HB 1057 2025
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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 adult day care services and 2
centers; amending s. 409.908, F.S.; providing a 3
reimbursement system for adult day care services 4
providers under the Medicaid program; defining the 5
term "tiered payment system"; providing reimbursement 6
rates for nonemergency medical transportation services 7
provided by adult day care centers to Medicaid 8
recipients; creating s. 429.924, F.S.; providing 9
purpose of specified provisions; authorizing waivers 10
under specified circumstances; providing annual 11
continuing education requirements for operators of 12
adult day care centers; providing that certain persons 13
qualify for specified course credits; requiring 14
persons and entities providing continuing education 15
courses to furnish specified documents to the 16
Department of Elder Affairs; providing that the 17
continuing education requirements are a condition 18
precedent to the issuance, continuation, 19
reinstatement, or renewal of an adult day care center 20
license; authorizing the department to grant an 21
extension for the education co urse completion under 22
certain circumstances; prohibiting the department from 23
renewing licenses until the course is completed; 24
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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
providing an effective date. 25
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Be It Enacted by the Legislature of the State of Florida: 27
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Section 1. Subsections (8) and (1 8) of section 409.908, 29
Florida Statutes, are amended to read: 30
409.908 Reimbursement of Medicaid providers. —Subject to 31
specific appropriations, the agency shall reimburse Medicaid 32
providers, in accordance with state and federal law, according 33
to methodologies set forth in the rules of the agency and in 34
policy manuals and handbooks incorporated by reference therein. 35
These methodologies may include fee schedules, reimbursement 36
methods based on cost reporting, negotiated fees, competitive 37
bidding pursuant to s. 287.057, and other mechanisms the agency 38
considers efficient and effective for purchasing services or 39
goods on behalf of recipients. If a provider is reimbursed based 40
on cost reporting and submits a cost report late and that cost 41
report would have been used to set a lower reimbursement rate 42
for a rate semester, then the provider's rate for that semester 43
shall be retroactively calculated using the new cost report, and 44
full payment at the recalculated rate shall be effected 45
retroactively. Medicare -granted extensions for filing cost 46
reports, if applicable, shall also apply to Medicaid cost 47
reports. Payment for Medicaid compensable services made on 48
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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
behalf of Medicaid-eligible persons is subject to the 49
availability of moneys and any limitations or directions 50
provided for in the General Appropriations Act or chapter 216. 51
Further, nothing in this section shall be construed to prevent 52
or limit the agency from adjusting fees, reimbursement rates, 53
lengths of stay, number of visits, or number of services, or 54
making any other adjustments necessary to comply with the 55
availability of moneys and any limitations or directions 56
provided for in the General Appropriations Act, provided the 57
adjustment is consistent with legislative intent. 58
(8)(a) Except as otherwise provided in paragraph (b), a 59
provider of home-based or community-based services rendered 60
pursuant to a federally approved waiver shall be reimbursed 61
based on an established or negotiated rate for each service. 62
These rates shall be established according to an analys is of the 63
expenditure history and prospective budget developed by each 64
contract provider participating in the waiver program, or under 65
any other methodology adopted by the agency and approved by the 66
Federal Government in accordance with the waiver. Private ly 67
owned and operated community -based residential facilities which 68
meet agency requirements and which formerly received Medicaid 69
reimbursement for the optional intermediate care facility for 70
the intellectually disabled service may participate in the 71
developmental services waiver as part of a home -and-community-72
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based continuum of care for Medicaid recipients who receive 73
waiver services. 74
(b)1. A provider of adult day care services rendered 75
pursuant to a federally approved waiver shall be reimbursed 76
pursuant to a tiered payment system. As used in this paragraph, 77
the term "tiered payment system" means a two -tiered payment 78
model that categorizes an adult day care center based on the 79
center's quality of care, facilities, compliance with 80
established standards, an d level of service. 81
a. For purposes of reimbursement as a Tier I center, the 82
center must meet all of the basic requirements for a licensed 83
adult day care center as provided in part III of chapter 429, 84
with the exception of the provision of specialized Al zheimer's 85
services, as defined in s. 429.918(2). The reimbursement rate 86
for a Tier I center shall be the minimum rate per day set by the 87
United States Department of Veterans Affairs for adult day 88
health care services, but not less than $90 per day. The 89
reimbursement rate shall be adjusted on January 1 of each year, 90
except that such adjustment may not exceed the lesser of 3 91
percent or the increase in the Consumer Price Index for All 92
Urban Consumers in the South Region as determined by the Bureau 93
of Labor Statistics of the United States Department of Labor. 94
b. For purposes of reimbursement as a Tier II center, the 95
center must meet all of the requirements of a Tier I center and 96
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must be designated as a specialized Alzheimer's services adult 97
day care center, as provided in s. 429.918. The reimbursement 98
rate for a Tier II center shall be the minimum rate per day set 99
by the United States Department of Veterans Affairs for adult 100
day health care services, plus 30 percent rate difference over 101
the standard contracted rate for a Tier I center; however, the 102
reimbursement rate may not be less than $110 per day. The 103
reimbursement rate shall be adjusted on January 1 of each year, 104
except that such adjustment may not exceed the lesser of 3 105
percent or the increase in the Consu mer Price Index for All 106
Urban Consumers in the South Region as determined by the Bureau 107
of Labor Statistics of the United States Department of Labor. 108
2. An adult day care center that provides nonemergency 109
medical transportation services to a Medicaid rec ipient shall be 110
reimbursed for such services at the rates paid by: 111
a. The applicable managed care plan to its contracted 112
nonemergency medical transportation vendor; or 113
b. The nonemergency medical transportation vendor to the 114
nonemergency medical transp ortation services provider, if the 115
adult day care center directly contracts with the nonemergency 116
medical transportation vendor of a managed care plan. 117
(18) Unless otherwise provided for in the General 118
Appropriations Act or in paragraph (8)(b) , a provider of 119
transportation services shall be reimbursed the lesser of the 120
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amount billed by the provider or the Medicaid maximum allowable 121
fee established by the agency, except when the agency has 122
entered into a direct contract with the provider, or with a 123
community transportation coordinator, for the provision of an 124
all-inclusive service, or when services are provided pursuant to 125
an agreement negotiated between the agency and the provider. The 126
agency, as provided for in s. 427.0135, shall purchase 127
transportation services through the community coordinated 128
transportation system, if available, unless the agency, after 129
consultation with the commission, determines that it cannot 130
reach mutually acceptable contract terms with the commission. 131
The agency may then contract f or the same transportation 132
services provided in a more cost -effective manner and of 133
comparable or higher quality and standards. Nothing in this 134
subsection shall be construed to limit or preclude the agency 135
from contracting for services using a prepaid capi tation rate or 136
from establishing maximum fee schedules, individualized 137
reimbursement policies by provider type, negotiated fees, prior 138
authorization, competitive bidding, increased use of mass 139
transit, or any other mechanism that the agency considers 140
efficient and effective for the purchase of services on behalf 141
of Medicaid clients, including implementing a transportation 142
eligibility process. The agency shall not be required to 143
contract with any community transportation coordinator or 144
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transportation operato r that has been determined by the agency, 145
the Department of Legal Affairs Medicaid Fraud Control Unit, or 146
any other state or federal agency to have engaged in any abusive 147
or fraudulent billing activities. The agency is authorized to 148
competitively procure t ransportation services or make other 149
changes necessary to secure approval of federal waivers needed 150
to permit federal financing of Medicaid transportation services 151
at the service matching rate rather than the administrative 152
matching rate. Notwithstanding c hapter 427, the agency is 153
authorized to continue contracting for Medicaid nonemergency 154
transportation services in agency service area 11 with managed 155
care plans that were under contract for those services before 156
July 1, 2004. 157
Section 2. Section 429.924 , Florida Statutes, is created 158
to read: 159
429.924 Continuing education requirements for operators. — 160
(1) The purpose of this section is to establish the 161
requirements and standards for a continuing education course for 162
operators managing the day -to-day operations of licensed adult 163
day care centers in this state. An operator who cannot comply 164
with the continuing education requirements of this section due 165
to active duty in the military may submit a written request for 166
a waiver to the department. 167
(2) In addition to any existing adult day care center 168
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staff training required by department rule or established under 169
this part, an operator must complete every year an 8 -hour 170
continuing education course developed and offered by the Florida 171
Adult Day Services Asso ciation and approved by the department. 172
The course must include training in the following subject areas: 173
(a) One hour on compliance with the Agency for Health Care 174
Administration. 175
(b) One hour on Alzheimer's disease and related disorders. 176
(c) One hour on the state comprehensive emergency 177
management plan. 178
(d) One hour on anti -fraud, abuse, and neglect. 179
(e) One hour on nonemergency medical transportation. 180
(f) One hour on daily management. 181
(g) One hour on staff compliance with Participant Care 182
Standards, rule 59A-16.103, Florida Administrative Code. 183
(h) One hour on the Health Insurance Portability and 184
Accountability Act. 185
(3) The continuing education course described in 186
subsection (2) may be offered in person or online. Upon 187
completion of the online course, an operator must pass a 188
department-approved online examination with a minimum score of 189
80 percent. An operator attending an in -person course is exempt 190
from the examination requirement. A person who teaches an 191
approved course of instruction, o r lectures in any approved 192
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course, and who attends the entire course qualifies for the same 193
number of classroom hours as a person who takes and successfully 194
completes such course. Credit is limited to the number of hours 195
actually taught or lectured unless the person attends the entire 196
course. 197
(4) Each person or entity providing a course for 198
continuing education credit must furnish, within 30 days after 199
completion of the course, in a form satisfactory to the 200
department or its designee, a roster showing the adult day care 201
center license numbers and the names of the operators who have 202
successfully completed the continuing education course and who 203
request the continuing education credits. 204
(5)(a) An operator's compliance with the continuing 205
education requirements of this section is a condition precedent 206
to the issuance, continuation, reinstatement, or renewal of an 207
adult day care center license. The department may, for good 208
cause shown, grant an operator an extension of time during which 209
the continuing educati on course must be completed, except that 210
any such extension may not exceed 1 year. 211
(b) Unless the department has granted an operator an 212
extension under paragraph (a), the department may not issue a 213
renewal license to an adult day care center whose operat or fails 214
to complete the requirements of this section until the operator 215
successfully completes the continuing education course. 216
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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
Section 3. This act shall take effect July 1, 2025. 217