Florida Senate - 2009                        COMMITTEE AMENDMENT
       Bill No. CS for SB 2422
       
       
       
       
       
       
                                Barcode 906036                          
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/06/2009           .                                
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       The Committee on Children, Families, and Elder Affairs (Storms)
       recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Between lines 279 and 280
    4  insert:
    5         Section 2. Paragraph (i) of subsection (2) of section
    6  409.9122, Florida Statutes, is amended to read:
    7         409.9122 Mandatory Medicaid managed care enrollment;
    8  programs and procedures.—
    9         (2)
   10         (i) After a recipient has made his or her selection or has
   11  been enrolled in a managed care plan or MediPass, the recipient
   12  shall have 90 days to exercise the opportunity to voluntarily
   13  disenroll and select another managed care plan or MediPass.
   14  After 90 days, no further changes may be made except for good
   15  cause. Good cause includes, but is not limited to, poor quality
   16  of care, lack of access to necessary specialty services, an
   17  unreasonable delay or denial of service, or fraudulent
   18  enrollment, or severe and persistent mental illness. The agency
   19  shall develop criteria for good cause disenrollment for
   20  chronically ill and disabled populations who are assigned to
   21  managed care plans if more appropriate care is available through
   22  the MediPass program. The agency must make a determination as to
   23  whether cause exists. However, the agency may require a
   24  recipient to use the managed care plan’s or MediPass grievance
   25  process prior to the agency’s determination of cause, except in
   26  cases in which immediate risk of permanent damage to the
   27  recipient’s health is alleged. The grievance process, when
   28  utilized, must be completed in time to permit the recipient to
   29  disenroll by the first day of the second month after the month
   30  the disenrollment request was made. If the managed care plan or
   31  MediPass, as a result of the grievance process, approves an
   32  enrollee’s request to disenroll, the agency is not required to
   33  make a determination in the case. The agency must make a
   34  determination and take final action on a recipient’s request so
   35  that disenrollment occurs no later than the first day of the
   36  second month after the month the request was made. If the agency
   37  fails to act within the specified timeframe, the recipient’s
   38  request to disenroll is deemed to be approved as of the date
   39  agency action was required. Recipients who disagree with the
   40  agency’s finding that cause does not exist for disenrollment
   41  shall be advised of their right to pursue a Medicaid fair
   42  hearing to dispute the agency’s finding.
   43  
   44  ================= T I T L E  A M E N D M E N T ================
   45         And the title is amended as follows:
   46         Delete line 10
   47  and insert:
   48         management services; amending s. 409.9122, F.S.;
   49         revising the criteria for good-cause disenrollment in
   50         a managed care plan or Medipass; providing an
   51         effective date.