SB 1544 — Long-term Care

(4) The Medicaid recipient, or his or her guardian or legal representative, shall continue to pay premiums on a life insurance policy that is subject to the collateral assignment.

The cost of premiums must be deducted from the recipient’s income for purposes of calculating his or her assets.

(5) Upon the recipient’s death:

(a) The agency shall file a claim for the death benefit under the policy, up to the costs expended to provide Medicaid services to the recipient, to be remitted to the state.

(b) The state shall pay to the recipient’s estate a funeral expense benefit of $7,500 or 5 percent of the policy’s face value, whichever is less.

(c) Any remaining balance of the death benefit must be paid by the issuer of each policy to other beneficiaries under the policy.

(6) A transfer of ownership of a whole or universal life insurance policy within the 60-month period preceding the Medicaid application by the applicant to a person or entity related to the applicant for less than the net present value of the death benefit, as determined by a standard actuarial discount factor, constitutes an improper asset transfer by the applicant unless the transferee collaterally assigns the face value of the policy pursuant to this section.

(7) The department and the agency shall, in collaboration with the Office of Insurance Regulation, adopt rules to administer this section.

(8) The agency may seek any federal waiver to implement this section.

Section 2. Subsection (3) of section 409.979, Florida Statutes, is amended to read:

409.979 Eligibility.— (3) REGISTRY OF INTEREST, WAIT LIST, RELEASE, AND OFFER PROCESS.—The Department of Elderly Affairs shall maintain a statewide wait list for enrollment for home and community-based services through the long-term care managed care program.

430.2053, aging resource center personnel shall administer rescreening annually foror individualsupon withnotification of a prioritysignificant scorechange ofin 3,an 4,individual’s orcircumstances 5;for an individual with a high priority score.

Aging resource center personnel may administer rescreening annually or upon notification of a significant change in an individual’s circumstances.circumstances for an individual with a low priority score.

(b) Upon completion of the screening or rescreening process, the Department of Elderly Affairs shall placenotify allthe individualsindividual withor athe priorityindividual’s scoreauthorized ofrepresentative 3,that 4,the orindividual 5has been placed on the wait list.list, unless the individual has a low priority score.

IndividualsThe withDepartment a priority score of 1Elderly orAffairs 2 must bemaintain placedcontact oninformation afor registryeach ofindividual interestwith establisheda andlow maintainedpriority byscore thefor Departmentpurposes of Elderlyany Affairs.future rescreening.

Aging resource center personnel shall inform individuals whowith arelow placedpriority onscores the registry of interest of other community resources that may be available to assist them and shall inform them that they may contact the agencyaging resource center for a new assessment at any time if they experience a significant change in circumstances.

PlacementSection on2. Paragraph the(a) registry of interestsubsection does(5) notof prohibitsection an430.205, individualFlorida fromStatutes, receivingis services,amended ifto available.read:

The Department of Elderly Affairs shall notify the individual or the individual’s authorized representative that the individual has been placed on the wait list or on the registry of interest.

(c) If the Department of Elderly Affairs is unable to contact the individual or the individual’s authorized representative to schedule an initial screening or rescreening, and documents the actions taken to make such contact, it shall send a letter to the last documented address of the individual or the individual’s authorized representative.

The letter must advise the individual or his or her authorized representative that he or she must contact the Department of Elderly Affairs within 30 calendar days after the date of the notice to schedule a screening or rescreening and must notify the individual that failure to complete the screening or rescreening will result in his or her termination from the screening process and the wait list.

(d) After notification by the agency of available capacity, the CARES program shall conduct a prerelease assessment.

The Department of Elderly Affairs shall release individuals from the wait list based on the priority scoring process and prerelease assessment results.

Upon release, individuals who meet all eligibility criteria may enroll in the long-term care managed care program.

(e) The Department of Elderly Affairs may terminate an individual’s inclusion on the wait list if the individual:

1. Does not have a current priority score due to the individual’s action or inaction;

2. Requests to be removed from the wait list;

3. Does not keep an appointment to complete the rescreening without scheduling another appointment and has not responded to three documented attempts by the Department of Elderly Affairs to contact the individual;

4. Receives an offer to begin the eligibility determination process for the long-term care managed care program;

or 5. Begins receiving services through the long-term care managed care program.

199 An individual whose inclusion on the wait list is terminated must initiate a new request for placement on the wait list, and any previous priority considerations must be disregarded.

(f) Notwithstanding this subsection, the following individuals are afforded priority enrollment for home and community-based services through the long-term care managed care program and do not have to complete the screening or wait-list process if all other long-term care managed care program eligibility requirements are met:

1. An individual who is 18, 19, or 20 years of age who has a chronic debilitating disease or condition of one or more physiological or organ systems which generally make the individual dependent upon 24-hour-per-day medical, nursing, or health supervision or intervention.

2. A nursing facility resident who requests to transition into the community and who has resided in a Florida-licensed skilled nursing facility for at least 60 consecutive days.

3. An individual who is referred by the Department of Children and Families pursuant to the Adult Protective Services Act, ss.

415.101-415.113, as high risk and who is placed in an assisted living facility temporarily funded by the Department of Children and Families.

(g) The Department of Elderly Affairs and the agency may adopt rules to implement this subsection.

Section 3. Subsection (15) is added to section 430.04, Florida Statutes, to read:

430.04 Duties and responsibilities of the Department of Elderly Affairs.—The Department of Elderly Affairs shall:

(15) Develop, and adopt by rule, a tool for comprehensive assessment of long-term-care supports and services needed by family and friend caregivers for elderly and disabled adults.

The tool is to be used by persons administering state funds for such supports and services in determining eligibility and which supports and services are appropriate for service recipients and their caregivers.

Section 4. Paragraph (a) of subsection (5) of section 430.205, Florida Statutes, is amended to read:

However,Regardless, a community-care-for-the-elderly services provider may dispute thea referral under this paragraph by requesting that the adult protective services program negotiate the referral placement of, and the services to be provided to, a vulnerable adult or victim of abuse, neglect, or exploitation.

If an agreement cannot be reached with the adult protective services program for modification of the referral decision, the determination by adult protective services program’s determination shall control.prevail.

Section 5. This3. This act shall take effect July 1, 2020.