| 1 | A bill to be entitled |
| 2 | An act relating to reimbursement for managed care; |
| 3 | amending s. 409.9124, F.S.; requiring the Agency for |
| 4 | Health Care Administration to amend its rule pertaining to |
| 5 | the methodology for reimbursing managed care plans; |
| 6 | providing for an increase in the percentage of the payment |
| 7 | limit specified in the rule for the 2006-2007 fiscal year; |
| 8 | prohibiting the payment limit from exceeding 100 percent; |
| 9 | deleting a provision prohibiting rates from exceeding the |
| 10 | amounts allowed in the General Appropriations Act; |
| 11 | providing an effective date. |
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| 13 | Be It Enacted by the Legislature of the State of Florida: |
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| 15 | Section 1. Subsections (1) and (2) of section 409.9124, |
| 16 | Florida Statutes, are amended to read: |
| 17 | 409.9124 Managed care reimbursement.--The agency shall |
| 18 | develop and adopt by rule a methodology for reimbursing managed |
| 19 | care plans. |
| 20 | (1) Final managed care rates shall be published annually |
| 21 | prior to September 1 of each year, based on methodology that: |
| 22 | (a) Uses Medicaid's fee-for-service expenditures. |
| 23 | (b) Is certified as an actuarially sound computation of |
| 24 | Medicaid fee-for-service expenditures for comparable groups of |
| 25 | Medicaid recipients and includes all fee-for-service |
| 26 | expenditures, including those fee-for-service expenditures |
| 27 | attributable to recipients who are enrolled for a portion of a |
| 28 | year in a managed care plan or waiver program. |
| 29 | (c) Is compliant with applicable federal laws and |
| 30 | regulations, including, but not limited to, the requirements to |
| 31 | include an allowance for administrative expenses and to account |
| 32 | for all fee-for-service expenditures, including fee-for-service |
| 33 | expenditures for those groups enrolled for part of a year. |
| 34 | (d) Effective for contracts beginning in the 2007-2008 |
| 35 | fiscal year and thereafter, the agency shall amend its rule |
| 36 | pertaining to the methodology for reimbursing managed care |
| 37 | plans, created pursuant to this section, and for each agency |
| 38 | area and eligibility category, the percentage of the payment |
| 39 | limit shall be increased by 3.9 percentage points from the |
| 40 | percentage of the payment limit specified in the rule applicable |
| 41 | to the 2006-2007 fiscal year. The percentage of the payment |
| 42 | limit may not exceed 100 percent in any agency area or |
| 43 | eligibility category. |
| 44 | (2) Each year prior to establishing new managed care |
| 45 | rates, the agency shall review all prior year adjustments for |
| 46 | changes in trend, and shall reduce or eliminate those |
| 47 | adjustments which are not reasonable and which reflect policies |
| 48 | or programs which are not in effect. In addition, the agency |
| 49 | shall apply only those policy reductions applicable to the |
| 50 | fiscal year for which the rates are being set, which can be |
| 51 | accurately estimated and verified by an independent actuary, and |
| 52 | which have been implemented prior to or will be implemented |
| 53 | during the fiscal year. The agency shall pay rates at per- |
| 54 | member, per-month averages that do not exceed the amounts |
| 55 | allowed for in the General Appropriations Act applicable to the |
| 56 | fiscal year for which the rates will be in effect. |
| 57 | Section 2. This act shall take effect July 1, 2007. |