HB 1535

CS

CHAMBER ACTION

1	The Elder & Long-Term Care Committee recommends the following:
2
3	Council/Committee Substitute
4	Remove the entire bill and insert:
5	A bill to be entitled
6	An act relating to mental health services providers;
7	amending s. 409.912, F.S.; providing requirements for the
8	provision of mental health services to residents of an
9	assisted living facility having a limited mental health
10	license; requiring the Agency for Health Care
11	Administration to establish a workgroup to examine
12	strategies and make recommendations prior to
13	implementation of any managed care plan that would include
14	behavioral health care services in specified counties;
15	providing for membership; providing an effective date.
16
17	Be It Enacted by the Legislature of the State of Florida:
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19	Section 1.  Subsection (6) of section 409.912, Florida
20	Statutes, is amended to read:
21	409.912  Cost-effective purchasing of health care.--The
22	agency shall purchase goods and services for Medicaid recipients
23	in the most cost-effective manner consistent with the delivery
24	of quality medical care. To ensure that medical services are
25	effectively utilized, the agency may, in any case, require a
26	confirmation or second physician's opinion of the correct
27	diagnosis for purposes of authorizing future services under the
28	Medicaid program. This section does not restrict access to
29	emergency services or poststabilization care services as defined
30	in 42 C.F.R. part 438.114. Such confirmation or second opinion
31	shall be rendered in a manner approved by the agency. The agency
32	shall maximize the use of prepaid per capita and prepaid
33	aggregate fixed-sum basis services when appropriate and other
34	alternative service delivery and reimbursement methodologies,
35	including competitive bidding pursuant to s. 287.057, designed
36	to facilitate the cost-effective purchase of a case-managed
37	continuum of care. The agency shall also require providers to
38	minimize the exposure of recipients to the need for acute
39	inpatient, custodial, and other institutional care and the
40	inappropriate or unnecessary use of high-cost services. The
41	agency may mandate prior authorization, drug therapy management,
42	or disease management participation for certain populations of
43	Medicaid beneficiaries, certain drug classes, or particular
44	drugs to prevent fraud, abuse, overuse, and possible dangerous
45	drug interactions. The Pharmaceutical and Therapeutics Committee
46	shall make recommendations to the agency on drugs for which
47	prior authorization is required. The agency shall inform the
48	Pharmaceutical and Therapeutics Committee of its decisions
49	regarding drugs subject to prior authorization. The agency is
50	authorized to limit the entities it contracts with or enrolls as
51	Medicaid providers by developing a provider network through
52	provider credentialing. The agency may limit its network based
53	on the assessment of beneficiary access to care, provider
54	availability, provider quality standards, time and distance
55	standards for access to care, the cultural competence of the
56	provider network, demographic characteristics of Medicaid
57	beneficiaries, practice and provider-to-beneficiary standards,
58	appointment wait times, beneficiary use of services, provider
59	turnover, provider profiling, provider licensure history,
60	previous program integrity investigations and findings, peer
61	review, provider Medicaid policy and billing compliance records,
62	clinical and medical record audits, and other factors. Providers
63	shall not be entitled to enrollment in the Medicaid provider
64	network. The agency is authorized to seek federal waivers
65	necessary to implement this policy.
66	(6)  The agency may contract with any public or private
67	entity otherwise authorized by this section on a prepaid or
68	fixed-sum basis for the provision of health care services to
69	recipients. An entity may provide prepaid services to
70	recipients, either directly or through arrangements with other
71	entities, if each entity involved in providing services:
72	(a)  Is organized primarily for the purpose of providing
73	health care or other services of the type regularly offered to
74	Medicaid recipients;
75	(b)  Ensures that services meet the standards set by the
76	agency for quality, appropriateness, and timeliness;
77	(c)  Ensures that each resident who lives in a licensed
78	assisted living facility that holds a limited mental health
79	license receives access to an adequate and appropriate array of
80	state-funded mental health services;
81	(d)  Ensures that state-funded mental health services
82	promote recovery by implementing best practices through
83	cooperative agreements between mental health providers and
84	assisted living facilities that hold a limited mental health
85	license, by implementing the community living support plans, and
86	by complying with s. 394.4574;
87	(e)  Ensures that a resident of an assisted living facility
88	may not be displaced as a result of the implementation of any
89	specialty behavioral health care managed care plan;
90	(f)  In order to provide state-funded mental health
91	services to a resident of an assisted living facility that holds
92	a limited mental health license:
93	1.  Develops and implements a plan that complies with s.
94	394.4574 for providing state-funded mental health services;
95	2.  Ensures that each resident of an assisted living
96	facility that holds a limited mental health license has access
97	to therapeutic medications, including atypical psychotropic
98	medications, as directed by the resident's doctor; and
99	3.  Ensures that each resident of an assisted living
100	facility that holds a limited mental health license has access
101	to state-funded primary care and mental health services covered
102	by the Medicaid program;
103	(g)(c)  Makes provisions satisfactory to the agency for
104	insolvency protection and ensures that neither enrolled Medicaid
105	recipients nor the agency will be liable for the debts of the
106	entity;
107	(h)(d)  Submits to the agency, if a private entity, a
108	financial plan that the agency finds to be fiscally sound and
109	that provides for working capital in the form of cash or
110	equivalent liquid assets excluding revenues from Medicaid
111	premium payments equal to at least the first 3 months of
112	operating expenses or $200,000, whichever is greater;
113	(i)(e)  Furnishes evidence satisfactory to the agency of
114	adequate liability insurance coverage or an adequate plan of
115	self-insurance to respond to claims for injuries arising out of
116	the furnishing of health care;
117	(j)(f)  Provides, through contract or otherwise, for
118	periodic review of its medical facilities and services, as
119	required by the agency; and
120	(k)(g)  Provides organizational, operational, financial,
121	and other information required by the agency.
122	Section 2.  (1)  Prior to implementation of any managed
123	care plan that would include behavioral health care services in
124	the counties of Nassau, Baker, Clay, Duval, and St. Johns, the
125	Agency for Health Care Administration shall establish a
126	workgroup to:
127	(a)  Examine strategies that would allow minority access
128	administrative service organizations and county-based
129	administrative service organizations the ability to seek a
130	capitation rate to provide innovative programs to improve access
131	to behavioral health care services in rural areas and areas
132	identified as in need of minority access providers.
133	(b)  Make recommendations to the Agency for Health Care
134	Administration for consideration in the request for proposal
135	process relating to minority access and the role of minority
136	access providers in emerging networks; the role of county-based
137	service delivery systems for the provision of behavioral health
138	care services; requirements to be met by managed care plans when
139	serving residents of limited mental health assisted living
140	facilities; the development of administrative service
141	organizations that may be appointed by rural counties that may
142	be part of the proposed managed care pilot; and the development
143	of administrative service organizations that would focus on
144	minority access issues and minority access providers located in
145	the proposed pilot areas.
146	(2)  The workgroup shall consist of local minority access
147	providers, a representative of the North Florida Behavioral
148	Health Center, a member of a local chapter of the National
149	Alliance for the Mentally Ill, consumer representatives, a
150	representative of a local county government, a representative
151	from the Department of Children and Family Services, a
152	representative from the Department of Health, a representative
153	from the Agency for Health Care Administration, and a
154	representative from the local advocacy council.
155	Section 3.  This act shall take effect July 1, 2005.

CODING: Words stricken are deletions; words underlined are additions.