Florida 2023 Regular Session

Florida House Bill H1365 Compare Versions

Only one version of the bill is available at this time.

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3	3	HB 1365 2023
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10	10	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
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14	14	A bill to be entitled 1
15	15	An act relating to health care provider 2
16	16	accountability; creating ss. 395.1062 and 400.0232, 3
17	17	F.S.; defining the terms "health care practitioner" 4
18	18	and "health care worker"; providing criminal and civil 5
19	19	immunity to health care workers of hospitals and 6
20	20	nursing home facilities, respectively, who carry out 7
21	21	directives of a supervising health care practitioner 8
22	22	or entity; providing an exception; amending s. 9
23	23	400.141, F.S.; requiring the Agency for Health Care 10
24	24	Administration to provide a report on the success of 11
25	25	the personal care attendant program to the Governor 12
26	26	and the Legislature by a specified date each year; 13
27	27	providing requirements for the report; requiring 14
28	28	nursing home facilities to report to the agency common 15
29	29	ownership relationships they or their parent companies 16
30	30	share with certain entities; requiring the agency to 17
31	31	work with stakeholders to determine how such reporting 18
32	32	shall be conducted; requiring the agency to submit a 19
33	33	report of such reported common ownership relationships 20
34	34	to the Governor and the Legislature by a specified 21
35	35	date each year; requiring the agency to adopt rules; 22
36	36	amending s. 409.908, F.S.; revising the rate 23
37	37	methodology for the agency's long -term care 24
38	38	reimbursement plan; requiring the agency to add a 25
39	39
40	40	HB 1365 2023
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47	47	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
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49	49
50	50
51	51	quality metric to its Quality Incentive Program for a 26
52	52	specified purpose; providing an effective date. 27
53	53	28
54	54	Be It Enacted by the Legislature of the State of Florida: 29
55	55	30
56	56	Section 1. Section 395.1062, Florida Statutes, is created 31
57	57	to read: 32
58	58	395.1062 Immunity from liability; certain health care 33
59	59	workers.— 34
60	60	(1) As used in this section, the term: 35
61	61	(a) "Health care practitioner" has the same meaning as 36
62	62	provided in s. 456.001. 37
63	63	(b) "Health care worker" means a health care practitioner 38
64	64	or a person otherwise licensed, registered, or certified to 39
65	65	provide health care services in this state. The term also 40
66	66	includes unlicensed persons authorized by law to perform tasks 41
67	67	delegated by, or provide health care services under the 42
68	68	supervision of, a licensed, registered, or certified person or 43
69	69	entity. 44
70	70	(2) A health care worker o f a hospital who carries out the 45
71	71	directive of a supervising health care practitioner or hospital 46
72	72	is not subject to criminal prosecution or civil liability, and 47
73	73	is deemed not to have engaged in unprofessional conduct, as a 48
74	74	result of carrying out the health care directive. 49
75	75	(3) This section does not apply if it is shown by a 50
76	76
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84	84	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
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86	86
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88	88	preponderance of the evidence that the health care worker did 51
89	89	not, in good faith, comply with the minimum standards of 52
90	90	acceptable and prevailing practice, including, but not limited 53
91	91	to, engaging in acts for which the health care worker is not 54
92	92	qualified by training or experience. 55
93	93	Section 2. Section 400.0232, Florida Statutes, is created 56
94	94	to read: 57
95	95	400.0232 Immunity from liability; certain health care 58
96	96	workers.— 59
97	97	(1) As used in this sec tion, the term: 60
98	98	(a) "Health care practitioner" has the same meaning as 61
99	99	provided in s. 456.001. 62
100	100	(b) "Health care worker" means a health care practitioner 63
101	101	or a person otherwise licensed, registered, or certified to 64
102	102	provide health care services in this st ate. The term also 65
103	103	includes unlicensed persons authorized by law to perform tasks 66
104	104	delegated by, or provide health care services under the 67
105	105	supervision of, a licensed, registered, or certified person or 68
106	106	entity. 69
107	107	(2) A health care worker who carries out the directive of 70
108	108	a supervising health care practitioner, a nursing home 71
109	109	administrator, or a nursing home facility is not subject to 72
110	110	criminal prosecution or civil liability, and is deemed not to 73
111	111	have engaged in unprofessional conduct, as a result of carrying 74
112	112	out the health care directive. 75
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121	121	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
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125	125	(3) This section does not apply if it is shown by a 76
126	126	preponderance of the evidence that the health care worker did 77
127	127	not, in good faith, comply with the minimum standards of 78
128	128	acceptable and prevailing practice, including, but not limited 79
129	129	to, engaging in acts for which the health care worker is not 80
130	130	qualified by training or experience. 81
131	131	Section 3. Paragraph (w) of subsection (1) of section 82
132	132	400.141, Florida Statutes, is amended, and paragraph (x) is 83
133	133	added to that subsection, to re ad: 84
134	134	400.141 Administration and management of nursing home 85
135	135	facilities.— 86
136	136	(1) Every licensed facility shall comply with all 87
137	137	applicable standards and rules of the agency and shall: 88
138	138	(w) Be allowed to employ personal care attendants as 89
139	139	defined in s. 400.21 1(2)(d), if such personal care attendants 90
140	140	are participating in the personal care attendant training 91
141	141	program developed by the agency, in accordance with 42 C.F.R. 92
142	142	ss. 483.151-483.154, in consultation with the Board of Nursing. 93
143	143	1. The personal care attenda nt program must consist of a 94
144	144	minimum of 16 hours of education and must include all of the 95
145	145	topics and lessons specified in the program curriculum. 96
146	146	2. The program curriculum must include, but need not be 97
147	147	limited to, training in all of the following content areas: 98
148	148	a. Residents' rights. 99
149	149	b. Confidentiality of residents' personal information and 100
150	150
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158	158	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
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160	160
161	161
162	162	medical records. 101
163	163	c. Control of contagious and infectious diseases. 102
164	164	d. Emergency response measures. 103
165	165	e. Assistance with activities of daily living. 104
166	166	f. Measuring vital signs. 105
167	167	g. Skin care and pressure sores prevention. 106
168	168	h. Portable oxygen use and safety. 107
169	169	i. Nutrition and hydration. 108
170	170	j. Dementia care. 109
171	171	3. A personal care attendant must complete the 16 hours of 110
172	172	required education before having any direct co ntact with a 111
173	173	resident. 112
174	174	4. A personal care attendant may not perform any task that 113
175	175	requires clinical assessment, interpretation, or judgment. 114
176	176	5. An individual employed as a personal care attendant 115
177	177	under s. 400.211(2)(d) must work exclusively for one nur sing 116
178	178	facility before becoming a certified nursing assistant. 117
179	179	118
180	180	The agency shall adopt rules necessary to implement this 119
181	181	paragraph. If the state of emergency declared by the Governor 120
182	182	pursuant to Executive Order No. 20 -52 is terminated before the 121
183	183	agency adopts rules to implement this paragraph, the agency 122
184	184	shall authorize the continuation of the personal care attendant 123
185	185	program until the agency adopts such rules. On January 1 of each 124
186	186	year, the agency shall provide a report to the Governor, the 125
187	187
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195	195	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
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197	197
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199	199	President of the Senate, and the Speaker of the House of 126
200	200	Representatives regarding the success of the program, including, 127
201	201	but not limited to, the number of personal care attendants who 128
202	202	took and passed the certified nursing assistant exam after 4 129
203	203	months of initial employment with a single nursing facility as 130
204	204	provided in s. 400.211(2); any adverse actions related to 131
205	205	patient care involving personal care attendants; the number of 132
206	206	certified nursing assistants who are employed and remain 133
207	207	employed each year after completing the per sonal care attendant 134
208	208	program; and the turnover rate of personal care attendants in 135
209	209	nursing home facilities. 136
210	210	(x) Report to the agency any common ownership the facility 137
211	211	or its parent company shares with a staffing or management 138
212	212	company, a vocational or phy sical rehabilitation company, or any 139
213	213	other company that conducts business within the nursing home 140
214	214	facility. The agency shall work with stakeholders to determine 141
215	215	how this reporting shall be conducted. By January 15 of each 142
216	216	year, the agency shall submit a re port to the Governor, the 143
217	217	President of the Senate, and the Speaker of the House of 144
218	218	Representatives on all common ownership relationships reported 145
219	219	to the agency in the preceding calendar year. The agency shall 146
220	220	adopt rules to implement this paragraph. 147
221	221	Section 4. Paragraph (b) of subsection (2) of section 148
222	222	409.908, Florida Statutes, is amended to read: 149
223	223	409.908 Reimbursement of Medicaid providers. —Subject to 150
224	224
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232	232	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
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234	234
235	235
236	236	specific appropriations, the agency shall reimburse Medicaid 151
237	237	providers, in accordance with state an d federal law, according 152
238	238	to methodologies set forth in the rules of the agency and in 153
239	239	policy manuals and handbooks incorporated by reference therein. 154
240	240	These methodologies may include fee schedules, reimbursement 155
241	241	methods based on cost reporting, negotiated f ees, competitive 156
242	242	bidding pursuant to s. 287.057, and other mechanisms the agency 157
243	243	considers efficient and effective for purchasing services or 158
244	244	goods on behalf of recipients. If a provider is reimbursed based 159
245	245	on cost reporting and submits a cost report late and that cost 160
246	246	report would have been used to set a lower reimbursement rate 161
247	247	for a rate semester, then the provider's rate for that semester 162
248	248	shall be retroactively calculated using the new cost report, and 163
249	249	full payment at the recalculated rate shall be effe cted 164
250	250	retroactively. Medicare -granted extensions for filing cost 165
251	251	reports, if applicable, shall also apply to Medicaid cost 166
252	252	reports. Payment for Medicaid compensable services made on 167
253	253	behalf of Medicaid-eligible persons is subject to the 168
254	254	availability of money s and any limitations or directions 169
255	255	provided for in the General Appropriations Act or chapter 216. 170
256	256	Further, nothing in this section shall be construed to prevent 171
257	257	or limit the agency from adjusting fees, reimbursement rates, 172
258	258	lengths of stay, number of visit s, or number of services, or 173
259	259	making any other adjustments necessary to comply with the 174
260	260	availability of moneys and any limitations or directions 175
261	261
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269	269	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
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271	271
272	272
273	273	provided for in the General Appropriations Act, provided the 176
274	274	adjustment is consistent with legislative intent. 177
275	275	(2) 178
276	276	(b) Subject to any limitations or directions in the 179
277	277	General Appropriations Act, the agency shall establish and 180
278	278	implement a state Title XIX Long -Term Care Reimbursement Plan 181
279	279	for nursing home care in order to provide care and services in 182
280	280	conformance with the applicable state and federal laws, rules, 183
281	281	regulations, and quality and safety standards and to ensure that 184
282	282	individuals eligible for medical assistance have reasonable 185
283	283	geographic access to such care. 186
284	284	1. The agency shall amend the long -term care reimbursement 187
285	285	plan and cost reporting system to create direct care and 188
286	286	indirect care subcomponents of the patient care component of the 189
287	287	per diem rate. These two subcomponents together shall equal the 190
288	288	patient care component of the per diem rate. Separate price s 191
289	289	shall be calculated for each patient care subcomponent, 192
290	290	initially based on the September 2016 rate setting cost reports 193
291	291	and subsequently based on the most recently audited cost report 194
292	292	used during a rebasing year. The direct care subcomponent of the 195
293	293	per diem rate for any providers still being reimbursed on a cost 196
294	294	basis shall be limited by the cost -based class ceiling, and the 197
295	295	indirect care subcomponent may be limited by the lower of the 198
296	296	cost-based class ceiling, the target rate class ceiling, or the 199
297	297	individual provider target. The ceilings and targets apply only 200
298	298
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306	306	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
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308	308
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310	310	to providers being reimbursed on a cost -based system. Effective 201
311	311	October 1, 2018, a prospective payment methodology shall be 202
312	312	implemented for rate setting purposes with the following 203
313	313	parameters: 204
314	314	a. Peer Groups, including: 205
315	315	(I) North-SMMC Regions 1-9, less Palm Beach and Okeechobee 206
316	316	Counties; and 207
317	317	(II) South-SMMC Regions 10-11, plus Palm Beach and 208
318	318	Okeechobee Counties. 209
319	319	b. Percentage of Median Costs based on the cost reports 210
320	320	used for September 2016 r ate setting: 211
321	321	(I) Direct Care Costs ................... 100 percent. 212
322	322	(II) Indirect Care Costs ................. 92 percent. 213
323	323	(III) Operating Costs .................... 86 percent. 214
324	324	c. Floors: 215
325	325	(I) Direct Care Component ............ 100 95 percent. 216
326	326	(II) Indirect Care Component ........... 92.5 percent. 217
327	327	(III) Operating Component ...................... None. 218
328	328	d. Pass-through Payments ............. Real Estate and 219
329	329	Personal Property 220
330	330	Taxes and Property Insurance. 221
331	331	e. Quality Incentive Program Payment 222
332	332	Pool 6 percent of September 223
333	333	2016 non-property related 224
334	334	payments of included facilities. 225
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343	343	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
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347	347	f. Quality Score Threshold t o Quality for Quality 226
348	348	Incentive 227
349	349	Payment ............ 20th percentile of included facilities. 228
350	350	g. Fair Rental Value System Payment Parameters: 229
351	351	(I) Building Value per Square Foot based on 2018 RS Means. 230
352	352	(II) Land Valuation 10 percent of Gross Building value. 231
353	353	(III) Facility Square Footage .. Actual Square Footage. 232
354	354	(IV) Moveable Equipment Allowance .... $8,000 per bed. 233
355	355	(V) Obsolescence Factor ................. 1.5 percent. 234
356	356	(VI) Fair Rental Rate of Return ........... 8 percent. 235
357	357	(VII) Minimum Occupancy .................. 90 percent. 236
358	358	(VIII) Maximum Facility Age ................ 40 years. 237
359	359	(IX) Minimum Square Footage per Bed .............. 350. 238
360	360	(X) Maximum Square Footage for Bed ............... 500. 239
361	361	(XI) Minimum Cost of a renovation/replacements $500 per 240
362	362	bed. 241
363	363	h. Ventilator Supplemental payment of $200 per Medicaid 242
364	364	day of 40,000 ventilator Medicaid days per f iscal year. 243
365	365	2. The direct care subcomponent shall include salaries and 244
366	366	benefits of direct care staff providing nursing services 245
367	367	including registered nurses, licensed practical nurses, and 246
368	368	certified nursing assistants who deliver care directly to 247
369	369	residents in the nursing home facility, allowable therapy costs, 248
370	370	and dietary costs. This excludes nursing administration, staff 249
371	371	development, the staffing coordinator, and the administrative 250
372	372
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380	380	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
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384	384	portion of the minimum data set and care plan coordinators. The 251
385	385	direct care subcomponent also includes medically necessary 252
386	386	dental care, vision care, hearing care, and podiatric care. 253
387	387	3. All other patient care costs shall be included in the 254
388	388	indirect care cost subcomponent of the patient care per diem 255
389	389	rate, including complex medical equipment, medical supplies, and 256
390	390	other allowable ancillary costs. Costs may not be allocated 257
391	391	directly or indirectly to the direct care subcomponent from a 258
392	392	home office or management company. 259
393	393	4. On July 1 of each year, the agency shall report to th e 260
394	394	Legislature direct and indirect care costs, including average 261
395	395	direct and indirect care costs per resident per facility and 262
396	396	direct care and indirect care salaries and benefits per category 263
397	397	of staff member per facility. 264
398	398	5. Every fourth year, the agency s hall rebase nursing home 265
399	399	prospective payment rates to reflect changes in cost based on 266
400	400	the most recently audited cost report for each participating 267
401	401	provider. 268
402	402	6. A direct care supplemental payment may be made to 269
403	403	providers whose direct care hours per patie nt day are above the 270
404	404	80th percentile and who provide Medicaid services to a larger 271
405	405	percentage of Medicaid patients than the state average. 272
406	406	7. For the period beginning on October 1, 2018, and ending 273
407	407	on September 30, 2021, the agency shall reimburse provid ers the 274
408	408	greater of their September 2016 cost -based rate or their 275
409	409
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417	417	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
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421	421	prospective payment rate. Effective October 1, 2021, the agency 276
422	422	shall reimburse providers the greater of 95 percent of their 277
423	423	cost-based rate or their rebased prospective payment rate, using 278
424	424	the most recently audited cost report for each facility. This 279
425	425	subparagraph shall expire September 30, 2023. 280
426	426	8. Pediatric, Florida Department of Veterans Affairs, and 281
427	427	government-owned facilities are exempt from the pricing model 282
428	428	established in this subsect ion and shall remain on a cost -based 283
429	429	prospective payment system. Effective October 1, 2018, the 284
430	430	agency shall set rates for all facilities remaining on a cost -285
431	431	based prospective payment system using each facility's most 286
432	432	recently audited cost report, eliminat ing retroactive 287
433	433	settlements. 288
434	434	9. The agency shall add a quality metric to the Quality 289
435	435	Incentive Program to measure direct care staff turnover and the 290
436	436	long-term retention of direct care staff for purposes of 291
437	437	recognizing that a stable workforce increases th e quality of 292
438	438	nursing home resident care, as described in s. 400.235. 293
439	439	294
440	440	It is the intent of the Legislature that the reimbursement plan 295
441	441	achieve the goal of providing access to health care for nursing 296
442	442	home residents who require large amounts of care while 297
443	443	encouraging diversion services as an alternative to nursing home 298
444	444	care for residents who can be served within the community. The 299
445	445	agency shall base the establishment of any maximum rate of 300
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454	454	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
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456	456
457	457
458	458	payment, whether overall or component, on the available moneys 301
459	459	as provided for in the General Appropriations Act. The agency 302
460	460	may base the maximum rate of payment on the results of 303
461	461	scientifically valid analysis and conclusions derived from 304
462	462	objective statistical data pertinent to the particular maximum 305
463	463	rate of payment. The agenc y shall base the rates of payments in 306
464	464	accordance with the minimum wage requirements as provided in the 307
465	465	General Appropriations Act. 308
466	466	Section 5. This act shall take effect July 1, 2023. 309