reglab/statecodes huggingface dataset:
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part II - Kidcare (Ss. 409.810-409.821) › 409.821 - Florida Kidcare program public records exemption.

409.821 Florida Kidcare program public records exemption.—
(1) Personal identifying information of a Florida Kidcare program applicant or enrollee, as defined in s. 409.811, held by the Agency for Health Care Administration, the Department of Children and Families, the Department of Health, or the Florida Healthy Kids Corporation is confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
(2)(a) Upon request, such information shall be disclosed to:
1. Another governmental entity in the performance of its official duties and responsibilities;
2. The Department of Revenue for purposes of administering the state Title IV-D program;
3. The Florida Health Choices, Inc., for the purpose of administering the program authorized pursuant to s. 408.910; or
4. Any person who has the written consent of the program applicant.
(b) This section does not prohibit an enrollee’s legal guardian from obtaining confirmation of coverage, dates of coverage, the name of the enrollee’s health plan, and the amount of premium being paid.
(3) This exemption applies to any information identifying a Florida Kidcare program applicant or enrollee held by the Agency for Health Care Administration, the Department of Children and Families, the Department of Health, or the Florida Healthy Kids Corporation before, on, or after the effective date of this exemption.
(4) A knowing and willful violation of this section is a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083.
History.—s. 1, ch. 98-119; s. 56, ch. 2000-153; ss. 1, 2, ch. 2003-104; s. 35, ch. 2005-39; s. 11, ch. 2005-82; ss. 1, 2, ch. 2008-146; s. 5, ch. 2011-195; s. 200, ch. 2014-19.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.90201 - Recipient address update process.

409.90201 Recipient address update process.—The Agency for Health Care Administration and the Department of Children and Families, in consultation with hospitals and nursing homes that serve Medicaid recipients, shall develop a process to update a recipient’s address in the Medicaid eligibility system at the time a recipient is admitted to a hospital or nursing home. If a recipient’s address information in the Medicaid eligibility system needs to be updated, the update shall be completed within 10 days after the recipient’s admission to a hospital or nursing home.
History.—s. 13, ch. 2012-33; s. 203, ch. 2014-19.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9021 - Forfeiture of eligibility agreement.

409.9021 Forfeiture of eligibility agreement.—As a condition of Medicaid eligibility, subject to federal approval, a Medicaid applicant shall agree in writing to forfeit all entitlements to any goods or services provided through the Medicaid program for the next 10 years if he or she has been found to have committed Medicaid fraud, through judicial or administrative determination. This provision applies only to the Medicaid recipient found to have committed or participated in Medicaid fraud and does not apply to any family member of the recipient who was not involved in the fraud.
History.—s. 4, ch. 2004-344; s. 8, ch. 2011-135.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9025 - Eligibility while an inmate.

409.9025 Eligibility while an inmate.—
(1) Notwithstanding any other provision of law other than s. 409.9021, in the event that a person who is an inmate in the state’s correctional system as defined in s. 944.02, in a county detention facility as defined in s. 951.23, or in a municipal detention facility as defined in s. 951.23 was in receipt of medical assistance under this chapter immediately prior to being admitted as an inmate, such person shall remain eligible for medical assistance while an inmate, except that no medical assistance shall be furnished under this chapter for any care, services, or supplies provided during such time as the person is an inmate; however, nothing in this section shall be deemed as preventing the provision of medical assistance for inpatient hospital services furnished to an inmate at a hospital outside of the premises of the inmate’s facility to the extent that federal financial participation is available for the costs of such services.
(2) Upon release from incarceration, such person shall continue to be eligible for receipt of medical assistance furnished under this chapter until such time as the person is otherwise determined to no longer be eligible for such assistance.
(3) To the extent permitted by federal law, the time during which such person is an inmate shall not be included in any calculation of when the person must recertify his or her eligibility for medical assistance in accordance with this chapter.
History.—s. 1, ch. 2008-217.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9062 - Lung transplant services for Medicaid recipients.

409.9062 Lung transplant services for Medicaid recipients.—Subject to the availability of funds and subject to any limitations or directions provided for in the General Appropriations Act or chapter 216, the Agency for Health Care Administration Medicaid program shall pay for medically necessary lung transplant services for Medicaid recipients. These payments must be used to reimburse approved lung transplant facilities a global fee for providing lung transplant services to Medicaid recipients.
History.—s. 2, ch. 2002-35; s. 4, ch. 2005-133.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9063 - Coverage of continuous glucose monitors for Medicaid recipients.

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409.9063 Coverage of continuous glucose monitors for Medicaid recipients.—
(1) As used in this section, the term “continuous glucose monitor” means an instrument or a device designed for the purpose of aiding in the treatment of diabetes by measuring glucose levels on demand or at set intervals through a small, electronic sensor that slightly penetrates a person’s skin when applied and that is designed to remain in place and active for at least 7 days.
(2) Subject to the availability of funds and subject to any limitations or directions provided in the General Appropriations Act, the agency must provide coverage for a continuous glucose monitor under the Medicaid pharmacy benefit for the treatment of a Medicaid recipient if:
(a) The recipient has been diagnosed by his or her primary care physician, or another licensed health care practitioner authorized to make such diagnosis, with Type 1 diabetes, Type 2 diabetes, gestational diabetes, or any other type of diabetes that may be treated with insulin; and
(b) A health care practitioner with the applicable prescribing authority has prescribed insulin to treat the recipient’s diabetes and a continuous glucose monitor to assist the recipient and practitioner in managing the recipient’s diabetes.
(3) Coverage under this section includes the cost of any necessary repairs or replacement parts for the continuous glucose monitor.
(4) To qualify for continued coverage under this section, the Medicaid recipient must participate in follow-up care with his or her treating health care practitioner, in person or through telehealth, at least once every 6 months during the first 18 months after the first prescription of the continuous glucose monitor for the recipient has been issued under this section, to assess the efficacy of using the monitor for treatment of his or her diabetes. After the first 18 months, such follow-up care must occur at least once every 12 months.
(5) The agency shall seek federal approval, if needed, for the implementation of this section.
History.—s. 1, ch. 2023-283.
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Note.—Section 2, ch. 2023-283, provides that “[t]he Agency for Health Care Administration shall include the rate impact of this act in the Medicaid managed medical assistance program and long-term care managed care program rates, as applicable, that take effect on October 1, 2023.”
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9066 - Medicare prescription discount program.

409.9066 Medicare prescription discount program.—
(1) As a condition of participation in the Florida Medicaid program or the pharmaceutical expense assistance program, a pharmacy must agree to charge any individual who is a Medicare beneficiary and who is a Florida resident showing a Medicare card when he or she presents a prescription, a price no greater than the cost of ingredients equal to the average wholesale price minus 9 percent, and a dispensing fee of $4.50.
(2) In lieu of the provisions of subsection (1), and as a condition of participation in the Florida Medicaid program or the pharmaceutical expense assistance program, a pharmacy must agree to:
(a) Provide a private voluntary prescription discount program to state residents who are Medicare beneficiaries; or
(b) Accept a private voluntary discount prescription program from state residents who are Medicare beneficiaries.
Discounts under this subsection must be at least as great as discounts under subsection (1).
(3) The Agency for Health Care Administration shall publish, on a free website available to the public, the most recent average wholesale prices for the 200 drugs most frequently dispensed and shall provide a mechanism that consumers may use to calculate the retail price and the price that should be paid after the discount required in subsection (1) is applied. The agency shall provide retail information by geographic area and retail information by provider within geographical areas.
History.—s. 3, ch. 2000-254; s. 1, ch. 2003-61; s. 12, ch. 2004-297.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9102 - A qualified state Long-Term Care Insurance Partnership Program in Florida.

409.9102 A qualified state Long-Term Care Insurance Partnership Program in Florida.—The Agency for Health Care Administration, in consultation with the Office of Insurance Regulation and the Department of Children and Families, is directed to establish a qualified state Long-Term Care Insurance Partnership Program in Florida, in compliance with the requirements of s. 1917(b) of the Social Security Act, as amended.
(1) The program shall:
(a) Provide incentives for an individual to obtain or maintain insurance to cover the cost of long-term care.
(b) Provide a mechanism to qualify for coverage of the costs of long-term care needs under Medicaid without first being required to substantially exhaust his or her assets, including a provision for the disregard of any assets in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under the program.
(c) Alleviate the financial burden on the state’s medical assistance program by encouraging the pursuit of private initiatives.
(2) The Agency for Health Care Administration, in consultation with the Office of Insurance Regulation and the Department of Children and Families, and in accordance with federal guidelines, shall create standards for long-term care partnership program information distributed to individuals through insurance companies offering approved long-term care partnership program policies.
(3) The Department of Children and Families, when determining eligibility for Medicaid long-term care services for an individual who is the beneficiary of an approved long-term care partnership program policy, shall reduce the total countable assets of the individual by an amount equal to the insurance benefit payments that are made to or on behalf of the individual.
History.—s. 2, ch. 2005-252; ss. 1, 3, ch. 2006-254; s. 206, ch. 2014-19; s. 30, ch. 2015-4.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9115 - Disproportionate share program for mental health hospitals.

409.9115 Disproportionate share program for mental health hospitals.—The Agency for Health Care Administration shall design and implement a system of making mental health disproportionate share payments to hospitals that qualify for disproportionate share payments under s. 409.911. This system of payments shall conform with federal requirements and shall distribute funds in each fiscal year for which an appropriation is made by making quarterly Medicaid payments. Notwithstanding s. 409.915, counties are exempt from contributing toward the cost of this special reimbursement for patients.
(1) The following formula shall be used by the agency to calculate the total amount earned for hospitals that participate in the mental health disproportionate share program:
TAP = (DSH/TDSH) x TA
Where:
TAP = total additional payment for a mental health hospital.
DSH = total amount earned by a mental health hospital under s. 409.911.
TDSH = sum of total amount earned by each hospital that participates in the mental health hospital disproportionate share program.
TA = total appropriation for the mental health hospital disproportionate share program.
(2) In order to receive payments under this section, a hospital must participate in the Florida Title XIX program and must:
(a) Agree to serve all individuals referred by the agency who require inpatient psychiatric services, regardless of ability to pay.
(b) Be certified or certifiable to be a provider of Title XVIII services.
(c) Receive all of its inpatient clients from admissions governed by the Baker Act as specified in chapter 394.
History.—s. 1, ch. 92-322; s. 5, ch. 95-430; s. 4, ch. 96-420; s. 3, ch. 97-153; ss. 4, 38, ch. 98-46; ss. 3, 53, ch. 99-228; s. 13, ch. 2000-171; s. 9, ch. 2002-2.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.91151 - Expenditure of funds generated through mental health disproportionate share program.

409.91151 Expenditure of funds generated through mental health disproportionate share program.—Funding generated through the mental health disproportionate share program shall be expended in accordance with legislatively authorized appropriations. If such funding is not addressed in legislatively authorized appropriations, the Agency for Health Care Administration shall prepare a plan and submit a request for spending authority in accordance with the applicable provisions of chapter 216.
History.—s. 2, ch. 92-322; s. 187, ch. 99-8.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9118 - Disproportionate share program for specialty hospitals.

409.9118 Disproportionate share program for specialty hospitals.—The Agency for Health Care Administration shall design and implement a system of making disproportionate share payments to those hospitals licensed in accordance with part I of chapter 395 as a specialty hospital which meet all requirements listed in subsection (2). Notwithstanding s. 409.915, counties are exempt from contributing toward the cost of this special reimbursement for patients.
(1) The following formula shall be used by the agency to calculate the total amount earned for hospitals that participate under this section:
TAE=(MD/TMD) x TA
Where:
TAE=total amount earned by a specialty hospital.
TA=total appropriation for payments to hospitals that qualify under this program.
MD=total Medicaid days for each qualifying hospital.
TMD=total Medicaid days for all hospitals that qualify under this program.
(2) In order to receive payments under this section, a hospital must be licensed in accordance with part I of chapter 395, to participate in the Florida Title XIX program, and meet the following requirements:
(a) Be certified or certifiable to be a provider of Title XVIII services.
(b) Receive inpatient clients through referrals or admissions from county public health departments, as defined in chapter 154.
(c) Require a diagnosis for the control of active tuberculosis or a history of noncompliance with prescribed drug regimens for the treatment of tuberculosis for admissions for inpatient treatment.
(d) Retain a contract with the Department of Health to accept clients for admission and inpatient treatment pursuant to s. 392.62.
History.—s. 13, ch. 97-260; s. 8, ch. 2013-48.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.91188 - Specialty prepaid health plans for Medicaid recipients with HIV or AIDS.

409.91188 Specialty prepaid health plans for Medicaid recipients with HIV or AIDS.—The Agency for Health Care Administration is authorized to contract with specialty prepaid health plans and pay them on a prepaid capitated basis to provide Medicaid benefits to Medicaid-eligible recipients who have human immunodeficiency syndrome (HIV) or acquired immunodeficiency syndrome (AIDS). The agency shall apply for and is authorized to implement federal waivers or other necessary federal authorization to implement the prepaid health plans authorized by this section. The agency shall procure the specialty prepaid health plans through a competitive procurement. In awarding a contract to a managed care plan, the agency shall take into account price, quality, accessibility, linkages to community-based organizations, and the comprehensiveness of the benefit package offered by the plan. The agency may bid the HIV/AIDS specialty plans on a county, regional, or statewide basis. Qualified plans must be licensed under chapter 641. The agency shall monitor and evaluate the implementation of this waiver program if it is approved by the Federal Government. To improve coordination of medical care delivery and to increase cost efficiency for the Medicaid program in treating HIV disease, the Agency for Health Care Administration shall seek all necessary federal waivers to allow participation in the MediPass HIV disease management program for Medicare beneficiaries who test positive for HIV infection and who also qualify for Medicaid benefits such as prescription medications not covered by Medicare.
History.—s. 169, ch. 2000-318; s. 147, ch. 2001-277; s. 69, ch. 2005-2.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.91196 - Supplemental rebate agreements; public records and public meetings exemption.

409.91196 Supplemental rebate agreements; public records and public meetings exemption.—
(1) The rebate amount, percent of rebate, manufacturer’s pricing, and supplemental rebate, and other trade secrets as defined in s. 688.002 that the agency has identified for use in negotiations, held by the Agency for Health Care Administration under s. 409.912(5)(a)7. are confidential and exempt from s. 119.07(1) and s. 24(a), Art. I of the State Constitution.
(2) That portion of a meeting of the Medicaid Pharmaceutical and Therapeutics Committee at which the rebate amount, percent of rebate, manufacturer’s pricing, or supplemental rebate, or other trade secrets as defined in s. 688.002 that the agency has identified for use in negotiations, are discussed is exempt from s. 286.011 and s. 24(b), Art. I of the State Constitution. A record shall be made of each exempt portion of a meeting. Such record must include the times of commencement and termination, all discussions and proceedings, the names of all persons present at any time, and the names of all persons speaking. No exempt portion of a meeting may be held off the record.
History.—ss. 1, 3, ch. 2001-216; s. 70, ch. 2002-1; s. 46, ch. 2003-1; s. 54, ch. 2004-5; s. 22, ch. 2004-344; s. 51, ch. 2006-1; s. 1, ch. 2006-159; s. 16, ch. 2011-135; s. 27, ch. 2015-3; s. 16, ch. 2017-4.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.91206 - Alternatives for health and long-term care reforms.

409.91206 Alternatives for health and long-term care reforms.—The Governor, the President of the Senate, and the Speaker of the House of Representatives may convene workgroups to propose alternatives for cost-effective health and long-term care reforms, including, but not limited to, reforms for Medicaid.
History.—s. 11, ch. 2008-143.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9121 - Legislative findings and intent.

409.9121 Legislative findings and intent.—The Legislature hereby finds that the Medicaid program has experienced an annual growth rate of approximately 28 percent per year for the past 5 years, and is consuming more than half of all new general revenue growth. The present Medicaid system must be reoriented to emphasize, to the maximum extent possible, the delivery of health care through entities and mechanisms which are designed to contain costs, to emphasize preventive and primary care, and to promote access and continuity of care. The Legislature further finds that the concept of “managed care” best encompasses these multiple goals. The Legislature also finds that, with the cooperation of the physician community, MediPass, the Medicaid primary care case management program, is responsible for ensuring that there is a sufficient supply of primary care to provide access to preventive and primary care services to Medicaid recipients. Therefore, the Legislature declares its intent that the Medicaid program require, to the maximum extent practicable and permitted by federal law, that all Medicaid recipients be enrolled in a managed care program.
History.—s. 50, ch. 93-129.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9123 - Quality-of-care reporting.

409.9123 Quality-of-care reporting.—In order to promote competition between Medicaid managed care plans and MediPass based on quality-of-care indicators, the agency shall annually develop and publish a set of measures of managed care plan performance. This information shall be made available to each Medicaid recipient who makes a choice of a managed care plan in her or his area. This information shall be easily understandable to the Medicaid recipient and shall use nationally recognized standards wherever possible. In formulating this information, the agency shall take into account at least the following:
(1) The recommendations of the National Committee for Quality Assurance Medicaid HEDIS Task Force.
(2) Requirements and recommendations of the Health Care Financing Administration.
(3) Recommendations of the managed care industry.
History.—s. 8, ch. 96-199; s. 1024, ch. 97-103.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9126 - Children with special health care needs.

409.9126 Children with special health care needs.—
(1) Except as provided in subsection (4), children eligible for Children’s Medical Services who receive Medicaid benefits, and other Medicaid-eligible children with special health care needs, shall be exempt from the provisions of s. 409.9122 and shall be served through the Children’s Medical Services network established in chapter 391.
(2) The Legislature directs the agency to apply to the federal Health Care Financing Administration for a waiver to assign to the Children’s Medical Services network all Medicaid-eligible children who meet the criteria for participation in the Children’s Medical Services program and other Medicaid-eligible children with special health care needs.
(3) Services provided through the Children’s Medical Services network shall be reimbursed on a fee-for-service basis and shall utilize a primary care case management process. Beginning July 1, 1999, the Florida Medicaid program shall phase in by geographical area, capitation payments to Children’s Medical Services for services provided to Medicaid children with special health care needs. By January 1, 2001, the Agency for Health Care Administration shall make capitation payments for Children’s Medical Services enrollees statewide, to the extent provided by federal law.
(4) The agency may approve requests to provide services to Medicaid-eligible children with special health care needs from managed care plans that meet access, quality-of-care, network, and service integration standards and are in good standing with the agency. The agency shall monitor on a quarterly basis managed care plans which have been approved to provide services to Medicaid-eligible children with special health care needs. The agency may determine the number of enrollment slots approved for a managed care plan based on the managed care plan’s network capacity to serve children with special health care needs.
(5) The agency, in consultation with the Department of Health, shall adopt rules that address Medicaid requirements for referral, enrollment, and disenrollment of children with special health care needs who are enrolled in Medicaid managed care plans and who may benefit from the Children’s Medical Services network.
History.—s. 11, ch. 96-199; s. 5, ch. 97-168; s. 53, ch. 98-288; s. 151, ch. 98-403; s. 35, ch. 99-397.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9127 - Preauthorization and concurrent utilization review; conflict-of-interest standards.

409.9127 Preauthorization and concurrent utilization review; conflict-of-interest standards.—
(1) The Agency for Health Care Administration shall be solely responsible for developing and enforcing standards to prohibit financial and other conflicts of interest among vendors selected to provide preauthorization and concurrent utilization review management with direct-service organizations providing substance abuse, mental health, or related services to clients or services to disabled persons who have services authorized through the preauthorization and concurrent utilization review management system established to achieve cost savings in the provision of substance abuse, mental health, or related services or services to disabled persons. The agency may require the posting of a surety bond to guarantee that no financial or other conflicts of interest exist or will exist among vendors selected to provide preauthorization and concurrent utilization review management services.
(2) Vendors selected to conduct preauthorization or concurrent utilization review management, or both, may be peer-review organizations, qualified licensed clinical practitioners, or public or private organizations that demonstrate the ability to conduct such reviews according to criteria developed by the agency and that have no financial or other conflict of interest with any direct-service organization providing substance abuse, mental health, or related services or services to disabled persons. Selection of vendors shall be accomplished through a competitive process.
(3) The agency shall help the Agency for Persons with Disabilities meet the requirements of s. 393.065(4). Only admissions approved pursuant to such assessments are eligible for reimbursement under this chapter.
History.—s. 5, ch. 97-260; s. 8, ch. 99-144; s. 54, ch. 2006-227.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9132 - Pilot project to monitor home health services.

409.9132 Pilot project to monitor home health services.—The Agency for Health Care Administration shall expand the home health agency monitoring pilot project in Miami-Dade County on a statewide basis effective July 1, 2012, except in counties in which the program is not cost-effective, as determined by the agency. The agency shall contract with a vendor to verify the utilization and delivery of home health services and provide an electronic billing interface for home health services. The contract must require the creation of a program to submit claims electronically for the delivery of home health services. The program must verify visits for the delivery of home health services by using technology that is effective for identifying delivery of the home health services and deterring fraudulent or abusive billing for these services. The agency may seek amendments to the Medicaid state plan and waivers of federal laws, as necessary, to implement or expand the pilot project. Notwithstanding s. 287.057(3)(e), the agency must award the contract through the competitive solicitation process and may use the current contract to expand the home health agency monitoring pilot project to include additional counties as authorized under this section.
History.—s. 21, ch. 2009-55; s. 31, ch. 2009-223; s. 44, ch. 2010-151; s. 16, ch. 2012-33; s. 15, ch. 2013-154; s. 2, ch. 2016-103.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9133 - Pilot project for home health care management.

409.9133 Pilot project for home health care management.—The Agency for Health Care Administration shall expand the comprehensive care management pilot project for home health services statewide and include private duty nursing and personal care services effective July 1, 2012, except in counties in which the program will not be cost-effective, as determined by the agency. The program must include face-to-face assessments by a nurse licensed pursuant to chapter 464, consultation with physicians ordering services to substantiate the medical necessity for services, and on-site or desk reviews of recipients’ medical records. The agency may contract with a qualified organization to implement or expand the pilot project. The agency shall use the current contract to expand the comprehensive care management pilot project to include the additional services and counties as authorized under this section. The agency may seek amendments to the Medicaid state plan and waivers of federal laws, as necessary, to implement or expand the pilot project.
History.—s. 22, ch. 2009-55; s. 32, ch. 2009-223; s. 17, ch. 2012-33.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9134 - Agency to distinguish certain services as to skilled home health services; prohibited from requiring home health agencies to meet certain requirements for Medicaid participation.

409.9134 Agency to distinguish certain services as to skilled home health services; prohibited from requiring home health agencies to meet certain requirements for Medicaid participation.—The Agency for Health Care Administration shall distinguish private duty nursing services and attendant nursing care services from skilled home health services in its Medicaid provider enrollment process. As of October 1, 2021, the agency may not require a home health agency that does not provide Medicaid-skilled home health services and provides only attendant nursing care services or private duty nursing services, or both, to meet the requirements of Medicare certification or its accreditation equivalents for participation in the Medicaid program.
History.—s. 7, ch. 2023-243.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.914 - Assistance for the uninsured.

409.914 Assistance for the uninsured.—
(1) The agency shall use the claims payment systems, utilization control systems, cost control systems, case management systems, and other systems and controls that it has developed for the management and control of the Medicaid program to assist other agencies and entities, if appropriate, in paying claims and performing other activities necessary for the conduct of programs of state government, or for working with other public and private agencies to solve problems of lack of insurance, underinsurance, or uninsurability. When conducting these services, the agency shall ensure:
(a) That full payment is received for services provided.
(b) That costs of providing these services are clearly segregated from costs necessary for the conduct of the Medicaid program.
(c) That the program conducted serves the interests of the state in ensuring that effective and quality health care at a reasonable cost is provided to the citizens of the state.
(2)(a) The agency shall seek federal statutory or regulatory reforms to establish a Medicaid buy-in program to provide medical assistance to persons ineligible for Medicaid because of current income and categorical restrictions. The agency shall use funds provided by the Robert Wood Johnson Foundation to assist in developing the buy-in program, including, but not limited to, the determination of eligibility and service coverages; cost-sharing requirements; managed care provisions; changes needed to the Medicaid program’s claims processing, utilization control, cost control, case management, and provider enrollment systems to operate a buy-in program.
(b) The agency shall seek federal authorization and financial support for a buy-in program that provides federally supported medical assistance coverage for persons with incomes up to 250 percent of the federal poverty level. The agency shall not implement the Medicaid buy-in program until it has received necessary federal authorization and financial participation and state appropriations.
History.—s. 45, ch. 91-282; s. 52, ch. 93-129; s. 189, ch. 99-8.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.916 - Grants and Donations Trust Fund.

409.916 Grants and Donations Trust Fund.—
(1) The agency shall deposit any funds received from pharmaceutical manufacturers and all other funds received by the agency from any other person as the result of a Medicaid cost containment strategy, in the nature of a rebate, grant, or other similar mechanism into the Grants and Donations Trust Fund. The agency shall deposit any funds received from private donations for the purpose of funding a certified electronic health record technology loan fund into the Grants and Donations Trust Fund.
(2) Funds received from pharmaceutical manufacturers shall be used as the state portion for funding Medicaid prescribed drug services. However, at least $75,000 may be appropriated from the Grants and Donations Trust Fund for Medicaid research and development activities as specified in the General Appropriations Act.
(3) Receipts from the agency’s share of Medicaid fraud and abuse recoupments and fines shall be deposited into the Grants and Donations Trust Fund for purposes established by law and the General Appropriations Act.
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(4) Quality assessment fees received from Medicaid providers shall be deposited into the Grants and Donations Trust Fund and used for purposes established by law and the General Appropriations Act.
(5) Funds received through grants and donations from the state and from counties, local governments, public entities, and taxing districts shall be deposited into the Grants and Donations Trust Fund and used for purposes established by law and the General Appropriations Act.
(6) Funds received from the leasehold licensee fee pursuant to s. 400.179(2)(d)2. shall be deposited into the Grants and Donations Trust Fund and used for purposes established by law and the General Appropriations Act.
History.—s. 47, ch. 91-282; s. 37, ch. 96-418; s. 191, ch. 99-8; s. 4, ch. 2009-47; s. 17, ch. 2009-55; s. 4, ch. 2009-172; s. 22, ch. 2021-37.
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Note.—As created by s. 17, ch. 2009-55. For a description of multiple acts in the same session affecting a statutory provision, see preface to the Florida Statutes, “Statutory Construction.” Subsection (4) was also created by s. 4, ch. 2009-47, and that version reads:
(4) Funds received from Medicaid providers as nursing home quality assessment fees shall be deposited into the Grants and Donations Trust Fund and used for purposes established by law and the General Appropriations Act.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.918 - Public Medical Assistance Trust Fund.

409.918 Public Medical Assistance Trust Fund.—It is declared that access to adequate health care is a right which should be available to all Floridians. However, rapidly increasing health care costs threaten to make such care unaffordable for many citizens. The Legislature finds that unreimbursed health care services provided to persons who are unable to pay for such services cause the cost of services to paying patients to increase in a manner unrelated to the actual cost of services delivered. Further, the Legislature finds that inequities between hospitals in the provision of unreimbursed services prevent hospitals that provide the bulk of such services from competing on an equitable economic basis with hospitals that provide relatively little care to indigent persons. Therefore, it is the intent of the Legislature to provide a method for funding the provision of health care services to indigent persons, the cost of which shall be borne by the state and by hospitals that are granted the privilege of operating in this state.
(1) All moneys collected pursuant to s. 395.701 shall be deposited into the Public Medical Assistance Trust Fund, which is hereby created.
(2) Moneys deposited into the Public Medical Assistance Trust Fund shall be used solely for the purposes specified by law.
History.—ss. 5, 7, ch. 84-35; s. 11, ch. 87-92; s. 25, ch. 88-294; s. 6, ch. 89-355; s. 48, ch. 91-282; s. 79, ch. 92-289; s. 9, ch. 96-417.
Note.—Former s. 409.2662.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.919 - Rules.

409.919 Rules.—The agency shall adopt any rules necessary to comply with or administer ss. 409.901-409.920 and all rules necessary to comply with federal requirements. In addition, the Department of Children and Families shall adopt and accept transfer of any rules necessary to carry out its responsibilities for receiving and processing Medicaid applications and determining Medicaid eligibility, and for assuring compliance with and administering ss. 409.901-409.906, as they relate to these responsibilities, and any other provisions related to responsibility for the determination of Medicaid eligibility.
History.—s. 49, ch. 91-282; s. 192, ch. 99-8; s. 20, ch. 2000-163; s. 56, ch. 2000-256; s. 1, ch. 2000-300; s. 211, ch. 2014-19.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9203 - Rewards for reporting Medicaid fraud.

409.9203 Rewards for reporting Medicaid fraud.—
(1) The Department of Law Enforcement or director of the Medicaid Fraud Control Unit shall, subject to availability of funds, pay a reward to a person who furnishes original information relating to and reports a violation of the state’s Medicaid fraud laws, unless the person declines the reward, if the information and report:
(a) Is made to the Office of the Attorney General, the Agency for Health Care Administration, the Department of Health, or the Department of Law Enforcement;
(b) Relates to criminal fraud upon Medicaid funds or a criminal violation of Medicaid laws by another person; and
(c) Leads to a recovery of a fine, penalty, or forfeiture of property.
(2) The reward may not exceed the lesser of 25 percent of the amount recovered or $500,000 in a single case.
(3) The reward shall be paid from the Operating Trust Fund from moneys collected pursuant to s. 68.085.
(4) A person who receives a reward pursuant to this section is not eligible to receive any funds pursuant to the Florida False Claims Act for Medicaid fraud for which a reward is received pursuant to this section.
(5) Notwithstanding s. 68.085(3), the 10 percent of any remaining proceeds deposited into the Operating Trust Fund from an action based on a claim of funds from the state Medicaid program shall be allocated in the following manner:
(a) Fifty percent of such moneys shall be used to fund rewards for reporting Medicaid fraud pursuant to this section.
(b) The remaining 50 percent of such moneys shall be used by the Medicaid Fraud Control Unit to fund its investigations of potential violations of s. 68.082 and any related civil actions.
History.—s. 20, ch. 2009-223; s. 2, ch. 2013-207; s. 3, ch. 2015-92.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part III - Medicaid (Ss. 409.901-409.9205) › 409.9205 - Medicaid Fraud Control Unit.

409.9205 Medicaid Fraud Control Unit.—
(1) Except as provided in s. 110.205, all positions in the Medicaid Fraud Control Unit of the Department of Legal Affairs are hereby transferred to the Career Service System.
(2) All investigators employed by the Medicaid Fraud Control Unit who have been certified under s. 943.1395 are law enforcement officers of the state. Such investigators have the authority to conduct criminal investigations, bear arms, make arrests, and apply for, serve, and execute search warrants, arrest warrants, capias, and other process throughout the state pertaining to Medicaid fraud as described in this chapter. The Attorney General shall provide reasonable notice of criminal investigations conducted by the Medicaid Fraud Control Unit to, and coordinate those investigations with, the sheriffs of the respective counties.
History.—s. 6, ch. 96-331; s. 7, ch. 2000-163; s. 1, ch. 2001-276; s. 59, ch. 2001-277.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part IV - Medicaid Managed Care (Ss. 409.961-409.9855) › 409.961 - Statutory construction; applicability; rules.

409.961 Statutory construction; applicability; rules.—It is the intent of the Legislature that if any conflict exists between the provisions contained in this part and in other parts of this chapter, the provisions in this part control. Sections 409.961-409.985 apply only to the Medicaid managed medical assistance program and long-term care managed care program, as provided in this part. The agency shall adopt any rules necessary to comply with or administer this part and all rules necessary to comply with federal requirements. In addition, the department shall adopt and accept the transfer of any rules necessary to carry out the department’s responsibilities for receiving and processing Medicaid applications and determining Medicaid eligibility and for ensuring compliance with and administering this part, as those rules relate to the department’s responsibilities, and any other provisions related to the department’s responsibility for the determination of Medicaid eligibility. Contracts with the agency and a person or entity, including Medicaid providers and managed care plans, necessary to administer the Medicaid program are not rules and are not subject to chapter 120.
History.—s. 2, ch. 2011-134; s. 4, ch. 2012-44.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part IV - Medicaid Managed Care (Ss. 409.961-409.9855) › 409.963 - Single state agency.

409.963 Single state agency.—The agency is designated as the single state agency authorized to manage, operate, and make payments for medical assistance and related services under Title XIX of the Social Security Act. Subject to any limitations or directions provided in the General Appropriations Act, these payments may be made only for services included in the program, only on behalf of eligible individuals, and only to qualified providers in accordance with federal requirements for Title XIX of the Social Security Act and state law. This program of medical assistance is designated as the “Medicaid program.” The department is responsible for Medicaid eligibility determinations, including, but not limited to, policy, rules, and the agreement with the Social Security Administration for Medicaid eligibility determinations for Supplemental Security Income recipients, as well as the actual determination of eligibility. As a condition of Medicaid eligibility, subject to federal approval, the agency and the department shall ensure that each Medicaid recipient consents to the release of her or his medical records to the agency and the Medicaid Fraud Control Unit of the Department of Legal Affairs.
History.—s. 4, ch. 2011-134.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part IV - Medicaid Managed Care (Ss. 409.961-409.9855) › 409.964 - Managed care program; state plan; waivers.

409.964 Managed care program; state plan; waivers.—The Medicaid program is established as a statewide, integrated managed care program for all covered services, including long-term care services. The agency shall apply for and implement state plan amendments or waivers of applicable federal laws and regulations necessary to implement the program.
History.—s. 5, ch. 2011-134; s. 101, ch. 2020-2; s. 3, ch. 2022-42.
2023 Florida Statutes › Title XXX - Social Welfare › Chapter 409 - Social and Economic Assistance › Part IV - Medicaid Managed Care (Ss. 409.961-409.9855) › 409.965 - Mandatory enrollment.

409.965 Mandatory enrollment.—All Medicaid recipients shall receive covered services through the statewide managed care program, except as provided by this part pursuant to an approved federal waiver. The following Medicaid recipients are exempt from participation in the statewide managed care program:
(1) Women who are eligible only for family planning services.
(2) Women who are eligible only for breast and cervical cancer services.
(3) Persons who are eligible for emergency Medicaid for aliens.
History.—s. 6, ch. 2011-134; s. 4, ch. 2014-57.