INTEROFFICE MEMORANDUM



Date: July 16, 2009

To: Hospice Administrators

From: Noël Cronin Lawrence, Program Administrator

Anne Menard, Unit Manager

Home Care Unit, Bureau of Health Facility Regulation, Division of Health Quality Assurance

Subject: Legislative changes effective July 1, 2009 affecting hospice providers

During the 2009 Florida legislative session, new laws were enacted that affect hospice providers. The primary legislation involved is Senate Bill 1986 which makes changes in Chapter 408, Part II, Florida Statutes (F.S.). This part is entitled “Health Care Licensing: General Provisions” and governs licensure of all provider types regulated by the Agency. Most provisions except where noted take effect on July 1, 2009.

The changes of specific interest to hospice providers are as follows:

• The definition of “licensee” now includes all legal entities.

• The definition of “change of ownership” now reads “An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or an event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned.” This does not apply to a licensee that is publicly traded on a recognized stock exchange.

• The requirement for not-for-profit corporate licensees to routinely submit affidavits of voluntary board members is eliminated. The Agency may still require supplementary documentation as needed. The recommended application form posted on the Agency’s website has been revised to reflect this change.

• The Affidavit of Compliance with Background Screening for Covered Employees is only required to be submitted at the time of licensure renewal.

• Applications will be returned if submitted more than 120 days before the expiration of the current license or the requested effective date (such as with a change of ownership).

• Additional grounds are authorized for denial of applications if the applicant or a controlling interest has been convicted, plead guilty or no contest for a felony under chapters 209, 817 or 893, F.S.; or 21 U.S.C. ss. 801-970 or 42 U.S.C. ss. 1395-1396; or been terminated for cause from the federal Medicare or any state Medicaid programs. Certain timeframes apply.

• Unless otherwise specified in authorizing statutes or applicable rules, any information required to be reported to the Agency must be submitted within 21 calendar days after the report period or effective date of the information, whichever is earlier. This includes, but is not limited to, any change of information contained in the most recent application for licensure.

• Additional disqualifying offenses have been added for persons who are required to undergo background screening. These will apply to persons hired after October 1, 2009. A person who serves as a controlling interest or is an employee on September 30, 2009 will not have to be rescreened due to the enactment of this new law, if they have previously met the background screening requirements. If a person has one of the new disqualifying offenses, he or she may request an exemption from the Agency or the appropriate board prior to September 30, 2009. For licensure purposes, the hospice administrator and financial officer must undergo level 2 screening every five years. A listing of the additional disqualifying offenses may be found in Senate Bill 1986

• Definitions of survey deficiency classifications are established for all licensed providers according to the nature of the violation and the gravity of its probable effect on patients.

• All hospice providers must designate a safety liaison as the primary contact for emergency operations.

• All hospice providers that operate freestanding inpatient facilities and/or residential units must utilize an online database approved by the Agency to report information regarding emergency status, planning and operations. This system is currently known as the Emergency Status System (ESS) and available at . Provisions for temporarily exceeding licensed capacity to act as a receiving provider in an emergency situation are included in the bill.

• Providers must give each patient and his or her immediate family or representative, if appropriate, a description of Medicaid fraud written by the Agency for Health Care Administration and the statewide toll-free telephone number for the central Medicaid fraud hotline. The written description must be clearly legible and include the words: “To report suspected Medicaid fraud, please call toll-free 1-888-419-3456.” The Agency’s description is as follows:

Medicaid Fraud means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him or herself or some other person. It includes any act that constitutes fraud under applicable federal or state law as it relates to Medicaid. The office of the Inspector General at the Agency for Health Care Administration accepts complaints regarding suspected fraud and abuse in the Florida Medicaid system by phone at 1-888-419-3456 or on the Agency web site at .

• The requirement to obtain a State Certificate of Exemption and pay a fee for clinical laboratories that perform only waived tests is eliminated. Hospice providers that perform waived tests will continue to be regulated by the federal CLIA program, which is administered by the Agency.

• The bill adds a provision that a certificate of need issued to an entity on or before April 1, 2009 will terminate 36 months after the date of issuance (instead of 18). Other conditions previously existing in statute may apply.

The bill contains information that addresses issues of Medicaid fraud, which providers are encouraged to review.

To access the full text of these new laws, please visit .

On a related note, hospice providers are reminded of the following:

• Section 400.602(1)(b), F.S., requires hospice providers prominently state the year of initial licensure directly beneath the name of the licensed entity in a type no less than 25 percent of the size used for the name or other indication of hospice services or hospice-like services at least one time on any document, item, or other medium offering, describing, or advertising hospice services or hospice-like services. Section 400.607(1), F.S., allows the Agency to impose an administrative fine for the violation of any provision of the hospice statutes, part II of chapter 408 or applicable rules.

• Hospice law and rule requires providers to notify the Agency at least 60 days before making a change in its name or address of the principal or satellite offices. Section 400.607(1), F.S., allows the Agency to impose an administrative fine for the violation of any provision of the hospice statutes, part II of chapter 408 or applicable rules.

• Hospice inpatient care and services may only be provided to patients located within an inpatient facility. The inpatient facility must be either a freestanding hospice inpatient facility or part of a hospital or nursing home as required in 42 Code of Federal Regulations 418.108 and Section 400.609(4), F.S. Hospice inpatient services may not be provided to a patient residing in a hospice residential unit, assisted living facility, adult family care home or other residential facility. Provision of inpatient services in an unauthorized setting would be viewed as a failure to meet the federal condition of participation at 418.108 (and possibly others) and put the hospice on a 90-day termination track with Medicare and Medicaid.

In addition, under Florida law, in order for a hospice to operate a freestanding hospice inpatient facility, it must first obtain a certificate of need from the Agency for Health Care Administration. Violation of these requirements would be considered unlicensed activity.

• While a hospice may provide care to existing residents of an assisted living facility, it may not contract with an assisted living facility for use of beds to provide residential hospice care. If the hospice intends to ‘lease’ assisted living facility beds strictly for hospice patients, the assisted living facility must de-license the beds and the hospice must apply to license them as a residential unit. Violation of these requirements would be considered unlicensed activity.

If you have questions, please contact Noël Cronin Lawrence at (850) 414-6010.

cc: AHCA Field Offices

Department of Elder Affairs

Florida Hospices & Palliative Care, Inc.

-----------------------

Visit AHCA online at



2727 Mahan Drive, MS 34

Tallahassee, Florida 32308-5407

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download