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The Committee on Children, Families, and Elder Affairs (Storms)

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recommended the following amendment:

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     Senate Amendment (with title amendment)

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     Delete everything after the enacting clause

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and insert:

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     Section 1.  Section 394.9082, Florida Statutes, is amended

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to read:

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     (Substantial rewording of section. See

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     s. 394.9082, F.S., for present text.)

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     394.9082 Behavioral health managing entities.--

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     (1) LEGISLATIVE FINDINGS AND INTENT.--The Legislature finds

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that untreated behavioral health disorders constitute major

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health problems for residents of this state, are a major economic

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burden to the citizens of this state, and substantially increase

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demands on the state's juvenile and adult criminal justice

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systems, the child welfare system, and health care systems. The

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Legislature finds that behavioral health disorders respond to

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appropriate treatment, rehabilitation, and supportive

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intervention. The Legislature finds that it has made a

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substantial long-term investment in the funding of the community-

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based behavioral health prevention and treatment service systems

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and facilities in order to provide critical emergency, acute

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care, residential, outpatient, and rehabilitative and recovery-

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based services. The Legislature finds that local communities have

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also made substantial investments in behavioral health services,

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contracting with safety net providers who by mandate and mission

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provide specialized services to vulnerable and hard-to-serve

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populations and have strong ties to local public health and

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public safety agencies. The Legislature finds that a management

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structure that places the responsibility for publicly financed

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behavioral health treatment and prevention services within a

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single private, nonprofit entity at the local level will promote

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improved access to care, promote service continuity, and provide

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for more efficient and effective delivery of substance abuse and

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mental health services. The Legislature finds that the

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transformation of existing data systems into effective

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decisionmaking models is required in order to provide timely and

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accurate information that is needed at the federal, state, and

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local levels to support the integrated system of community-based

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care. The Legislature finds that streamlining administrative

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processes will create cost efficiencies and provide flexibility

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to better match available services to consumers' identified

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needs.

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     (2) DEFINITIONS.--As used in this section, the term:

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     (a) "Behavioral health services" means mental health

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services and substance abuse prevention and treatment services as

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defined in this chapter and chapter 397 which are provided using

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state and federal funds.

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     (b) "Decisionmaking model" means a comprehensive management

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information system needed to answer the following management

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questions at the federal, state, region, circuit, and local

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provider levels: who receives what services from which providers

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with what outcomes and at what costs?

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     (c) "Geographic area" means a county, circuit, regional, or

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multiregional area in this state.

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     (d) "Managing entity" means a corporation that is organized

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in this state, is designated or filed as a nonprofit organization

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under s. 501(c)3) of the Internal Revenue Service, and is under

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contract to the department to manage the day-to-day operational

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delivery of behavioral health services through an organized

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system of care.

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     (e) "Provider networks" mean the direct service agencies

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that are under contract with a managing entity and that together

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constitute a comprehensive array of emergency, acute care,

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residential, outpatient, recovery support, and consumer support

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services.

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     (3) SERVICE DELIVERY STRATEGIES.--The department may work

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through managing entities to develop service delivery strategies

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that will improve the coordination, integration, and management

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of the delivery of behavioral health services to people who have

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mental or substance use disorders. It is the intent of the

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Legislature that a well-managed service delivery system will

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increase access for those in need of care, improve the

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coordination and continuity of care for vulnerable and high-risk

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populations, and redirect service dollars from restrictive care

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settings to community-based recovery services.

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     (4) DATA INTEGRATION.--For the purpose of data integration

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and cost-effectiveness, the department shall enter into data

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sharing agreements with other state agencies in order to develop

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a person-centered reporting system having uniform definitions and

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reporting categories to determine behavioral health care services

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provided, as well as the outcomes and costs of these services.

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     (5) CONTRACT FOR SERVICES.--

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     (a) The department may contract for the purchase and

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management of behavioral health services with community-based

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managing entities. The department may require a managing entity

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to contract for specialized services that are not currently part

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of the managing entity's network if the department determines

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that it is in the best interests of consumers of services. The

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Legislature may require that managing entities contract with

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specific types of providers in order to carry out special

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projects. The secretary shall determine the schedule for phasing

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in contracts with managing entities. The managing entities shall

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be accountable at a minimum for the operational oversight of the

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delivery of behavioral health services funded by the department

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and for the collection and submission of the required data

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pertaining to these contracted services. A managing entity shall

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serve a geographic area designated by the department. The

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geographic area must be of sufficient size in population and have

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enough public funds for behavioral health services to allow for

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flexibility and maximum efficiency.

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     (b) The operating costs of the managing entity contract

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shall be funded through funds from the department and any savings

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and efficiencies achieved through the implementation of managing

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entities when realized by their participating provider network

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agencies. The department recognizes that managing entities will

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have infrastructure development costs during start-up, so that

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any efficiencies to be realized by providers from consolidation

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of management functions, and the resulting savings, will not be

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achieved during the early years of operation. The department

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shall negotiate with the managing entity a reasonable and

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appropriate administrative cost rate. The Legislature intends

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that reduced local and state contract management and other

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administrative duties passed on to the managing entity allows

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funds previously allocated for these purposes to be

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proportionately reduced and the savings used to purchase the

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administrative functions of the managing entity. Policies and

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procedures of the department for monitoring contracts with

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managing entities shall include provisions for eliminating

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duplication of the department's and the managing entities'

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contract management and other administrative activities in order

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to achieve the goals of cost-effectiveness and regulatory relief.

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To the maximum extent possible, provider-monitoring activities

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shall be assigned to the managing entity.

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     (c) Contracting and payment mechanisms for services must

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promote clinical and financial flexibility and responsiveness

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and must allow different categorical funds to be integrated at

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the point of service. The contracted service array must be

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determined by using public input, needs assessment, and evidence-

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based and promising best-practice models. The department may

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employ care-management methodologies, prepaid capitation, and

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case rate or other methods of payment which promote flexibility,

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efficiency, and accountability.

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     (6) GOALS.--The goal of the service delivery strategies is

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to provide a design for an effective coordination, integration,

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and management approach for delivering effective behavioral

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health services to persons who are experiencing a mental health

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or substance abuse crisis, who have a disabling mental illness or

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a substance use or co-occurring disorder and will require

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extended services in order to recover from their illness, or who

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need brief treatment or longer-term supportive interventions to

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avoid a crisis or disability. Other goals include:

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     (a) Improving accountability for a local system of

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behavioral health care services to meet performance outcomes and

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standards through the use of reliable and timely data.

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     (b) Enhancing the continuity of care for all children,

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adolescents, and adults who enter the publicly funded behavioral

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health service system.

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     (c) Preserving the "safety net" of publicly funded

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behavioral health services and providers, and recognizing and

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ensuring continued local contributions to these services, by

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establishing locally designed and community-monitored systems of

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care.

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     (d) Providing early diagnosis and treatment interventions

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to enhance recovery and prevent hospitalization.

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     (e) Improving the assessment of local needs for behavioral

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health services.

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     (f) Improving the overall quality of behavioral health

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services through the use of evidence-based, best-practice, and

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promising-practice models.

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     (g) Demonstrating improved service integration between

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behavioral health programs and other programs, such as vocational

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rehabilitation, education, child welfare, primary health care,

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emergency services, juvenile justice, and criminal justice.

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     (h) Providing for additional testing of creative and

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flexible strategies for financing behavioral health services to

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enhance individualized treatment and support services.

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     (i) Promoting cost-effective quality care.

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     (j) Working with the state to coordinate the admissions and

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discharges from state civil and forensic hospitals and

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coordinating admissions and discharges from residential treatment

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centers.

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     (k) Improving the integration, accessibility, and

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dissemination of behavioral health data for planning and

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monitoring purposes.

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     (l) Promoting specialized behavioral health services to

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residents of assisted living facilities.

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     (m) Working with the state and other stakeholders to reduce

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the admissions and the length of stay for dependent children in

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residential treatment centers.

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     (n) Providing services to abused and neglected children and

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their families as indicated in court-ordered case plans.

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     (o) Providing services to adults and children with co-

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occurring disorders of mental illnesses and substance abuse

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problems.

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     (p) Providing services to elder adults in crisis or at-risk

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for placement in a more restrictive setting due to a serious

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mental illness or substance abuse.

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     (7) ESSENTIAL ELEMENTS.--It is the intent of the

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Legislature that the department may plan for and enter into

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contracts with managing entities to manage care in geographical

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areas throughout the state. Managing entities shall own and

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operate information systems that have the capacities to provide,

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at a minimum, information required for federal and state

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reporting, monitoring care, assessing local needs, and measuring

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outcomes.

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     (a) The managing entity must demonstrate the ability of its

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network of providers to comply with the pertinent provisions of

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this chapter and chapter 397 and to ensure the provision of

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comprehensive behavioral health services. The network of

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providers must include, but need not be limited to, community

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mental health agencies, substance abuse treatment providers, and

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best-practice consumer services providers.

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     (b) The department shall terminate its mental health or

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substance abuse provider contracts for services to be provided by

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the managing entity at the same time it contracts with the

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managing entity.

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     (c) The managing entity shall ensure that its provider

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network is broadly conceived. All mental health or substance

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abuse treatment providers currently under contract with the

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department shall be offered a contract by the managing entity.

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     (d) The department may contract with managing entities to

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provide the following core functions:

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     1. Financial accountability;

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     2. Allocation of funds to network providers in a manner

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that reflects the department's strategic direction and plans;

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     3. Provider monitoring to ensure compliance with federal

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and state laws, rules, and regulations;

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     4. Data collection, reporting, and analysis;

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     5. Operational plans to implement objectives of the

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department's strategic plan;

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     6. Contract compliance;

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     7. Performance management;

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     8. Collaboration with community stakeholders, including

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local government;

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     9. System of care through network development;

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     10. Consumer care coordination;

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     11. Continuous quality improvement;

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     12. Timely access to appropriate services;

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     13. Cost-effectiveness and system improvements;

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     14. Assistance in the development of the department's

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strategic plan;

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     15. Participation in community, circuit, regional, and state

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planning;

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     16. Resource management and maximization, including pursuit

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of third-party payments and grant applications;

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     17. Incentives for providers to improve quality and access;

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     18. Liaison with consumers;

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     19. Community needs assessment; and

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     20. Securing local matching funds.

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     (e) The managing entity shall ensure that written

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cooperative agreements are developed and implemented among the

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criminal and juvenile justice systems, the local community-based

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care network, and the local behavioral health providers in the

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geographic area which define strategies and alternatives for

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diverting people who have mental illness and substance abuse

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problems from the criminal justice system to the community. These

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agreements must also address the provision of appropriate

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services to persons who have behavioral health problems and leave

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the criminal justice system.

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     (f) Managing entities must collect and submit data to the

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department regarding persons served, outcomes of persons served,

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and the costs of services provided through the department's

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contract. The department shall evaluate managing entity services

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based on consumer-centered outcome measures that reflect national

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standards that can dependably be measured. The department shall

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work with managing entities to establish performance standards

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related to:

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     1. The extent to which individuals in the community receive

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services.

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     2. The improvement of quality of care for individuals

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served.

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     3. The success of strategies to divert jail, prison, and

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forensic facility admissions.

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     4. Consumer and family satisfaction.

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     5. The satisfaction of key community constituents such as

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law enforcement agencies, juvenile justice agencies, the courts,

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the schools, local government entities, hospitals, and others as

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appropriate for the geographical area of the managing entity.

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     (g) The Agency for Health Care Administration may establish

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a certified match program, which must be voluntary. Under a

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certified match program, reimbursement is limited to the federal

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Medicaid share to Medicaid-enrolled strategy participants. The

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agency shall take no action to implement a certified match

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program without ensuring that the consultation provisions of

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chapter 216 have been met. The agency may seek federal waivers

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that are necessary to implement the behavioral health service

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delivery strategies.

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     (8) MANAGING ENTITY REQUIREMENTS.--The department may adopt

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rules and standards and a process for the qualification and

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operation of managing entities which shall be based, in part, on

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the following criteria:

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     (a) Managing entities must be corporations organized in

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this state and designated or filed as nonprofit organizations

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under s. 501(c)(3) of the Internal Revenue Code.

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     (b) A managing entity's governance structure shall be

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representative and shall, at a minimum, include consumers and

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family members, appropriate community stakeholders and

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organizations, and providers of substance abuse and mental health

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services as defined in this chapter and chapter 397.

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     (c) A managing entity that was originally formed primarily

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by substance abuse or mental health providers must present and

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demonstrate a detailed, consensus approach to expanding its

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provider network and governance to include both substance abuse

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and mental health providers.

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     (d) A managing entity must submit a network management plan

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and budget in such form and manner as the department determines.

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The plan must detail the means for implementing the duties to be

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contracted to the managing entity and the efficiencies to be

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anticipated by the department as a result of executing the

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contract. The department may require modifications to the plan

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and must approve the plan before contracting with a managing

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entity. The department may contract with a managing entity that

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demonstrates readiness to assume core functions, and may continue

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to add functions and responsibilities to the managing entity's

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contract over time as additional competencies are developed as

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identified in paragraph (g). Notwithstanding other provisions of

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this section, the department may continue and expand managing

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entity contracts if the department determines that the managing

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entity meets the requirements specified in this section.

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     (e) Managing entities shall operate in a transparent

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manner, providing public access to information, notice of

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meetings, and opportunities for broad public participation in

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decisionmaking. The managing entity's network management plan

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must detail policies and procedures that will ensure

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transparency.

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     (f) Before contracting with a managing entity, the

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department must perform an on-site readiness review of a managing

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entity to determine its operational capacity to satisfactorily

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perform the duties to be contracted.

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     (g) The department shall engage community stakeholders,

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including providers and managing entities under contract with the

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department, in the development of objective standards to measure

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the competencies of managing entities, their readiness to assume

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the responsibilities described in this section, and the outcomes

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to hold them accountable.

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     (h) Notwithstanding other provisions in law, the Department

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of Financial Services and the Department of Management Services

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shall provide the department with the flexibility needed to

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implement this section.

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     (9) DEPARTMENT RESPONSIBILITIES.--With the introduction of

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managing entities to monitor department-contracted providers'

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day-to-day operations, the department and its regional and

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circuit offices will have increased ability to focus on broad

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systemic substance abuse and mental health issues. After the

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department enters into a managing entity contract in a geographic

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area, the regional and circuit offices of the department in that

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area shall direct their efforts primarily to monitoring the

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managing entity contract, including negotiation of system quality

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improvement goals each contract year and review of the managing

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entity plans to execute department strategic plans; carrying out

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statutorily mandated licensure functions; conducting community

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and regional substance abuse and mental health planning;

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communicating to the department the local needs assessed by the

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managing entity; preparing department strategic plans;

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coordinating with other state and local agencies; assisting the

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department to assess local trends and issues and advising

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departmental headquarters on local priorities; and providing

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leadership in disaster planning and preparation.

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     (10) MANAGEMENT INFORMATION SYSTEM REQUIREMENTS.--

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     (a) The department, in collaboration with the managing

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entities, shall design and implement a comprehensive behavioral

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health management information system.

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     (b) Each managing entity shall develop and maintain a data

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system that includes data from agencies under contract with the

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managing entity. At a minimum, the managing entity's data system

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shall provide information needed by the managing entity to

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address the management and clinical care needs of the local

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provider networks and information needed by the department to

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meet state and federal data-reporting requirements, planning

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requirements, and its system-of-care needs and evaluation.

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     (c) The department shall collaborate with managing entities

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to develop business requirements that managing entities will use

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to extract data required at the state and federal levels from

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their local database systems and to submit these data

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electronically into the department's central data system. The

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Legislature recognizes that the department is not in the business

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of application software development and maintenance and is not

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adequately staffed to do so. The initial development and ongoing

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maintenance and operation of the department's central data system

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shall be outsourced through contract with an established third-

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party information technology vendor to increase system access to

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users and provide timely and accurate information to stakeholders

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at all levels of management.

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     (d) The department shall use the central data system to

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make nonconfidential data accessible to stakeholders for

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planning, monitoring, evaluation, and research purposes.

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     (11) REPORTING.--Reports of the department's activities,

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progress, and needs in achieving the goal of contracting with

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managing entities in each circuit and region statewide must be

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submitted to the appropriate substantive and appropriations

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committees in the Senate and the House of Representatives on

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January 1 and July 1 of each year until the full transition to

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managing entities has been accomplished statewide. A section of

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each report shall address accomplishments and barriers to

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implementation of the Management Information System described in

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this section as necessary to support decisionmaking, including

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the department's actions and to assist managing entities

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statewide to achieve the desired interoperability of their

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information systems.

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     (12) RULES.--The department shall adopt rules to administer

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this section and, as necessary, to further specify requirements

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of managing entities.

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     Section 2.  This act shall take effect July 1, 2008.

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================ T I T L E  A M E N D M E N T ================

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And the title is amended as follows:

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     Delete everything before the enacting clause

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and insert:

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A bill to be entitled

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An act relating to mental health and substance abuse

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services; amending s. 394.9082, F.S.; providing

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legislative findings and intent; establishing goals;

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specifying roles and responsibilities of the Department of

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Children and Family Services; creating community-based

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systems of care; authorizing the implementation of

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managing entities by the Department of Children and Family

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Services; establishing a process for contracting with

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managing entities; specifying qualifying criteria for

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managing entities; specifying responsibilities of managing

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entities; specifying requirements for management

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information systems; providing for evaluations and

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reports; providing for a monitoring process; providing an

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effective date.

3/31/2008  12:05:00 PM     10-06104B-08