The Home Care Association of Florida (HCAF) drew over 95 home care providers to its May 12th District 11 meeting held at the Double Tree Hotel in Miami. They came to learn about the impact of Senate Bill 1986 on Miami-Dade County.
Senate Bill 1986 passed in the Senate and House of Representatives this past legislative session without opposition and is expected to be signed into law by Governor Charlie Crist on July 1, 2009. Senate Bill 1986 designates Miami-Dade as a health care fraud area of concern and introduces new regulations pertaining to the licensing of agencies in an effort to prevent, reduce, and mitigate health care fraud, waste, and abuse in Miami-Dade and Broward counties. The Bill was sponsored by Florida State Senators Don Gaetz and Peaden Durrell. The proposed new regulations mandate that no new agencies will be licensed until 2010 unless the agency had applied for accreditation by May 1, 2009 and submitted a license application by July 1, 2009. Currently, there are 894 home care agencies operating in Miami-Dade County serving a total population of 2,487,118. Regulations call for a new provider-to-population ratio of 5,000 persons per home care agency. It is estimated that there is an excess of 401 home care agencies serving the current population based on that formula. Miami-Dade County’s Medicare population age 65 and over is approximately 383,000, and this means that there is currently one agency per 335 Medicare beneficiaries in Miami-Dade County. It is estimated that approximately 519 of the 894 existing agencies are not needed to serve the existing Medicare population.
(l-r) Bobby Lolley, R.N., Executive Director Home Care Association of Florida and José R. Fox, President & CEO United HomeCare Services
- In Miami-Dade County only, AHCA may not issue a renewal license for a home health agency that has been administratively sanctioned during 2 years prior to the submission of licensure or for an intentional or negligent act affecting the health or safety of a client or for knowingly providing home health services to an unlicensed assisted living facility.
- The sale or change of ownership of existing agencies will be prohibited in Miami-Dade County for one-year with the possibility of renewal for a longer period of time.
- AHCA may not issue or renew a license to a provider that has more than one agency in operation in the same county.
- AHCA may not pay for home health services for Medicaid beneficiaries, unless the services are medically necessary, and the services are ordered by a physician.
- The physician ordering home health services for Medicaid enrollees must have examined the patient within 30 days preceding the initial request for services and bi-annually thereafter.
- A Nurse Registry is exempt from the remuneration prohibition policy if it does not bill the Florida Medicaid or Medicare Program or have a controlling interest with an agency that is licensed, registered, or certified.
José R. Fox, District 11 Representative and Board Member of HCAF, raised concerns about amendments and exemptions that were added to Senate Bill 1986 that can potentially weaken the enforcement of the current law, which prohibits “remuneration.” Sections E & J of the bill use vague and difficult to enforce Federal Kickback Laws and Stark Laws to prosecute agencies that violate the “no remuneration” law. The current law is effective to prevent “pay to play” practices that encourage providers to give doctors and other referral sources gifts for client referrals. Gene J. Tischer, Esq. added that the HCAF membership was split on the remuneration issue.
