Florida Statutes § 400.148

“Medicaid “Up-or-Out” Quality of Care Contract Management Program under the public health law” 

The Medicaid “Up-or-Out” Quality of Care Contract Management Program is a Medicaid pilot project established to increase the quality of care for nursing home residents and reduce the number of lawsuits against nursing homes. The Agency for Health Care Administration must oversee the program and ensure:

• Oversight and coordination of all aspects of a resident’s medical care and stay in a nursing home;
• Facilitation of close communication between the resident, the resident’s guardian or legal representative, the resident’s attending physician, the resident’s family, and staff of the nursing facility;
• Frequent onsite visits to the resident;
• Early detection of medical or quality problems that have the potential to lead to adverse outcomes and unnecessary hospitalization;
• Immediate investigation of resident quality-of-care complaints and communication and cooperation with the appropriate entity to address those complaints, including the ombudsman, state agencies, agencies responsible for Medicaid program integrity, and local law enforcement agencies;
• Assistance to the resident or the resident’s representative to relocate the resident if quality-of-care issues are not otherwise addressed; and
• Use of Medicare and other third-party funds to support activities of the program, to the extent possible.