HB 1519 2023
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A bill to be entitled 1
An act relating to assisted care communities; amending 2
s. 409.908, F.S.; authorizing the Agency for Health 3
Care Administration to reimburse adult day care 4
services on a fee-for-service basis under the Medicaid 5
program; amending s. 429.41, F.S.; specifying 6
requirements for certain standards for assisted living 7
facilities the agency is required to adopt by rule; 8
creating s. 429.932, F.S.; providing a purpose; 9
requiring operators of adult day care centers to 10
annually complete specified continuing education; 11
providing requirements for the content and approval of 12
such continuing education courses; authorizing 13
approved courses to be offered in person and online; 14
providing requirements for courses completed online; 15
providing additional methods to satisfy the contin uing 16
education requirements; providing that compliance with 17
the continuing education requirements is a condition 18
precedent for licensure; authorizing the Department of 19
Elderly Affairs to grant an extension, not to exceed 1 20
year, for completion of the conti nuing education under 21
certain circumstances; requiring persons or entities 22
offering continuing education courses to submit 23
certain information to the department within a 24
specified timeframe; providing applicability; 25
HB 1519 2023
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authorizing certain operators to request a waiver from 26
the continuing education requirements; prohibiting the 27
department from renewing the license of an adult day 28
care center under certain circumstances; providing an 29
exception; providing an effective date. 30
31
Be It Enacted by the Legislature o f the State of Florida: 32
33
Section 1. Present paragraphs (a) through (u) of 34
subsection (3) of section 409.908, Florida Statutes, are 35
redesignated as paragraphs (b) through (v), respectively, a new 36
paragraph (a) is added to that subsection, and subsection (8) of 37
that section is amended, to read: 38
409.908 Reimbursement of Medicaid providers. —Subject to 39
specific appropriations, the agency shall reimburse Medicaid 40
providers, in accordance with state and federal law, according 41
to methodologies set forth in th e rules of the agency and in 42
policy manuals and handbooks incorporated by reference therein. 43
These methodologies may include fee schedules, reimbursement 44
methods based on cost reporting, negotiated fees, competitive 45
bidding pursuant to s. 287.057, and othe r mechanisms the agency 46
considers efficient and effective for purchasing services or 47
goods on behalf of recipients. If a provider is reimbursed based 48
on cost reporting and submits a cost report late and that cost 49
report would have been used to set a lower reimbursement rate 50
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for a rate semester, then the provider's rate for that semester 51
shall be retroactively calculated using the new cost report, and 52
full payment at the recalculated rate shall be effected 53
retroactively. Medicare -granted extensions for filin g cost 54
reports, if applicable, shall also apply to Medicaid cost 55
reports. Payment for Medicaid compensable services made on 56
behalf of Medicaid-eligible persons is subject to the 57
availability of moneys and any limitations or directions 58
provided for in the G eneral Appropriations Act or chapter 216. 59
Further, nothing in this section shall be construed to prevent 60
or limit the agency from adjusting fees, reimbursement rates, 61
lengths of stay, number of visits, or number of services, or 62
making any other adjustments necessary to comply with the 63
availability of moneys and any limitations or directions 64
provided for in the General Appropriations Act, provided the 65
adjustment is consistent with legislative intent. 66
(3) Subject to any limitations or directions provided fo r 67
in the General Appropriations Act, the following Medicaid 68
services and goods may be reimbursed on a fee -for-service basis. 69
For each allowable service or goods furnished in accordance with 70
Medicaid rules, policy manuals, handbooks, and state and federal 71
law, the payment shall be the amount billed by the provider, the 72
provider's usual and customary charge, or the maximum allowable 73
fee established by the agency, whichever amount is less, with 74
the exception of those services or goods for which the agency 75
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makes payment using a methodology based on capitation rates, 76
average costs, or negotiated fees. 77
(a) Adult day care services. 78
(8) A provider of home -based or community-based services 79
rendered pursuant to a federally approved waiver shall be 80
reimbursed based on an established or negotiated rate for each 81
service, except that adult day care services shall be reimbursed 82
on a fee-for-service basis as provided in subsection (3) . These 83
rates shall be established according to an analysis of the 84
expenditure history a nd prospective budget developed by each 85
contract provider participating in the waiver program, or under 86
any other methodology adopted by the agency and approved by the 87
Federal Government in accordance with the waiver. Privately 88
owned and operated community -based residential facilities which 89
meet agency requirements and which formerly received Medicaid 90
reimbursement for the optional intermediate care facility for 91
the intellectually disabled service may participate in the 92
developmental services waiver as part of a home-and-community-93
based continuum of care for Medicaid recipients who receive 94
waiver services. 95
Section 2. Subsection (2) of section 429.41, Florida 96
Statutes, is amended to read: 97
429.41 Rules establishing standards. — 98
(2) In adopting any rules pursuant to this part, the 99
agency shall make distinct standards for facilities based upon 100
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facility size; the types of care provided; the physical and 101
mental capabilities and needs of residents; the type, frequency, 102
and amount of services and care offered; and the staffing 103
characteristics of the facility. Rules developed pursuant to 104
this section may not restrict the use of shared staffing and 105
shared programming in facilities that are part of retirement 106
communities that provide multiple levels of care and ot herwise 107
meet the requirements of law and rule. If a continuing care 108
facility licensed under chapter 651 or a retirement community 109
offering multiple levels of care licenses a building or part of 110
a building designated for independent living for assisted 111
living, staffing requirements established in rule apply only to 112
residents who receive personal, limited nursing, or extended 113
congregate care services under this part. Such facilities shall 114
retain a log listing the names and unit number for residents 115
receiving these services. The log must be available to surveyors 116
upon request. The agency shall adopt by rule separate and 117
distinct standards for facilities with 16 or fewer beds and for 118
facilities with 17 or more beds ; however, minimum staffing 119
standards for facili ties with 6 or fewer beds may not exceed 168 120
hours per week. The standards for facilities with 16 or fewer 121
beds must be appropriate for a noninstitutional residential 122
environment; however, the structure may not be more than two 123
stories in height and all pe rsons who cannot exit the facility 124
unassisted in an emergency must reside on the first floor. The 125
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agency may make other distinctions among types of facilities as 126
necessary to enforce this part. When Where appropriate, the 127
agency shall offer alternate solut ions for complying with 128
established standards, based on distinctions made by the agency 129
relative to the physical characteristics of facilities and the 130
types of care offered. 131
Section 3. Section 429.932, Florida Statutes, is created 132
to read: 133
429.932 Continuing education requirements. — 134
(1) The purpose of this section is to establish 135
requirements and standards for continuing education courses for 136
an operator handling the day -to-day operations of an adult day 137
care center licensed under this part. 138
(2) In addition to any existing adult day care center 139
staff training requirements required under this part or by 140
department rule, each operator must complete at least 8 hours of 141
continuing education each calendar year, which must include 1 142
hour of training in e ach of the following topic areas: 143
(a) Compliance with requirements of the Agency for Health 144
Care Administration. 145
(b) Alzheimer's disease and related disorders. 146
(c) State and local comprehensive emergency management 147
plans. 148
(d) Anti-fraud laws and regulations. 149
(e) Nonemergency medical transportation. 150
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(f) Daily management of facility operations. 151
(g) Staff compliance. 152
(h) The Health Insurance Portability and Accountability 153
Act and related requirements. 154
(3) The continuing education courses mu st be developed and 155
offered by the Florida Adult Day Services Association and 156
approved by the department. Courses may also be provided by any 157
other educational provider approved by the department. 158
(4) Approved courses may be offered in person or online. 159
Upon completion of an online course, an operator must pass an 160
online department-approved exam with a minimum score of 80 161
percent or higher. An operator attending an in -person course is 162
exempt from the exam requirement. An individual teaching an 163
approved course or lecturing at an approved seminar and 164
attending the entire course or seminar qualifies for the same 165
number of classroom hours as would be granted to a person taking 166
and successfully completing such course or seminar. Such credit 167
is limited to the nu mber of hours actually taught by the 168
individual unless he or she attends the entire course or 169
seminar. 170
(5) Compliance with the continuing education requirements 171
of this section is a condition precedent to the issuance, 172
continuation, reinstatement, or ren ewal of an operator's adult 173
day care center license subject to this part. However, for good 174
cause shown, the department may grant the operator an extension 175
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of time, not to exceed 1 year, to complete the continuing 176
education required under this section. 177
(6) Each person or entity offering a course for continuing 178
education credit under this section must submit to the 179
department, within 30 days after completion of the course, in a 180
form satisfactory to the department or its designee, a roster 181
including the adult day care license number and the name of the 182
operator who successfully completed such course and is 183
requesting credit. 184
(7) Except as otherwise provided in this section, this 185
section applies to all operators handling the day -to-day 186
operations of adult d ay care centers licensed under this part. 187
Operators who are unable to comply with the continuing education 188
requirements due to active duty in the military may submit a 189
written request for a waiver to the department. 190
(8) Unless the operator has been grant ed an extension or a 191
waiver by the department, the department may not renew the 192
license of an adult day care center whose operator has failed to 193
complete the continuing education required under this section 194
until such time as the operator completes such co ntinuing 195
education. 196
Section 4. This act shall take effect July 1, 2023. 197