86
defined by agency rule. 87
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The agency shall adopt rules to implement this paragraph. 89
(z) Post on its Internet website, and update annually, the 90
maximum rates to be charged for the use of facilities and the 91
provision of services, including the rates for services paid 92
through public and private payer sources. 93
1. A nursing home facility shall post on its Internet 94
website a list of all facility owners and submit such list to 95
the agency for posting on the agency's Internet website. Such 96
list must be updated within 30 days after any changes are made 97
to the list. 98
2. A nursing home facility shall also post on its Internet 99
website a summary of any contract or agreement entered into by 100
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the facility for the provision of goods or services in w hich the 101
facility has an ownership interest and pays for such goods or 102
services using any portion of Medicaid funds within 30 days 103
after such contract or agreement is executed. 104
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The agency shall adopt rules to implement this paragraph. 106
Section 2. Subsections (5) and (6) of section 408.061, 107
Florida Statutes, are amended to read: 108
408.061 Data collection; uniform systems of financial 109
reporting; information relating to physician charges; 110
confidential information; immunity. — 111
(5) Within 120 days after the end of its fiscal year, each 112
nursing home as defined in s. 408.07 shall file with the agency, 113
on forms adopted by the agency and based on the uniform system 114
of financial reporting, its actual financial experience for that 115
fiscal year, including expenditur es, revenues, and statistical 116
measures. Such data may be based on internal financial reports 117
that are certified to be complete and accurate by the chief 118
financial officer of the nursing home. A nursing home's actual 119
financial experience shall be its audite d actual experience. 120
This audited actual experience must include the fiscal year -end 121
balance sheet, income statement, statement of cash flow, and 122
statement of retained earnings and must be submitted to the 123
agency in addition to the information filed in the uniform 124
system of financial reporting. The financial statements must tie 125
HB 1237 2022
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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
to the information submitted in the uniform system of financial 126
reporting, and a crosswalk must be submitted along with the 127
financial statements. 128
(6) Within 120 days after the end of its fiscal year, the 129
home office of each nursing home as defined in s. 408.07 shall 130
file with the agency, on forms adopted by the agency and based 131
on the uniform system of financial reporting, its actual 132
financial experience for that fiscal year, includ ing 133
expenditures, revenues, and statistical measures. Such data may 134
be based on internal financial reports that are certified to be 135
complete and accurate by the chief financial officer of the 136
nursing home. The actual financial experience of the home office 137
of a nursing home shall be its audited actual experience. This 138
audited actual experience must include the fiscal year -end 139
balance sheet, income statement, statement of cash flow, and 140
statement of retained earnings and must be submitted to the 141
agency in addition to the information filed in the uniform 142
system of financial reporting. The financial statements must tie 143
to the information submitted in the uniform system of financial 144
reporting, and a crosswalk must be submitted along with the 145
audited financial st atements. 146
Section 3. This act shall take effect October 1, 2022. 147