Florida Senate - 2011                                    SB 1972
       
       
       
       By Senator Negron
       
       
       
       
       28-01190B-11                                          20111972__
    1                        A bill to be entitled                      
    2         An act relating to health and human services; amending
    3         s. 393.0661, F.S.; conforming provisions to changes
    4         made by the act; amending s. 409.016, F.S.; conforming
    5         provisions to changes made by the act; creating s.
    6         409.16713, F.S.; providing for medical assistance for
    7         children in out-of-home care and adopted children;
    8         specifying how those services will be funded under
    9         certain circumstances; providing legislative intent;
   10         providing a directive to the Division of Statutory
   11         Revision; transferring, renumbering, and amending s.
   12         624.91, F.S.; decreasing the administrative cost and
   13         raising the minimum loss ratio for health plans;
   14         increasing compensation to the insurer or provider for
   15         dental contracts; requiring the Florida Healthy Kids
   16         Corporation to include use of the school breakfast and
   17         lunch application form in the corporation’s plan for
   18         publicizing the program; conforming provisions to
   19         changes made by the act; amending ss. 409.813,
   20         409.8132, 409.815, 409.818, 154.503, and 408.915,
   21         F.S.; conforming provisions to changes made by the
   22         act; amending s. 1006.06, F.S.; requiring school
   23         districts to collaborate with the Florida Kidcare
   24         program to use the application form for the school
   25         breakfast and lunch programs to provide information
   26         about the Florida Kidcare program and to authorize
   27         data on the application form be shared with state
   28         agencies and the Florida Healthy Kids Corporation and
   29         its agents; authorizing each school district the
   30         option to share the data electronically; requiring
   31         interagency agreements to ensure that the data
   32         exchanged is protected from unauthorized disclosure
   33         and is used only for enrollment in the Florida Kidcare
   34         program; amending s. 409.901, F.S.; revising
   35         definitions relating to Medicaid; amending s. 409.902,
   36         F.S.; revising provisions relating to the designation
   37         of the Agency for Health Care Administration as the
   38         state Medicaid agency; specifying that eligibility and
   39         state funds for medical services apply only to
   40         citizens and certain noncitizens; providing
   41         exceptions; providing a limitation on persons
   42         transferring assets in order to become eligible for
   43         certain services; amending s. 409.9021, F.S.; revising
   44         provisions relating to conditions for Medicaid
   45         eligibility; increasing the number of years a Medicaid
   46         applicant forfeits entitlements to the Medicaid
   47         program if he or she has committed fraud; providing
   48         for the payment of monthly premiums by Medicaid
   49         recipients; providing exemptions to the premium
   50         requirement; requiring applicants to agree to
   51         participate in certain health programs; prohibiting a
   52         recipient who has access to employer-sponsored health
   53         care from obtaining services reimbursed through the
   54         Medicaid fee-for-service system; requiring the agency
   55         to develop a process to allow the Medicaid premium
   56         that would have been received to be used to pay
   57         employer premiums; requiring that the agency allow
   58         opt-out opportunities for certain recipients; creating
   59         s. 409.9022, F.S.; specifying procedures to be
   60         implemented by a state agency if the Medicaid
   61         expenditures exceed appropriations; amending s.
   62         409.903, F.S.; conforming provisions to changes made
   63         by the act; deleting obsolete provisions; amending s.
   64         409.904, F.S.; conforming provisions to changes made
   65         by the act; renaming the “medically needy” program as
   66         the “Medicaid nonpoverty medical subsidy”; narrowing
   67         the subsidy to cover only certain services for a
   68         family, persons age 65 or older, or blind or disabled
   69         persons; revising the criteria for the agency’s
   70         assessment of need for private duty nursing services;
   71         amending s. 409.905, F.S.; conforming provisions to
   72         changes made by the act; requiring prior authorization
   73         for home health services; amending s. 409.906, F.S.;
   74         providing for a parental fee based on family income to
   75         be assessed against the parents of children with
   76         developmental disabilities served by home and
   77         community-based waivers; prohibiting the agency from
   78         paying for certain psychotropic medications prescribed
   79         for a child; conforming provisions to changes made by
   80         the act; amending ss. 409.9062 and 409.907, F.S.;
   81         conforming provisions to changes made by the act;
   82         amending s. 409.908, F.S.; modifying the nursing home
   83         patient care per diem rate to include dental care and
   84         podiatric care; directing the agency to seek a waiver
   85         to treat a portion of the nursing home per diem as
   86         capital for self-insurance purposes; requiring primary
   87         physicians to be paid the Medicare fee-for-service
   88         rate by a certain date; deleting the requirement that
   89         the agency contract for transportation services with
   90         the community transportation system; authorizing
   91         qualified plans to contract for transportation
   92         services; deleting obsolete provisions; conforming
   93         provisions to changes made by the act; amending s.
   94         409.9081, F.S.; revising copayments for physician
   95         visits; requiring the agency to seek a waiver to allow
   96         the increase of copayments for nonemergency services
   97         furnished in a hospital emergency department; amending
   98         s. 409.912, F.S.; requiring Medicaid-eligible children
   99         who have open child welfare cases and who reside in
  100         AHCA area 10 to be enrolled in specified capitated
  101         managed care plans; expanding the number of children
  102         eligible to receive behavioral health care services
  103         through a specialty prepaid plan; repealing provisions
  104         relating to a provider lock-in program; eliminating
  105         obsolete provisions and updating provisions;
  106         conforming cross-references; amending s. 409.915,
  107         F.S.; conforming provisions to changes made by the
  108         act; transferring, renumbering, and amending s.
  109         409.9301, F.S.; conforming provisions to changes made
  110         by the act; amending s. 409.9126, F.S.; conforming a
  111         cross-reference; providing a directive to the Division
  112         of Statutory Revision; creating s. 409.961, F.S.;
  113         providing for statutory construction of provisions
  114         relating to Medicaid managed care; creating s.
  115         409.962, F.S.; providing definitions; creating s.
  116         409.963, F.S.; establishing the Medicaid managed care
  117         program as the statewide, integrated managed care
  118         program for medical assistance and long-term care
  119         services; directing the agency to apply for and
  120         implement waivers; providing for public notice and
  121         comment; providing for a limited managed care program
  122         if waivers are not approved; creating s. 409.964,
  123         F.S.; requiring all Medicaid recipients to be enrolled
  124         in Medicaid managed care; providing exemptions;
  125         prohibiting a recipient who has access to employer
  126         sponsored health care from enrolling in Medicaid
  127         managed care; requiring the agency to develop a
  128         process to allow the Medicaid premium that would have
  129         been received to be used to pay employer premiums;
  130         requiring that the agency allow opt-out opportunities
  131         for certain recipients; providing for voluntary
  132         enrollment; creating s. 409.965, F.S.; providing
  133         requirements for qualified plans that provide services
  134         in the Medicaid managed care program; requiring the
  135         agency to issue an invitation to negotiate; requiring
  136         the agency to compile and publish certain information;
  137         establishing regions for separate procurement of
  138         plans; establishing selection criteria for plan
  139         selection; limiting the number of plans in a region;
  140         authorizing the agency to conduct negotiations if
  141         funding is insufficient; specifying circumstances
  142         under which the agency may issue a new invitation to
  143         negotiate; providing that the Children’s Medical
  144         Service Network is a qualified plan; directing the
  145         agency to assign Medicaid provider agreements for a
  146         limited time to a provider services network
  147         participating in the managed care program in a rural
  148         area; creating s. 409.966, F.S.; providing managed
  149         care plan contract requirements; establishing contract
  150         terms; providing for annual rate setting; providing
  151         for contract extension under certain circumstances;
  152         establishing access requirements; requiring the agency
  153         to establish performance standards for plans;
  154         requiring each plan to publish specified measures on
  155         the plan’s website; providing for program integrity;
  156         requiring plans to provide encounter data; providing
  157         penalties for failure to submit data; requiring plans
  158         to accept electronic claims; providing for prompt
  159         payment; providing for payments to noncontract
  160         emergency providers; requiring a qualified plan to
  161         post a surety bond or establish a letter of credit or
  162         a deposit in a trust account; requiring plans to
  163         establish a grievance resolution process; requiring
  164         plan solvency; requiring guaranteed savings; providing
  165         costs and penalties for early termination of contracts
  166         or reduction in enrollment levels; requiring the
  167         agency to terminate qualified plans for noncompliance
  168         under certain circumstances; creating s. 409.967,
  169         F.S.; providing for managed care plan accountability;
  170         requiring plans to use a uniform method of accounting
  171         for medical costs; establishing a medical loss ratio;
  172         requiring that a plan pay back to the agency a
  173         specified amount in specified circumstances;
  174         authorizing plans to limit providers in networks;
  175         mandating that certain providers be offered contracts
  176         during the first year; authorizing plans to exclude
  177         certain providers in certain circumstances; requiring
  178         plans to monitor the quality and performance history
  179         of providers; requiring plans to hold primary care
  180         physicians responsible for certain activities;
  181         requiring plans to offer certain programs and
  182         procedures; requiring plans to pay primary care
  183         providers the same rate as Medicare by a certain date;
  184         providing for conflict resolution between plans and
  185         providers; creating s. 409.968, F.S.; providing for
  186         managed care plan payments on a per-member, per-month
  187         basis; requiring the agency to establish a methodology
  188         to ensure the availability of certain types of
  189         payments to specified providers; requiring the
  190         development of rate cells; requiring that the amount
  191         paid to the plans for supplemental payments or
  192         enhanced rates be reconciled to the amount required to
  193         pay providers; requiring that plans make certain
  194         payments to providers within a certain time; creating
  195         s. 409.969, F.S.; authorizing Medicaid recipients to
  196         select any plan within a region; providing for
  197         automatic enrollment of recipients by the agency in
  198         specified circumstances; providing criteria for
  199         automatic enrollment; authorizing disenrollment under
  200         certain circumstances; providing for a grievance
  201         process; defining the term “good cause” for purposes
  202         of disenrollment; requiring recipients to stay in
  203         plans for a specified time; providing for reenrollment
  204         of recipients who move out of a region; creating s.
  205         409.970, F.S.; requiring the agency to maintain an
  206         encounter data system; providing requirements for
  207         prepaid plans to submit data in a certain format;
  208         requiring the agency to analyze the data; requiring
  209         the agency to test the data for certain purposes by a
  210         certain date; creating s. 409.971, F.S.; providing for
  211         managed care medical assistance; providing deadlines
  212         for beginning and finalizing implementation; creating
  213         s. 409.972, F.S.; establishing minimum services for
  214         the managed medical assistance; providing for optional
  215         services; authorizing plans to customize benefit
  216         packages; requiring the agency to provide certain
  217         services to hemophiliacs; creating s. 409.973, F.S.;
  218         providing for managed long-term care; providing
  219         deadlines for beginning and finalizing implementation;
  220         providing duties for the Department of Elderly Affairs
  221         relating to the program; creating s. 409.974, F.S.;
  222         providing recipient eligibility requirements for
  223         managed long-term care; listing programs for which
  224         certain recipients are eligible; specifying that an
  225         entitlement to home and community-based services is
  226         not created; creating s. 409.975, F.S.; establishing
  227         minimum services for managed long-term care; creating
  228         s. 409.976, F.S.; providing criteria for the selection
  229         of plans to provide managed long-term care; creating
  230         s. 409.977, F.S.; providing for managed long-term care
  231         plan accountability; requiring the agency to establish
  232         standards for specified providers; creating s.
  233         409.978, F.S.; requiring that the agency operate the
  234         Comprehensive Assessment and Review for Long-Term Care
  235         Services program through an interagency agreement with
  236         the Department of Elderly Affairs; providing duties of
  237         the program; requiring the program to assign plan
  238         enrollees to a level of care; providing for the
  239         evaluation of dually eligible nursing home residents;
  240         transferring, renumbering, and amending ss. 409.91207,
  241         409.91211, 409.9122, F.S.; conforming provisions to
  242         changes made by the act; updating provisions and
  243         deleting obsolete provisions; transferring and
  244         renumbering ss. 409.9123 and 409.9124, F.S.; amending
  245         s. 430.04, F.S.; eliminating outdated provisions;
  246         requiring the Department of Elderly Affairs to develop
  247         a transition plan for specified elders and disabled
  248         adults receiving long-term care Medicaid services if
  249         qualified plans become available; amending s.
  250         430.2053, F.S.; eliminating outdated provisions;
  251         providing additional duties of aging resource centers;
  252         providing an additional exception to direct services
  253         that may not be provided by an aging resource center;
  254         providing for the cessation of specified payments by
  255         the department as qualified plans become available;
  256         eliminating provisions requiring reports; amending s.
  257         39.407, F.S.; requiring a motion by the Department of
  258         Children and Family Services to provide psychotropic
  259         medication to a child 10 years of age or younger to
  260         include a review by a child psychiatrist; providing
  261         that a court may not authorize the administration of
  262         such medication absent a finding of compelling state
  263         interest based on the review; amending s. 216.262,
  264         F.S.; providing that limitations on an agency’s total
  265         number of positions does not apply to certain
  266         positions in the Department of Health; amending s.
  267         381.06014, F.S.; redefining the term “blood
  268         establishment” and defining the term “volunteer
  269         donor”; requiring that blood establishments disclose
  270         specified information on their Internet website;
  271         providing an exception for certain hospitals;
  272         authorizing the Department of Legal Affairs to assess
  273         a civil penalty against a blood establishment that
  274         fails to disclose the information; providing that the
  275         civil penalty accrues to the state and requiring that
  276         it be deposited into the General Revenue Fund;
  277         prohibiting local governments from restricting access
  278         to public facilities or infrastructure for certain
  279         activities based on whether a blood establishment is
  280         operating as a for-profit or not-for-profit
  281         organization; prohibiting a blood establishment from
  282         considering whether certain customers are operating as
  283         for-profit or not-for-profit organizations when
  284         determining service fees for blood or blood
  285         components; amending s. 400.023, F.S.; requiring the
  286         trial judge to conduct an evidentiary hearing to
  287         determine the sufficiency of evidence for claims
  288         against certain persons relating to a nursing home;
  289         limiting noneconomic damages in a wrongful death
  290         action against the nursing home; amending s. 400.0237,
  291         F.S.; revising provisions relating to punitive damages
  292         against a nursing home; authorizing a defendant to
  293         proffer admissible evidence to refute a claimant’s
  294         proffer of evidence for punitive damages; requiring
  295         the trial judge to conduct an evidentiary hearing and
  296         the plaintiff to demonstrate that a reasonable basis
  297         exists for the recovery of punitive damages;
  298         prohibiting discovery of the defendant’s financial
  299         worth until the judge approves the pleading on
  300         punitive damages; revising definitions; amending s.
  301         408.7057, F.S.; requiring that the dispute resolution
  302         program include a hearing in specified circumstances;
  303         providing that the dispute resolution program
  304         established to resolve claims disputes between
  305         providers and health plans does not provide an
  306         independent right of recovery; requiring that the
  307         conclusions of law in the written recommendation of
  308         the resolution organization identify certain
  309         information; providing a directive to the Division of
  310         Statutory Revision; amending s. 409.1671, F.S.;
  311         modifying the amount and limits of general liability
  312         coverage, automobile coverage, and tort coverage that
  313         must be carried by eligible community lead agency
  314         providers and their subcontractors; providing that the
  315         Department of Children and Family Services is not
  316         liable for the acts or omissions of such lead agencies
  317         and that the agencies may not be required to indemnify
  318         the department; creating ss. 458.3167 and 459.0078,
  319         F.S.; providing for an expert witness certificate for
  320         allopathic and osteopathic physicians licensed in
  321         other states or Canada which authorizes such
  322         physicians to provide expert medical opinions in this
  323         state; providing application requirements and
  324         timeframes for approval or denial by the Board of
  325         Medicine and Board of Osteopathic Medicine,
  326         respectively; requiring the boards to adopt rules and
  327         set fees; providing for expiration of a certificate;
  328         amending ss. 458.331 and 459.015, F.S.; providing
  329         grounds for disciplinary action for providing
  330         misleading, deceptive, or fraudulent expert witness
  331         testimony relating to the practice of medicine and of
  332         osteopathic medicine, respectively; providing for
  333         construction with respect to the doctrine of
  334         incorporation by reference; amending s. 499.003, F.S.;
  335         redefining the term “health care entity” to clarify
  336         that a blood establishment is a health care entity
  337         that may engage in certain activities; amending s.
  338         499.005, F.S.; clarifying provisions that prohibit the
  339         unauthorized wholesale distribution of a prescription
  340         drug that was purchased by a hospital or other health
  341         care entity or donated or supplied at a reduced price
  342         to a charitable organization, to conform to changes
  343         made by the act; amending s. 499.01, F.S.; exempting
  344         certain blood establishments from the requirements to
  345         be permitted as a prescription drug manufacturer and
  346         register products; requiring that certain blood
  347         establishments obtain a restricted prescription drug
  348         distributor permit under specified conditions;
  349         limiting the prescription drugs that a blood
  350         establishment may distribute under a restricted
  351         prescription drug distributor permit; authorizing the
  352         Department of Health to adopt rules regarding the
  353         distribution of prescription drugs by blood
  354         establishments; amending s. 626.9541, F.S.;
  355         authorizing insurers to offer rewards or incentives to
  356         health benefit plan members to encourage or reward
  357         participation in wellness or health improvement
  358         programs; authorizing insurers to require plan members
  359         not participating in programs to provide verification
  360         that their medical condition warrants
  361         nonparticipation; providing application; amending s.
  362         627.4147, F.S.; deleting a requirement that a medical
  363         malpractice insurance contract include a clause
  364         authorizing an insurer to admit liability and make a
  365         settlement offer if the offer is within policy limits
  366         without the insured’s permission; amending s. 766.102,
  367         F.S.; providing that a physician who is an expert
  368         witness in a medical malpractice presuit action must
  369         meet certain requirements; amending s. 766.104, F.S.;
  370         requiring a good faith demonstration in a medical
  371         malpractice case that there has been a breach of the
  372         standard of care; amending s. 766.106, F.S.;
  373         clarifying that a physician acting as an expert
  374         witness is subject to disciplinary actions; amending
  375         s. 766.1115, F.S.; conforming provisions to changes
  376         made by the act; creating s. 766.1183, F.S.; defining
  377         terms; providing for the recovery of civil damages by
  378         Medicaid recipients according to a modified standard
  379         of care; providing for recovery of certain excess
  380         judgments by act of the Legislature; requiring the
  381         Department of Children and Family Services to provide
  382         notice to program applicants; creating s. 766.1184,
  383         F.S.; defining terms; providing for the recovery of
  384         civil damages by certain recipients of primary care
  385         services at primary care clinics receiving specified
  386         low-income pool funds according to a modified standard
  387         of care; providing for recovery of certain excess
  388         judgments by act of the Legislature; providing
  389         requirements of health care providers receiving such
  390         funds in order for the liability provisions to apply;
  391         requiring notice to low-income pool recipients;
  392         amending s. 766.203, F.S.; requiring the presuit
  393         investigations conducted by the claimant and the
  394         prospective defendant in a medical malpractice action
  395         to provide grounds for a breach of the standard of
  396         care; amending s. 768.28, F.S.; revising a definition;
  397         providing that certain colleges and universities that
  398         own or operate an accredited medical school and their
  399         employees and agents providing patient services in a
  400         teaching hospital pursuant to an affiliation agreement
  401         or contract with the teaching hospital are considered
  402         agents of the hospital for the purposes of sovereign
  403         immunity; providing definitions; requiring patients of
  404         such hospitals to be provided with notice of their
  405         remedies under sovereign immunity; providing an
  406         exception; providing legislative findings and intent
  407         with respect to including certain colleges and
  408         universities and their employees and agents under
  409         sovereign immunity; providing a statement of public
  410         necessity; amending s. 1004.41, F.S.; clarifying
  411         provisions relating to references to the corporation
  412         known as Shands Teaching Hospital and Clinics, Inc.;
  413         clarifying provisions regarding the purpose of the
  414         corporation; authorizing the corporation to create
  415         corporate subsidiaries and affiliates; providing that
  416         Shands Teaching Hospital and Clinics, Inc., Shands
  417         Jacksonville Medical Center, Inc., Shands Jacksonville
  418         Healthcare, Inc., and any not-for-profit subsidiary of
  419         such entities are instrumentalities of the state for
  420         purposes of sovereign immunity; repealing s. 409.9121,
  421         F.S., relating to legislative intent concerning
  422         managed care; repealing s. 409.919, F.S., relating to
  423         rule authority; repealing s. 624.915, F.S., relating
  424         to the Florida Healthy Kids Corporation operating
  425         fund; renumbering and transferring ss. 409.942,
  426         409.944, 409.945, 409.946, 409.953, and 409.9531,
  427         F.S., as ss. 414.29, 163.464, 163.465, 163.466,
  428         402.81, and 402.82, F.S., respectively; amending s.
  429         443.111, F.S.; conforming a cross-reference; directing
  430         the Agency for Health Care Administration to submit a
  431         reorganization plan to the Legislature; providing for
  432         the state’s withdrawal from the Medicaid program under
  433         certain circumstances; providing for severability;
  434         providing an effective date.
  435  
  436  Be It Enacted by the Legislature of the State of Florida:
  437  
  438         Section 1. Present subsections (7) and (8) of section
  439  393.0661, Florida Statutes, are redesignated as subsections (8)
  440  and (9), respectively, a new subsection (7) is added to that
  441  section, and present subsection (7) of that section is amended,
  442  to read:
  443         393.0661 Home and community-based services delivery system;
  444  comprehensive redesign.—The Legislature finds that the home and
  445  community-based services delivery system for persons with
  446  developmental disabilities and the availability of appropriated
  447  funds are two of the critical elements in making services
  448  available. Therefore, it is the intent of the Legislature that
  449  the Agency for Persons with Disabilities shall develop and
  450  implement a comprehensive redesign of the system.
  451         (7) The agency shall impose and collect the fee authorized
  452  by s. 409.906(13)(d) upon approval by the Centers for Medicare
  453  and Medicaid Services.
  454         (8)(7)Nothing in This section or related in any
  455  administrative rule does not shall be construed to prevent or
  456  limit the Agency for Health Care Administration, in consultation
  457  with the Agency for Persons with Disabilities, from adjusting
  458  fees, reimbursement rates, lengths of stay, number of visits, or
  459  number of services, or from limiting enrollment, or making any
  460  other adjustment necessary to comply with the availability of
  461  moneys and any limitations or directions provided for in the
  462  General Appropriations Act or pursuant to s. 409.9022.
  463         Section 2. The Division of Statutory Revision is requested
  464  to designate ss. 409.016-409.803, Florida Statutes, as part I of
  465  chapter 409, Florida Statutes, entitled “SOCIAL AND ECONOMIC
  466  ASSISTANCE.
  467         Section 3. Section 409.016, Florida Statutes, is amended to
  468  read:
  469         409.016 Definitions.—As used in this part, the term
  470  chapter:
  471         (1) “Department,unless otherwise specified, means the
  472  Department of Children and Family Services.
  473         (2) “Secretary” means the Secretary of the Department of
  474  Children and Family Services.
  475         (3) “Social and economic services,within the meaning of
  476  this chapter, means the providing of financial assistance as
  477  well as preventive and rehabilitative social services for
  478  children, adults, and families.
  479         Section 4. Section 409.16713, Florida Statutes, is created
  480  to read:
  481         409.16713 Medical assistance for children in out-of-home
  482  care and adopted children.—
  483         (1) A child who is eligible under Title IV-E of the Social
  484  Security Act, as amended, for subsidized board payments, foster
  485  care, or adoption subsidies, and a child for whom the state has
  486  assumed temporary or permanent responsibility and who does not
  487  qualify for Title IV-E assistance but is in foster care, shelter
  488  or emergency shelter care, or subsidized adoption is eligible
  489  for medical assistance as provided in s. 409.903(4). This
  490  includes a young adult who is eligible to receive services under
  491  s. 409.1451(5) until the young adult reaches 21 years of age,
  492  and a person who was eligible, as a child, under Title IV-E for
  493  foster care or the state-provided foster care and who is a
  494  participant in the Road-to-Independence Program.
  495         (2) If medical assistance under Title XIX of the Social
  496  Security Act, as amended, is not available due to the refusal of
  497  the federal Department of Health and Human Services to provide
  498  federal funds, a child or young adult described in subsection
  499  (1) is eligible for medical services under the Medicaid managed
  500  care program established in s. 409.963. Such medical assistance
  501  shall be obtained by the community-based care lead agencies
  502  established under s. 409.1671 and is subject to the availability
  503  of funds appropriated for such purpose in the General
  504  Appropriations Act.
  505         (3) It is the intent of the Legislature that the provision
  506  of medical assistance meet the requirements of s. 471(a)(21) of
  507  the Social Security Act, as amended, 42 U.S.C. s. 671(a)(21),
  508  related to eligibility for Title IV-E of the Social Security
  509  Act, and that compliance with such provisions meet the
  510  requirements of s. 402(a)(3) of the Social Security Act, as
  511  amended, 42 U.S.C. s. 602(a)(3), relating to the Temporary
  512  Assistance for Needy Families Block Grant Program.
  513         Section 5. The Division of Statutory Revision is requested
  514  to designate ss. 409.810-409.821, Florida Statutes, as part II
  515  of chapter 409, Florida Statutes, entitled “KIDCARE.
  516         Section 6. Section 624.91, Florida Statutes, is
  517  transferred, renumbered as section 409.8115, Florida Statutes,
  518  paragraph (b) of subsection (5) of that section is amended, and
  519  subsection (8) is added to that section, to read:
  520         409.8115 624.91 The Florida Healthy Kids Corporation Act.—
  521         (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
  522         (b) The Florida Healthy Kids Corporation shall:
  523         1. Arrange for the collection of any family, local
  524  contributions, or employer payment or premium, in an amount to
  525  be determined by the board of directors, to provide for payment
  526  of premiums for comprehensive insurance coverage and for the
  527  actual or estimated administrative expenses.
  528         2. Arrange for the collection of any voluntary
  529  contributions to provide for payment of Florida Kidcare program
  530  premiums for children who are not eligible for medical
  531  assistance under Title XIX or Title XXI of the Social Security
  532  Act.
  533         3. Subject to the provisions of s. 409.8134, accept
  534  voluntary supplemental local match contributions that comply
  535  with the requirements of Title XXI of the Social Security Act
  536  for the purpose of providing additional Florida Kidcare coverage
  537  in contributing counties under Title XXI.
  538         4. Establish the administrative and accounting procedures
  539  for the operation of the corporation.
  540         5. Establish, with consultation from appropriate
  541  professional organizations, standards for preventive health
  542  services and providers and comprehensive insurance benefits
  543  appropriate to children if, provided that such standards for
  544  rural areas do shall not limit primary care providers to board
  545  certified pediatricians.
  546         6. Determine eligibility for children seeking to
  547  participate in the Title XXI-funded components of the Florida
  548  Kidcare program consistent with the requirements specified in s.
  549  409.814, as well as the non-Title-XXI-eligible children as
  550  provided in subsection (3).
  551         7. Establish procedures under which providers of local
  552  match to, applicants to, and participants in the program may
  553  have grievances reviewed by an impartial body and reported to
  554  the board of directors of the corporation.
  555         8. Establish participation criteria and, if appropriate,
  556  contract with an authorized insurer, health maintenance
  557  organization, or third-party administrator to provide
  558  administrative services to the corporation.
  559         9. Establish enrollment criteria that include penalties or
  560  30-day waiting periods of 30 days for reinstatement of coverage
  561  upon voluntary cancellation for nonpayment of family premiums.
  562         10. Contract with authorized insurers or providers any
  563  provider of health care services, who meet meeting standards
  564  established by the corporation, for the provision of
  565  comprehensive insurance coverage to participants. Such standards
  566  must shall include criteria under which the corporation may
  567  contract with more than one provider of health care services in
  568  program sites. Health plans shall be selected through a
  569  competitive bid process. The Florida Healthy Kids Corporation
  570  shall purchase goods and services in the most cost-effective
  571  manner consistent with the delivery of quality medical care. The
  572  maximum administrative cost for a Florida Healthy Kids
  573  Corporation contract shall be 10 15 percent. For health care
  574  contracts, the minimum medical loss ratio for a Florida Healthy
  575  Kids Corporation contract shall be 90 85 percent. For dental
  576  contracts, the remaining compensation to be paid to the
  577  authorized insurer or provider must be at least 90 under a
  578  Florida Healthy Kids Corporation contract shall be no less than
  579  an amount which is 85 percent of the premium, and; to the extent
  580  any contract provision does not provide for this minimum
  581  compensation, this section prevails shall prevail. The health
  582  plan selection criteria and scoring system, and the scoring
  583  results, shall be available upon request for inspection after
  584  the bids have been awarded.
  585         11. Establish disenrollment criteria if in the event local
  586  matching funds are insufficient to cover enrollments.
  587         12. Develop and implement a plan to publicize the Florida
  588  Kidcare program, the eligibility requirements of the program,
  589  and the procedures for enrollment in the program and to maintain
  590  public awareness of the corporation and the program. Such plan
  591  must include using the application form for the school lunch and
  592  breakfast programs as provided under s. 1006.06(7).
  593         13. Secure staff necessary to properly administer the
  594  corporation. Staff costs shall be funded from state and local
  595  matching funds and such other private or public funds as become
  596  available. The board of directors shall determine the number of
  597  staff members necessary to administer the corporation.
  598         14. In consultation with the partner agencies, provide an
  599  annual a report on the Florida Kidcare program annually to the
  600  Governor, the Chief Financial Officer, the Commissioner of
  601  Education, the President of the Senate, the Speaker of the House
  602  of Representatives, and the Minority Leaders of the Senate and
  603  the House of Representatives.
  604         15. Provide information on a quarterly basis to the
  605  Legislature and the Governor which compares the costs and
  606  utilization of the full-pay enrolled population and the Title
  607  XXI-subsidized enrolled population in the Florida Kidcare
  608  program. The information, At a minimum, the information must
  609  include:
  610         a. The monthly enrollment and expenditure for full-pay
  611  enrollees in the Medikids and Florida Healthy Kids programs
  612  compared to the Title XXI-subsidized enrolled population; and
  613         b. The costs and utilization by service of the full-pay
  614  enrollees in the Medikids and Florida Healthy Kids programs and
  615  the Title XXI-subsidized enrolled population.
  616  
  617  By February 1, 2010, the Florida Healthy Kids Corporation shall
  618  provide a study to the Legislature and the Governor on premium
  619  impacts to the subsidized portion of the program from the
  620  inclusion of the full-pay program, which must shall include
  621  recommendations on how to eliminate or mitigate possible impacts
  622  to the subsidized premiums.
  623         16. Establish benefit packages that conform to the
  624  provisions of the Florida Kidcare program, as created under this
  625  part in ss. 409.810-409.821.
  626         (8) OPERATING FUND.—The Florida Healthy Kids Corporation
  627  may establish and manage an operating fund for the purposes of
  628  addressing the corporation’s unique cash-flow needs and
  629  facilitating the fiscal management of the corporation. At any
  630  given time, the corporation may accumulate and maintain in the
  631  operating fund a cash balance reserve equal to no more than 25
  632  percent of its annualized operating expenses. Upon dissolution
  633  of the corporation, any remaining cash balances of state funds
  634  shall revert to the General Revenue Fund, or such other state
  635  funds consistent with the appropriated funding, as provided by
  636  law.
  637         Section 7. Subsection (1) of section 409.813, Florida
  638  Statutes, is amended to read:
  639         409.813 Health benefits coverage; program components;
  640  entitlement and nonentitlement.—
  641         (1) The Florida Kidcare program includes health benefits
  642  coverage provided to children through the following program
  643  components, which shall be marketed as the Florida Kidcare
  644  program:
  645         (a) Medicaid.;
  646         (b) Medikids as created in s. 409.8132.;
  647         (c) The Florida Healthy Kids Corporation as created in s.
  648  409.8115. 624.91;
  649         (d) Employer-sponsored group health insurance plans
  650  approved under this part. ss. 409.810-409.821; and
  651         (e) The Children’s Medical Services network established in
  652  chapter 391.
  653         Section 8. Subsection (4) of section 409.8132, Florida
  654  Statutes, is amended to read:
  655         409.8132 Medikids program component.—
  656         (4) APPLICABILITY OF LAWS RELATING TO MEDICAID.—The
  657  provisions of ss. 409.902, 409.905, 409.906, 409.907, 409.908,
  658  409.912, 409.9121, 409.9122, 409.9123, 409.9124, 409.9127,
  659  409.9128, 409.913, 409.916, 409.919, 409.920, and 409.9205,
  660  409.987, 409.988, and 409.989 apply to the administration of the
  661  Medikids program component of the Florida Kidcare program,
  662  except that s. 409.987 409.9122 applies to Medikids as modified
  663  by the provisions of subsection (7).
  664         Section 9. Subsection (1) of section 409.815, Florida
  665  Statutes, is amended to read:
  666         409.815 Health benefits coverage; limitations.—
  667         (1) MEDICAID BENEFITS.—For purposes of the Florida Kidcare
  668  program, benefits available under Medicaid and Medikids include
  669  those goods and services provided under the medical assistance
  670  program authorized by Title XIX of the Social Security Act, and
  671  regulations thereunder, as administered in this state by the
  672  agency. This includes those mandatory Medicaid services
  673  authorized under s. 409.905 and optional Medicaid services
  674  authorized under s. 409.906, rendered on behalf of eligible
  675  individuals by qualified providers, in accordance with federal
  676  requirements for Title XIX, subject to any limitations or
  677  directions provided for in the General Appropriations Act, or
  678  chapter 216, or s. 409.9022, and according to methodologies and
  679  limitations set forth in agency rules and policy manuals and
  680  handbooks incorporated by reference thereto.
  681         Section 10. Subsection (5) of section 409.818, Florida
  682  Statutes, is amended to read:
  683         409.818 Administration.—In order to implement ss. 409.810
  684  409.821, the following agencies shall have the following duties:
  685         (5) The Florida Healthy Kids Corporation shall retain its
  686  functions as authorized in s. 409.8115 624.91, including
  687  eligibility determination for participation in the Healthy Kids
  688  program.
  689         Section 11. Paragraph (e) of subsection (2) of section
  690  154.503, Florida Statutes, is amended to read:
  691         154.503 Primary Care for Children and Families Challenge
  692  Grant Program; creation; administration.—
  693         (2) The department shall:
  694         (e) Coordinate with the primary care program developed
  695  pursuant to s. 154.011, the Florida Healthy Kids Corporation
  696  program created in s. 409.8115 624.91, the school health
  697  services program created in ss. 381.0056 and 381.0057, the
  698  Healthy Communities, Healthy People Program created in s.
  699  381.734, and the volunteer health care provider program
  700  established developed pursuant to s. 766.1115.
  701         Section 12. Paragraph (c) of subsection (4) of section
  702  408.915, Florida Statutes, is amended to read:
  703         408.915 Eligibility pilot project.—The Agency for Health
  704  Care Administration, in consultation with the steering committee
  705  established in s. 408.916, shall develop and implement a pilot
  706  project to integrate the determination of eligibility for health
  707  care services with information and referral services.
  708         (4) The pilot project shall include eligibility
  709  determinations for the following programs:
  710         (c) Florida Healthy Kids as described in s. 409.8115 624.91
  711  and within eligibility guidelines provided in s. 409.814.
  712         Section 13. Subsection (7) is added to section 1006.06,
  713  Florida Statutes, to read:
  714         1006.06 School food service programs.—
  715         (7)Each school district shall collaborate with the Florida
  716  Kidcare program created pursuant to ss. 409.810-409.821 to:
  717         (a)At a minimum:
  718         1.Provide application information about the Kidcare
  719  program or an application for Kidcare to students at the
  720  beginning of each school year.
  721         2.Modify the school district’s application form for the
  722  lunch program under subsection (4) and the breakfast program
  723  under subsection (5) to incorporate a provision that permits the
  724  school district to share data from the application form with the
  725  state agencies and the Florida Healthy Kids Corporation and its
  726  agents that administer the Kidcare program unless the child’s
  727  parent or guardian opts out of the provision.
  728         (b)At the option of the school district, share income and
  729  other demographic data through an electronic interchange with
  730  the Florida Healthy Kids Corporation and other state agencies in
  731  order to determine eligibility for the Kidcare program on a
  732  regular and periodic basis.
  733         (c)Establish interagency agreements ensuring that data
  734  exchanged under this subsection is used only to enroll eligible
  735  children in the Florida Kidcare program and is protected from
  736  unauthorized disclosure pursuant to 42 U.S.C. s. 1758(b)(6).
  737         Section 14. The Division of Statutory Revision is requested
  738  to designate ss. 409.901 through 409.9205, Florida Statutes, as
  739  part III of chapter 409, Florida Statutes, entitled “MEDICAID.
  740         Section 15. Section 409.901, Florida Statutes, is amended
  741  to read:
  742         409.901 Definitions; ss. 409.901-409.920.—As used in this
  743  part and part IV ss. 409.901-409.920, except as otherwise
  744  specifically provided, the term:
  745         (1) “Affiliate” or “affiliated person” means any person who
  746  directly or indirectly manages, controls, or oversees the
  747  operation of a corporation or other business entity that is a
  748  Medicaid provider, regardless of whether such person is a
  749  partner, shareholder, owner, officer, director, agent, or
  750  employee of the entity.
  751         (2) “Agency” means the Agency for Health Care
  752  Administration. The agency is the Medicaid agency for the state,
  753  as provided under federal law.
  754         (3) “Applicant” means an individual whose written
  755  application for medical assistance provided by Medicaid under
  756  ss. 409.903-409.906 has been submitted to the Department of
  757  Children and Family Services, or to the Social Security
  758  Administration if the application is for Supplemental Security
  759  Income, but has not received final action. The This term
  760  includes an individual, who need not be alive at the time of
  761  application, and whose application is submitted through a
  762  representative or a person acting for the individual.
  763         (4) “Benefit” means any benefit, assistance, aid,
  764  obligation, promise, debt, liability, or the like, related to
  765  any covered injury, illness, or necessary medical care, goods,
  766  or services.
  767         (5) “Capitation” means a prospective per-member, per-month
  768  payment designed to represent, in the aggregate, an actuarially
  769  sound estimate of expenditures required for the management and
  770  provision of a specified set of medical services or long-term
  771  care services needed by members enrolled in a prepaid health
  772  plan.
  773         (6)(5) “Change of ownership” has the same meaning as in s.
  774  408.803 and includes means:
  775         (a) An event in which the provider ownership changes to a
  776  different individual entity as evidenced by a change in federal
  777  employer identification number or taxpayer identification
  778  number;
  779         (b) An event in which 51 percent or more of the ownership,
  780  shares, membership, or controlling interest of a provider is in
  781  any manner transferred or otherwise assigned. This paragraph
  782  does not apply to a licensee that is publicly traded on a
  783  recognized stock exchange; or
  784         (c) When the provider is licensed or registered by the
  785  agency, an event considered a change of ownership under part II
  786  of chapter 408 for licensure as defined in s. 408.803.
  787  
  788  A change solely in the management company or board of directors
  789  is not a change of ownership.
  790         (7)(6) “Claim” means any communication, whether written or
  791  electronic (electronic impulse or magnetic), which is used by
  792  any person to apply for payment from the Medicaid program, or
  793  its fiscal agent, or a qualified plan under part IV of this
  794  chapter for each item or service purported by any person to have
  795  been provided by a person to a any Medicaid recipient.
  796         (8)(7) “Collateral” means:
  797         (a) Any and all causes of action, suits, claims,
  798  counterclaims, and demands that accrue to a the recipient or to
  799  a the recipient’s legal representative, related to any covered
  800  injury, illness, or necessary medical care, goods, or services
  801  that resulted in necessitated that Medicaid providing provide
  802  medical assistance.
  803         (b) All judgments, settlements, and settlement agreements
  804  rendered or entered into and related to such causes of action,
  805  suits, claims, counterclaims, demands, or judgments.
  806         (c) Proceeds, as defined in this section.
  807         (9)(8) “Convicted” or “conviction” means a finding of
  808  guilt, with or without an adjudication of guilt, in any federal
  809  or state trial court of record relating to charges brought by
  810  indictment or information, as a result of a jury verdict,
  811  nonjury trial, or entry of a plea of guilty or nolo contendere,
  812  regardless of whether an appeal from judgment is pending.
  813         (10)(9) “Covered injury or illness” means any sickness,
  814  injury, disease, disability, deformity, abnormality disease,
  815  necessary medical care, pregnancy, or death for which a third
  816  party is, may be, could be, should be, or has been liable, and
  817  for which Medicaid is, or may be, obligated to provide, or has
  818  provided, medical assistance.
  819         (11)(10) “Emergency medical condition” has the same meaning
  820  as in s. 395.002. means:
  821         (a) A medical condition manifesting itself by acute
  822  symptoms of sufficient severity, which may include severe pain
  823  or other acute symptoms, such that the absence of immediate
  824  medical attention could reasonably be expected to result in any
  825  of the following:
  826         1. Serious jeopardy to the health of a patient, including a
  827  pregnant woman or a fetus.
  828         2. Serious impairment to bodily functions.
  829         3. Serious dysfunction of any bodily organ or part.
  830         (b) With respect to a pregnant woman:
  831         1. That there is inadequate time to effect safe transfer to
  832  another hospital prior to delivery.
  833         2. That a transfer may pose a threat to the health and
  834  safety of the patient or fetus.
  835         3. That there is evidence of the onset and persistence of
  836  uterine contractions or rupture of the membranes.
  837         (12)(11) “Emergency services and care” has the same meaning
  838  as in s. 395.002 means medical screening, examination, and
  839  evaluation by a physician, or, to the extent permitted by
  840  applicable laws, by other appropriate personnel under the
  841  supervision of a physician, to determine whether an emergency
  842  medical condition exists and, if it does, the care, treatment,
  843  or surgery for a covered service by a physician which is
  844  necessary to relieve or eliminate the emergency medical
  845  condition, within the service capability of a hospital.
  846         (13)(12) “Legal representative” means a guardian,
  847  conservator, survivor, or personal representative of a recipient
  848  or applicant, or of the property or estate of a recipient or
  849  applicant.
  850         (14)(13) “Managed care plan” means a health insurer
  851  authorized under chapter 624, an exclusive provider organization
  852  authorized under chapter 627, a health maintenance organization
  853  authorized under chapter 641, a provider service network
  854  authorized under s. 409.912(4)(d), or an accountable care
  855  organization authorized under federal law health maintenance
  856  organization authorized pursuant to chapter 641 or a prepaid
  857  health plan authorized pursuant to s. 409.912.
  858         (15)(14) “Medicaid” or Medicaid program means the medical
  859  assistance program authorized by Title XIX of the Social
  860  Security Act, 42 U.S.C. s. 1396 et seq., and regulations
  861  thereunder, as administered in this state by the agency.
  862         (15) “Medicaid agency” or “agency” means the single state
  863  agency that administers or supervises the administration of the
  864  state Medicaid plan under federal law.
  865         (16) “Medicaid program” means the program authorized under
  866  Title XIX of the federal Social Security Act which provides for
  867  payments for medical items or services, or both, on behalf of
  868  any person who is determined by the Department of Children and
  869  Family Services, or, for Supplemental Security Income, by the
  870  Social Security Administration, to be eligible on the date of
  871  service for Medicaid assistance.
  872         (16)(17) “Medicaid provider” or “provider” means a person
  873  or entity that has a Medicaid provider agreement in effect with
  874  the agency and is in good standing with the agency. The term
  875  also includes a person or entity that provides medical services
  876  to a Medicaid recipient under the Medicaid managed care program
  877  in part IV of this chapter.
  878         (17)(18) “Medicaid provider agreement” or “provider
  879  agreement” means a contract between the agency and a provider
  880  for the provision of services or goods, or both, to Medicaid
  881  recipients pursuant to Medicaid.
  882         (18)(19) “Medicaid recipient” or “recipient” means an
  883  individual whom the Department of Children and Family Services,
  884  or, for Supplemental Security Income, by the Social Security
  885  Administration, determines is eligible, pursuant to federal and
  886  state law, to receive medical assistance and related services
  887  for which the agency may make payments under the Medicaid
  888  program. For the purposes of determining third-party liability,
  889  the term includes an individual formerly determined to be
  890  eligible for Medicaid, an individual who has received medical
  891  assistance under the Medicaid program, or an individual on whose
  892  behalf Medicaid has become obligated.
  893         (19)(20) “Medicaid-related records” means records that
  894  relate to the provider’s business or profession and to a
  895  Medicaid recipient. The term includes Medicaid-related records
  896  include records related to non-Medicaid customers, clients, or
  897  patients but only to the extent that the documentation is shown
  898  by the agency to be necessary for determining to determine a
  899  provider’s entitlement to payments under the Medicaid program.
  900         (20)(21) “Medical assistance” means any provision of,
  901  payment for, or liability for medical services or care by
  902  Medicaid to, or on behalf of, a Medicaid any recipient.
  903         (21)(22) “Medical services” or “medical care” means medical
  904  or medically related institutional or noninstitutional care,
  905  goods, or services covered by the Medicaid program. The term
  906  includes any services authorized and funded in the General
  907  Appropriations Act.
  908         (22)(23) “MediPass” means a primary care case management
  909  program operated by the agency.
  910         (23)(24) “Minority physician network” means a network of
  911  primary care physicians with experience in managing Medicaid or
  912  Medicare recipients which that is predominantly owned by
  913  minorities, as defined in s. 288.703, and which may have a
  914  collaborative partnership with a public college or university
  915  and a tax-exempt charitable corporation.
  916         (24)(25) “Payment,” as it relates to third-party benefits,
  917  means performance of a duty, promise, or obligation, or
  918  discharge of a debt or liability, by the delivery, provision, or
  919  transfer of third-party benefits for medical services. To “pay”
  920  means to do any of the acts set forth in this subsection.
  921         (25)(26) “Proceeds” means whatever is received upon the
  922  sale, exchange, collection, or other disposition of the
  923  collateral or proceeds thereon and includes insurance payable by
  924  reason of loss or damage to the collateral or proceeds. Money,
  925  checks, deposit accounts, and the like are “cash proceeds.” All
  926  other proceeds are “noncash proceeds.”
  927         (26)(27) “Third party” means an individual, entity, or
  928  program, excluding Medicaid, that is, may be, could be, should
  929  be, or has been liable for all or part of the cost of medical
  930  services related to any medical assistance covered by Medicaid.
  931  A third party includes a third-party administrator or a pharmacy
  932  benefits manager.
  933         (27)(28) “Third-party benefit” means any benefit that is or
  934  may be available at any time through contract, court award,
  935  judgment, settlement, agreement, or any arrangement between a
  936  third party and any person or entity, including, without
  937  limitation, a Medicaid recipient, a provider, another third
  938  party, an insurer, or the agency, for any Medicaid-covered
  939  injury, illness, goods, or services, including costs of medical
  940  services related thereto, for personal injury or for death of
  941  the recipient, but specifically excluding policies of life
  942  insurance on the recipient, unless available under terms of the
  943  policy to pay medical expenses prior to death. The term
  944  includes, without limitation, collateral, as defined in this
  945  section, health insurance, any benefit under a health
  946  maintenance organization, a preferred provider arrangement, a
  947  prepaid health clinic, liability insurance, uninsured motorist
  948  insurance or personal injury protection coverage, medical
  949  benefits under workers’ compensation, and any obligation under
  950  law or equity to provide medical support.
  951         Section 16. Section 409.902, Florida Statutes, is amended
  952  to read:
  953         409.902 Designated single state agency; eligibility
  954  determinations; rules payment requirements; program title;
  955  release of medical records.—
  956         (1) The agency for Health Care Administration is designated
  957  as the single state agency authorized to administer the Medicaid
  958  state plan and to make payments for medical assistance and
  959  related services under Title XIX of the Social Security Act.
  960  These payments shall be made, subject to any limitations or
  961  directions provided for in the General Appropriations Act, only
  962  for services included in the Medicaid program, shall be made
  963  only on behalf of eligible individuals, and shall be made only
  964  to qualified providers in accordance with federal requirements
  965  under for Title XIX of the Social Security Act and the
  966  provisions of state law.
  967         (a) The agency must notify the Legislature before seeking
  968  an amendment to the state plan for purposes of implementing
  969  provisions authorized by the Deficit Reduction Act of 2005.
  970         (b) The agency shall adopt any rules necessary to carry out
  971  its statutory duties under this subsection and any other
  972  statutory provisions related to its responsibility for the
  973  Medicaid program and state compliance with federal Medicaid
  974  requirements, including the Medicaid managed care program. This
  975  program of medical assistance is designated the “Medicaid
  976  program.”
  977         (2) The Department of Children and Family Services is
  978  responsible for determining Medicaid eligibility determinations,
  979  including, but not limited to, policy, rules, and the agreement
  980  with the Social Security Administration for Medicaid eligibility
  981  determinations for Supplemental Security Income recipients, as
  982  well as the actual determination of eligibility. As a condition
  983  of Medicaid eligibility, subject to federal approval, the agency
  984  for Health Care Administration and the Department of Children
  985  and Family Services shall ensure that each recipient of Medicaid
  986  consents to the release of her or his medical records to the
  987  agency for Health Care Administration and the Medicaid Fraud
  988  Control Unit of the Department of Legal Affairs.
  989         (a) Eligibility is restricted to United States citizens and
  990  to lawfully admitted noncitizens who meet the criteria provided
  991  in s. 414.095(3).
  992         1. Citizenship or immigration status must be verified. For
  993  noncitizens, this includes verification of the validity of
  994  documents with the United States Citizenship and Immigration
  995  Services using the federal SAVE verification process.
  996         2. State funds may not be used to provide medical services
  997  to individuals who do not meet the requirements of this
  998  paragraph unless the services are necessary to treat an
  999  emergency medical condition or are for pregnant women. Such
 1000  services are authorized only to the extent provided under
 1001  federal law and in accordance with federal regulations as
 1002  provided in 42 C.F.R. s. 440.255.
 1003         (b) When adopting rules relating to eligibility for
 1004  institutional care services, hospice services, and home and
 1005  community-based waiver programs, and regardless of whether a
 1006  penalty will be applied due to the unlawful transfer of assets,
 1007  the payment of fair compensation by an applicant for a personal
 1008  care services contract entered into on or after October 1, 2011,
 1009  shall be evaluated using the following criteria:
 1010         1. The contracted services do not duplicate services
 1011  available through other sources or providers, such as Medicaid,
 1012  Medicare, private insurance, or another legally obligated third
 1013  party;
 1014         2. The contracted services directly benefit the individual
 1015  and are not services normally provided out of love and
 1016  consideration for the individual;
 1017         3. The actual cost to deliver services is computed in a
 1018  manner that clearly reflects the actual number of hours to be
 1019  expended, and the contract clearly identifies each specific
 1020  service and the average number of hours of each service to be
 1021  delivered each month;
 1022         4. The hourly rate for each contracted service is equal to
 1023  or less than the amount normally charged by a professional who
 1024  traditionally provides the same or similar services;
 1025         5. The contracted services are provided on a prospective
 1026  basis only and not for services provided in the past; and
 1027         6. The contract provides fair compensation to the
 1028  individual in his or her lifetime as set forth in life
 1029  expectancy tables adopted in rule 65A-1.716, Florida
 1030  Administrative Code.
 1031         (c) The department shall adopt any rules necessary to carry
 1032  out its statutory duties under this subsection for receiving and
 1033  processing Medicaid applications and determining Medicaid
 1034  eligibility, and any other statutory provisions related to
 1035  responsibility for the determination of Medicaid eligibility.
 1036         Section 17. Section 409.9021, Florida Statutes, is amended
 1037  to read:
 1038         409.9021 Conditions for Medicaid Forfeiture of eligibility
 1039  agreement.—As a condition of Medicaid eligibility, subject to
 1040  federal regulation and approval:,
 1041         (1) A Medicaid applicant must consent shall agree in
 1042  writing to:
 1043         (a) Have her or his medical records released to the agency
 1044  and the Medicaid Fraud Control Unit of the Department of Legal
 1045  Affairs.
 1046         (b) Forfeit all entitlements to any goods or services
 1047  provided through the Medicaid program for the next 10 years if
 1048  he or she has been found to have committed Medicaid fraud,
 1049  through judicial or administrative determination, two times in a
 1050  period of 5 years. This provision applies only to the Medicaid
 1051  recipient found to have committed or participated in Medicaid
 1052  the fraud and does not apply to any family member of the
 1053  recipient who was not involved in the fraud.
 1054         (2) A Medicaid applicant must pay a $10 monthly premium
 1055  that covers all Medicaid-eligible recipients in the applicant’s
 1056  family. However, an individual who is eligible for the
 1057  Supplemental Security Income related Medicaid and is receiving
 1058  institutional care payments is exempt from this requirement. The
 1059  agency shall seek a federal waiver to authorize the imposition
 1060  and collection of this premium effective December 31, 2011. Upon
 1061  approval, the agency shall establish by rule procedures for
 1062  collecting premiums from recipients, advance notice of
 1063  cancellation, and waiting periods for reinstatement of coverage
 1064  upon voluntary cancellation for nonpayment of premiums.
 1065         (3) A Medicaid applicant must participate, in good faith,
 1066  in:
 1067         (a) A medically approved smoking cessation program if the
 1068  applicant smokes.
 1069         (b) A medically directed weight loss program if the
 1070  applicant is or becomes morbidly obese.
 1071         (c) A medically approved alcohol or substance abuse
 1072  recovery program if the applicant is or becomes diagnosed as a
 1073  substance abuser.
 1074  
 1075  The agency shall seek a federal waiver to authorize the
 1076  implementation of this subsection in order to assist the
 1077  recipient in mitigating lifestyle choices and avoiding behaviors
 1078  associated with the use of high-cost medical services.
 1079         (4)A person who is eligible for Medicaid services and who
 1080  has access to health care coverage through an employer-sponsored
 1081  health plan may not receive Medicaid services reimbursed under
 1082  s. 409.908, s. 409.912,or s. 409.986, but may use Medicaid
 1083  financial assistance to pay the cost of premiums for the
 1084  employer-sponsored health plan for the eligible person and his
 1085  or her Medicaid-eligible family members.
 1086         (5) A Medicaid recipient who has access to other insurance
 1087  or coverage created pursuant to state or federal law may opt out
 1088  of the Medicaid services provided under s. 409.908, s. 409.912,
 1089  or s. 409.986 and use Medicaid financial assistance to pay the
 1090  cost of premiums for the recipient and the recipient’s Medicaid
 1091  eligible family members.
 1092         (6) Subsections (4) and (5) shall be administered by the
 1093  agency in accordance with s. 409.964(1)(j). The maximum amount
 1094  available for the Medicaid financial assistance shall be
 1095  calculated based on the Medicaid capitated rate as if the
 1096  Medicaid recipient and the recipient’s eligible family members
 1097  participated in a qualified plan for Medicaid managed care under
 1098  part IV of this chapter.
 1099         Section 18. Section 409.9022, Florida Statutes, is created
 1100  to read:
 1101         409.9022 Limitations on Medicaid expenditures.—
 1102         (1) Except as specifically authorized in this section, a
 1103  state agency may not obligate or expend funds for the Medicaid
 1104  program in excess of the amount appropriated in the General
 1105  Appropriations Act.
 1106         (2) If, at any time during the fiscal year, a state agency
 1107  determines that Medicaid expenditures may exceed the amount
 1108  appropriated during the fiscal year, the state agency shall
 1109  notify the Social Services Estimating Conference, which shall
 1110  meet to estimate Medicaid expenditures for the remainder of the
 1111  fiscal year. If, pursuant to this paragraph or for any other
 1112  purpose, the conference determines that Medicaid expenditures
 1113  will exceed appropriations for the fiscal year, the state agency
 1114  shall develop and submit a plan for revising Medicaid
 1115  expenditures in order to remain within the annual appropriation.
 1116  The plan must include cost-mitigating strategies to negate the
 1117  projected deficit for the remainder of the fiscal year and shall
 1118  be submitted in the form of a budget amendment to the
 1119  Legislative Budget Commission. The conference shall also
 1120  estimate the amount of savings which will result from such cost
 1121  mitigating strategies proposed by the state agency as well as
 1122  any other strategies the conference may consider and recommend.
 1123         (3) In preparing the budget amendment to revise Medicaid
 1124  expenditures in order to remain within appropriations, a state
 1125  agency shall include the following revisions to the Medicaid
 1126  state plan, in the priority order listed below:
 1127         (a) Reduction in administrative costs.
 1128         (b) Elimination of optional benefits.
 1129         (c) Elimination of optional eligibility groups.
 1130         (d) Reduction to institutional and provider reimbursement
 1131  rates.
 1132         (e) Reduction in the amount, duration, and scope of
 1133  mandatory benefits.
 1134  
 1135  The state agency may not implement any of these cost-containment
 1136  measures until the amendment is approved by the Legislative
 1137  Budget Commission.
 1138         (4) In order to remedy a projected expenditure in excess of
 1139  the amount appropriated in a specific appropriation within the
 1140  Medicaid budget, a state agency may, consistent with chapter
 1141  216:
 1142         (a) Submit a budget amendment to transfer budget authority
 1143  between appropriation categories;
 1144         (b) Submit a budget amendment to increase federal trust
 1145  authority or grants and donations trust authority if additional
 1146  federal or local funds are available; or
 1147         (c) Submit any other budget amendment consistent with
 1148  chapter 216.
 1149         (5) The agency shall amend the Medicaid state plan to
 1150  incorporate the provisions of this section.
 1151         (6) Chapter 216 does not permit the transfer of funds from
 1152  any other program into the Medicaid program or the transfer of
 1153  funds out of the Medicaid program into any other program.
 1154         Section 19. Section 409.903, Florida Statutes, is amended
 1155  to read:
 1156         409.903 Mandatory payments for eligible persons.—The agency
 1157  shall make payments for medical assistance and related services
 1158  on behalf of the following categories of persons who the
 1159  Department of Children and Family Services, or the Social
 1160  Security Administration by contract with the department of
 1161  Children and Family Services, determines to be eligible for
 1162  Medicaid, subject to the income, assets, and categorical
 1163  eligibility tests set forth in federal and state law. Payment on
 1164  behalf of these recipients Medicaid eligible persons is subject
 1165  to the availability of moneys and any limitations established by
 1166  the General Appropriations Act, or chapter 216, or s. 409.9022.
 1167         (1) Low-income families with children if are eligible for
 1168  Medicaid provided they meet the following requirements:
 1169         (a) The family includes a dependent child who is living
 1170  with a caretaker relative.
 1171         (b) The family’s income does not exceed the gross income
 1172  test limit.
 1173         (c) The family’s countable income and resources do not
 1174  exceed the applicable Aid to Families with Dependent Children
 1175  (AFDC) income and resource standards under the AFDC state plan
 1176  in effect on in July 1996, except as amended in the Medicaid
 1177  state plan to conform as closely as possible to the requirements
 1178  of the welfare transition program, to the extent permitted by
 1179  federal law.
 1180         (2) A person who receives payments from, who is determined
 1181  eligible for, or who was eligible for but lost cash benefits
 1182  from the federal program known as the Supplemental Security
 1183  Income program (SSI). This category includes a low-income person
 1184  age 65 or over and a low-income person under age 65 considered
 1185  to be permanently and totally disabled.
 1186         (3) A child under age 21 living in a low-income, two-parent
 1187  family, and a child under age 7 living with a nonrelative, if
 1188  the income and assets of the family or child, as applicable, do
 1189  not exceed the resource limits under the Temporary Cash
 1190  Assistance Program.
 1191         (4) A child who is eligible under Title IV-E of the Social
 1192  Security Act for subsidized board payments, foster care, or
 1193  adoption subsidies, and a child for whom the state has assumed
 1194  temporary or permanent responsibility and who does not qualify
 1195  for Title IV-E assistance but is in foster care, shelter or
 1196  emergency shelter care, or subsidized adoption. This category
 1197  includes a young adult who is eligible to receive services under
 1198  s. 409.1451(5), until the young adult reaches 21 years of age,
 1199  without regard to any income, resource, or categorical
 1200  eligibility test that is otherwise required. This category also
 1201  includes a person who as a child was eligible under Title IV-E
 1202  of the Social Security Act for foster care or the state-provided
 1203  foster care and who is a participant in the Road-to-Independence
 1204  Program.
 1205         (5) A pregnant woman for the duration of her pregnancy and
 1206  for the postpartum period as defined in federal law and rule, or
 1207  a child under age 1, if either is living in a family that has an
 1208  income which is at or below 150 percent of the most current
 1209  federal poverty level, or, effective January 1, 1992, that has
 1210  an income which is at or below 185 percent of the most current
 1211  federal poverty level. Such a person is not subject to an assets
 1212  test. Further, A pregnant woman who applies for eligibility for
 1213  the Medicaid program through a qualified Medicaid provider must
 1214  be offered the opportunity, subject to federal rules, to be made
 1215  presumptively eligible for the Medicaid program.
 1216         (6) A child born after September 30, 1983, living in a
 1217  family that has an income which is at or below 100 percent of
 1218  the current federal poverty level, who has attained the age of
 1219  6, but has not attained the age of 19. In determining the
 1220  eligibility of such a child, an assets test is not required. A
 1221  child who is eligible for Medicaid under this subsection must be
 1222  offered the opportunity, subject to federal rules, to be made
 1223  presumptively eligible. A child who has been deemed
 1224  presumptively eligible may for Medicaid shall not be enrolled in
 1225  a managed care plan until the child’s full eligibility
 1226  determination for Medicaid has been determined completed.
 1227         (7) A child living in a family that has an income that
 1228  which is at or below 133 percent of the current federal poverty
 1229  level, who has attained the age of 1, but has not attained the
 1230  age of 6. In determining the eligibility of such a child, an
 1231  assets test is not required. A child who is eligible for
 1232  Medicaid under this subsection must be offered the opportunity,
 1233  subject to federal rules, to be made presumptively eligible. A
 1234  child who has been deemed presumptively eligible may for
 1235  Medicaid shall not be enrolled in a managed care plan until the
 1236  child’s full eligibility determination for Medicaid has been
 1237  determined completed.
 1238         (8) A person who is age 65 or over or is determined by the
 1239  agency to be disabled, whose income is at or below 100 percent
 1240  of the most current federal poverty level and whose assets do
 1241  not exceed limitations established by the agency. However, the
 1242  agency may only pay for premiums, coinsurance, and deductibles,
 1243  as required by federal law, unless additional coverage is
 1244  provided for any or all members of this group under by s.
 1245  409.904(1).
 1246         Section 20. Section 409.904, Florida Statutes, is amended
 1247  to read:
 1248         409.904 Optional payments for eligible persons.—The agency
 1249  may make payments for medical assistance and related services on
 1250  behalf of the following categories of persons who are determined
 1251  to be eligible for Medicaid, subject to the income, assets, and
 1252  categorical eligibility tests set forth in federal and state
 1253  law. Payment on behalf of these Medicaid eligible persons is
 1254  subject to the availability of moneys and any limitations
 1255  established by the General Appropriations Act, or chapter 216,
 1256  or s. 409.9022.
 1257         (1) Effective January 1, 2006, and Subject to federal
 1258  waiver approval, a person who is age 65 or older or is
 1259  determined to be disabled, whose income is at or below 88
 1260  percent of the federal poverty level, whose assets do not exceed
 1261  established limitations, and who is not eligible for Medicare
 1262  or, if eligible for Medicare, is also eligible for and receiving
 1263  Medicaid-covered institutional care services, hospice services,
 1264  or home and community-based services. The agency shall seek
 1265  federal authorization through a waiver to provide this coverage.
 1266  This subsection expires June 30, 2011.
 1267         (2) The following persons who are eligible for the Medicaid
 1268  nonpoverty medical subsidy, which includes the same services as
 1269  those provided to other Medicaid recipients, with the exception
 1270  of services in skilled nursing facilities and intermediate care
 1271  facilities for the developmentally disabled:
 1272         (a) A family, a pregnant woman, a child under age 21, a
 1273  person age 65 or over, or a blind or disabled person, who would
 1274  be eligible under any group listed in s. 409.903(1), (2), or
 1275  (3), except that the income or assets of such family or person
 1276  exceed established limitations. For a family or person in one of
 1277  these coverage groups, medical expenses are deductible from
 1278  income in accordance with federal requirements in order to make
 1279  a determination of eligibility. A family or person eligible
 1280  under the coverage known as the “medically needy,” is eligible
 1281  to receive the same services as other Medicaid recipients, with
 1282  the exception of services in skilled nursing facilities and
 1283  intermediate care facilities for the developmentally disabled.
 1284  This paragraph expires June 30, 2011.
 1285         (b) Effective June 30 July 1, 2011, a pregnant woman or a
 1286  child younger than 21 years of age who would be eligible under
 1287  any group listed in s. 409.903, except that the income or assets
 1288  of such group exceed established limitations. For a person in
 1289  one of these coverage groups, medical expenses are deductible
 1290  from income in accordance with federal requirements in order to
 1291  make a determination of eligibility. A person eligible under the
 1292  coverage known as the “medically needy” is eligible to receive
 1293  the same services as other Medicaid recipients, with the
 1294  exception of services in skilled nursing facilities and
 1295  intermediate care facilities for the developmentally disabled.
 1296         (c)A family, a person age 65 or older, or a blind or
 1297  disabled person, who would be eligible under any group listed in
 1298  s. 409.903(1), (2), or (3), except that the income or assets of
 1299  such family or person exceed established limitations. For a
 1300  family or person in one of these coverage groups, medical
 1301  expenses are deductible from income in accordance with federal
 1302  requirements in order to make a determination of eligibility. A
 1303  family, a person age 65 or older, or a blind or disabled person,
 1304  covered under the Medicaid nonpoverty medical subsidy, is
 1305  eligible to receive physician services only.
 1306         (3) A person who is in need of the services of a licensed
 1307  nursing facility, a licensed intermediate care facility for the
 1308  developmentally disabled, or a state mental hospital, whose
 1309  income does not exceed 300 percent of the SSI income standard,
 1310  and who meets the assets standards established under federal and
 1311  state law. In determining the person’s responsibility for the
 1312  cost of care, the following amounts must be deducted from the
 1313  person’s income:
 1314         (a) The monthly personal allowance for residents as set
 1315  based on appropriations.
 1316         (b) The reasonable costs of medically necessary services
 1317  and supplies that are not reimbursable by the Medicaid program.
 1318         (c) The cost of premiums, copayments, coinsurance, and
 1319  deductibles for supplemental health insurance.
 1320         (4) A low-income person who meets all other requirements
 1321  for Medicaid eligibility except citizenship and who is in need
 1322  of emergency medical services. The eligibility of such a
 1323  recipient is limited to the period of the emergency, in
 1324  accordance with federal regulations.
 1325         (5) Subject to specific federal authorization, a woman
 1326  living in a family that has an income that is at or below 185
 1327  percent of the most current federal poverty level. Coverage is
 1328  limited to is eligible for family planning services as specified
 1329  in s. 409.905(3) for a period of up to 24 months following a
 1330  loss of Medicaid benefits.
 1331         (6) A child who has not attained the age of 19 who has been
 1332  determined eligible for the Medicaid program is deemed to be
 1333  eligible for a total of 6 months, regardless of changes in
 1334  circumstances other than attainment of the maximum age.
 1335  Effective January 1, 1999, A child who has not attained the age
 1336  of 5 and who has been determined eligible for the Medicaid
 1337  program is deemed to be eligible for a total of 12 months
 1338  regardless of changes in circumstances other than attainment of
 1339  the maximum age.
 1340         (7) A child under 1 year of age who lives in a family that
 1341  has an income above 185 percent of the most recently published
 1342  federal poverty level, but which is at or below 200 percent of
 1343  such poverty level. In determining the eligibility of such
 1344  child, an assets test is not required. A child who is eligible
 1345  for Medicaid under this subsection must be offered the
 1346  opportunity, subject to federal rules, to be made presumptively
 1347  eligible.
 1348         (8) An eligible person A Medicaid-eligible individual for
 1349  the individual’s health insurance premiums, if the agency
 1350  determines that such payments are cost-effective.
 1351         (9) Eligible women with incomes at or below 200 percent of
 1352  the federal poverty level and under age 65, for cancer treatment
 1353  pursuant to the federal Breast and Cervical Cancer Prevention
 1354  and Treatment Act of 2000, screened through the Mary Brogan
 1355  Breast and Cervical Cancer Early Detection Program established
 1356  under s. 381.93.
 1357         Section 21. Section 409.905, Florida Statutes, is amended
 1358  to read:
 1359         409.905 Mandatory Medicaid services.—The agency shall may
 1360  make payments for the following services, which are required of
 1361  the state by Title XIX of the Social Security Act, furnished by
 1362  Medicaid providers to recipients who are determined to be
 1363  eligible on the dates on which the services were provided. Any
 1364  service under this section shall be provided only when medically
 1365  necessary and in accordance with state and federal law.
 1366  Mandatory services rendered by providers in mobile units to
 1367  Medicaid recipients may be restricted by the agency. This
 1368  section does not Nothing in this section shall be construed to
 1369  prevent or limit the agency from adjusting fees, reimbursement
 1370  rates, lengths of stay, number of visits, number of services, or
 1371  any other adjustments necessary to comply with the availability
 1372  of moneys and any limitations or directions provided for in the
 1373  General Appropriations Act, or chapter 216, or s. 409.9022.
 1374         (1) ADVANCED REGISTERED NURSE PRACTITIONER SERVICES.—The
 1375  agency shall pay for services provided to a recipient by a
 1376  licensed advanced registered nurse practitioner who has a valid
 1377  collaboration agreement with a licensed physician on file with
 1378  the Department of Health or who provides anesthesia services in
 1379  accordance with established protocol required by state law and
 1380  approved by the medical staff of the facility in which the
 1381  anesthetic service is performed. Reimbursement for such services
 1382  must be provided in an amount that equals at least not less than
 1383  80 percent of the reimbursement to a physician who provides the
 1384  same services, unless otherwise provided for in the General
 1385  Appropriations Act.
 1386         (2) EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT
 1387  SERVICES.—The agency shall pay for early and periodic screening
 1388  and diagnosis of a recipient under age 21 to ascertain physical
 1389  and mental problems and conditions and provide treatment to
 1390  correct or ameliorate these problems and conditions. These
 1391  services include all services determined by the agency to be
 1392  medically necessary for the treatment, correction, or
 1393  amelioration of these problems and conditions, including
 1394  personal care, private duty nursing, durable medical equipment,
 1395  physical therapy, occupational therapy, speech therapy,
 1396  respiratory therapy, and immunizations.
 1397         (3) FAMILY PLANNING SERVICES.—The agency shall pay for
 1398  services necessary to enable a recipient voluntarily to plan
 1399  family size or to space children. These services include
 1400  information; education; counseling regarding the availability,
 1401  benefits, and risks of each method of pregnancy prevention;
 1402  drugs and supplies; and necessary medical care and followup.
 1403  Each recipient participating in the family planning portion of
 1404  the Medicaid program must be provided the choice of freedom to
 1405  choose any alternative method of family planning, as required by
 1406  federal law.
 1407         (4) HOME HEALTH CARE SERVICES.—The agency shall pay for
 1408  nursing and home health aide services, supplies, appliances, and
 1409  durable medical equipment, necessary to assist a recipient
 1410  living at home. An entity that provides such services must
 1411  pursuant to this subsection shall be licensed under part III of
 1412  chapter 400. These services, equipment, and supplies, or
 1413  reimbursement therefor, may be limited as provided in the
 1414  General Appropriations Act and do not include services,
 1415  equipment, or supplies provided to a person residing in a
 1416  hospital or nursing facility.
 1417         (a) In providing home health care services, The agency
 1418  shall may require prior authorization of home health services
 1419  care based on diagnosis, utilization rates, and or billing
 1420  rates. The agency shall require prior authorization for visits
 1421  for home health services that are not associated with a skilled
 1422  nursing visit when the home health agency billing rates exceed
 1423  the state average by 50 percent or more. The home health agency
 1424  must submit the recipient’s plan of care and documentation that
 1425  supports the recipient’s diagnosis to the agency when requesting
 1426  prior authorization.
 1427         (b) The agency shall implement a comprehensive utilization
 1428  management program that requires prior authorization of all
 1429  private duty nursing services, an individualized treatment plan
 1430  that includes information about medication and treatment orders,
 1431  treatment goals, methods of care to be used, and plans for care
 1432  coordination by nurses and other health professionals. The
 1433  utilization management program must shall also include a process
 1434  for periodically reviewing the ongoing use of private duty
 1435  nursing services. The assessment of need shall be based on a
 1436  child’s condition;, family support and care supplements;, a
 1437  family’s ability to provide care;, and a family’s and child’s
 1438  schedule regarding work, school, sleep, and care for other
 1439  family dependents; and a determination of the medical necessity
 1440  for private duty nursing instead of other more cost-effective
 1441  in-home services. When implemented, the private duty nursing
 1442  utilization management program shall replace the current
 1443  authorization program used by the agency for Health Care
 1444  Administration and the Children’s Medical Services program of
 1445  the Department of Health. The agency may competitively bid on a
 1446  contract to select a qualified organization to provide
 1447  utilization management of private duty nursing services. The
 1448  agency may is authorized to seek federal waivers to implement
 1449  this initiative.
 1450         (c) The agency may not pay for home health services unless
 1451  the services are medically necessary and:
 1452         1. The services are ordered by a physician.
 1453         2. The written prescription for the services is signed and
 1454  dated by the recipient’s physician before the development of a
 1455  plan of care and before any request requiring prior
 1456  authorization.
 1457         3. The physician ordering the services is not employed,
 1458  under contract with, or otherwise affiliated with the home
 1459  health agency rendering the services. However, this subparagraph
 1460  does not apply to a home health agency affiliated with a
 1461  retirement community, of which the parent corporation or a
 1462  related legal entity owns a rural health clinic certified under
 1463  42 C.F.R. part 491, subpart A, ss. 1-11, a nursing home licensed
 1464  under part II of chapter 400, or an apartment or single-family
 1465  home for independent living. For purposes of this subparagraph,
 1466  the agency may, on a case-by-case basis, provide an exception
 1467  for medically fragile children who are younger than 21 years of
 1468  age.
 1469         4. The physician ordering the services has examined the
 1470  recipient within the 30 days preceding the initial request for
 1471  the services and biannually thereafter.
 1472         5. The written prescription for the services includes the
 1473  recipient’s acute or chronic medical condition or diagnosis, the
 1474  home health service required, and, for skilled nursing services,
 1475  the frequency and duration of the services.
 1476         6. The national provider identifier, Medicaid
 1477  identification number, or medical practitioner license number of
 1478  the physician ordering the services is listed on the written
 1479  prescription for the services, the claim for home health
 1480  reimbursement, and the prior authorization request.
 1481         (5) HOSPITAL INPATIENT SERVICES.—The agency shall pay for
 1482  all covered services provided for the medical care and treatment
 1483  of a recipient who is admitted as an inpatient by a licensed
 1484  physician or dentist to a hospital licensed under part I of
 1485  chapter 395. However, the agency shall limit the payment for
 1486  inpatient hospital services for a Medicaid recipient 21 years of
 1487  age or older to 45 days or the number of days necessary to
 1488  comply with the General Appropriations Act.
 1489         (a) The agency may is authorized to implement reimbursement
 1490  and utilization management reforms in order to comply with any
 1491  limitations or directions in the General Appropriations Act,
 1492  which may include, but are not limited to: prior authorization
 1493  for inpatient psychiatric days; prior authorization for
 1494  nonemergency hospital inpatient admissions for individuals 21
 1495  years of age and older; authorization of emergency and urgent
 1496  care admissions within 24 hours after admission; enhanced
 1497  utilization and concurrent review programs for highly utilized
 1498  services; reduction or elimination of covered days of service;
 1499  adjusting reimbursement ceilings for variable costs; adjusting
 1500  reimbursement ceilings for fixed and property costs; and
 1501  implementing target rates of increase. The agency may limit
 1502  prior authorization for hospital inpatient services to selected
 1503  diagnosis-related groups, based on an analysis of the cost and
 1504  potential for unnecessary hospitalizations represented by
 1505  certain diagnoses. Admissions for normal delivery and newborns
 1506  are exempt from requirements for prior authorization. In
 1507  implementing the provisions of this section related to prior
 1508  authorization, the agency must shall ensure that the process for
 1509  authorization is accessible 24 hours per day, 7 days per week
 1510  and that authorization is automatically granted if when not
 1511  denied within 4 hours after the request. Authorization
 1512  procedures must include steps for reviewing review of denials.
 1513  Upon implementing the prior authorization program for hospital
 1514  inpatient services, the agency shall discontinue its hospital
 1515  retrospective review program.
 1516         (b) A licensed hospital maintained primarily for the care
 1517  and treatment of patients having mental disorders or mental
 1518  diseases may is not eligible to participate in the hospital
 1519  inpatient portion of the Medicaid program except as provided in
 1520  federal law. However, the Department of Children and Family
 1521  Services shall apply for a waiver, within 9 months after June 5,
 1522  1991, designed to provide hospitalization services for mental
 1523  health reasons to children and adults in the most cost-effective
 1524  and lowest cost setting possible. Such waiver shall include a
 1525  request for the opportunity to pay for care in hospitals known
 1526  under federal law as “institutions for mental disease” or
 1527  “IMD’s.” The waiver proposal shall propose no additional
 1528  aggregate cost to the state or Federal Government, and shall be
 1529  conducted in Hillsborough County, Highlands County, Hardee
 1530  County, Manatee County, and Polk County. The waiver proposal may
 1531  incorporate competitive bidding for hospital services,
 1532  comprehensive brokering, prepaid capitated arrangements, or
 1533  other mechanisms deemed by the department to show promise in
 1534  reducing the cost of acute care and increasing the effectiveness
 1535  of preventive care. When developing the waiver proposal, the
 1536  department shall take into account price, quality,
 1537  accessibility, linkages of the hospital to community services
 1538  and family support programs, plans of the hospital to ensure the
 1539  earliest discharge possible, and the comprehensiveness of the
 1540  mental health and other health care services offered by
 1541  participating providers.
 1542         (c) The agency shall adjust a hospital’s current inpatient
 1543  per diem rate to reflect the cost of serving the Medicaid
 1544  population at that institution if:
 1545         1. The hospital experiences an increase in Medicaid
 1546  caseload by more than 25 percent in any year, primarily
 1547  resulting from the closure of a hospital in the same service
 1548  area occurring after July 1, 1995;
 1549         2. The hospital’s Medicaid per diem rate is at least 25
 1550  percent below the Medicaid per patient cost for that year; or
 1551         3. The hospital is located in a county that has six or
 1552  fewer general acute care hospitals, began offering obstetrical
 1553  services on or after September 1999, and has submitted a request
 1554  in writing to the agency for a rate adjustment after July 1,
 1555  2000, but before September 30, 2000, in which case such
 1556  hospital’s Medicaid inpatient per diem rate shall be adjusted to
 1557  cost, effective July 1, 2002. By October 1 of each year, the
 1558  agency must provide estimated costs for any adjustment in a
 1559  hospital inpatient per diem rate to the Executive Office of the
 1560  Governor, the House of Representatives General Appropriations
 1561  Committee, and the Senate Appropriations Committee. Before the
 1562  agency implements a change in a hospital’s inpatient per diem
 1563  rate pursuant to this paragraph, the Legislature must have
 1564  specifically appropriated sufficient funds in the General
 1565  Appropriations Act to support the increase in cost as estimated
 1566  by the agency.
 1567         (d) The agency shall implement a hospitalist program in
 1568  nonteaching hospitals, select counties, or statewide. The
 1569  program shall require hospitalists to manage Medicaid
 1570  recipients’ hospital admissions and lengths of stay. Individuals
 1571  who are dually eligible for Medicare and Medicaid are exempted
 1572  from this requirement. Medicaid participating physicians and
 1573  other practitioners with hospital admitting privileges shall
 1574  coordinate and review admissions of Medicaid recipients with the
 1575  hospitalist. The agency may competitively bid a contract for
 1576  selection of a single qualified organization to provide
 1577  hospitalist services. The agency may procure hospitalist
 1578  services by individual county or may combine counties in a
 1579  single procurement. The qualified organization shall contract
 1580  with or employ board-eligible physicians in Miami-Dade, Palm
 1581  Beach, Hillsborough, Pasco, and Pinellas Counties. The agency
 1582  may is authorized to seek federal waivers to implement this
 1583  program.
 1584         (e) The agency shall implement a comprehensive utilization
 1585  management program for hospital neonatal intensive care stays in
 1586  certain high-volume participating hospitals, select counties, or
 1587  statewide, and shall replace existing hospital inpatient
 1588  utilization management programs for neonatal intensive care
 1589  admissions. The program shall be designed to manage the lengths
 1590  of stay for children being treated in neonatal intensive care
 1591  units and must seek the earliest medically appropriate discharge
 1592  to the child’s home or other less costly treatment setting. The
 1593  agency may competitively bid a contract for selection of a
 1594  qualified organization to provide neonatal intensive care
 1595  utilization management services. The agency may is authorized to
 1596  seek any federal waivers to implement this initiative.
 1597         (f) The agency may develop and implement a program to
 1598  reduce the number of hospital readmissions among the non
 1599  Medicare population eligible in areas 9, 10, and 11.
 1600         (6) HOSPITAL OUTPATIENT SERVICES.—The agency shall pay for
 1601  preventive, diagnostic, therapeutic, or palliative care and
 1602  other services provided to a recipient in the outpatient portion
 1603  of a hospital licensed under part I of chapter 395, and provided
 1604  under the direction of a licensed physician or licensed dentist,
 1605  except that payment for such care and services is limited to
 1606  $1,500 per state fiscal year per recipient, unless an exception
 1607  has been made by the agency, and with the exception of a
 1608  Medicaid recipient under age 21, in which case the only
 1609  limitation is medical necessity.
 1610         (7) INDEPENDENT LABORATORY SERVICES.—The agency shall pay
 1611  for medically necessary diagnostic laboratory procedures ordered
 1612  by a licensed physician or other licensed health care
 1613  practitioner of the healing arts which are provided for a
 1614  recipient in a laboratory that meets the requirements for
 1615  Medicare participation and is licensed under chapter 483, if
 1616  required.
 1617         (8) NURSING FACILITY SERVICES.—The agency shall pay for 24
 1618  hour-a-day nursing and rehabilitative services for a recipient
 1619  in a nursing facility licensed under part II of chapter 400 or
 1620  in a rural hospital, as defined in s. 395.602, or in a Medicare
 1621  certified skilled nursing facility operated by a general
 1622  hospital, as defined in by s. 395.002(10), which that is
 1623  licensed under part I of chapter 395, and in accordance with
 1624  provisions set forth in s. 409.908(2)(a), which services are
 1625  ordered by and provided under the direction of a licensed
 1626  physician. However, if a nursing facility has been destroyed or
 1627  otherwise made uninhabitable by natural disaster or other
 1628  emergency and another nursing facility is not available, the
 1629  agency must pay for similar services temporarily in a hospital
 1630  licensed under part I of chapter 395 provided federal funding is
 1631  approved and available. The agency shall pay only for bed-hold
 1632  days if the facility has an occupancy rate of 95 percent or
 1633  greater. The agency is authorized to seek any federal waivers to
 1634  implement this policy.
 1635         (9) PHYSICIAN SERVICES.—The agency shall pay for covered
 1636  services and procedures rendered to a Medicaid recipient by, or
 1637  under the personal supervision of, a person licensed under state
 1638  law to practice medicine or osteopathic medicine. These services
 1639  may be furnished in the physician’s office, the Medicaid
 1640  recipient’s home, a hospital, a nursing facility, or elsewhere,
 1641  but must shall be medically necessary for the treatment of a
 1642  covered an injury or, illness, or disease within the scope of
 1643  the practice of medicine or osteopathic medicine as defined by
 1644  state law. The agency may shall not pay for services that are
 1645  clinically unproven, experimental, or for purely cosmetic
 1646  purposes.
 1647         (10) PORTABLE X-RAY SERVICES.—The agency shall pay for
 1648  professional and technical portable radiological services
 1649  ordered by a licensed physician or other licensed health care
 1650  practitioner of the healing arts which are provided by a
 1651  licensed professional in a setting other than a hospital,
 1652  clinic, or office of a physician or practitioner of the healing
 1653  arts, on behalf of a recipient.
 1654         (11) RURAL HEALTH CLINIC SERVICES.—The agency shall pay for
 1655  outpatient primary health care services for a recipient provided
 1656  by a clinic certified by and participating in the Medicare
 1657  program which is located in a federally designated, rural,
 1658  medically underserved area and has on its staff one or more
 1659  licensed primary care nurse practitioners or physician
 1660  assistants, and a licensed staff supervising physician or a
 1661  consulting supervising physician.
 1662         (12) TRANSPORTATION SERVICES.—The agency shall ensure that
 1663  appropriate transportation services are available for a Medicaid
 1664  recipient in need of transport to a qualified Medicaid provider
 1665  for medically necessary and Medicaid-compensable services, if
 1666  the recipient’s provided a client’s ability to choose a specific
 1667  transportation provider is shall be limited to those options
 1668  resulting from policies established by the agency to meet the
 1669  fiscal limitations of the General Appropriations Act. The agency
 1670  may pay for necessary transportation and other related travel
 1671  expenses as necessary only if these services are not otherwise
 1672  available.
 1673         Section 22. Section 409.906, Florida Statutes, is amended
 1674  to read:
 1675         409.906 Optional Medicaid services.—Subject to specific
 1676  appropriations, the agency may make payments for services which
 1677  are optional to the state under Title XIX of the Social Security
 1678  Act and are furnished by Medicaid providers to recipients who
 1679  are determined to be eligible on the dates on which the services
 1680  were provided. Any optional service that is provided shall be
 1681  provided only when medically necessary and in accordance with
 1682  state and federal law. Optional services rendered by providers
 1683  in mobile units to Medicaid recipients may be restricted or
 1684  prohibited by the agency. Nothing in This section does not shall
 1685  be construed to prevent or limit the agency from adjusting fees,
 1686  reimbursement rates, lengths of stay, number of visits, or
 1687  number of services, or making any other adjustments necessary to
 1688  comply with the availability of moneys and any limitations or
 1689  directions provided for in the General Appropriations Act, or
 1690  chapter 216, or s. 409.9022. If necessary to safeguard the
 1691  state’s systems of providing services to elderly and disabled
 1692  persons and subject to the notice and review provisions of s.
 1693  216.177, the Governor may direct the Agency for Health Care
 1694  Administration to amend the Medicaid state plan to delete the
 1695  optional Medicaid service known as “Intermediate Care Facilities
 1696  for the Developmentally Disabled.” Optional services may
 1697  include:
 1698         (1) ADULT DENTAL SERVICES.—For a recipient who is 21 years
 1699  of age or older:
 1700         (a) The agency may pay for medically necessary, emergency
 1701  dental procedures to alleviate pain or infection. Emergency
 1702  dental care is shall be limited to emergency oral examinations,
 1703  necessary radiographs, extractions, and incision and drainage of
 1704  abscess, for a recipient who is 21 years of age or older.
 1705         (b) Beginning July 1, 2006, The agency may pay for full or
 1706  partial dentures, the procedures required to seat full or
 1707  partial dentures, and the repair and reline of full or partial
 1708  dentures, provided by or under the direction of a licensed
 1709  dentist, for a recipient who is 21 years of age or older.
 1710         (c) However, Medicaid will not provide reimbursement for
 1711  dental services provided in a mobile dental unit, except for a
 1712  mobile dental unit:
 1713         1. Owned by, operated by, or having a contractual agreement
 1714  with the Department of Health and complying with Medicaid’s
 1715  county health department clinic services program specifications
 1716  as a county health department clinic services provider.
 1717         2. Owned by, operated by, or having a contractual
 1718  arrangement with a federally qualified health center and
 1719  complying with Medicaid’s federally qualified health center
 1720  specifications as a federally qualified health center provider.
 1721         3. Rendering dental services to Medicaid recipients, 21
 1722  years of age and older, at nursing facilities.
 1723         4. Owned by, operated by, or having a contractual agreement
 1724  with a state-approved dental educational institution.
 1725         (2) ADULT HEALTH SCREENING SERVICES.—The agency may pay for
 1726  an annual routine physical examination, conducted by or under
 1727  the direction of a licensed physician, for a recipient age 21 or
 1728  older, without regard to medical necessity, in order to detect
 1729  and prevent disease, disability, or other health condition or
 1730  its progression.
 1731         (3) AMBULATORY SURGICAL CENTER SERVICES.—The agency may pay
 1732  for services provided to a recipient in an ambulatory surgical
 1733  center licensed under part I of chapter 395, by or under the
 1734  direction of a licensed physician or dentist.
 1735         (4) BIRTH CENTER SERVICES.—The agency may pay for
 1736  examinations and delivery, recovery, and newborn assessment, and
 1737  related services, provided in a licensed birth center staffed
 1738  with licensed physicians, certified nurse midwives, and midwives
 1739  licensed in accordance with chapter 467, to a recipient expected
 1740  to experience a low-risk pregnancy and delivery.
 1741         (5) CASE MANAGEMENT SERVICES.—The agency may pay for
 1742  primary care case management services rendered to a recipient
 1743  pursuant to a federally approved waiver, and targeted case
 1744  management services for specific groups of targeted recipients,
 1745  for which funding has been provided and which are rendered
 1746  pursuant to federal guidelines. The agency may is authorized to
 1747  limit reimbursement for targeted case management services in
 1748  order to comply with any limitations or directions provided for
 1749  in the General Appropriations Act.
 1750         (6) CHILDREN’S DENTAL SERVICES.—The agency may pay for
 1751  diagnostic, preventive, or corrective procedures, including
 1752  orthodontia in severe cases, provided to a recipient under age
 1753  21, by or under the supervision of a licensed dentist. Services
 1754  provided under this program include treatment of the teeth and
 1755  associated structures of the oral cavity, as well as treatment
 1756  of disease, injury, or impairment that may affect the oral or
 1757  general health of the individual. However, Medicaid may will not
 1758  provide reimbursement for dental services provided in a mobile
 1759  dental unit, except for a mobile dental unit:
 1760         (a) Owned by, operated by, or having a contractual
 1761  agreement with the Department of Health and complying with
 1762  Medicaid’s county health department clinic services program
 1763  specifications as a county health department clinic services
 1764  provider.
 1765         (b) Owned by, operated by, or having a contractual
 1766  arrangement with a federally qualified health center and
 1767  complying with Medicaid’s federally qualified health center
 1768  specifications as a federally qualified health center provider.
 1769         (c) Rendering dental services to Medicaid recipients, 21
 1770  years of age and older, at nursing facilities.
 1771         (d) Owned by, operated by, or having a contractual
 1772  agreement with a state-approved dental educational institution.
 1773         (7) CHIROPRACTIC SERVICES.—The agency may pay for manual
 1774  manipulation of the spine and initial services, screening, and X
 1775  rays provided to a recipient by a licensed chiropractic
 1776  physician.
 1777         (8) COMMUNITY MENTAL HEALTH SERVICES.—
 1778         (a) The agency may pay for rehabilitative services provided
 1779  to a recipient by a mental health or substance abuse provider
 1780  under contract with the agency or the Department of Children and
 1781  Family Services to provide such services. Those Services that
 1782  which are psychiatric in nature must shall be rendered or
 1783  recommended by a psychiatrist, and those services that which are
 1784  medical in nature must shall be rendered or recommended by a
 1785  physician or psychiatrist.
 1786         (a) The agency shall must develop a provider enrollment
 1787  process for community mental health providers which bases
 1788  provider enrollment on an assessment of service need. The
 1789  provider enrollment process shall be designed to control costs,
 1790  prevent fraud and abuse, consider provider expertise and
 1791  capacity, and assess provider success in managing utilization of
 1792  care and measuring treatment outcomes. Providers must will be
 1793  selected through a competitive procurement or selective
 1794  contracting process. In addition to other community mental
 1795  health providers, the agency shall consider enrolling for
 1796  enrollment mental health programs licensed under chapter 395 and
 1797  group practices licensed under chapter 458, chapter 459, chapter
 1798  490, or chapter 491. The agency may is also authorized to
 1799  continue the operation of its behavioral health utilization
 1800  management program and may develop new services, if these
 1801  actions are necessary, to ensure savings from the implementation
 1802  of the utilization management system. The agency shall
 1803  coordinate the implementation of this enrollment process with
 1804  the Department of Children and Family Services and the
 1805  Department of Juvenile Justice. The agency may use is authorized
 1806  to utilize diagnostic criteria in setting reimbursement rates,
 1807  to preauthorize certain high-cost or highly utilized services,
 1808  to limit or eliminate coverage for certain services, or to make
 1809  any other adjustments necessary to comply with any limitations
 1810  or directions provided for in the General Appropriations Act.
 1811         (b) The agency may is authorized to implement reimbursement
 1812  and use management reforms in order to comply with any
 1813  limitations or directions in the General Appropriations Act,
 1814  which may include, but are not limited to: prior authorization
 1815  of treatment and service plans; prior authorization of services;
 1816  enhanced use review programs for highly used services; and
 1817  limits on services for recipients those determined to be abusing
 1818  their benefit coverages.
 1819         (9) DIALYSIS FACILITY SERVICES.—Subject to specific
 1820  appropriations being provided for this purpose, the agency may
 1821  pay a dialysis facility that is approved as a dialysis facility
 1822  in accordance with Title XVIII of the Social Security Act, for
 1823  dialysis services that are provided to a Medicaid recipient
 1824  under the direction of a physician licensed to practice medicine
 1825  or osteopathic medicine in this state, including dialysis
 1826  services provided in the recipient’s home by a hospital-based or
 1827  freestanding dialysis facility.
 1828         (10) DURABLE MEDICAL EQUIPMENT.—The agency may authorize
 1829  and pay for certain durable medical equipment and supplies
 1830  provided to a Medicaid recipient as medically necessary.
 1831         (11) HEALTHY START SERVICES.—The agency may pay for a
 1832  continuum of risk-appropriate medical and psychosocial services
 1833  for the Healthy Start program in accordance with a federal
 1834  waiver. The agency may not implement the federal waiver unless
 1835  the waiver permits the state to limit enrollment or the amount,
 1836  duration, and scope of services to ensure that expenditures will
 1837  not exceed funds appropriated by the Legislature or available
 1838  from local sources. If the Health Care Financing Administration
 1839  does not approve a federal waiver for Healthy Start services is
 1840  not approved, the agency, in consultation with the Department of
 1841  Health and the Florida Association of Healthy Start Coalitions,
 1842  may is authorized to establish a Medicaid certified-match
 1843  program for Healthy Start services. Participation in the Healthy
 1844  Start certified-match program is shall be voluntary, and
 1845  reimbursement is shall be limited to the federal Medicaid share
 1846  provided to Medicaid-enrolled Healthy Start coalitions for
 1847  services provided to Medicaid recipients. The agency may not
 1848  shall take no action to implement a certified-match program
 1849  without ensuring that the amendment and review requirements of
 1850  ss. 216.177 and 216.181 have been met.
 1851         (12) HEARING SERVICES.—The agency may pay for hearing and
 1852  related services, including hearing evaluations, hearing aid
 1853  devices, dispensing of the hearing aid, and related repairs, if
 1854  provided to a recipient by a licensed hearing aid specialist,
 1855  otolaryngologist, otologist, audiologist, or physician.
 1856         (13) HOME AND COMMUNITY-BASED SERVICES.—
 1857         (a) The agency may pay for home-based or community-based
 1858  services that are rendered to a recipient in accordance with a
 1859  federally approved waiver program. The agency may limit or
 1860  eliminate coverage for certain services, preauthorize high-cost
 1861  or highly utilized services, or make any other adjustments
 1862  necessary to comply with any limitations or directions provided
 1863  for in the General Appropriations Act.
 1864         (b) The agency may consolidate types of services offered in
 1865  the Aged and Disabled Waiver, the Channeling Waiver, the Project
 1866  AIDS Care Waiver, and the Traumatic Brain and Spinal Cord Injury
 1867  Waiver programs in order to group similar services under a
 1868  single service, or continue a service upon evidence of the need
 1869  for including a particular service type in a particular waiver.
 1870  The agency may is authorized to seek a Medicaid state plan
 1871  amendment or federal waiver approval to implement this policy.
 1872         (c) The agency may implement a utilization management
 1873  program designed to prior-authorize home and community-based
 1874  service plans which and includes, but is not limited to,
 1875  assessing proposed quantity and duration of services and
 1876  monitoring ongoing service use by participants in the program.
 1877  The agency may is authorized to competitively procure a
 1878  qualified organization to provide utilization management of home
 1879  and community-based services. The agency may is authorized to
 1880  seek any federal waivers to implement this initiative.
 1881         (d) The agency shall assess a fee against the parents of a
 1882  child who is being served by a waiver under this subsection if
 1883  the adjusted household income is greater than 100 percent of the
 1884  federal poverty level. The amount of the fee shall be calculated
 1885  using a sliding scale based on the size of the family, the
 1886  amount of the parent’s adjusted gross income, and the federal
 1887  poverty guidelines. The agency shall seek a federal waiver to
 1888  implement this provision.
 1889         (14) HOSPICE CARE SERVICES.—The agency may pay for all
 1890  reasonable and necessary services for the palliation or
 1891  management of a recipient’s terminal illness, if the services
 1892  are provided by a hospice that is licensed under part IV of
 1893  chapter 400 and meets Medicare certification requirements.
 1894         (15) INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY
 1895  DISABLED SERVICES.—The agency may pay for health-related care
 1896  and services provided on a 24-hour-a-day basis by a facility
 1897  licensed and certified as a Medicaid Intermediate Care Facility
 1898  for the Developmentally Disabled, for a recipient who needs such
 1899  care because of a developmental disability. Payment may shall
 1900  not include bed-hold days except in facilities with occupancy
 1901  rates of 95 percent or greater. The agency may is authorized to
 1902  seek any federal waiver approvals to implement this policy. If
 1903  necessary to safeguard the state’s systems of providing services
 1904  to elderly and disabled persons and subject to notice and review
 1905  under s. 216.177, the Governor may direct the agency to amend
 1906  the Medicaid state plan to delete these services.
 1907         (16) INTERMEDIATE CARE SERVICES.—The agency may pay for 24
 1908  hour-a-day intermediate care nursing and rehabilitation services
 1909  rendered to a recipient in a nursing facility licensed under
 1910  part II of chapter 400, if the services are ordered by and
 1911  provided under the direction of a physician.
 1912         (17) OPTOMETRIC SERVICES.—The agency may pay for services
 1913  provided to a recipient, including examination, diagnosis,
 1914  treatment, and management, related to ocular pathology, if the
 1915  services are provided by a licensed optometrist or physician.
 1916         (18) PHYSICIAN ASSISTANT SERVICES.—The agency may pay for
 1917  all services provided to a recipient by a physician assistant
 1918  licensed under s. 458.347 or s. 459.022. Reimbursement for such
 1919  services must be at least not less than 80 percent of the
 1920  reimbursement that would be paid to a physician who provided the
 1921  same services.
 1922         (19) PODIATRIC SERVICES.—The agency may pay for services,
 1923  including diagnosis and medical, surgical, palliative, and
 1924  mechanical treatment, related to ailments of the human foot and
 1925  lower leg, if provided to a recipient by a podiatric physician
 1926  licensed under state law.
 1927         (20) PRESCRIBED DRUG SERVICES.—The agency may pay for
 1928  medications that are prescribed for a recipient by a physician
 1929  or other licensed health care practitioner of the healing arts
 1930  authorized to prescribe medications and that are dispensed to
 1931  the recipient by a licensed pharmacist or physician in
 1932  accordance with applicable state and federal law. However, the
 1933  agency may not pay for any psychotropic medication prescribed
 1934  for a child younger than the age for which the federal Food and
 1935  Drug Administration has approved its use.
 1936         (21) REGISTERED NURSE FIRST ASSISTANT SERVICES.—The agency
 1937  may pay for all services provided to a recipient by a registered
 1938  nurse first assistant as described in s. 464.027. Reimbursement
 1939  for such services must be at least may not be less than 80
 1940  percent of the reimbursement that would be paid to a physician
 1941  providing the same services.
 1942         (22) STATE HOSPITAL SERVICES.—The agency may pay for all
 1943  inclusive psychiatric inpatient hospital care provided to a
 1944  recipient age 65 or older in a state mental hospital.
 1945         (23) VISUAL SERVICES.—The agency may pay for visual
 1946  examinations, eyeglasses, and eyeglass repairs for a recipient
 1947  if they are prescribed by a licensed physician specializing in
 1948  diseases of the eye or by a licensed optometrist. Eyeglass
 1949  frames for adult recipients are shall be limited to one pair per
 1950  recipient every 2 years, except a second pair may be provided
 1951  during that period after prior authorization. Eyeglass lenses
 1952  for adult recipients are shall be limited to one pair per year
 1953  except a second pair may be provided during that period after
 1954  prior authorization.
 1955         (24) CHILD-WELFARE-TARGETED CASE MANAGEMENT.—The agency for
 1956  Health Care Administration, in consultation with the Department
 1957  of Children and Family Services, may establish a targeted case
 1958  management project in those counties identified by the
 1959  department of Children and Family Services and for all counties
 1960  with a community-based child welfare project, as authorized
 1961  under s. 409.1671, which have been specifically approved by the
 1962  department. The covered group that is of individuals who are
 1963  eligible for to receive targeted case management include
 1964  children who are eligible for Medicaid; who are between the ages
 1965  of birth through 21; and who are under protective supervision or
 1966  postplacement supervision, under foster-care supervision, or in
 1967  shelter care or foster care. The number of eligible children
 1968  individuals who are eligible to receive targeted case management
 1969  is limited to the number for whom the department of Children and
 1970  Family Services has matching funds to cover the costs. The
 1971  general revenue funds required to match the funds for services
 1972  provided by the community-based child welfare projects are
 1973  limited to funds available for services described under s.
 1974  409.1671. The department of Children and Family Services may
 1975  transfer the general revenue matching funds as billed by the
 1976  agency for Health Care Administration.
 1977         (25) ASSISTIVE-CARE SERVICES.—The agency may pay for
 1978  assistive-care services provided to recipients with functional
 1979  or cognitive impairments residing in assisted living facilities,
 1980  adult family-care homes, or residential treatment facilities.
 1981  These services may include health support, assistance with the
 1982  activities of daily living and the instrumental acts of daily
 1983  living, assistance with medication administration, and
 1984  arrangements for health care.
 1985         (26) HOME AND COMMUNITY-BASED SERVICES FOR AUTISM SPECTRUM
 1986  DISORDER AND OTHER DEVELOPMENTAL DISABILITIES.—The agency may is
 1987  authorized to seek federal approval through a Medicaid waiver or
 1988  a state plan amendment for the provision of occupational
 1989  therapy, speech therapy, physical therapy, behavior analysis,
 1990  and behavior assistant services to individuals who are 5 years
 1991  of age and under and have a diagnosed developmental disability
 1992  as defined in s. 393.063, or autism spectrum disorder as defined
 1993  in s. 627.6686, or Down syndrome, a genetic disorder caused by
 1994  the presence of extra chromosomal material on chromosome 21.
 1995  Causes of the syndrome may include Trisomy 21, Mosaicism,
 1996  Robertsonian Translocation, and other duplications of a portion
 1997  of chromosome 21. Coverage for such services is shall be limited
 1998  to $36,000 annually and may not exceed $108,000 in total
 1999  lifetime benefits. The agency shall submit an annual report
 2000  beginning on January 1, 2009, to the President of the Senate,
 2001  the Speaker of the House of Representatives, and the relevant
 2002  committees of the Senate and the House of Representatives
 2003  regarding progress on obtaining federal approval and
 2004  recommendations for the implementation of these home and
 2005  community-based services. The agency may not implement this
 2006  subsection without prior legislative approval.
 2007         (27) ANESTHESIOLOGIST ASSISTANT SERVICES.—The agency may
 2008  pay for all services provided to a recipient by an
 2009  anesthesiologist assistant licensed under s. 458.3475 or s.
 2010  459.023. Reimbursement for such services must be at least not
 2011  less than 80 percent of the reimbursement that would be paid to
 2012  a physician who provided the same services.
 2013         Section 23. Section 409.9062, Florida Statutes, is amended
 2014  to read:
 2015         409.9062 Lung transplant services for Medicaid recipients.
 2016  Subject to the availability of funds and subject to any
 2017  limitations or directions provided for in the General
 2018  Appropriations Act, or chapter 216, or s. 409.9022, the Agency
 2019  for Health Care Administration Medicaid program shall pay for
 2020  medically necessary lung transplant services for Medicaid
 2021  recipients. These payments must be used to reimburse approved
 2022  lung transplant facilities a global fee for providing lung
 2023  transplant services to Medicaid recipients.
 2024         Section 24. Paragraph (h) of subsection (3) of section
 2025  409.907, Florida Statutes, is amended to read:
 2026         409.907 Medicaid provider agreements.—The agency may make
 2027  payments for medical assistance and related services rendered to
 2028  Medicaid recipients only to an individual or entity who has a
 2029  provider agreement in effect with the agency, who is performing
 2030  services or supplying goods in accordance with federal, state,
 2031  and local law, and who agrees that no person shall, on the
 2032  grounds of handicap, race, color, or national origin, or for any
 2033  other reason, be subjected to discrimination under any program
 2034  or activity for which the provider receives payment from the
 2035  agency.
 2036         (3) The provider agreement developed by the agency, in
 2037  addition to the requirements specified in subsections (1) and
 2038  (2), shall require the provider to:
 2039         (h) Be liable for and indemnify, defend, and hold the
 2040  agency harmless from all claims, suits, judgments, or damages,
 2041  including court costs and attorney’s fees, arising out of the
 2042  negligence or omissions of the provider in the course of
 2043  providing services to a recipient or a person believed to be a
 2044  recipient, subject to s. 766.1183 or s. 766.1184.
 2045         Section 25. Section 409.908, Florida Statutes, is amended
 2046  to read:
 2047         409.908 Reimbursement of Medicaid providers.—Subject to
 2048  specific appropriations, the agency shall reimburse Medicaid
 2049  providers, in accordance with state and federal law, according
 2050  to methodologies set forth in the rules of the agency and in
 2051  policy manuals and handbooks incorporated by reference therein.
 2052  These methodologies may include fee schedules, reimbursement
 2053  methods based on cost reporting, negotiated fees, competitive
 2054  bidding pursuant to s. 287.057, and other mechanisms the agency
 2055  considers efficient and effective for purchasing services or
 2056  goods on behalf of recipients. If a provider is reimbursed based
 2057  on cost reporting and submits a cost report late and that cost
 2058  report would have been used to set a lower reimbursement rate
 2059  for a rate semester, then the provider’s rate for that semester
 2060  shall be retroactively calculated using the new cost report, and
 2061  full payment at the recalculated rate shall be effected
 2062  retroactively. Medicare-granted extensions for filing cost
 2063  reports, if applicable, shall also apply to Medicaid cost
 2064  reports. Payment for Medicaid compensable services made on
 2065  behalf of Medicaid eligible persons is subject to the
 2066  availability of moneys and any limitations or directions
 2067  provided for in the General Appropriations Act, or chapter 216,
 2068  or s. 409.9022. Further, nothing in This section does not shall
 2069  be construed to prevent or limit the agency from adjusting fees,
 2070  reimbursement rates, lengths of stay, number of visits, or
 2071  number of services, or making any other adjustments necessary to
 2072  comply with the availability of moneys and any limitations or
 2073  directions provided for in the General Appropriations Act if,
 2074  provided the adjustment is consistent with legislative intent.
 2075         (1) HOSPITAL SERVICES.Reimbursement to hospitals licensed
 2076  under part I of chapter 395 must be made prospectively or on the
 2077  basis of negotiation.
 2078         (a) Inpatient care.
 2079         1. Reimbursement for inpatient care is limited as provided
 2080  for in s. 409.905(5), except for:
 2081         a.1. The raising of rate reimbursement caps, excluding
 2082  rural hospitals.
 2083         b.2. Recognition of the costs of graduate medical
 2084  education.
 2085         c.3. Other methodologies recognized in the General
 2086  Appropriations Act.
 2087         2.If During the years funds are transferred from the
 2088  Department of Health, any reimbursement supported by such funds
 2089  is shall be subject to certification by the Department of Health
 2090  that the hospital has complied with s. 381.0403. The agency may
 2091  is authorized to receive funds from state entities, including,
 2092  but not limited to, the Department of Health, local governments,
 2093  and other local political subdivisions, for the purpose of
 2094  making special exception payments, including federal matching
 2095  funds, through the Medicaid inpatient reimbursement
 2096  methodologies. Funds received from state entities or local
 2097  governments for this purpose shall be separately accounted for
 2098  and may shall not be commingled with other state or local funds
 2099  in any manner. The agency may certify all local governmental
 2100  funds used as state match under Title XIX of the Social Security
 2101  Act, to the extent that the identified local health care
 2102  provider that is otherwise entitled to and is contracted to
 2103  receive such local funds is the benefactor under the state’s
 2104  Medicaid program as determined under the General Appropriations
 2105  Act and pursuant to an agreement between the agency for Health
 2106  Care Administration and the local governmental entity. The local
 2107  governmental entity shall use a certification form prescribed by
 2108  the agency. At a minimum, the certification form must shall
 2109  identify the amount being certified and describe the
 2110  relationship between the certifying local governmental entity
 2111  and the local health care provider. The agency shall prepare an
 2112  annual statement of impact which documents the specific
 2113  activities undertaken during the previous fiscal year pursuant
 2114  to this paragraph, to be submitted to the Legislature annually
 2115  by no later than January 1, annually.
 2116         (b) Outpatient care.
 2117         1. Reimbursement for hospital outpatient care is limited to
 2118  $1,500 per state fiscal year per recipient, except for:
 2119         a.1.Such Care provided to a Medicaid recipient under age
 2120  21, in which case the only limitation is medical necessity.
 2121         b.2. Renal dialysis services.
 2122         c.3. Other exceptions made by the agency.
 2123         2. The agency may is authorized to receive funds from state
 2124  entities, including, but not limited to, the Department of
 2125  Health, the Board of Governors of the State University System,
 2126  local governments, and other local political subdivisions, for
 2127  the purpose of making payments, including federal matching
 2128  funds, through the Medicaid outpatient reimbursement
 2129  methodologies. Funds received from state entities and local
 2130  governments for this purpose shall be separately accounted for
 2131  and may shall not be commingled with other state or local funds
 2132  in any manner.
 2133         3. The agency may limit inflationary increases for
 2134  outpatient hospital services as directed by the General
 2135  Appropriations Act.
 2136         (c) Disproportionate share.Hospitals that provide services
 2137  to a disproportionate share of low-income Medicaid recipients,
 2138  or that participate in the regional perinatal intensive care
 2139  center program under chapter 383, or that participate in the
 2140  statutory teaching hospital disproportionate share program may
 2141  receive additional reimbursement. The total amount of payment
 2142  for disproportionate share hospitals shall be fixed by the
 2143  General Appropriations Act. The computation of these payments
 2144  must comply be made in compliance with all federal regulations
 2145  and the methodologies described in ss. 409.911, 409.9112, and
 2146  409.9113.
 2147         (d) The agency is authorized to limit inflationary
 2148  increases for outpatient hospital services as directed by the
 2149  General Appropriations Act.
 2150         (2) NURSING HOME CARE.
 2151         (a)1. Reimbursement to nursing homes licensed under part II
 2152  of chapter 400 and state-owned-and-operated intermediate care
 2153  facilities for the developmentally disabled licensed under part
 2154  VIII of chapter 400 must be made prospectively.
 2155         (a)2. Unless otherwise limited or directed in the General
 2156  Appropriations Act, reimbursement to hospitals licensed under
 2157  part I of chapter 395 for the provision of swing-bed nursing
 2158  home services must be based made on the basis of the average
 2159  statewide nursing home payment, and reimbursement to a hospital
 2160  licensed under part I of chapter 395 for the provision of
 2161  skilled nursing services must be based made on the basis of the
 2162  average nursing home payment for those services in the county in
 2163  which the hospital is located. If When a hospital is located in
 2164  a county that does not have any community nursing homes,
 2165  reimbursement shall be determined by averaging the nursing home
 2166  payments in counties that surround the county in which the
 2167  hospital is located. Reimbursement to hospitals, including
 2168  Medicaid payment of Medicare copayments, for skilled nursing
 2169  services is shall be limited to 30 days, unless a prior
 2170  authorization has been obtained from the agency. Medicaid
 2171  reimbursement may be extended by the agency beyond 30 days, and
 2172  approval must be based upon verification by the patient’s
 2173  physician that the patient requires short-term rehabilitative
 2174  and recuperative services only, in which case an extension of no
 2175  more than 15 days may be approved. Reimbursement to a hospital
 2176  licensed under part I of chapter 395 for the temporary provision
 2177  of skilled nursing services to nursing home residents who have
 2178  been displaced as the result of a natural disaster or other
 2179  emergency may not exceed the average county nursing home payment
 2180  for those services in the county in which the hospital is
 2181  located and is limited to the period of time which the agency
 2182  considers necessary for continued placement of the nursing home
 2183  residents in the hospital.
 2184         (b) Subject to any limitations or directions provided for
 2185  in the General Appropriations Act, the agency shall establish
 2186  and implement a Florida Title XIX Long-Term Care Reimbursement
 2187  Plan (Medicaid) for nursing home care in order to provide care
 2188  and services that conform to in conformance with the applicable
 2189  state and federal laws, rules, regulations, and quality and
 2190  safety standards and to ensure that individuals eligible for
 2191  medical assistance have reasonable geographic access to such
 2192  care.
 2193         1. The agency shall amend the long-term care reimbursement
 2194  plan and cost reporting system to create direct care and
 2195  indirect care subcomponents of the patient care component of the
 2196  per diem rate. These two subcomponents together must shall equal
 2197  the patient care component of the per diem rate. Separate cost
 2198  based ceilings shall be calculated for each patient care
 2199  subcomponent. The direct care subcomponent of the per diem rate
 2200  is shall be limited by the cost-based class ceiling, and the
 2201  indirect care subcomponent may be limited by the lower of the
 2202  cost-based class ceiling, the target rate class ceiling, or the
 2203  individual provider target.
 2204         2. The direct care subcomponent includes shall include
 2205  salaries and benefits of direct care staff providing nursing
 2206  services, including registered nurses, licensed practical
 2207  nurses, and certified nursing assistants who deliver care
 2208  directly to residents in the nursing home facility. This
 2209  excludes nursing administration, minimum data set, and care plan
 2210  coordinators, staff development, and the staffing coordinator.
 2211  The direct care subcomponent also includes medically necessary
 2212  dental care or podiatric care.
 2213         3. All other patient care costs are shall be included in
 2214  the indirect care cost subcomponent of the patient care per diem
 2215  rate. There shall be no Costs may not be directly or indirectly
 2216  allocated to the direct care subcomponent from a home office or
 2217  management company.
 2218         4. On July 1 of each year, the agency shall report to the
 2219  Legislature direct and indirect care costs, including average
 2220  direct and indirect care costs per resident per facility and
 2221  direct care and indirect care salaries and benefits per category
 2222  of staff member per facility.
 2223         5. In order to offset the cost of general and professional
 2224  liability insurance, the agency shall amend the plan to allow
 2225  for interim rate adjustments to reflect increases in the cost of
 2226  general or professional liability insurance for nursing homes.
 2227  This provision shall be implemented to the extent existing
 2228  appropriations are available.
 2229  
 2230  It is the intent of the Legislature that the reimbursement plan
 2231  achieve the goal of providing access to health care for nursing
 2232  home residents who require large amounts of care while
 2233  encouraging diversion services as an alternative to nursing home
 2234  care for residents who can be served within the community. The
 2235  agency shall base the establishment of any maximum rate of
 2236  payment, whether overall or component, on the available moneys
 2237  as provided for in the General Appropriations Act. The agency
 2238  may base the maximum rate of payment on the results of
 2239  scientifically valid analysis and conclusions derived from
 2240  objective statistical data pertinent to the particular maximum
 2241  rate of payment.
 2242         (c) The agency shall request and implement Medicaid waivers
 2243  approved by the federal Centers for Medicare and Medicaid
 2244  Services to advance and treat a portion of the Medicaid nursing
 2245  home per diem as capital for creating and operating a risk
 2246  retention group for self-insurance purposes, consistent with
 2247  federal and state laws and rules.
 2248         (3) FEE-FOR-SERVICE REIMBURSEMENT.Subject to any
 2249  limitations or directions provided for in the General
 2250  Appropriations Act, the following Medicaid services and goods
 2251  may be reimbursed on a fee-for-service basis. For each allowable
 2252  service or goods furnished in accordance with Medicaid rules,
 2253  policy manuals, handbooks, and state and federal law, the
 2254  payment shall be the amount billed by the provider, the
 2255  provider’s usual and customary charge, or the maximum allowable
 2256  fee established by the agency, whichever amount is less, with
 2257  the exception of those services or goods for which the agency
 2258  makes payment using a methodology based on capitation rates,
 2259  average costs, or negotiated fees.
 2260         (a) Advanced registered nurse practitioner services.
 2261         (b) Birth center services.
 2262         (c) Chiropractic services.
 2263         (d) Community mental health services.
 2264         (e) Dental services, including oral and maxillofacial
 2265  surgery.
 2266         (f) Durable medical equipment.
 2267         (g) Hearing services.
 2268         (h) Occupational therapy for Medicaid recipients under age
 2269  21.
 2270         (i) Optometric services.
 2271         (j) Orthodontic services.
 2272         (k) Personal care for Medicaid recipients under age 21.
 2273         (l) Physical therapy for Medicaid recipients under age 21.
 2274         (m) Physician assistant services.
 2275         (n) Podiatric services.
 2276         (o) Portable X-ray services.
 2277         (p) Private-duty nursing for Medicaid recipients under age
 2278  21.
 2279         (q) Registered nurse first assistant services.
 2280         (r) Respiratory therapy for Medicaid recipients under age
 2281  21.
 2282         (s) Speech therapy for Medicaid recipients under age 21.
 2283         (t) Visual services.
 2284         (4) MANAGED CARE SERVICES.Subject to any limitations or
 2285  directions provided for in the General Appropriations Act,
 2286  alternative health plans, health maintenance organizations, and
 2287  prepaid health plans shall be reimbursed a fixed, prepaid amount
 2288  negotiated, or competitively bid pursuant to s. 287.057, by the
 2289  agency and prospectively paid to the provider monthly for each
 2290  Medicaid recipient enrolled. The amount may not exceed the
 2291  average amount the agency determines it would have paid, based
 2292  on claims experience, for recipients in the same or similar
 2293  category of eligibility. The agency shall calculate capitation
 2294  rates on a regional basis and, beginning September 1, 1995,
 2295  shall include age-band differentials in such calculations.
 2296         (5) AMBULATORY SURGICAL CENTERS.An ambulatory surgical
 2297  center shall be reimbursed the lesser of the amount billed by
 2298  the provider or the Medicare-established allowable amount for
 2299  the facility.
 2300         (6) EPSDT SERVICES.A provider of early and periodic
 2301  screening, diagnosis, and treatment services to Medicaid
 2302  recipients who are children under age 21 shall be reimbursed
 2303  using an all-inclusive rate stipulated in a fee schedule
 2304  established by the agency. A provider of the visual, dental, and
 2305  hearing components of such services shall be reimbursed the
 2306  lesser of the amount billed by the provider or the Medicaid
 2307  maximum allowable fee established by the agency.
 2308         (7) FAMILY PLANNING SERVICES.A provider of family planning
 2309  services shall be reimbursed the lesser of the amount billed by
 2310  the provider or an all-inclusive amount per type of visit for
 2311  physicians and advanced registered nurse practitioners, as
 2312  established by the agency in a fee schedule.
 2313         (8) HOME OR COMMUNITY-BASED SERVICES.A provider of home
 2314  based or community-based services rendered pursuant to a
 2315  federally approved waiver shall be reimbursed based on an
 2316  established or negotiated rate for each service. These rates
 2317  shall be established according to an analysis of the expenditure
 2318  history and prospective budget developed by each contract
 2319  provider participating in the waiver program, or under any other
 2320  methodology adopted by the agency and approved by the Federal
 2321  Government in accordance with the waiver. Privately owned and
 2322  operated community-based residential facilities that which meet
 2323  agency requirements and which formerly received Medicaid
 2324  reimbursement for the optional intermediate care facility for
 2325  the mentally retarded service may participate in the
 2326  developmental services waiver as part of a home-and-community
 2327  based continuum of care for Medicaid recipients who receive
 2328  waiver services.
 2329         (9) HOME HEALTH SERVICES AND MEDICAL SUPPLIES.A provider
 2330  of home health care services or of medical supplies and
 2331  appliances shall be reimbursed on the basis of competitive
 2332  bidding or for the lesser of the amount billed by the provider
 2333  or the agency’s established maximum allowable amount, except
 2334  that, in the case of the rental of durable medical equipment,
 2335  the total rental payments for durable medical equipment may not
 2336  exceed the purchase price of the equipment over its expected
 2337  useful life or the agency’s established maximum allowable
 2338  amount, whichever amount is less.
 2339         (10) HOSPICE.A hospice shall be reimbursed through a
 2340  prospective system for each Medicaid hospice patient at Medicaid
 2341  rates using the methodology established for hospice
 2342  reimbursement pursuant to Title XVIII of the federal Social
 2343  Security Act.
 2344         (11) LABORATORY SERVICES.A provider of independent
 2345  laboratory services shall be reimbursed on the basis of
 2346  competitive bidding or for the least of the amount billed by the
 2347  provider, the provider’s usual and customary charge, or the
 2348  Medicaid maximum allowable fee established by the agency.
 2349         (12) PHYSICIAN SERVICES.
 2350         (a) A physician shall be reimbursed the lesser of the
 2351  amount billed by the provider or the Medicaid maximum allowable
 2352  fee established by the agency.
 2353         (b) The agency shall adopt a fee schedule, subject to any
 2354  limitations or directions provided for in the General
 2355  Appropriations Act, based on a resource-based relative value
 2356  scale for pricing Medicaid physician services. Under the this
 2357  fee schedule, physicians shall be paid a dollar amount for each
 2358  service based on the average resources required to provide the
 2359  service, including, but not limited to, estimates of average
 2360  physician time and effort, practice expense, and the costs of
 2361  professional liability insurance. The fee schedule must shall
 2362  provide increased reimbursement for preventive and primary care
 2363  services and lowered reimbursement for specialty services by
 2364  using at least two conversion factors, one for cognitive
 2365  services and another for procedural services. The fee schedule
 2366  may shall not increase total Medicaid physician expenditures
 2367  unless moneys are available. The agency for Health Care
 2368  Administration shall seek the advice of a 16-member advisory
 2369  panel in formulating and adopting the fee schedule. The panel
 2370  shall consist of Medicaid physicians licensed under chapters 458
 2371  and 459 and shall be composed of 50 percent primary care
 2372  physicians and 50 percent specialty care physicians.
 2373         (c) Notwithstanding paragraph (b), reimbursement fees to
 2374  physicians for providing total obstetrical services to Medicaid
 2375  recipients, which include prenatal, delivery, and postpartum
 2376  care, must shall be at least $1,500 per delivery for a pregnant
 2377  woman with low medical risk and at least $2,000 per delivery for
 2378  a pregnant woman with high medical risk. However, reimbursement
 2379  to physicians working in regional perinatal intensive care
 2380  centers designated pursuant to chapter 383, for services to
 2381  certain pregnant Medicaid recipients with a high medical risk,
 2382  may be made according to obstetrical care and neonatal care
 2383  groupings and rates established by the agency. Nurse midwives
 2384  licensed under part I of chapter 464 or midwives licensed under
 2385  chapter 467 shall be reimbursed at least no less than 80 percent
 2386  of the low medical risk fee. The agency shall by rule determine,
 2387  for the purpose of this paragraph, what constitutes a high or
 2388  low medical risk pregnant woman and may shall not pay more based
 2389  solely on the fact that a caesarean section was performed,
 2390  rather than a vaginal delivery. The agency shall by rule
 2391  determine a prorated payment for obstetrical services in cases
 2392  where only part of the total prenatal, delivery, or postpartum
 2393  care was performed. The Department of Health shall adopt rules
 2394  for appropriate insurance coverage for midwives licensed under
 2395  chapter 467. Before issuing and renewing Prior to the issuance
 2396  and renewal of an active license, or reactivating reactivation
 2397  of an inactive license for midwives licensed under chapter 467,
 2398  such licensees must shall submit proof of coverage with each
 2399  application.
 2400         (d) Effective January 1, 2013, Medicaid fee-for-service
 2401  payments to primary care physicians for primary care services
 2402  must be at least 100 percent of the Medicare payment rate for
 2403  such services.
 2404         (13) DUALLY ELIGIBLE RECIPIENTS.Medicare premiums for
 2405  persons eligible for both Medicare and Medicaid coverage shall
 2406  be paid at the rates established by Title XVIII of the Social
 2407  Security Act. For Medicare services rendered to Medicaid
 2408  eligible persons, Medicaid shall pay Medicare deductibles and
 2409  coinsurance as follows:
 2410         (a) Medicaid’s financial obligation for deductibles and
 2411  coinsurance payments shall be based on Medicare allowable fees,
 2412  not on a provider’s billed charges.
 2413         (b) Medicaid may not will pay any no portion of Medicare
 2414  deductibles and coinsurance if when payment that Medicare has
 2415  made for the service equals or exceeds what Medicaid would have
 2416  paid if it had been the sole payor. The combined payment of
 2417  Medicare and Medicaid may shall not exceed the amount Medicaid
 2418  would have paid had it been the sole payor. The Legislature
 2419  finds that there has been confusion regarding the reimbursement
 2420  for services rendered to dually eligible Medicare beneficiaries.
 2421  Accordingly, the Legislature clarifies that it has always been
 2422  the intent of the Legislature before and after 1991 that, in
 2423  reimbursing in accordance with fees established by Title XVIII
 2424  for premiums, deductibles, and coinsurance for Medicare services
 2425  rendered by physicians to Medicaid eligible persons, physicians
 2426  be reimbursed at the lesser of the amount billed by the
 2427  physician or the Medicaid maximum allowable fee established by
 2428  the agency for Health Care Administration, as is permitted by
 2429  federal law. It has never been the intent of the Legislature
 2430  with regard to such services rendered by physicians that
 2431  Medicaid be required to provide any payment for deductibles,
 2432  coinsurance, or copayments for Medicare cost sharing, or any
 2433  expenses incurred relating thereto, in excess of the payment
 2434  amount provided for under the State Medicaid plan for physician
 2435  services such service. This payment methodology is applicable
 2436  even in those situations in which the payment for Medicare cost
 2437  sharing for a qualified Medicare beneficiary with respect to an
 2438  item or service is reduced or eliminated. This expression of the
 2439  Legislature clarifies is in clarification of existing law and
 2440  applies shall apply to payment for, and with respect to provider
 2441  agreements with respect to, items or services furnished on or
 2442  after July 1, 2000 the effective date of this act. This
 2443  paragraph applies to payment by Medicaid for items and services
 2444  furnished before July 1, 2000, the effective date of this act if
 2445  such payment is the subject of a lawsuit that is based on the
 2446  provisions of this section, and that is pending as of, or is
 2447  initiated after that date, the effective date of this act.
 2448         (c) Notwithstanding paragraphs (a) and (b):
 2449         1. Medicaid payments for Nursing Home Medicare part A
 2450  coinsurance are limited to the Medicaid nursing home per diem
 2451  rate less any amounts paid by Medicare, but only up to the
 2452  amount of Medicare coinsurance. The Medicaid per diem rate is
 2453  shall be the rate in effect for the dates of service of the
 2454  crossover claims and may not be subsequently adjusted due to
 2455  subsequent per diem rate adjustments.
 2456         2. Medicaid shall pay all deductibles and coinsurance for
 2457  Medicare-eligible recipients receiving freestanding end stage
 2458  renal dialysis center services.
 2459         3. Medicaid payments for general and specialty hospital
 2460  inpatient services are limited to the Medicare deductible and
 2461  coinsurance per spell of illness. Medicaid payments for hospital
 2462  Medicare Part A coinsurance are shall be limited to the Medicaid
 2463  hospital per diem rate less any amounts paid by Medicare, but
 2464  only up to the amount of Medicare coinsurance. Medicaid payments
 2465  for coinsurance are shall be limited to the Medicaid per diem
 2466  rate in effect for the dates of service of the crossover claims
 2467  and may not be subsequently adjusted due to subsequent per diem
 2468  adjustments.
 2469         4. Medicaid shall pay all deductibles and coinsurance for
 2470  Medicare emergency transportation services provided by
 2471  ambulances licensed pursuant to chapter 401.
 2472         5. Medicaid shall pay all deductibles and coinsurance for
 2473  portable X-ray Medicare Part B services provided in a nursing
 2474  home.
 2475         (14) PRESCRIBED DRUGS.A provider of prescribed drugs shall
 2476  be reimbursed the least of the amount billed by the provider,
 2477  the provider’s usual and customary charge, or the Medicaid
 2478  maximum allowable fee established by the agency, plus a
 2479  dispensing fee. The Medicaid maximum allowable fee for
 2480  ingredient cost must will be based on the lower of the: average
 2481  wholesale price (AWP) minus 16.4 percent, wholesaler acquisition
 2482  cost (WAC) plus 4.75 percent, the federal upper limit (FUL), the
 2483  state maximum allowable cost (SMAC), or the usual and customary
 2484  (UAC) charge billed by the provider.
 2485         (a) Medicaid providers must are required to dispense
 2486  generic drugs if available at lower cost and the agency has not
 2487  determined that the branded product is more cost-effective,
 2488  unless the prescriber has requested and received approval to
 2489  require the branded product.
 2490         (b) The agency shall is directed to implement a variable
 2491  dispensing fee for payments for prescribed medicines while
 2492  ensuring continued access for Medicaid recipients. The variable
 2493  dispensing fee may be based upon, but not limited to, either or
 2494  both the volume of prescriptions dispensed by a specific
 2495  pharmacy provider, the volume of prescriptions dispensed to an
 2496  individual recipient, and dispensing of preferred-drug-list
 2497  products.
 2498         (c) The agency may increase the pharmacy dispensing fee
 2499  authorized by statute and in the annual General Appropriations
 2500  Act by $0.50 for the dispensing of a Medicaid preferred-drug
 2501  list product and reduce the pharmacy dispensing fee by $0.50 for
 2502  the dispensing of a Medicaid product that is not included on the
 2503  preferred drug list.
 2504         (d) The agency may establish a supplemental pharmaceutical
 2505  dispensing fee to be paid to providers returning unused unit
 2506  dose packaged medications to stock and crediting the Medicaid
 2507  program for the ingredient cost of those medications if the
 2508  ingredient costs to be credited exceed the value of the
 2509  supplemental dispensing fee.
 2510         (e) The agency may is authorized to limit reimbursement for
 2511  prescribed medicine in order to comply with any limitations or
 2512  directions provided for in the General Appropriations Act, which
 2513  may include implementing a prospective or concurrent utilization
 2514  review program.
 2515         (15) PRIMARY CARE CASE MANAGEMENT.A provider of primary
 2516  care case management services rendered pursuant to a federally
 2517  approved waiver shall be reimbursed by payment of a fixed,
 2518  prepaid monthly sum for each Medicaid recipient enrolled with
 2519  the provider.
 2520         (16) RURAL HEALTH CLINICS.A provider of rural health
 2521  clinic services and federally qualified health center services
 2522  shall be reimbursed a rate per visit based on total reasonable
 2523  costs of the clinic, as determined by the agency in accordance
 2524  with federal regulations.
 2525         (17) TARGETED CASE MANAGEMENT.A provider of targeted case
 2526  management services shall be reimbursed pursuant to an
 2527  established fee, except where the Federal Government requires a
 2528  public provider be reimbursed on the basis of average actual
 2529  costs.
 2530         (18) TRANSPORTATION.Unless otherwise provided for in the
 2531  General Appropriations Act, a provider of transportation
 2532  services shall be reimbursed the lesser of the amount billed by
 2533  the provider or the Medicaid maximum allowable fee established
 2534  by the agency, except if when the agency has entered into a
 2535  direct contract with the provider, or with a community
 2536  transportation coordinator, for the provision of an all
 2537  inclusive service, or if when services are provided pursuant to
 2538  an agreement negotiated between the agency and the provider. The
 2539  agency, as provided for in s. 427.0135, shall purchase
 2540  transportation services through the community coordinated
 2541  transportation system, if available, unless the agency, after
 2542  consultation with the commission, determines that it cannot
 2543  reach mutually acceptable contract terms with the commission.
 2544  The agency may then contract for the same transportation
 2545  services provided in a more cost-effective manner and of
 2546  comparable or higher quality and standards. Nothing in
 2547         (a) This subsection does not shall be construed to limit or
 2548  preclude the agency from contracting for services using a
 2549  prepaid capitation rate or from establishing maximum fee
 2550  schedules, individualized reimbursement policies by provider
 2551  type, negotiated fees, prior authorization, competitive bidding,
 2552  increased use of mass transit, or any other mechanism that the
 2553  agency considers efficient and effective for the purchase of
 2554  services on behalf of Medicaid clients, including implementing a
 2555  transportation eligibility process.
 2556         (b) The agency may shall not be required to contract with
 2557  any community transportation coordinator or transportation
 2558  operator that has been determined by the agency, the Department
 2559  of Legal Affairs Medicaid Fraud Control Unit, or any other state
 2560  or federal agency to have engaged in any abusive or fraudulent
 2561  billing activities.
 2562         (c) The agency shall is authorized to competitively procure
 2563  transportation services or make other changes necessary to
 2564  secure approval of federal waivers needed to permit federal
 2565  financing of Medicaid transportation services at the service
 2566  matching rate rather than the administrative matching rate.
 2567  Notwithstanding chapter 427, the agency is authorized to
 2568  continue contracting for Medicaid nonemergency transportation
 2569  services in agency service area 11 with managed care plans that
 2570  were under contract for those services before July 1, 2004.
 2571         (d) Transportation to access covered services provided by a
 2572  qualified plan pursuant to part IV of this chapter shall be
 2573  contracted for by the plan. A qualified plan is not required to
 2574  purchase such services through a coordinated transportation
 2575  system established pursuant to part I of chapter 427.
 2576         (19) COUNTY HEALTH DEPARTMENTS.County health department
 2577  services shall be reimbursed a rate per visit based on total
 2578  reasonable costs of the clinic, as determined by the agency in
 2579  accordance with federal regulations under the authority of 42
 2580  C.F.R. s. 431.615.
 2581         (20) DIALYSIS.A renal dialysis facility that provides
 2582  dialysis services under s. 409.906(9) must be reimbursed the
 2583  lesser of the amount billed by the provider, the provider’s
 2584  usual and customary charge, or the maximum allowable fee
 2585  established by the agency, whichever amount is less.
 2586         (21) SCHOOL-BASED SERVICES.The agency shall reimburse
 2587  school districts that which certify the state match pursuant to
 2588  ss. 409.9071 and 1011.70 for the federal portion of the school
 2589  district’s allowable costs to deliver the services, based on the
 2590  reimbursement schedule. The school district shall determine the
 2591  costs for delivering services as authorized in ss. 409.9071 and
 2592  1011.70 for which the state match will be certified.
 2593  Reimbursement of school-based providers is contingent on such
 2594  providers being enrolled as Medicaid providers and meeting the
 2595  qualifications contained in 42 C.F.R. s. 440.110, unless
 2596  otherwise waived by the federal Centers for Medicare and
 2597  Medicaid Services Health Care Financing Administration. Speech
 2598  therapy providers who are certified through the Department of
 2599  Education pursuant to rule 6A-4.0176, Florida Administrative
 2600  Code, are eligible for reimbursement for services that are
 2601  provided on school premises. Any employee of the school district
 2602  who has been fingerprinted and has received a criminal
 2603  background check in accordance with Department of Education
 2604  rules and guidelines is shall be exempt from any agency
 2605  requirements relating to criminal background checks.
 2606         (22) The agency shall request and implement Medicaid
 2607  waivers from the federal Health Care Financing Administration to
 2608  advance and treat a portion of the Medicaid nursing home per
 2609  diem as capital for creating and operating a risk-retention
 2610  group for self-insurance purposes, consistent with federal and
 2611  state laws and rules.
 2612         (22)(23)(a)LIMITATION ON REIMBURSEMENT RATES.The agency
 2613  shall establish rates at a level that ensures no increase in
 2614  statewide expenditures resulting from a change in unit costs for
 2615  2 fiscal years effective July 1, 2009. Reimbursement rates for
 2616  the 2 fiscal years shall be as provided in the General
 2617  Appropriations Act.
 2618         (a)(b) This subsection applies to the following provider
 2619  types:
 2620         1. Inpatient hospitals.
 2621         2. Outpatient hospitals.
 2622         3. Nursing homes.
 2623         4. County health departments.
 2624         5. Community intermediate care facilities for the
 2625  developmentally disabled.
 2626         6. Prepaid health plans.
 2627         (b) The agency shall apply the effect of this subsection to
 2628  the reimbursement rates for nursing home diversion programs.
 2629         (c) The agency shall create a workgroup on hospital
 2630  reimbursement, a workgroup on nursing facility reimbursement,
 2631  and a workgroup on managed care plan payment. The workgroups
 2632  shall evaluate alternative reimbursement and payment
 2633  methodologies for hospitals, nursing facilities, and managed
 2634  care plans, including prospective payment methodologies for
 2635  hospitals and nursing facilities. The nursing facility workgroup
 2636  shall also consider price-based methodologies for indirect care
 2637  and acuity adjustments for direct care. The agency shall submit
 2638  a report on the evaluated alternative reimbursement
 2639  methodologies to the relevant committees of the Senate and the
 2640  House of Representatives by November 1, 2009.
 2641         (c)(d) This subsection expires June 30, 2011.
 2642         (23) PAYMENT METHODOLOGIES.If a provider is reimbursed
 2643  based on cost reporting and submits a cost report late and that
 2644  cost report would have been used to set a lower reimbursement
 2645  rate for a rate semester, the provider’s rate for that semester
 2646  shall be retroactively calculated using the new cost report, and
 2647  full payment at the recalculated rate shall be applied
 2648  retroactively. Medicare-granted extensions for filing cost
 2649  reports, if applicable, also apply to Medicaid cost reports.
 2650         (24) RETURN OF PAYMENTS.If a provider fails to notify the
 2651  agency within 5 business days after suspension or disenrollment
 2652  from Medicare, sanctions may be imposed pursuant to this
 2653  chapter, and the provider may be required to return funds paid
 2654  to the provider during the period of time that the provider was
 2655  suspended or disenrolled as a Medicare provider.
 2656         Section 26. Subsection (1) of section 409.9081, Florida
 2657  Statutes, is amended to read:
 2658         409.9081 Copayments.—
 2659         (1) The agency shall require, Subject to federal
 2660  regulations and limitations, each Medicaid recipient must to pay
 2661  at the time of service a nominal copayment for the following
 2662  Medicaid services:
 2663         (a) Hospital outpatient services: up to $3 for each
 2664  hospital outpatient visit.
 2665         (b) Physician services: up to $2 copayment for each visit
 2666  with a primary care physician and up to $3 copayment for each
 2667  visit with a specialty care physician licensed under chapter
 2668  458, chapter 459, chapter 460, chapter 461, or chapter 463.
 2669         (c) Hospital emergency department visits for nonemergency
 2670  care: 5 percent of up to the first $300 of the Medicaid payment
 2671  for emergency room services, not to exceed $15. The agency shall
 2672  seek a federal waiver of the requirement that cost-sharing
 2673  amounts for nonemergency services and care furnished in a
 2674  hospital emergency department be nominal. Upon waiver approval,
 2675  a Medicaid recipient who requests such services and care, must
 2676  pay a $100 copayment to the hospital for the nonemergency
 2677  services and care provided in the hospital emergency department.
 2678         (d) Prescription drugs: a coinsurance equal to 2.5 percent
 2679  of the Medicaid cost of the prescription drug at the time of
 2680  purchase. The maximum coinsurance is shall be $7.50 per
 2681  prescription drug purchased.
 2682         Section 27. Paragraph (b) and (d) of subsection (4) and
 2683  subsections (8), (34), (44), (47), and (53) of section 409.912,
 2684  Florida Statutes, are amended, and subsections (48) through (52)
 2685  of that section are renumbered as subsections (47) through (51)
 2686  respectively, to read:
 2687         409.912 Cost-effective purchasing of health care.—The
 2688  agency shall purchase goods and services for Medicaid recipients
 2689  in the most cost-effective manner consistent with the delivery
 2690  of quality medical care. To ensure that medical services are
 2691  effectively utilized, the agency may, in any case, require a
 2692  confirmation or second physician’s opinion of the correct
 2693  diagnosis for purposes of authorizing future services under the
 2694  Medicaid program. This section does not restrict access to
 2695  emergency services or poststabilization care services as defined
 2696  in 42 C.F.R. part 438.114. Such confirmation or second opinion
 2697  shall be rendered in a manner approved by the agency. The agency
 2698  shall maximize the use of prepaid per capita and prepaid
 2699  aggregate fixed-sum basis services when appropriate and other
 2700  alternative service delivery and reimbursement methodologies,
 2701  including competitive bidding pursuant to s. 287.057, designed
 2702  to facilitate the cost-effective purchase of a case-managed
 2703  continuum of care. The agency shall also require providers to
 2704  minimize the exposure of recipients to the need for acute
 2705  inpatient, custodial, and other institutional care and the
 2706  inappropriate or unnecessary use of high-cost services. The
 2707  agency shall contract with a vendor to monitor and evaluate the
 2708  clinical practice patterns of providers in order to identify
 2709  trends that are outside the normal practice patterns of a
 2710  provider’s professional peers or the national guidelines of a
 2711  provider’s professional association. The vendor must be able to
 2712  provide information and counseling to a provider whose practice
 2713  patterns are outside the norms, in consultation with the agency,
 2714  to improve patient care and reduce inappropriate utilization.
 2715  The agency may mandate prior authorization, drug therapy
 2716  management, or disease management participation for certain
 2717  populations of Medicaid beneficiaries, certain drug classes, or
 2718  particular drugs to prevent fraud, abuse, overuse, and possible
 2719  dangerous drug interactions. The Pharmaceutical and Therapeutics
 2720  Committee shall make recommendations to the agency on drugs for
 2721  which prior authorization is required. The agency shall inform
 2722  the Pharmaceutical and Therapeutics Committee of its decisions
 2723  regarding drugs subject to prior authorization. The agency is
 2724  authorized to limit the entities it contracts with or enrolls as
 2725  Medicaid providers by developing a provider network through
 2726  provider credentialing. The agency may competitively bid single
 2727  source-provider contracts if procurement of goods or services
 2728  results in demonstrated cost savings to the state without
 2729  limiting access to care. The agency may limit its network based
 2730  on the assessment of beneficiary access to care, provider
 2731  availability, provider quality standards, time and distance
 2732  standards for access to care, the cultural competence of the
 2733  provider network, demographic characteristics of Medicaid
 2734  beneficiaries, practice and provider-to-beneficiary standards,
 2735  appointment wait times, beneficiary use of services, provider
 2736  turnover, provider profiling, provider licensure history,
 2737  previous program integrity investigations and findings, peer
 2738  review, provider Medicaid policy and billing compliance records,
 2739  clinical and medical record audits, and other factors. Providers
 2740  shall not be entitled to enrollment in the Medicaid provider
 2741  network. The agency shall determine instances in which allowing
 2742  Medicaid beneficiaries to purchase durable medical equipment and
 2743  other goods is less expensive to the Medicaid program than long
 2744  term rental of the equipment or goods. The agency may establish
 2745  rules to facilitate purchases in lieu of long-term rentals in
 2746  order to protect against fraud and abuse in the Medicaid program
 2747  as defined in s. 409.913. The agency may seek federal waivers
 2748  necessary to administer these policies.
 2749         (4) The agency may contract with:
 2750         (b) An entity that is providing comprehensive behavioral
 2751  health care services to certain Medicaid recipients through a
 2752  capitated, prepaid arrangement pursuant to the federal waiver
 2753  authorized under s. 409.905(5)(b) provided for by s. 409.905(5).
 2754  Such entity must be licensed under chapter 624, chapter 636, or
 2755  chapter 641, or authorized under paragraph (c) or paragraph (d),
 2756  and must possess the clinical systems and operational competence
 2757  to manage risk and provide comprehensive behavioral health care
 2758  to Medicaid recipients. As used in this paragraph, the term
 2759  “comprehensive behavioral health care services” means covered
 2760  mental health and substance abuse treatment services that are
 2761  available to Medicaid recipients. The Secretary of the
 2762  Department of Children and Family Services must shall approve
 2763  provisions of procurements related to children in the
 2764  department’s care or custody before enrolling such children in a
 2765  prepaid behavioral health plan. Any contract awarded under this
 2766  paragraph must be competitively procured. In developing The
 2767  behavioral health care prepaid plan procurement document must
 2768  require, the agency shall ensure that the procurement document
 2769  requires the contractor to develop and implement a plan to
 2770  ensure compliance with s. 394.4574 related to services provided
 2771  to residents of licensed assisted living facilities that hold a
 2772  limited mental health license. Except as provided in
 2773  subparagraph 5. 8., and except in counties where the Medicaid
 2774  managed care pilot program is authorized pursuant to s. 409.986
 2775  409.91211, the agency shall seek federal approval to contract
 2776  with a single entity meeting these requirements to provide
 2777  comprehensive behavioral health care services to all Medicaid
 2778  recipients not enrolled in a Medicaid managed care plan
 2779  authorized under s. 409.986 409.91211, a provider service
 2780  network authorized under paragraph (d), or a Medicaid health
 2781  maintenance organization in an AHCA area. In an AHCA area where
 2782  the Medicaid managed care pilot program is authorized pursuant
 2783  to s. 409.986 409.91211 in one or more counties, the agency may
 2784  procure a contract with a single entity to serve the remaining
 2785  counties as an AHCA area or the remaining counties may be
 2786  included with an adjacent AHCA area and are subject to this
 2787  paragraph. Each entity must offer a sufficient choice of
 2788  providers in its network to ensure recipient access to care and
 2789  the opportunity to select a provider with whom they are
 2790  satisfied. The network shall include all public mental health
 2791  hospitals. To ensure unimpaired access to behavioral health care
 2792  services by Medicaid recipients, all contracts issued pursuant
 2793  to this paragraph must require that 90 80 percent of the
 2794  capitation paid to the managed care plan, including health
 2795  maintenance organizations and capitated provider service
 2796  networks, to be expended for the provision of behavioral health
 2797  care services. If the managed care plan expends less than 90 80
 2798  percent of the capitation paid for the provision of behavioral
 2799  health care services, the difference shall be returned to the
 2800  agency. The agency shall provide the plan with a certification
 2801  letter indicating the amount of capitation paid during each
 2802  calendar year for behavioral health care services pursuant to
 2803  this section. The agency may reimburse for substance abuse
 2804  treatment services on a fee-for-service basis until the agency
 2805  finds that adequate funds are available for capitated, prepaid
 2806  arrangements.
 2807         1. By January 1, 2001, The agency shall modify the
 2808  contracts with the entities providing comprehensive inpatient
 2809  and outpatient mental health care services to Medicaid
 2810  recipients in Hillsborough, Highlands, Hardee, Manatee, and Polk
 2811  Counties, to include substance abuse treatment services.
 2812         2. By July 1, 2003, the agency and the Department of
 2813  Children and Family Services shall execute a written agreement
 2814  that requires collaboration and joint development of all policy,
 2815  budgets, procurement documents, contracts, and monitoring plans
 2816  that have an impact on the state and Medicaid community mental
 2817  health and targeted case management programs.
 2818         2.3. Except as provided in subparagraph 5. 8., by July 1,
 2819  2006, the agency and the Department of Children and Family
 2820  Services shall contract with managed care entities in each AHCA
 2821  area except area 6 or arrange to provide comprehensive inpatient
 2822  and outpatient mental health and substance abuse services
 2823  through capitated prepaid arrangements to all Medicaid
 2824  recipients who are eligible to participate in such plans under
 2825  federal law and regulation. In AHCA areas where there are fewer
 2826  than 150,000 eligible individuals number less than 150,000, the
 2827  agency shall contract with a single managed care plan to provide
 2828  comprehensive behavioral health services to all recipients who
 2829  are not enrolled in a Medicaid health maintenance organization,
 2830  a provider service network authorized under paragraph (d), or a
 2831  Medicaid capitated managed care plan authorized under s. 409.986
 2832  409.91211. The agency may contract with more than one
 2833  comprehensive behavioral health provider to provide care to
 2834  recipients who are not enrolled in a Medicaid capitated managed
 2835  care plan authorized under s. 409.986 409.91211, a provider
 2836  service network authorized under paragraph (d), or a Medicaid
 2837  health maintenance organization in AHCA areas where the eligible
 2838  population exceeds 150,000. In an AHCA area where the Medicaid
 2839  managed care pilot program is authorized pursuant to s. 409.986
 2840  409.91211 in one or more counties, the agency may procure a
 2841  contract with a single entity to serve the remaining counties as
 2842  an AHCA area or the remaining counties may be included with an
 2843  adjacent AHCA area and shall be subject to this paragraph.
 2844  Contracts for comprehensive behavioral health providers awarded
 2845  pursuant to this section must shall be competitively procured.
 2846  Both for-profit and not-for-profit corporations are eligible to
 2847  compete. Managed care plans contracting with the agency under
 2848  subsection (3) or paragraph (d), shall provide and receive
 2849  payment for the same comprehensive behavioral health benefits as
 2850  provided in AHCA rules, including handbooks incorporated by
 2851  reference. In AHCA area 11, the agency shall contract with at
 2852  least two comprehensive behavioral health care providers to
 2853  provide behavioral health care to recipients in that area who
 2854  are enrolled in, or assigned to, the MediPass program. One of
 2855  the behavioral health care contracts must be with the existing
 2856  provider service network pilot project, as described in
 2857  paragraph (d), for the purpose of demonstrating the cost
 2858  effectiveness of the provision of quality mental health services
 2859  through a public hospital-operated managed care model. Payment
 2860  shall be at an agreed-upon capitated rate to ensure cost
 2861  savings. Of the recipients in area 11 who are assigned to
 2862  MediPass under s. 409.9122(2)(k), a minimum of 50,000 of those
 2863  MediPass-enrolled recipients shall be assigned to the existing
 2864  provider service network in area 11 for their behavioral care.
 2865         4. By October 1, 2003, the agency and the department shall
 2866  submit a plan to the Governor, the President of the Senate, and
 2867  the Speaker of the House of Representatives which provides for
 2868  the full implementation of capitated prepaid behavioral health
 2869  care in all areas of the state.
 2870         a. Implementation shall begin in 2003 in those AHCA areas
 2871  of the state where the agency is able to establish sufficient
 2872  capitation rates.
 2873         b. If the agency determines that the proposed capitation
 2874  rate in any area is insufficient to provide appropriate
 2875  services, the agency may adjust the capitation rate to ensure
 2876  that care will be available. The agency and the department may
 2877  use existing general revenue to address any additional required
 2878  match but may not over-obligate existing funds on an annualized
 2879  basis.
 2880         c. Subject to any limitations provided in the General
 2881  Appropriations Act, the agency, in compliance with appropriate
 2882  federal authorization, shall develop policies and procedures
 2883  that allow for certification of local and state funds.
 2884         3.5. Children residing in a statewide inpatient psychiatric
 2885  program, or in a Department of Juvenile Justice or a Department
 2886  of Children and Family Services residential program approved as
 2887  a Medicaid behavioral health overlay services provider may not
 2888  be included in a behavioral health care prepaid health plan or
 2889  any other Medicaid managed care plan pursuant to this paragraph.
 2890         6. In converting to a prepaid system of delivery, the
 2891  agency shall in its procurement document require an entity
 2892  providing only comprehensive behavioral health care services to
 2893  prevent the displacement of indigent care patients by enrollees
 2894  in the Medicaid prepaid health plan providing behavioral health
 2895  care services from facilities receiving state funding to provide
 2896  indigent behavioral health care, to facilities licensed under
 2897  chapter 395 which do not receive state funding for indigent
 2898  behavioral health care, or reimburse the unsubsidized facility
 2899  for the cost of behavioral health care provided to the displaced
 2900  indigent care patient.
 2901         4.7. Traditional community mental health providers under
 2902  contract with the Department of Children and Family Services
 2903  pursuant to part IV of chapter 394, child welfare providers
 2904  under contract with the Department of Children and Family
 2905  Services in areas 1 and 6, and inpatient mental health providers
 2906  licensed pursuant to chapter 395 must be offered an opportunity
 2907  to accept or decline a contract to participate in any provider
 2908  network for prepaid behavioral health services.
 2909         5.8. All Medicaid-eligible children, except children in
 2910  area 1 and children in Highlands County, Hardee County, Polk
 2911  County, or Manatee County in of area 6, whose cases that are
 2912  open for child welfare services in the statewide automated child
 2913  welfare information HomeSafeNet system, shall receive their
 2914  behavioral health care services through a specialty prepaid plan
 2915  operated by community-based lead agencies through a single
 2916  agency or formal agreements among several agencies. The
 2917  specialty prepaid plan must result in savings to the state
 2918  comparable to savings achieved in other Medicaid managed care
 2919  and prepaid programs. Such plan must provide mechanisms to
 2920  maximize state and local revenues. The specialty prepaid plan
 2921  shall be developed by the agency and the Department of Children
 2922  and Family Services. The agency may seek federal waivers to
 2923  implement this initiative. Medicaid-eligible children whose
 2924  cases are open for child welfare services in the statewide
 2925  automated child welfare information HomeSafeNet system and who
 2926  reside in AHCA area 10 shall be enrolled in a capitated managed
 2927  care plan, which includes provider service networks, which, in
 2928  coordination with available community-based care providers
 2929  specified in s. 409.1671, shall provide sufficient medical,
 2930  developmental, behavioral, and emotional services to meet the
 2931  needs of these children, subject to funding as provided in the
 2932  General Appropriations Act are exempt from the specialty prepaid
 2933  plan upon the development of a service delivery mechanism for
 2934  children who reside in area 10 as specified in s.
 2935  409.91211(3)(dd).
 2936         (d) A provider service network, which may be reimbursed on
 2937  a fee-for-service or prepaid basis.
 2938         1. A provider service network that which is reimbursed by
 2939  the agency on a prepaid basis is shall be exempt from parts I
 2940  and III of chapter 641, but must comply with the solvency
 2941  requirements in s. 641.2261(2) and meet appropriate financial
 2942  reserve, quality assurance, and patient rights requirements as
 2943  established by the agency.
 2944         2.Medicaid recipients assigned to a provider service
 2945  network shall be chosen equally from those who would otherwise
 2946  have been assigned to prepaid plans and MediPass. The agency may
 2947  is authorized to seek federal Medicaid waivers as necessary to
 2948  implement the provisions of this section. Any contract
 2949  previously awarded to a provider service network operated by a
 2950  hospital pursuant to this subsection shall remain in effect for
 2951  a period of 3 years following the current contract expiration
 2952  date, regardless of any contractual provisions to the contrary.
 2953         3. A provider service network is a network established or
 2954  organized and operated by a health care provider, or group of
 2955  affiliated health care providers, including minority physician
 2956  networks and emergency room diversion programs that meet the
 2957  requirements of s. 409.986 409.91211, which provides a
 2958  substantial proportion of the health care items and services
 2959  under a contract directly through the provider or affiliated
 2960  group of providers and may make arrangements with physicians or
 2961  other health care professionals, health care institutions, or
 2962  any combination of such individuals or institutions to assume
 2963  all or part of the financial risk on a prospective basis for the
 2964  provision of basic health services by the physicians, by other
 2965  health professionals, or through the institutions. The health
 2966  care providers must have a controlling interest in the governing
 2967  body of the provider service network organization.
 2968         (8)(a) The agency may contract on a prepaid or fixed-sum
 2969  basis with an exclusive provider organization to provide health
 2970  care services to Medicaid recipients if provided that the
 2971  exclusive provider organization meets applicable managed care
 2972  plan requirements in this section, ss. 409.987, 409.988
 2973  409.9122, 409.9123, 409.9128, and 627.6472, and other applicable
 2974  provisions of law.
 2975         (b) For a period of no longer than 24 months after the
 2976  effective date of this paragraph, when a member of an exclusive
 2977  provider organization that is contracted by the agency to
 2978  provide health care services to Medicaid recipients in rural
 2979  areas without a health maintenance organization obtains services
 2980  from a provider that participates in the Medicaid program in
 2981  this state, the provider shall be paid in accordance with the
 2982  appropriate fee schedule for services provided to eligible
 2983  Medicaid recipients. The agency may seek waiver authority to
 2984  implement this paragraph.
 2985         (34) The agency and entities that contract with the agency
 2986  to provide health care services to Medicaid recipients under
 2987  this section or ss. 409.986 and 409.987 409.91211 and 409.9122
 2988  must comply with the provisions of s. 641.513 in providing
 2989  emergency services and care to Medicaid recipients and MediPass
 2990  recipients. Where feasible, safe, and cost-effective, the agency
 2991  shall encourage hospitals, emergency medical services providers,
 2992  and other public and private health care providers to work
 2993  together in their local communities to enter into agreements or
 2994  arrangements to ensure access to alternatives to emergency
 2995  services and care for those Medicaid recipients who need
 2996  nonemergent care. The agency shall coordinate with hospitals,
 2997  emergency medical services providers, private health plans,
 2998  capitated managed care networks as established in s. 409.986
 2999  409.91211, and other public and private health care providers to
 3000  implement the provisions of ss. 395.1041(7), 409.91255(3)(g),
 3001  627.6405, and 641.31097 to develop and implement emergency
 3002  department diversion programs for Medicaid recipients.
 3003         (44) The agency for Health Care Administration shall ensure
 3004  that any Medicaid managed care plan as defined in s.
 3005  409.987(2)(f) 409.9122(2)(f), whether paid on a capitated basis
 3006  or a shared savings basis, is cost-effective. For purposes of
 3007  this subsection, the term “cost-effective” means that a
 3008  network’s per-member, per-month costs to the state, including,
 3009  but not limited to, fee-for-service costs, administrative costs,
 3010  and case-management fees, if any, must be no greater than the
 3011  state’s costs associated with contracts for Medicaid services
 3012  established under subsection (3), which may be adjusted for
 3013  health status. The agency shall conduct actuarially sound
 3014  adjustments for health status in order to ensure such cost
 3015  effectiveness and shall annually publish the results on its
 3016  Internet website. Contracts established pursuant to this
 3017  subsection which are not cost-effective may not be renewed.
 3018         (47) The agency shall conduct a study of available
 3019  electronic systems for the purpose of verifying the identity and
 3020  eligibility of a Medicaid recipient. The agency shall recommend
 3021  to the Legislature a plan to implement an electronic
 3022  verification system for Medicaid recipients by January 31, 2005.
 3023         (53) Before seeking an amendment to the state plan for
 3024  purposes of implementing programs authorized by the Deficit
 3025  Reduction Act of 2005, the agency shall notify the Legislature.
 3026         Section 28. Paragraph (a) of subsection (1) of section
 3027  409.915, Florida Statutes, is amended to read:
 3028         409.915 County contributions to Medicaid.—Although the
 3029  state is responsible for the full portion of the state share of
 3030  the matching funds required for the Medicaid program, in order
 3031  to acquire a certain portion of these funds, the state shall
 3032  charge the counties for certain items of care and service as
 3033  provided in this section.
 3034         (1) Each county shall participate in the following items of
 3035  care and service:
 3036         (a) For both health maintenance members and fee-for-service
 3037  beneficiaries, payments for inpatient hospitalization in excess
 3038  of 10 days, but not in excess of 45 days, with the exception of
 3039  pregnant women and children whose income is greater than in
 3040  excess of the federal poverty level and who do not receive a
 3041  Medicaid nonpoverty medical subsidy participate in the Medicaid
 3042  medically needy Program, and for adult lung transplant services.
 3043         Section 29. Section 409.9301, Florida Statutes, is
 3044  transferred, renumbered as section 409.9067, Florida Statutes,
 3045  and subsections (1) and (2) of that section are amended, to
 3046  read:
 3047         409.9067 409.9301 Pharmaceutical expense assistance.—
 3048         (1) PROGRAM ESTABLISHED.—A program is established in the
 3049  agency for Health Care Administration to provide pharmaceutical
 3050  expense assistance to individuals diagnosed with cancer or
 3051  individuals who have obtained received organ transplants who
 3052  received a Medicaid nonpoverty medical subsidy before were
 3053  medically needy recipients prior to January 1, 2006.
 3054         (2) ELIGIBILITY.—Eligibility for the program is limited to
 3055  an individual who:
 3056         (a) Is a resident of this state;
 3057         (b) Was a Medicaid recipient who received a nonpoverty
 3058  medical subsidy before under the Florida Medicaid medically
 3059  needy program prior to January 1, 2006;
 3060         (c) Is eligible for Medicare;
 3061         (d) Is a cancer patient or an organ transplant recipient;
 3062  and
 3063         (e) Requests to be enrolled in the program.
 3064         Section 30. Subsection (1) of section 409.9126, Florida
 3065  Statutes, is amended to read:
 3066         409.9126 Children with special health care needs.—
 3067         (1) Except as provided in subsection (4), children eligible
 3068  for Children’s Medical Services who receive Medicaid benefits,
 3069  and other Medicaid-eligible children with special health care
 3070  needs, are shall be exempt from the provisions of s. 409.987
 3071  409.9122 and shall be served through the Children’s Medical
 3072  Services network established in chapter 391.
 3073         Section 31. The Division of Statutory Revision is requested
 3074  to create part IV of chapter 409, Florida Statutes, consisting
 3075  of sections 409.961-409.978, Florida Statutes, entitled
 3076  “MEDICAID MANAGED CARE.”
 3077         Section 32. Section 409.961, Florida Statutes, is created
 3078  to read:
 3079         409.961Construction; applicability.—It is the intent of
 3080  the Legislature that if any conflict exists between ss. 409.961
 3081  409.978 and other parts or sections of this chapter, the
 3082  provisions in ss. 409.961-409.978 control. Sections 409.961
 3083  409.978 apply only to the Medicaid managed care program, as
 3084  provided in this part.
 3085         Section 33. Section 409.962, Florida Statutes, is created
 3086  to read:
 3087         409.962Definitions.—As used in this part, and including
 3088  the terms defined in s. 409.901, the term:
 3089         (1) “Direct care management” means care management
 3090  activities that involve direct interaction between providers and
 3091  patients.
 3092         (2) “Home and community-based services” means a specific
 3093  set of services designed to assist recipients qualifying under
 3094  s. 409.974 in avoiding institutionalization.
 3095         (3) “Medicaid managed care program” means the integrated,
 3096  statewide Medicaid program created in this part, which includes
 3097  the provision of managed care medical assistance services
 3098  described in ss. 409.971 and 409.972 and managed long-term care
 3099  services described in ss. 409.973-409.978.
 3100         (4) “Provider service network” means an entity of which a
 3101  controlling interest is owned by a health care provider, a group
 3102  of affiliated providers, or a public agency or entity that
 3103  delivers health services. Health care providers include Florida
 3104  licensed health care professionals or licensed health care
 3105  facilities, federally qualified health care centers, and home
 3106  health care agencies.
 3107         (5) “Qualified plan” means a managed care plan that is
 3108  determined eligible to participate in the Medicaid managed care
 3109  program pursuant to s. 409.965.
 3110         (6) “Specialty plan” means a qualified plan that serves
 3111  Medicaid recipients who meet specified criteria based on age,
 3112  medical condition, or diagnosis.
 3113         Section 34. Section 409.963, Florida Statutes, is created
 3114  to read:
 3115         409.963Medicaid managed care program.—The Medicaid managed
 3116  care program is established as a statewide, integrated managed
 3117  care program for all covered medical assistance services and
 3118  long-term care services as provided under this part. Pursuant to
 3119  s. 409.902, the program shall be administered by the agency, and
 3120  eligibility for the program shall be determined by the
 3121  Department of Children and Family Services.
 3122         (1) The agency shall submit amendments to the Medicaid
 3123  state plan or to existing waivers, or submit new waiver requests
 3124  under section 1115 or other applicable sections of the Social
 3125  Security Act, by August 1, 2011, as needed to implement the
 3126  managed care program. At a minimum, the waiver requests must
 3127  include a waiver that allows home and community-based services
 3128  to be preferred over nursing home services for persons who can
 3129  be safely managed in the home and community, and a waiver that
 3130  requires dually eligible recipients to participate in the
 3131  Medicaid managed care program. The waiver requests must also
 3132  include provisions authorizing the state to limit enrollment in
 3133  managed long-term care, establish waiting lists, and limit the
 3134  amount, duration, and scope of home and community-based services
 3135  to ensure that expenditures for persons eligible for managed
 3136  long-term care services do not exceed funds provided in the
 3137  General Appropriations Act.
 3138         (a) The agency shall initiate any necessary procurements
 3139  required to implement the managed care program as soon as
 3140  practicable, but no later than July 1, 2011, in anticipation of
 3141  prompt approval of the waivers needed for the managed care
 3142  program by the United States Department of Health and Human
 3143  Services.
 3144         (b) In submitting waivers, the agency shall work with the
 3145  federal Centers for Medicare and Medicaid Services to accomplish
 3146  approval of all waivers by December 1, 2011, in order to begin
 3147  implementation of the managed care program by December 31, 2011.
 3148         (c) Before seeking a waiver, the agency shall provide
 3149  public notice and the opportunity for public comment and include
 3150  public feedback in the waiver application.
 3151         (2) The agency shall begin implementation of the Medicaid
 3152  managed care program on December 31, 2011. If waiver approval is
 3153  obtained, the program shall be implemented in accordance with
 3154  the terms and conditions of the waiver. If necessary waivers
 3155  have not been timely received, the agency shall notify the
 3156  Centers for Medicare and Medicaid Services of the state’s
 3157  implementation of the managed care program and request the
 3158  federal agency to continue providing federal funds equivalent to
 3159  the funding level provided under the Federal Medical Assistance
 3160  Percentage in order to implement the managed care program.
 3161         (a) If the Centers for Medicare and Medicaid Services
 3162  refuses to continue providing federal funds, the managed care
 3163  program shall be implemented as a state-only funded program to
 3164  the extent state funds are available.
 3165         (b) If implemented as a state-only funded program, priority
 3166  shall be given to providing:
 3167         1. Nursing home services to persons eligible for nursing
 3168  home care.
 3169         2. Medical services to persons served by the Agency for
 3170  Persons with Disabilities.
 3171         3. Medical services to pregnant women.
 3172         4. Physician and hospital services to persons who are
 3173  determined to be eligible for Medicaid subject to the income,
 3174  assets, and categorical eligibility tests set forth in federal
 3175  and state law.
 3176         5. Services provided under the Healthy Start waiver.
 3177         6. Medical services provided to persons in the Nursing Home
 3178  Diversion waiver.
 3179         7. Medical services provided to persons in intermediate
 3180  care facilities for the developmentally disabled.
 3181         8. Services to children in the child welfare system whose
 3182  medical care is provided in accordance with s. 409.16713, as
 3183  authorized by the General Appropriations Act.
 3184         (c)If implemented as a state-only funded program pursuant
 3185  to paragraph (b), provisions related to the eligibility
 3186  standards of the state and federally funded Medicaid program
 3187  remain in effect, except as otherwise provided under the managed
 3188  care program.
 3189         (d) If implemented as a state-only funded program pursuant
 3190  to paragraph (a), provider agreements and other contracts that
 3191  provide for Medicaid services to recipients identified in
 3192  paragraph (b) continue in effect.
 3193         Section 35. Section 409.964, Florida Statutes, is created
 3194  to read:
 3195         409.964Enrollment.—All Medicaid recipients shall receive
 3196  medical services through the Medicaid managed care program
 3197  established under this part unless excluded under this section.
 3198         (1) The following recipients are excluded from
 3199  participation in the Medicaid managed care program:
 3200         (a) Women who are eligible only for family planning
 3201  services.
 3202         (b) Women who are eligible only for breast and cervical
 3203  cancer services.
 3204         (c) Persons who have a developmental disability as defined
 3205  in s. 393.063.
 3206         (d) Persons who are eligible for a Medicaid nonpoverty
 3207  medical subsidy.
 3208         (e) Persons who receive eligible services under emergency
 3209  Medicaid for aliens.
 3210         (f) Persons who are residing in a nursing home facility or
 3211  are considered residents under the nursing home’s bed-hold
 3212  policy on or before July 1, 2011.
 3213         (g) Persons who are eligible for and receiving prescribed
 3214  pediatric extended care.
 3215         (h)Persons who are dependent on a respirator by medical
 3216  necessity and who meet the definition of a medically dependent
 3217  or technologically dependent child under s. 400.902.
 3218         (i) Persons who select the Medicaid hospice benefit and are
 3219  receiving hospice services from a hospice licensed under part IV
 3220  of chapter 400.
 3221         (j)A person who is eligible for services under the
 3222  Medicaid program who has access to health care coverage through
 3223  an employer-sponsored health plan. Such person may not receive
 3224  Medicaid services under the fee-for-service program but may use
 3225  Medicaid financial assistance to pay the cost of premiums for
 3226  the employer-sponsored health plan. For purposes of this
 3227  paragraph, access to health care coverage through an employer
 3228  sponsored health plan means that the Medicaid financial
 3229  assistance available to the person is sufficient to pay the
 3230  premium for the employer-sponsored health plan for the eligible
 3231  person and his or her Medicaid eligible family members.
 3232         1.The agency shall develop a process that allows a
 3233  recipient who has access to employer-sponsored health coverage
 3234  to use Medicaid financial assistance to pay the cost of the
 3235  premium for the recipient and the recipient’s Medicaid-eligible
 3236  family members for such coverage. The amount of financial
 3237  assistance may not exceed the Medicaid capitated rate that would
 3238  have been paid to a qualified plan for that recipient and the
 3239  recipient’s family members.
 3240         2.Contingent upon federal approval, the agency shall also
 3241  allow recipients who have access to other insurance or coverage
 3242  created pursuant to state or federal law to opt out of Medicaid
 3243  managed care and apply the Medicaid capitated rate that would
 3244  have been paid to a qualified plan for that recipient and the
 3245  recipient’s family to pay for the other insurance product.
 3246         (2) The following Medicaid recipients are exempt from
 3247  mandatory enrollment in the managed care program but may
 3248  volunteer to participate in the program:
 3249         (a) Recipients residing in residential commitment
 3250  facilities operated through the Department of Juvenile Justice,
 3251  group care facilities operated by the Department of Children and
 3252  Family Services, or treatment facilities funded through the
 3253  substance abuse and mental health program of the Department of
 3254  Children and Family Services.
 3255         (b) Persons eligible for refugee assistance.
 3256         (3) Medicaid recipients who are exempt from mandatory
 3257  participation under this section and who do not choose to enroll
 3258  in the Medicaid managed care program shall be served though the
 3259  Medicaid fee-for-service program as provided under part III of
 3260  this chapter.
 3261         Section 36. Section 409.965, Florida Statutes, is created
 3262  to read:
 3263         409.965Qualified plans; regions; selection criteria.
 3264  Services in the Medicaid managed care program shall be provided
 3265  by qualified plans.
 3266         (1) The agency shall select qualified plans to participate
 3267  in the Medicaid managed care program using an invitation to
 3268  negotiate issued pursuant to s. 287.057.
 3269         (a) The agency shall notice separate invitations to
 3270  negotiate for the managed medical assistance component and the
 3271  managed long-term care component of the managed care program.
 3272         (b) At least 30 days before noticing the invitation to
 3273  negotiate and annually thereafter, the agency shall compile and
 3274  publish a databook consisting of a comprehensive set of
 3275  utilization and spending data for the 3 most recent contract
 3276  years, consistent with the rate-setting periods for all Medicaid
 3277  recipients by region and county. Pursuant to s. 409.970, the
 3278  source of the data must include both historic fee-for-service
 3279  claims and validated data from the Medicaid Encounter Data
 3280  System. The report shall be made available electronically and
 3281  must delineate utilization by age, gender, eligibility group,
 3282  geographic area, and acuity level.
 3283         (2) Separate and simultaneous procurements shall be
 3284  conducted in each of the following regions:
 3285         (a) Region 1, which consists of Escambia, Okaloosa, Santa
 3286  Rosa, and Walton counties.
 3287         (b) Region 2, which consists of Franklin, Gadsden,
 3288  Jefferson, Leon, Liberty, and Wakulla counties.
 3289         (c) Region 3, which consists of Columbia, Dixie, Hamilton,
 3290  Lafayette, Madison, Suwannee, and Taylor counties.
 3291         (d) Region 4, which consists of Baker, Clay, Duval, and
 3292  Nassau counties.
 3293         (e) Region 5, which consists of Citrus, Hernando, Lake,
 3294  Marion, and Sumter counties.
 3295         (f) Region 6, which consists of Pasco and Pinellas
 3296  counties.
 3297         (g) Region 7, which consists of Flagler, Putnam, St. Johns,
 3298  and Volusia counties.
 3299         (h) Region 8, which consists of Alachua, Bradford,
 3300  Gilchrist, Levy, and Union counties.
 3301         (i) Region 9, which consists of Orange and Osceola
 3302  counties.
 3303         (j) Region 10, which consists of Hardee, Highlands, and
 3304  Polk counties.
 3305         (k) Region 11, which consists of Miami-Dade and Monroe
 3306  counties.
 3307         (l) Region 12, which consists of DeSoto, Manatee, and
 3308  Sarasota counties.
 3309         (m) Region 13, which consists of Hillsborough County.
 3310         (n) Region 14, which consists of Bay, Calhoun, Gulf,
 3311  Holmes, Jackson, and Washington counties.
 3312         (o) Region 15, which consists of Palm Beach County.
 3313         (p) Region 16, which consists of Broward County.
 3314         (q) Region 17, which consists of Brevard and Seminole
 3315  counties.
 3316         (r) Region 18, which consists of Indian River, Martin,
 3317  Okeechobee, and St. Lucie counties.
 3318         (s) Region 19, which consists of Charlotte, Collier,
 3319  Glades, Hendry, and Lee counties.
 3320         (3) The invitation to negotiate must specify the criteria
 3321  and the relative weight of the criteria to be used for
 3322  determining the acceptability of a reply and guiding the
 3323  selection of qualified plans with which the agency shall
 3324  contract. In addition to other criteria developed by the agency,
 3325  the agency shall give preference to the following factors in
 3326  selecting qualified plans:
 3327         (a) Accreditation by the National Committee for Quality
 3328  Assurance or another nationally recognized accrediting body.
 3329         (b) Experience serving similar populations, including the
 3330  organization’s record in achieving specific quality standards
 3331  for similar populations.
 3332         (c) Availability and accessibility of primary care and
 3333  specialty physicians in the provider network.
 3334         (d) Establishment of partnerships with community providers
 3335  that provide community-based services.
 3336         (e) The organization’s commitment to quality improvement
 3337  and documentation of achievements in specific quality
 3338  improvement projects, including active involvement by the
 3339  organization’s leadership.
 3340         (f) Provision of additional benefits, particularly dental
 3341  care for all recipients, disease management, and other programs
 3342  offering additional benefits.
 3343         (g) Establishment of incentive programs that reward
 3344  specific behaviors with health-related benefits not otherwise
 3345  covered by the organizations’ benefit plan. Such behaviors may
 3346  include participation in smoking-cessation programs, weight-loss
 3347  programs, or other activities designed to mitigate lifestyle
 3348  choices and avoid behaviors associated with the use of high-cost
 3349  medical services.
 3350         (h) Organizations without a history of voluntary or
 3351  involuntary withdrawal from any state Medicaid program or
 3352  program area.
 3353         (i) Evidence that an organization has written agreements or
 3354  signed contracts or has made substantial progress in
 3355  establishing relationships with providers before the
 3356  organization submits a reply. The agency shall evaluate such
 3357  evidence based on the following factors:
 3358         1. Contracts with primary care and specialty physicians in
 3359  sufficient numbers to meet the specific performance standards
 3360  established pursuant to s. 409.966(2)(b).
 3361         2. Specific arrangements that provide evidence that the
 3362  compensation offered by the plan is sufficient to retain primary
 3363  care and specialty physicians in sufficient numbers to comply
 3364  with the performance standards established pursuant to s.
 3365  409.966(2) throughout the 5-year contract term. The agency shall
 3366  give preference to plans that provide evidence that primary care
 3367  physicians within the plan’s provider network will be
 3368  compensated for primary care services with payments equivalent
 3369  to or greater than payments for such services under the Medicare
 3370  program, whether compensation is made on a fee-for-service basis
 3371  or by sub-capitation.
 3372         3. Contracts with community pharmacies located in rural
 3373  areas; contracts with community pharmacies serving specialty
 3374  disease populations, including, but not limited to, HIV/AIDS
 3375  patients, hemophiliacs, patients suffering from end-stage renal
 3376  disease, diabetes, or cancer; community pharmacies located
 3377  within distinct cultural communities that reflect the unique
 3378  cultural dynamics of such communities, including, but not
 3379  limited to, languages spoken, ethnicities served, unique disease
 3380  states serviced, and geographic location within the
 3381  neighborhoods of culturally distinct populations; and community
 3382  pharmacies providing value-added services to patients, such as
 3383  free delivery, immunizations, disease management, diabetes
 3384  education, and medication utilization review.
 3385         4. Contracts with cancer disease management programs that
 3386  have a proven record of clinical efficiencies and cost savings.
 3387         5. Contracts with diabetes disease management programs that
 3388  have a proven record of clinical efficiencies and cost savings.
 3389         (j) The capitated rates provided in the reply to the
 3390  invitation to negotiate.
 3391         (k) Establishment of a claims payment process to ensure
 3392  that claims that are not contested or denied will be paid within
 3393  20 days after receipt.
 3394         (l) For long-term care plans, additional criteria as
 3395  specified in s. 409.976(3).
 3396         (4) Acceptable replies to the invitation to negotiate for
 3397  each region shall be ranked, and the agency shall select the
 3398  number of qualified plans with which to contract in each region.
 3399         (a) The agency may not select more than one plan per 20,000
 3400  Medicaid recipients residing in the region who are subject to
 3401  mandatory managed care enrollment, except that, in addition to
 3402  the Children’s Medical Services Network, a region may not have
 3403  more than 10 qualified plans for the managed medical assistance
 3404  or the managed long-term care components of the program.
 3405         (b) If the funding available in the General Appropriations
 3406  Act is not adequate to meet the proposed statewide requirement
 3407  under the Medicaid managed care program, the agency shall enter
 3408  into negotiations with qualified plans that responded to the
 3409  invitation to negotiate. The negotiation process may alter the
 3410  rank of a qualified plan. If negotiations are conducted, the
 3411  agency shall select qualified plans that are responsive and
 3412  provide the best value to the state.
 3413         (5)The agency may issue a new invitation to negotiate in
 3414  any region:
 3415         (a) At any time if:
 3416         1.Data becomes available to the agency indicating that the
 3417  population of recipients residing in the region who are subject
 3418  to mandatory managed care enrollment cannot be served by the
 3419  plans under contract with the agency in that region or has
 3420  increased by more than 20,000 since the most recent invitation
 3421  to negotiate was issued in that region; and
 3422         2.The agency has not contracted with the maximum number of
 3423  plans authorized for that region.
 3424         (b) At any time during the first 2 years after the initial
 3425  contract period and upon the request of a qualified plan under
 3426  contract in one or more regions if:
 3427         1. Data becomes available to the agency indicating that the
 3428  population of Medicaid recipients residing in the region who are
 3429  subject to mandatory managed care enrollment has increased by
 3430  more than 20,000 since the initial invitation to negotiate was
 3431  issued for the contract period; and
 3432         2. The agency has not contracted with the maximum number of
 3433  plans authorized for that region.
 3434  
 3435  The term of a contract executed under this subsection shall be
 3436  for the remainder of the 5-year contract cycle.
 3437         (6) The Children’s Medical Services Network authorized
 3438  under chapter 391 is a qualified plan for purposes of the
 3439  managed care medical assistance component of the Medicaid
 3440  managed care program. Participation by the network shall be
 3441  pursuant to a single statewide contract with the agency which is
 3442  not subject to the procurement requirements of this section. The
 3443  network must meet all other plan requirements for the managed
 3444  care medical assistance component of the program.
 3445         (7) In order to allow a provider service network in rural
 3446  areas sufficient time to develop an adequate provider network to
 3447  participate in the Medicaid managed care program on a capitated
 3448  basis, the network may submit an application or invitation to
 3449  negotiate after July 1, 2011, as required by the agency, for a
 3450  region where there was no Medicaid-contracted health maintenance
 3451  organization or provider service network on July 1, 2011. For
 3452  the first 12 months that the network operates in the region, the
 3453  agency shall assign existing Medicaid provider agreements to the
 3454  provider service network for purposes of administering managed
 3455  care services and building an adequate provider network to meet
 3456  the access standards established by the agency.
 3457         Section 37. Section 409.966, Florida Statutes, is created
 3458  to read:
 3459         409.966Plan contracts.—
 3460         (1) The agency shall execute a 5-year contract with each
 3461  qualified plan selected through the procurement process
 3462  described in s. 409.965. A contract between the agency and the
 3463  qualified plan may be amended annually, or as needed, to reflect
 3464  capitated rate adjustments due to funding availability pursuant
 3465  to the General Appropriations Act and ss. 409.9022, 409.972, and
 3466  409.975(2).
 3467         (a) A plan contract may not be renewed; however, the agency
 3468  may extend the term of a contract, keeping intact all
 3469  operational provisions in the contract, including capitation
 3470  rates, to cover any delays in transitioning to a new plan.
 3471         (b) If a plan applies for a rate increase that is not the
 3472  result of a solicitation from the agency and the application for
 3473  rate increase is not timely withdrawn, the plan will be deemed
 3474  to have submitted a notice of intent to leave the region before
 3475  the end of the contract term.
 3476         (2) The agency shall establish such contract requirements
 3477  as are necessary for the operation of the Medicaid managed care
 3478  program. In addition to any other provisions the agency may deem
 3479  necessary, the contract must require:
 3480         (a) Access.—The agency shall establish specific standards
 3481  for the number, type, and regional distribution of providers in
 3482  plan networks in order to ensure access to care. Each qualified
 3483  plan shall:
 3484         1. Maintain a network of providers in sufficient numbers to
 3485  meet the access standards for specified services for all
 3486  recipients enrolled in the plan.
 3487         2. Establish and maintain an accurate and complete
 3488  electronic database of contracted providers, including
 3489  information about licensure or registration, locations and hours
 3490  of operation, specialty credentials and other certifications,
 3491  specific performance indicators, and such other information as
 3492  the agency deems necessary. The provider database must be
 3493  available online to both the agency and the public and allow
 3494  comparison of the availability of providers to network adequacy
 3495  standards, and accept and display feedback from each provider’s
 3496  patients.
 3497         3. Provide for reasonable and adequate hours of operation,
 3498  including 24-hour availability of information, referral, and
 3499  treatment for emergency medical conditions.
 3500         4. Assign each new enrollee to a primary care provider and
 3501  ensure that an appointment with that provider has been scheduled
 3502  within 30 days after the enrollment in the plan.
 3503         5. Submit quarterly reports to the agency identifying the
 3504  number of enrollees assigned to each primary care provider.
 3505         (b) Performance standards.—The agency shall establish
 3506  specific performance standards and expected milestones or
 3507  timelines for improving plan performance over the term of the
 3508  contract.
 3509         1. Each plan shall establish an internal health care
 3510  quality improvement system that includes enrollee satisfaction
 3511  and disenrollment surveys and incentives and disincentives for
 3512  network providers.
 3513         2. Each plan must collect and report the Health Plan
 3514  Employer Data and Information Set (HEDIS) measures, as specified
 3515  by the agency. These measures must be published on the plan’s
 3516  website in a manner that allows recipients to reliably compare
 3517  the performance of plans. The agency shall use the HEDIS
 3518  measures as a tool to monitor plan performance.
 3519         3. A qualified plan that is not accredited when the
 3520  contract is executed with the agency must become accredited or
 3521  have initiated the accreditation process within 1 year after the
 3522  contract is executed. If the plan is not accredited within 18
 3523  months after executing the contract, the plan shall be suspended
 3524  from automated enrollments pursuant to s. 409.969(2).
 3525         4. In addition to agency standards, a qualified plan must
 3526  ensure that the agency is notified of the impending birth of a
 3527  child to an enrollee or as soon as practicable after the child’s
 3528  birth. Upon the birth, the child is deemed enrolled with the
 3529  qualified plan, regardless of the administrative enrollment
 3530  procedures, and the qualified plan is responsible for providing
 3531  Medicaid services to the child on a capitated basis.
 3532         (c) Program integrity.—Each plan shall establish program
 3533  integrity functions and activities in order to reduce the
 3534  incidence of fraud and abuse, including, at a minimum:
 3535         1. A provider credentialing system and ongoing provider
 3536  monitoring. Each plan must verify at least annually that all
 3537  providers have a valid and unencumbered license or permit to
 3538  provide services to Medicaid recipients, and shall establish a
 3539  procedure for providers to notify the plan when the provider has
 3540  been notified by a licensing or regulatory agency that the
 3541  provider’s license or permit is to be revoked or suspended, or
 3542  when an event has occurred which would prevent the provider from
 3543  renewing its license or permit. The provider must also notify
 3544  the plan if the license or permit is revoked or suspended, if
 3545  renewal of the license or permit is denied or expires by
 3546  operation of law, or if the provider requests that the license
 3547  or permit be inactivated. The plan must immediately exclude a
 3548  provider from the plan’s provider network if the provider’s
 3549  license is suspended or invalid;
 3550         2. An effective prepayment and postpayment review process
 3551  that includes, at a minimum, data analysis, system editing, and
 3552  auditing of network providers;
 3553         3. Procedures for reporting instances of fraud and abuse
 3554  pursuant to s. 409.91212;
 3555         4. The establishment of an anti-fraud plan pursuant to s.
 3556  409.91212; and
 3557         5. Designation of a program integrity compliance officer.
 3558         (d) Encounter data.—Each plan must comply with the agency’s
 3559  reporting requirements for the Medicaid Encounter Data System
 3560  under s. 409.970. The agency shall assess a fine of $5,000 per
 3561  day against a qualified plan for failing to comply with this
 3562  requirement. If a plan fails to comply for more than 30 days,
 3563  the agency shall assess a fine of $10,000 per day beginning on
 3564  the 31st day. If a plan is fined $300,000 or more for failing to
 3565  comply, in addition to paying the fine, the plan shall be
 3566  disqualified from the Medicaid managed care program for 3 years.
 3567  If the plan is disqualified, the plan shall be deemed to have
 3568  terminated its contract before the scheduled end date and shall
 3569  also be subject to applicable penalties under paragraph (l).
 3570  However, the agency may waive or reduce the fine upon a showing
 3571  of good cause for the failure to comply.
 3572         (e) Electronic claims.Plans shall accept electronic claims
 3573  that are in compliance with federal standards.
 3574         (f) Prompt payment.—All qualified plans must comply with
 3575  ss. 641.315, 641.3155, and 641.513. Qualified plans shall pay
 3576  nursing homes by the 10th day of the month for enrollees who are
 3577  residing in the nursing home on the 1st day of the month.
 3578  Payment for the month in which an enrollee initiates residency
 3579  in a nursing home shall be in accordance with s. 641.3155. On an
 3580  annual basis, qualified plans shall submit a report certifying
 3581  compliance with the prompt payment requirements for the plan
 3582  year.
 3583         (g) Emergency services.—Qualified plans must pay for
 3584  emergency services and care required under ss. 395.1041 and
 3585  401.45 and rendered by a noncontracted provider in accordance
 3586  with the prompt payment standards established in s. 641.3155.
 3587  The payment rate shall be the fee-for-service rate the agency
 3588  would pay the noncontracted provider for such services.
 3589         (h) Surety bond.—A qualified plan shall post and maintain a
 3590  surety bond with the agency, payable to the agency, or in lieu
 3591  of a surety bond, establish and maintain an irrevocable letter
 3592  of credit or a deposit in a trust account in a financial
 3593  institution, payable to the agency.
 3594         1. The amount of the surety bond, letter of credit, or
 3595  trust account shall be 125 percent of the estimated annual
 3596  guaranteed savings for each qualified plan, and at least $2
 3597  million but no more than $15 million for each qualified plan.
 3598  The estimated guaranteed savings shall be calculated before the
 3599  execution of the contract as follows:
 3600         a. The agreed-upon monthly contractual capitated rate for
 3601  each level of acuity multiplied by the estimated population in
 3602  the region for the plan for each level of acuity, multiplied by
 3603  12 months, multiplied by 7 percent, multiplied by 125 percent.
 3604         b. The estimated population in the region for the plan
 3605  under sub-subparagraph a. shall be based on the maximum enrollee
 3606  level that the agency initially authorizes. The factors that the
 3607  agency may consider in determining the maximum enrollee level
 3608  include, but are not limited to, requested capacity, projected
 3609  enrollment, network adequacy, and the available budget in the
 3610  General Appropriations Act.
 3611         2. The purpose of the surety bond, letter of credit, or
 3612  trust account is to protect the agency if the entity terminates
 3613  its contract with the agency before the scheduled end date for
 3614  the contract, if the plan fails to comply with the terms of the
 3615  contract, including, but not limited to, the timely submission
 3616  of encounter data, if the agency imposes fines or penalties for
 3617  noncompliance, or if the plan fails to achieve the guaranteed
 3618  savings. If any of those events occurs, the agency shall first
 3619  request payment from the qualified plan. If the qualified plan
 3620  does not pay all costs, fines, penalties, or the differential in
 3621  the guaranteed savings in full within 30 days, the agency shall
 3622  pursue a claim against the surety bond, letter of credit, or
 3623  trust account for all applicable moneys and the legal and
 3624  administrative costs associated with pursuing such claim.
 3625         (i) Grievance resolution.—Each plan shall establish and the
 3626  agency shall approve an internal process for reviewing and
 3627  responding to grievances from enrollees consistent with s.
 3628  641.511. Each plan shall submit quarterly reports to the agency
 3629  on the number, description, and outcome of grievances filed by
 3630  enrollees.
 3631         (j) Solvency.—A qualified plan must meet and maintain the
 3632  surplus and solvency requirements under s. 409.912(17) and (18).
 3633  A provider service network may satisfy the surplus and solvency
 3634  requirements if the network’s performance and financial
 3635  obligations are guaranteed in writing by an entity licensed by
 3636  the Office of Insurance Regulation which meets the surplus and
 3637  solvency requirements of s. 624.408 or s. 641.225.
 3638         (k)Guaranteed savings.During the first contract period, a
 3639  qualified plan must agree to provide a guaranteed minimum
 3640  savings of 7 percent to the state. The agency shall conduct a
 3641  cost reconciliation to determine the amount of cost savings
 3642  achieved by the qualified plan compared with the reimbursements
 3643  the agency would have incurred under fee-for-service provisions.
 3644         (l) Costs and penalties.—Plans that reduce enrollment
 3645  levels or leave a region before the end of the contract term
 3646  must reimburse the agency for the cost of enrollment changes and
 3647  other transition activities. If more than one plan leaves a
 3648  region at the same time, costs shall be shared by the departing
 3649  plans proportionate to their enrollment. In addition to the
 3650  payment of costs, departing plans must pay a penalty of 1
 3651  month’s payment calculated as an average of the past 12 months
 3652  of payments, or since inception if the plan has not contracted
 3653  with the agency for 12 months, plus the differential of the
 3654  guaranteed savings based on the original contract term and the
 3655  corresponding termination date. Plans must provide the agency
 3656  with at least 180 days notice before withdrawing from a region.
 3657         (3) If the agency terminates more than one regional
 3658  contract with a qualified plan due to the plan’s noncompliance
 3659  with one or more requirements of this section, the agency shall
 3660  terminate all regional contracts with the plan under the
 3661  Medicaid managed care program, as well as any other contracts or
 3662  agreements for other programs or services, and the plan may not
 3663  be awarded new contracts for 3 years.
 3664         Section 38. Section 409.967, Florida Statutes, is created
 3665  to read:
 3666         409.967Plan accountability.—In addition to the contract
 3667  requirements of s. 409.966, plans and providers participating in
 3668  the Medicaid managed care program must comply with this section.
 3669         (1) The agency shall require qualified plans to use a
 3670  uniform method of reporting and accounting for medical, direct
 3671  care management, and nonmedical costs and shall evaluate plan
 3672  spending patterns after the plan completes 2 full years of
 3673  operation and at least annually thereafter.
 3674         (2) The agency shall implement the following thresholds and
 3675  consequences of various spending patterns for qualified plans
 3676  under the managed medical assistance component of the Medicaid
 3677  managed care program:
 3678         (a)The minimum medical loss ratio shall be 90 percent.
 3679         (b) A plan that spends less than 90 percent of its Medicaid
 3680  capitation revenue on medical services and direct care
 3681  management, as determined by the agency, must pay back to the
 3682  agency a share of the dollar difference between the plan’s
 3683  actual medical loss ratio and the minimum medical loss ratio, as
 3684  follows:
 3685         1. If the plan’s actual medical loss ratio is not lower
 3686  than 87 percent, the plan must pay back 50 percent of the dollar
 3687  difference between the actual medical loss ratio and the minimum
 3688  medical loss ratio of 90 percent.
 3689         2. If the plan’s actual medical loss ratio is lower than 87
 3690  percent, the plan must pay back 50 percent of the dollar
 3691  difference between a medical loss ratio of 87 percent and the
 3692  minimum medical loss ratio of 90 percent, plus 100 percent of
 3693  the dollar difference between the actual medical loss ratio and
 3694  a medical loss ratio of 87 percent.
 3695         (c) To administer this subsection, the agency shall adopt
 3696  rules that specify a methodology for calculating medical loss
 3697  ratios and the requirements for plans to annually report
 3698  information related to medical loss ratios. Repayments required
 3699  by this subsection must be made annually.
 3700         (3) Plans may limit the providers in their networks.
 3701         (a) However, during the first year in which a qualified
 3702  plan is operating in a region after the initial plan procurement
 3703  for that region, the plan must offer a network contract to the
 3704  following providers in the region:
 3705         1. Federally qualified health centers.
 3706         2. Nursing homes if the plan is providing managed long-term
 3707  care services.
 3708         3. Aging network service providers that have previously
 3709  participated in home and community-based waivers serving elders,
 3710  or community-service programs administered by the Department of
 3711  Elderly Affairs if the plan is providing managed long-term care
 3712  services.
 3713         (b) After 12 months of active participation in a plan’s
 3714  network, the plan may exclude any of the providers listed in
 3715  paragraph (a) from the network while maintaining the network
 3716  performance standards required under s. 409.966(2)(b). If the
 3717  plan excludes a nursing home that meets the standards for
 3718  ongoing Medicaid certification, the plan must provide an
 3719  alternative residence in that community for Medicaid recipients
 3720  residing in that nursing home. If a Medicaid recipient residing
 3721  in an excluded nursing home does not choose to change residence,
 3722  the plan must continue to pay for the recipient’s care in that
 3723  nursing home. If the plan excludes a provider, the plan must
 3724  provide written notice to all enrollees who have chosen that
 3725  provider for care. Notice to excluded providers must be
 3726  delivered at least 30 days before the effective date of the
 3727  exclusion.
 3728         (c) Qualified plans and providers shall engage in good
 3729  faith negotiations to reach contract terms.
 3730         1. If a qualified plan seeks to develop a provider network
 3731  in a county or region that, as of June 30, 2011, does not have a
 3732  capitated managed care plan providing comprehensive acute care
 3733  for Medicaid recipients, and the qualified plan has made at
 3734  least three documented, unsuccessful, good faith attempts to
 3735  contract with a specific provider, the plan may request the
 3736  agency to examine the negotiation process. During the
 3737  examination, the agency shall consider similar counties or
 3738  regions in which qualified plans have contracted with providers
 3739  under similar circumstances, as well as the contracted rates
 3740  between qualified plans and that provider and similar providers
 3741  in the same region. If the agency determines that the plan has
 3742  made three good faith attempts to contract with the provider,
 3743  the agency shall consider that provider to be part of the
 3744  qualified plan’s provider network for the purpose of determining
 3745  network adequacy, and the plan shall pay the provider for
 3746  services to Medicaid recipients on a noncontracted basis at a
 3747  rate or rates determined by the agency to be the average of
 3748  rates for corresponding services paid by the qualified plan and
 3749  other qualified plans in the region and in similar counties or
 3750  regions under similar circumstances.
 3751         2. The agency may continue to calculate Medicaid hospital
 3752  inpatient per diem rates and outpatient rates. However, these
 3753  rates may not be the basis for contract negotiations between a
 3754  managed care plan and a hospital.
 3755         (4) Each qualified plan shall monitor the quality and
 3756  performance of each provider within its network based on metrics
 3757  established by the agency for evaluating and documenting
 3758  provider performance and determining continued participation in
 3759  the network. The agency shall establish requirements for
 3760  qualified plans to report, at least annually, provider
 3761  performance data compiled under this subsection. If a plan uses
 3762  additional metrics to evaluate the provider’s performance and to
 3763  determine continued participation in the network, the plan must
 3764  notify the network providers of these metrics at the beginning
 3765  of the contract period.
 3766         (a) At a minimum, a qualified plan shall hold primary care
 3767  physicians responsible for the following activities:
 3768         1. Supervision, coordination, and provision of care to each
 3769  assigned enrollee.
 3770         2. Initiation of referrals for medically necessary
 3771  specialty care and other services.
 3772         3. Maintaining continuity of care for each assigned
 3773  enrollee.
 3774         4. Maintaining the enrollee’s medical record, including
 3775  documentation of all medical services provided to the enrollee
 3776  by the primary care physician, as well as any specialty or
 3777  referral services.
 3778         (b) Qualified plans shall establish and implement policies
 3779  and procedures to monitor primary care physician activities and
 3780  ensure that primary care physicians are adequately notified and
 3781  receive documentation of specialty and referral services
 3782  provided to enrollees by specialty physicians and other health
 3783  care providers within the plan’s provider network.
 3784         (5) Each qualified plan shall establish specific programs
 3785  and procedures to improve pregnancy outcomes and infant health,
 3786  including, but not limited to, coordination with the Healthy
 3787  Start program, immunization programs, and referral to the
 3788  Special Supplemental Nutrition Program for Women, Infants, and
 3789  Children, and the Children’s Medical Services Program for
 3790  children with special health care needs.
 3791         (a) Qualified plans must ensure that primary care
 3792  physicians who provide obstetrical care are available to
 3793  pregnant recipients and that an obstetrical care provider is
 3794  assigned to each pregnant recipient for the duration of her
 3795  pregnancy and postpartum care, by referral of the recipient’s
 3796  primary care physician if necessary.
 3797         (b) Qualified plans within the managed long-term care
 3798  component are exempt from this subsection.
 3799         (6) Each qualified plan shall achieve an annual screening
 3800  rate for early and periodic screening, diagnosis, and treatment
 3801  services of at least 80 percent of those recipients continuously
 3802  enrolled for at least 8 months. Qualified plans within the
 3803  managed long-term care component are exempt from this
 3804  requirement.
 3805         (7) Effective January 1, 2013, qualified plans must
 3806  compensate primary care physicians for primary care services at
 3807  payment rates that are equivalent to or greater than payments
 3808  under the federal Medicare program, whether compensation is made
 3809  on a fee-for-service basis or by sub-capitation.
 3810         (8) In order to protect the continued operation of the
 3811  Medicaid managed care program, unresolved disputes, including
 3812  claim and other types of disputes, between a qualified plan and
 3813  a provider shall proceed in accordance with s. 408.7057. This
 3814  process may not be used to review or reverse a decision by a
 3815  qualified plan to exclude a provider from its network if the
 3816  decision does not conflict with s. 409.967(3).
 3817         Section 39. Section 409.968, Florida Statutes, is created
 3818  to read:
 3819         409.968Plan payment.—Payments for managed medical
 3820  assistance and managed long-term care services under this part
 3821  shall be made in accordance with a capitated managed care model.
 3822  Qualified plans shall receive per-member, per-month payments
 3823  pursuant to the procurements described in s. 409.965 and annual
 3824  adjustments as described in s. 409.966(1). Payment rates must be
 3825  based on the acuity level for each member pursuant to ss.
 3826  409.972 and 409.978. Payment rates for managed long-term care
 3827  plans shall be combined with rates for managed medical
 3828  assistance plans.
 3829         (1) The agency shall develop a methodology and request a
 3830  waiver that ensures the availability of intergovernmental
 3831  transfers in the Medicaid managed care program to support
 3832  providers that have historically served Medicaid recipients.
 3833  Such providers include, but are not limited to, safety net
 3834  providers, trauma hospitals, children’s hospitals, statutory
 3835  teaching hospitals, and medical and osteopathic physicians
 3836  employed by or under contract with a medical school in this
 3837  state. The agency may develop a supplemental capitation rate,
 3838  risk pool, or incentive payment for plans that contract with
 3839  these providers. A plan is eligible for a supplemental payment
 3840  only if there are sufficient intergovernmental transfers
 3841  available from allowable sources.
 3842         (2) The agency shall evaluate the development of the rate
 3843  cell to accurately reflect the underlying utilization to the
 3844  maximum extent possible. This methodology may include interim
 3845  rate adjustments as permitted under federal regulations. Any
 3846  such methodology must preserve federal funding to these entities
 3847  and be actuarially sound. In the absence of federal approval of
 3848  the methodology, the agency may set an enhanced rate and require
 3849  that plans pay the rate if the agency determines the enhanced
 3850  rate is necessary to ensure access to care by the providers
 3851  described in this subsection.
 3852         (3) The amount paid to the plans to make supplemental
 3853  payments or to enhance provider rates pursuant to this
 3854  subsection must be reconciled to the exact amounts the plans are
 3855  required to pay providers. The plans shall make the designated
 3856  payments to providers within 15 business days after notification
 3857  by the agency regarding provider-specific distributions.
 3858         Section 40. Section 409.969, Florida Statutes, is created
 3859  to read:
 3860         409.969Enrollment; disenrollment; grievance procedure.—
 3861         (1) Each Medicaid recipient may choose any available plan
 3862  within the region in which the recipient resides unless that
 3863  plan is a specialty plan for which the recipient does not
 3864  qualify. The agency may not provide or contract for choice
 3865  counseling services for persons enrolling in the Medicaid
 3866  managed care program.
 3867         (2) If a recipient has not made a choice of plans within 30
 3868  days after having been notified to choose a plan, the agency
 3869  shall assign the recipient to a plan in accordance with the
 3870  following:
 3871         (a) A recipient who was previously enrolled in a plan
 3872  within the preceding 90 days shall automatically be enrolled in
 3873  the same plan, if available.
 3874         (b) Newborns of eligible mothers enrolled in a plan at the
 3875  time of the child’s birth shall be enrolled in the mother’s
 3876  plan; however, the mother may choose another plan for the
 3877  newborn within 90 days after the child’s birth.
 3878         (c) If the recipient is diagnosed with HIV/AIDS and resides
 3879  in region 11, region 15, or region 16, the agency shall assign
 3880  the recipient to a plan that:
 3881         1.Is a specialty plan under contract with the agency
 3882  pursuant to s. 409.965; and
 3883         2. Offers a delivery system through a teaching- and
 3884  research-oriented organization that specializes in providing
 3885  health care services and treatment for individuals diagnosed
 3886  with HIV/AIDS.
 3887  
 3888  The agency shall assign recipients under this paragraph on an
 3889  even basis among all such plans within a region under contract
 3890  with the agency.
 3891         (d) Other recipients shall be enrolled into a qualified
 3892  plan in accordance with an auto-assignment enrollment algorithm
 3893  that the agency develops by rule. The algorithm must heavily
 3894  weigh family continuity.
 3895         1. Automatic enrollment of recipients in plans must be
 3896  based on the following criteria:
 3897         a. Whether the plan has sufficient network capacity to meet
 3898  the needs of recipients.
 3899         b. Whether the recipient has previously received services
 3900  from one of the plan’s primary care providers.
 3901         c. Whether primary care providers in one plan are more
 3902  geographically accessible to the recipient’s residence than
 3903  providers in other plans.
 3904         d.If a recipient is eligible for long-term care services,
 3905  whether the recipient has previously received services from one
 3906  of the plan’s home and community-based service providers.
 3907         e.If a recipient is eligible for long-term care services,
 3908  whether the home and community-based providers in one plan are
 3909  more geographically accessible to the recipient’s residence than
 3910  providers in other plans.
 3911         2.The agency shall automatically enroll recipients in
 3912  plans that meet or exceed the performance or quality standards
 3913  established pursuant to s. 409.967, and may not automatically
 3914  enroll recipients in a plan that is not meeting those standards.
 3915  Except as provided by law or rule, the agency may not engage in
 3916  practices that favor one qualified plan over another.
 3917         (3) After a recipient has enrolled in a qualified plan, the
 3918  enrollee shall have 90 days to voluntarily disenroll and select
 3919  another plan. After 90 days, no further changes may be made
 3920  except for good cause. Good cause includes, but is not limited
 3921  to, poor quality of care, lack of access to necessary specialty
 3922  services, an unreasonable delay or denial of service, or
 3923  fraudulent enrollment. The agency shall determine whether good
 3924  cause exists. The agency may require an enrollee to use the
 3925  plan’s grievance process before the agency makes a determination
 3926  of good cause, unless an immediate risk of permanent damage to
 3927  the enrollee’s health is alleged.
 3928         (a) If used, the qualified plan’s internal grievance
 3929  process must be completed in time to allow the enrollee to
 3930  disenroll by the first day of the second month after the month
 3931  the disenrollment request was made. If the grievance process
 3932  approves an enrollee’s request to disenroll, the agency is not
 3933  required to make a determination of good cause.
 3934         (b) The agency must make a determination of good cause and
 3935  take final action on an enrollee’s request so that disenrollment
 3936  occurs by the first day of the second month after the month the
 3937  request was made. If the agency fails to act within this
 3938  timeframe, the enrollee’s request to disenroll is deemed
 3939  approved as of the date agency action was required. Enrollees
 3940  who disagree with the agency’s finding that good cause for
 3941  disenrollment does not exist shall be advised of their right to
 3942  pursue a Medicaid fair hearing to dispute the agency’s finding.
 3943         (c) Medicaid recipients enrolled in a qualified plan after
 3944  the 90-day period must remain in the plan for the remainder of
 3945  the 12-month period. After 12 months, the enrollee may select
 3946  another plan. An enrollee may change primary care providers
 3947  within the plan at any time.
 3948         (d) On the first day of the next month after receiving
 3949  notice from a recipient that the recipient has moved to another
 3950  region, the agency shall automatically disenroll the recipient
 3951  from the plan the recipient is currently enrolled in and treat
 3952  the recipient as if the recipient is a new enrollee. At that
 3953  time, the recipient may choose another plan pursuant to the
 3954  enrollment process established in this section.
 3955         Section 41. Section 409.970, Florida Statutes, is created
 3956  to read:
 3957         409.970Medicaid Encounter Data System.—The agency shall
 3958  maintain and operate the Medicaid Encounter Data System to
 3959  collect, process, and report on covered services provided to all
 3960  Medicaid recipients enrolled in qualified plans.
 3961         (1) Qualified plans shall submit encounter data
 3962  electronically in a format that complies with provisions of the
 3963  federal Health Insurance Portability and Accountability Act for
 3964  electronic claims and in accordance with deadlines established
 3965  by the agency. Plans must certify that the data reported is
 3966  accurate and complete. The agency is responsible for validating
 3967  the data submitted by the plans.
 3968         (2) The agency shall develop methods and protocols for
 3969  ongoing analysis of the encounter data, which must adjust for
 3970  differences in the characteristics of enrollees in order to
 3971  allow for the comparison of service utilization among plans. The
 3972  analysis shall be used to identify possible cases of systemic
 3973  overutilization, underutilization, inappropriate denials of
 3974  claims, and inappropriate utilization of covered services, such
 3975  as higher than expected emergency department and pharmacy
 3976  encounters. One of the primary focus areas for the analysis
 3977  shall be the use of prescription drugs.
 3978         (3) The agency shall provide periodic feedback to the plans
 3979  based on the analysis and establish corrective action plans if
 3980  necessary.
 3981         (4) The agency shall make encounter data available to plans
 3982  accepting enrollees who are reassigned to them from other plans
 3983  leaving a region.
 3984         (5) Beginning July 1, 2011, the agency shall conduct
 3985  appropriate tests and establish specific criteria for
 3986  determining whether the Medicaid Encounter Data System has
 3987  valid, complete, and sound data for a sufficient period of time
 3988  to provide qualified plans with a reliable basis for determining
 3989  and proposing actuarially sound payment rates.
 3990         Section 42. Section 409.971, Florida Statutes, is created
 3991  to read:
 3992         409.971Managed care medical assistance.—Pursuant to s.
 3993  409.902, the agency shall administer the managed care medical
 3994  assistance component of the Medicaid managed care program
 3995  described in this section and s. 409.972. Unless otherwise
 3996  specified, the provisions of ss. 409.961-409.970 apply to the
 3997  provision of managed care medical assistance. By December 31,
 3998  2011, the agency shall begin implementation of managed care
 3999  medical assistance, and full implementation in all regions must
 4000  be completed by December 31, 2012.
 4001         Section 43. Section 409.972, Florida Statutes, is created
 4002  to read:
 4003         409.972Managed care medical assistance services.—
 4004         (1) Qualified plans providing managed care medical
 4005  assistance must, at a minimum, cover the following services:
 4006         (a) Ambulatory patient services.
 4007         (b) Dental services for a recipient who is under age 21.
 4008         (c) Dental services as provided in s. 627.419(7) for a
 4009  recipient who is 21 years of age or older.
 4010         (d) Dialysis services.
 4011         (e) Durable medical equipment and supplies.
 4012         (f) Early periodic screening diagnosis and treatment
 4013  services, hearing services and hearing aids, and vision services
 4014  and eyeglasses for enrollees under age 21.
 4015         (g) Emergency services.
 4016         (h) Family planning services.
 4017         (i) Hearing services for a recipient who is under age 21.
 4018         (j) Hearing services that are medically indicated for a
 4019  recipient who is 21 years of age or older.
 4020         (k) Home health services.
 4021         (l) Hospital inpatient services.
 4022         (m) Hospital outpatient services.
 4023         (n) Laboratory and imaging services.
 4024         (o) Maternity and newborn care and birth center services.
 4025         (p) Mental health services, substance abuse disorder
 4026  services, and behavioral health treatment.
 4027         (q) Prescription drugs.
 4028         (r) Primary care service, referred specialty care services,
 4029  preventive services, and wellness services.
 4030         (s) Skilled nursing facility or inpatient rehabilitation
 4031  facility services.
 4032         (t) Transplant services.
 4033         (u) Transportation to access covered services.
 4034         (v) Vision services for a recipient who is under age 21.
 4035         (w)Vision services that are medically indicated for a
 4036  recipient who is 21 years of age or older.
 4037         (2) Subject to specific appropriations, the agency may make
 4038  payments for services that are optional.
 4039         (3) Qualified plans may customize benefit packages for
 4040  nonpregnant adults, vary cost-sharing provisions, and provide
 4041  coverage for additional services. The agency shall evaluate the
 4042  proposed benefit packages to ensure that services are sufficient
 4043  to meet the needs of the plans’ enrollees and to verify
 4044  actuarial equivalence.
 4045         (4) For Medicaid recipients diagnosed with hemophilia who
 4046  have been prescribed anti-hemophilic-factor replacement
 4047  products, the agency shall provide for those products and
 4048  hemophilia overlay services through the agency’s hemophilia
 4049  disease management program authorized under s. 409.912.
 4050         (5) Managed care medical assistance services provided under
 4051  this section must be medically necessary and provided in
 4052  accordance with state and federal law. This section does not
 4053  prevent the agency from adjusting fees, reimbursement rates,
 4054  lengths of stay, number of visits, or number of services, or
 4055  from making any other adjustments necessary to comply with the
 4056  availability of funding and any limitations or directions
 4057  provided in the General Appropriations Act, chapter 216, or s.
 4058  409.9022.
 4059         Section 44. Section 409.973, Florida Statutes, is created
 4060  to read:
 4061         409.973Managed long-term care.—
 4062         (1) Qualified plans providing managed care medical
 4063  assistance may also participate in the managed long-term care
 4064  component of the Medicaid managed care program. Unless otherwise
 4065  specified, the provisions of ss. 409.961-409.970 apply to the
 4066  managed long-term care component of the managed care program.
 4067         (2) Pursuant to s. 409.902, the agency shall administer the
 4068  managed long-term care component described in this section and
 4069  ss. 409.974-409.978, but may delegate specific duties and
 4070  responsibilities to the Department of Elderly Affairs and other
 4071  state agencies. By March 31, 2012, the agency shall begin
 4072  implementation of the managed long-term care component, with
 4073  full implementation in all regions by March 31, 2013.
 4074         (3) The Department of Elderly Affairs shall assist the
 4075  agency in developing specifications for use in the invitation to
 4076  negotiate and the model contract, determining clinical
 4077  eligibility for enrollment in managed long-term care plans,
 4078  monitoring plan performance and measuring quality of service
 4079  delivery, assisting clients and families in order to address
 4080  complaints with the plans, facilitating working relationships
 4081  between plans and providers serving elders and disabled adults,
 4082  and performing other functions specified in a memorandum of
 4083  agreement.
 4084         Section 45. Section 409.974, Florida Statutes, is created
 4085  to read:
 4086         409.974Recipient eligibility for managed long-term care.—
 4087         (1) Medicaid recipients shall receive covered long-term
 4088  care services through the managed long-term care component of
 4089  the Medicaid managed care program unless excluded pursuant to s.
 4090  409.964. In order to participate in the managed long-term care
 4091  component, the recipient must be:
 4092         (a) Sixty-five years of age or older or eligible for
 4093  Medicaid by reason of a disability; and
 4094         (b) Determined by the Comprehensive Assessment Review and
 4095  Evaluation for Long-Term Care Services (CARES) Program to meet
 4096  the criteria for nursing facility care.
 4097         (2) Medicaid recipients who are enrolled in one of the
 4098  following Medicaid long-term care waiver programs on the date
 4099  that a managed long-term care plan becomes available in the
 4100  recipient’s region may remain in that program if it is
 4101  operational on that date:
 4102         (a) The Assisted Living for the Frail Elderly Waiver.
 4103         (b) The Aged and Disabled Adult Waiver.
 4104         (c) The Adult Day Health Care Waiver.
 4105         (d) The Consumer-Directed Care Program as described in s.
 4106  409.221.
 4107         (e) The Program of All-inclusive Care for the Elderly.
 4108         (f) The Long-Term Care Community Diversion Pilot Project as
 4109  described in s. 430.705.
 4110         (g) The Channeling Services Waiver for Frail Elders.
 4111         (3) If a long-term care waiver program in which the
 4112  recipient is enrolled ceases to operate, the Medicaid recipient
 4113  may transfer to another long-term care waiver program or to the
 4114  Medicaid managed long-term care component of the Medicaid
 4115  managed care program. If no waivers are operational in the
 4116  recipient’s region and the recipient continues to participate in
 4117  Medicaid, the recipient must transfer to the managed long-term
 4118  care component of the Medicaid managed care program.
 4119         (4) New enrollment in a waiver program ends on the date
 4120  that a managed long-term care plan becomes available in a
 4121  region.
 4122         (5) Medicaid recipients who are residing in a nursing home
 4123  facility on the date that a managed long-term care plan becomes
 4124  available in the recipient’s region are eligible for the long
 4125  term care Medicaid waiver programs.
 4126         (6) This section does not create an entitlement to any home
 4127  and community-based services provided under the managed long
 4128  term care component.
 4129         Section 46. Section 409.975, Florida Statutes, is created
 4130  to read:
 4131         409.975Managed long-term care services.—
 4132         (1) Qualified plans participating in the managed long-term
 4133  care component of the Medicaid managed care program, at a
 4134  minimum, shall cover the following services:
 4135         (a) The services listed in s. 409.972.
 4136         (b) Nursing facility services.
 4137         (c) Home and community-based services, including, but not
 4138  limited to, assisted living facility services.
 4139         (2) Services provided under this section must be medically
 4140  necessary and provided in accordance with state and federal law.
 4141  This section does not prevent the agency from adjusting fees,
 4142  reimbursement rates, lengths of stay, number of visits, or
 4143  number of services, or from making any other adjustments
 4144  necessary to comply with the availability of funding and any
 4145  limitations or directions provided in the General Appropriations
 4146  Act, chapter 216, or s. 409.9022.
 4147         Section 47. Section 409.976, Florida Statutes, is created
 4148  to read:
 4149         409.976Qualified managed long-term care plans.—
 4150         (1) For purposes of managed long-term care, qualified plans
 4151  also include:
 4152         (a) Entities who are qualified under 42 C.F.R. part 422 as
 4153  Medicare Advantage Preferred Provider Organizations, Medicare
 4154  Advantage Provider-sponsored Organizations, and Medicare
 4155  Advantage Special Needs Plans. Such plans may participate in the
 4156  managed long-term care component. A plan submitting a response
 4157  to the invitation to negotiate for the managed long-term care
 4158  component may reference one or more of these entities as part of
 4159  its demonstration of network adequacy for the provision of
 4160  services required under s. 409.972 for dually eligible
 4161  enrollees.
 4162         (b)The Program of All-inclusive Care for the Elderly
 4163  (PACE). Participation by PACE shall be pursuant to a contract
 4164  with the agency and is not subject to the procurement
 4165  requirements of this section. PACE plans may continue to provide
 4166  services to recipients at such levels and enrollment caps as
 4167  authorized by the General Appropriations Act.
 4168         (2) The agency shall select qualified plans through the
 4169  procurement described in s. 409.965. The agency shall notice the
 4170  invitation to negotiate by November 14, 2011.
 4171         (3) In addition to the criteria established in s. 409.965,
 4172  the agency shall give preference to the following factors in
 4173  selecting qualified plans:
 4174         (a) The plan’s employment of executive managers having
 4175  expertise and experience in serving aged and disabled persons
 4176  who require long-term care.
 4177         (b) The plan’s establishment of a network of service
 4178  providers dispersed throughout the region and in sufficient
 4179  numbers to meet specific service standards established by the
 4180  agency for a continuum of care, beginning from the provision of
 4181  assistance with the activities of daily living at a recipient’s
 4182  home and the provision of other home and community-based care
 4183  through the provision of nursing home care. These providers
 4184  include:
 4185         1. Adult day centers.
 4186         2. Adult family care homes.
 4187         3. Assisted living facilities.
 4188         4. Health care services pools.
 4189         5. Home health agencies.
 4190         6. Homemaker and companion services.
 4191         7. Community Care for the Elderly lead agencies.
 4192         8. Nurse registries.
 4193         9. Nursing homes.
 4194  
 4195  All providers are not required to be located within the region;
 4196  however, the provider network must be sufficient to ensure that
 4197  services are available throughout the region.
 4198         (c) Whether a plan offers consumer-directed care services
 4199  to enrollees pursuant to s. 409.221 or includes attendant care
 4200  or paid family caregivers in the benefit package. Consumer
 4201  directed care services must provide a flexible budget, which is
 4202  managed by enrollees and their families or representatives, and
 4203  allows them to choose service providers, determine provider
 4204  rates of payment, and direct the delivery of services to best
 4205  meet their special long-term care needs. If all other factors
 4206  are equal among competing qualified plans, the agency shall give
 4207  preference to such plans.
 4208         (d) Evidence that a qualified plan has written agreements
 4209  or signed contracts or has made substantial progress in
 4210  establishing relationships with providers before the plan
 4211  submits a response.
 4212         (e) The availability and accessibility of case managers in
 4213  the plan and provider network.
 4214         Section 48. Section 409.977, Florida Statutes, is created
 4215  to read:
 4216         409.977Managed long-term plan and provider
 4217  accountability.—In addition to the requirements of ss. 409.966
 4218  and 409.967, plans and providers participating in managed long
 4219  term care must comply with s. 641.31(25) and with the specific
 4220  standards established by the agency for the number, type, and
 4221  regional distribution of the following providers in the plan’s
 4222  network, which must include:
 4223         (1) Adult day centers.
 4224         (2) Adult family care homes.
 4225         (3) Assisted living facilities.
 4226         (4) Health care services pools.
 4227         (5) Home health agencies.
 4228         (6) Homemaker and companion services.
 4229         (7) Community Care for the Elderly lead agencies.
 4230         (8) Nurse registries.
 4231         (9) Nursing homes.
 4232         Section 49. Section 409.978, Florida Statutes, is created
 4233  to read:
 4234         409.978CARES program screening; levels of care.—
 4235         (1) The agency shall operate the Comprehensive Assessment
 4236  and Review for Long-Term Care Services (CARES) preadmission
 4237  screening program to ensure that only recipients whose
 4238  conditions require long-term care services are enrolled in
 4239  managed long-term care plans.
 4240         (2) The agency shall operate the CARES program through an
 4241  interagency agreement with the Department of Elderly Affairs.
 4242  The agency, in consultation with the department, may contract
 4243  for any function or activity of the CARES program, including any
 4244  function or activity required by 42 C.F.R. part 483.20, relating
 4245  to preadmission screening and review.
 4246         (3) The CARES program shall determine if a recipient
 4247  requires nursing facility care and, if so, assign the recipient
 4248  to one of the following levels of care:
 4249         (a) Level of care 1 consists of enrollees who require the
 4250  constant availability of routine medical and nursing treatment
 4251  and care, have a limited need for health-related care and
 4252  services, are mildly medically or physically incapacitated, and
 4253  cannot be managed at home due to inadequacy of home-based
 4254  services.
 4255         (b) Level of care 2 consists of enrollees who require the
 4256  constant availability of routine medical and nursing treatment
 4257  and care, and require extensive health-related care and services
 4258  because of mental or physical incapacitation. Current enrollees
 4259  in home and community-based waiver programs for persons who are
 4260  elderly or adults with physical disability, or both, who remain
 4261  financially eligible for Medicaid are not required to meet new
 4262  level-of-care criteria except for immediate placement in a
 4263  nursing home.
 4264         (c) Level of care 3 consists of enrollees residing in
 4265  nursing homes, or needing immediate placement in a nursing home,
 4266  and who have a priority score of 5 or above as determined by
 4267  CARES.
 4268         (4) For recipients whose nursing home stay is initially
 4269  funded by Medicare and Medicare coverage is being terminated for
 4270  lack of progress towards rehabilitation, CARES staff shall
 4271  consult with the person determining the recipient’s progress
 4272  toward rehabilitation in order to ensure that the recipient is
 4273  not being inappropriately disqualified from Medicare coverage.
 4274  If, in their professional judgment, CARES staff believes that a
 4275  Medicare beneficiary is still making progress, they may assist
 4276  the Medicare beneficiary with appealing the disqualification
 4277  from Medicare coverage. The CARES teams may review Medicare
 4278  denials for coverage under this section only if it is determined
 4279  that such reviews qualify for federal matching funds through
 4280  Medicaid. The agency shall seek or amend federal waivers as
 4281  necessary to implement this section.
 4282         Section 50. Section 409.91207, Florida Statutes, is
 4283  transferred, renumbered as section 409.985, Florida Statutes,
 4284  and subsection (1) of that section is amended to read:
 4285         409.985 409.91207 Medical home pilot project.—
 4286         (1) The agency shall develop a plan to implement a medical
 4287  home pilot project that uses utilizes primary care case
 4288  management enhanced by medical home networks to provide
 4289  coordinated and cost-effective care that is reimbursed on a fee
 4290  for-service basis and to compare the performance of the medical
 4291  home networks with other existing Medicaid managed care models.
 4292  The agency may is authorized to seek a federal Medicaid waiver
 4293  or an amendment to any existing Medicaid waiver, except for the
 4294  current 1115 Medicaid waiver authorized in s. 409.986 409.91211,
 4295  as needed, to develop the pilot project created in this section
 4296  but must obtain approval of the Legislature before prior to
 4297  implementing the pilot project.
 4298         Section 51. Section 409.91211, Florida Statutes, is
 4299  transferred, renumbered as section 409.986, Florida Statutes,
 4300  and paragraph (aa) of subsection (3) and paragraph (a) of
 4301  subsection (4) of that section are amended, to read:
 4302         409.986 409.91211 Medicaid managed care pilot program.—
 4303         (3) The agency shall have the following powers, duties, and
 4304  responsibilities with respect to the pilot program:
 4305         (aa) To implement a mechanism whereby Medicaid recipients
 4306  who are already enrolled in a managed care plan or the MediPass
 4307  program in the pilot areas are shall be offered the opportunity
 4308  to change to capitated managed care plans on a staggered basis,
 4309  as defined by the agency. All Medicaid recipients shall have 30
 4310  days in which to make a choice of capitated managed care plans.
 4311  Those Medicaid recipients who do not make a choice shall be
 4312  assigned to a capitated managed care plan in accordance with
 4313  paragraph (4)(a) and shall be exempt from s. 409.987 409.9122.
 4314  To facilitate continuity of care for a Medicaid recipient who is
 4315  also a recipient of Supplemental Security Income (SSI), prior to
 4316  assigning the SSI recipient to a capitated managed care plan,
 4317  the agency shall determine whether the SSI recipient has an
 4318  ongoing relationship with a provider or capitated managed care
 4319  plan, and, if so, the agency shall assign the SSI recipient to
 4320  that provider or capitated managed care plan where feasible.
 4321  Those SSI recipients who do not have such a provider
 4322  relationship shall be assigned to a capitated managed care plan
 4323  provider in accordance with paragraph (4)(a) and shall be exempt
 4324  from s. 409.987 409.9122.
 4325         (4)(a) A Medicaid recipient in the pilot area who is not
 4326  currently enrolled in a capitated managed care plan upon
 4327  implementation is not eligible for services as specified in ss.
 4328  409.905 and 409.906, for the amount of time that the recipient
 4329  does not enroll in a capitated managed care network. If a
 4330  Medicaid recipient has not enrolled in a capitated managed care
 4331  plan within 30 days after eligibility, the agency shall assign
 4332  the Medicaid recipient to a capitated managed care plan based on
 4333  the assessed needs of the recipient as determined by the agency
 4334  and the recipient shall be exempt from s. 409.987 409.9122. When
 4335  making assignments, the agency shall take into account the
 4336  following criteria:
 4337         1. A capitated managed care network has sufficient network
 4338  capacity to meet the needs of members.
 4339         2. The capitated managed care network has previously
 4340  enrolled the recipient as a member, or one of the capitated
 4341  managed care network’s primary care providers has previously
 4342  provided health care to the recipient.
 4343         3. The agency has knowledge that the member has previously
 4344  expressed a preference for a particular capitated managed care
 4345  network as indicated by Medicaid fee-for-service claims data,
 4346  but has failed to make a choice.
 4347         4. The capitated managed care network’s primary care
 4348  providers are geographically accessible to the recipient’s
 4349  residence.
 4350         Section 52. Section 409.9122, Florida Statutes, is
 4351  transferred, renumbered as section 409.987, and paragraph (a) of
 4352  subsection (2) of that section is amended to read:
 4353         409.987 409.9122 Mandatory Medicaid managed care
 4354  enrollment; programs and procedures.—
 4355         (2)(a) The agency shall enroll all Medicaid recipients in a
 4356  managed care plan or MediPass all Medicaid recipients, except
 4357  those Medicaid recipients who are: in an institution, receiving
 4358  a Medicaid nonpoverty medical subsidy,; enrolled in the Medicaid
 4359  medically needy Program; or eligible for both Medicaid and
 4360  Medicare. Upon enrollment, recipients may individuals will be
 4361  able to change their managed care option during the 90-day opt
 4362  out period required by federal Medicaid regulations. The agency
 4363  may is authorized to seek the necessary Medicaid state plan
 4364  amendment to implement this policy. However, to the extent
 4365         1. If permitted by federal law, the agency may enroll in a
 4366  managed care plan or MediPass a Medicaid recipient who is exempt
 4367  from mandatory managed care enrollment in a managed care plan or
 4368  MediPass if, provided that:
 4369         a.1. The recipient’s decision to enroll in a managed care
 4370  plan or MediPass is voluntary;
 4371         b.2.If The recipient chooses to enroll in a managed care
 4372  plan, the agency has determined that the managed care plan
 4373  provides specific programs and services that which address the
 4374  special health needs of the recipient; and
 4375         c.3. The agency receives the any necessary waivers from the
 4376  federal Centers for Medicare and Medicaid Services.
 4377         2. The agency shall develop rules to establish policies by
 4378  which exceptions to the mandatory managed care enrollment
 4379  requirement may be made on a case-by-case basis. The rules must
 4380  shall include the specific criteria to be applied when
 4381  determining making a determination as to whether to exempt a
 4382  recipient from mandatory enrollment in a managed care plan or
 4383  MediPass.
 4384         3. School districts participating in the certified school
 4385  match program pursuant to ss. 409.908(21) and 1011.70 shall be
 4386  reimbursed by Medicaid, subject to the limitations of s.
 4387  1011.70(1), for a Medicaid-eligible child participating in the
 4388  services as authorized in s. 1011.70, as provided for in s.
 4389  409.9071, regardless of whether the child is enrolled in
 4390  MediPass or a managed care plan. Managed care plans must shall
 4391  make a good faith effort to execute agreements with school
 4392  districts regarding the coordinated provision of services
 4393  authorized under s. 1011.70.
 4394         4. County health departments delivering school-based
 4395  services pursuant to ss. 381.0056 and 381.0057 shall be
 4396  reimbursed by Medicaid for the federal share for a Medicaid
 4397  eligible child who receives Medicaid-covered services in a
 4398  school setting, regardless of whether the child is enrolled in
 4399  MediPass or a managed care plan. Managed care plans shall make a
 4400  good faith effort to execute agreements with county health
 4401  departments that coordinate the regarding the coordinated
 4402  provision of services to a Medicaid-eligible child. To ensure
 4403  continuity of care for Medicaid patients, the agency, the
 4404  Department of Health, and the Department of Education shall
 4405  develop procedures for ensuring that a student’s managed care
 4406  plan or MediPass provider receives information relating to
 4407  services provided in accordance with ss. 381.0056, 381.0057,
 4408  409.9071, and 1011.70.
 4409         Section 53. Section 409.9123, Florida Statutes, is
 4410  transferred and renumbered as section 409.988, Florida Statutes.
 4411         Section 54. Section 409.9124, Florida Statutes, is
 4412  transferred and renumbered as section 409.989.
 4413         Section 55. Subsection (15) of section 430.04, Florida
 4414  Statutes, is amended to read:
 4415         430.04 Duties and responsibilities of the Department of
 4416  Elderly Affairs.—The Department of Elderly Affairs shall:
 4417         (15) Administer all Medicaid waivers and programs relating
 4418  to elders and their appropriations. The waivers include, but are
 4419  not limited to:
 4420         (a) The Alzheimer’s Dementia-Specific Medicaid Waiver as
 4421  established in s. 430.502(7), (8), and (9).
 4422         (a)(b) The Assisted Living for the Frail Elderly Waiver.
 4423         (b)(c) The Aged and Disabled Adult Waiver.
 4424         (c)(d) The Adult Day Health Care Waiver.
 4425         (d)(e) The Consumer-Directed Care Plus Program as defined
 4426  in s. 409.221.
 4427         (e)(f) The Program of All-inclusive Care for the Elderly.
 4428         (f)(g) The Long-Term Care Community-Based Diversion Pilot
 4429  Project as described in s. 430.705.
 4430         (g)(h) The Channeling Services Waiver for Frail Elders.
 4431  
 4432  The department shall develop a transition plan for recipients
 4433  receiving services under long-term care Medicaid waivers for
 4434  elders or disabled adults on the date qualified plans become
 4435  available in each recipient’s region pursuant to s. 409.973(2)
 4436  in order to enroll those recipients in qualified plans.
 4437         Section 56. Section 430.2053, Florida Statutes, is amended
 4438  to read:
 4439         430.2053 Aging resource centers.—
 4440         (1) The department, in consultation with the Agency for
 4441  Health Care Administration and the Department of Children and
 4442  Family Services, shall develop pilot projects for aging resource
 4443  centers. By October 31, 2004, the department, in consultation
 4444  with the agency and the Department of Children and Family
 4445  Services, shall develop an implementation plan for aging
 4446  resource centers and submit the plan to the Governor, the
 4447  President of the Senate, and the Speaker of the House of
 4448  Representatives. The plan must include qualifications for
 4449  designation as a center, the functions to be performed by each
 4450  center, and a process for determining that a current area agency
 4451  on aging is ready to assume the functions of an aging resource
 4452  center.
 4453         (2) Each area agency on aging shall develop, in
 4454  consultation with the existing community care for the elderly
 4455  lead agencies within their planning and service areas, a
 4456  proposal that describes the process the area agency on aging
 4457  intends to undertake to transition to an aging resource center
 4458  prior to July 1, 2005, and that describes the area agency’s
 4459  compliance with the requirements of this section. The proposals
 4460  must be submitted to the department prior to December 31, 2004.
 4461  The department shall evaluate all proposals for readiness and,
 4462  prior to March 1, 2005, shall select three area agencies on
 4463  aging which meet the requirements of this section to begin the
 4464  transition to aging resource centers. Those area agencies on
 4465  aging which are not selected to begin the transition to aging
 4466  resource centers shall, in consultation with the department and
 4467  the existing community care for the elderly lead agencies within
 4468  their planning and service areas, amend their proposals as
 4469  necessary and resubmit them to the department prior to July 1,
 4470  2005. The department may transition additional area agencies to
 4471  aging resource centers as it determines that area agencies are
 4472  in compliance with the requirements of this section.
 4473         (3) The Auditor General and the Office of Program Policy
 4474  Analysis and Government Accountability (OPPAGA) shall jointly
 4475  review and assess the department’s process for determining an
 4476  area agency’s readiness to transition to an aging resource
 4477  center.
 4478         (a) The review must, at a minimum, address the
 4479  appropriateness of the department’s criteria for selection of an
 4480  area agency to transition to an aging resource center, the
 4481  instruments applied, the degree to which the department
 4482  accurately determined each area agency’s compliance with the
 4483  readiness criteria, the quality of the technical assistance
 4484  provided by the department to an area agency in correcting any
 4485  weaknesses identified in the readiness assessment, and the
 4486  degree to which each area agency overcame any identified
 4487  weaknesses.
 4488         (b) Reports of these reviews must be submitted to the
 4489  appropriate substantive and appropriations committees in the
 4490  Senate and the House of Representatives on March 1 and September
 4491  1 of each year until full transition to aging resource centers
 4492  has been accomplished statewide, except that the first report
 4493  must be submitted by February 1, 2005, and must address all
 4494  readiness activities undertaken through December 31, 2004. The
 4495  perspectives of all participants in this review process must be
 4496  included in each report.
 4497         (2)(4) The purposes of an aging resource center are shall
 4498  be:
 4499         (a) To provide Florida’s elders and their families with a
 4500  locally focused, coordinated approach to integrating information
 4501  and referral for all available services for elders with the
 4502  eligibility determination entities for state and federally
 4503  funded long-term-care services.
 4504         (b) To provide for easier access to long-term-care services
 4505  by Florida’s elders and their families by creating multiple
 4506  access points to the long-term-care network that flow through
 4507  one established entity with wide community recognition.
 4508         (3)(5) The duties of an aging resource center are to:
 4509         (a) Develop referral agreements with local community
 4510  service organizations, such as senior centers, existing elder
 4511  service providers, volunteer associations, and other similar
 4512  organizations, to better assist clients who do not need or do
 4513  not wish to enroll in programs funded by the department or the
 4514  agency. The referral agreements must also include a protocol,
 4515  developed and approved by the department, which provides
 4516  specific actions that an aging resource center and local
 4517  community service organizations must take when an elder or an
 4518  elder’s representative seeking information on long-term-care
 4519  services contacts a local community service organization prior
 4520  to contacting the aging resource center. The protocol shall be
 4521  designed to ensure that elders and their families are able to
 4522  access information and services in the most efficient and least
 4523  cumbersome manner possible.
 4524         (b) Provide an initial screening of all clients who request
 4525  long-term-care services to determine whether the person would be
 4526  most appropriately served through any combination of federally
 4527  funded programs, state-funded programs, locally funded or
 4528  community volunteer programs, or private funding for services.
 4529         (c) Determine eligibility for the programs and services
 4530  listed in subsection (9) (11) for persons residing within the
 4531  geographic area served by the aging resource center and
 4532  determine a priority ranking for services which is based upon
 4533  the potential recipient’s frailty level and likelihood of
 4534  institutional placement without such services.
 4535         (d) Manage the availability of financial resources for the
 4536  programs and services listed in subsection (9) (11) for persons
 4537  residing within the geographic area served by the aging resource
 4538  center.
 4539         (e) If When financial resources become available, refer a
 4540  client to the most appropriate entity to begin receiving
 4541  services. The aging resource center shall make referrals to lead
 4542  agencies for service provision that ensure that individuals who
 4543  are vulnerable adults in need of services pursuant to s.
 4544  415.104(3)(b), or who are victims of abuse, neglect, or
 4545  exploitation in need of immediate services to prevent further
 4546  harm and are referred by the adult protective services program,
 4547  are given primary consideration for receiving community-care
 4548  for-the-elderly services in compliance with the requirements of
 4549  s. 430.205(5)(a) and that other referrals for services are in
 4550  compliance with s. 430.205(5)(b).
 4551         (f) Convene a work group to advise in the planning,
 4552  implementation, and evaluation of the aging resource center. The
 4553  work group shall be composed comprised of representatives of
 4554  local service providers, Alzheimer’s Association chapters,
 4555  housing authorities, social service organizations, advocacy
 4556  groups, representatives of clients receiving services through
 4557  the aging resource center, and any other persons or groups as
 4558  determined by the department. The aging resource center, in
 4559  consultation with the work group, must develop annual program
 4560  improvement plans that shall be submitted to the department for
 4561  consideration. The department shall review each annual
 4562  improvement plan and make recommendations on how to implement
 4563  the components of the plan.
 4564         (g) Enhance the existing area agency on aging in each
 4565  planning and service area by integrating, either physically or
 4566  virtually, the staff and services of the area agency on aging
 4567  with the staff of the department’s local CARES Medicaid nursing
 4568  home preadmission screening unit and a sufficient number of
 4569  staff from the Department of Children and Family Services’
 4570  Economic Self-Sufficiency Unit necessary to determine the
 4571  financial eligibility for all persons age 60 and older residing
 4572  within the area served by the aging resource center who that are
 4573  seeking Medicaid services, Supplemental Security Income, and
 4574  food assistance.
 4575         (h) Assist clients who request long-term care services in
 4576  being evaluated for eligibility for the long-term care managed
 4577  care component of the Medicaid managed care program as qualified
 4578  plans become available in each of the regions pursuant to s.
 4579  409.973(2).
 4580         (i) Provide enrollment and coverage information to Medicaid
 4581  managed long-term care enrollees as qualified plans become
 4582  available in each of the regions pursuant to s. 409.973(2).
 4583         (j) Assist enrollees in the Medicaid long-term care managed
 4584  care program with informally resolving grievances with a managed
 4585  care network and in accessing the managed care network’s formal
 4586  grievance process as qualified plans become available in each of
 4587  the regions pursuant to s. 409.973(2).
 4588         (4)(6) The department shall select the entities to become
 4589  aging resource centers based on each entity’s readiness and
 4590  ability to perform the duties listed in subsection (3) (5) and
 4591  the entity’s:
 4592         (a) Expertise in the needs of each target population the
 4593  center proposes to serve and a thorough knowledge of the
 4594  providers that serve these populations.
 4595         (b) Strong connections to service providers, volunteer
 4596  agencies, and community institutions.
 4597         (c) Expertise in information and referral activities.
 4598         (d) Knowledge of long-term-care resources, including
 4599  resources designed to provide services in the least restrictive
 4600  setting.
 4601         (e) Financial solvency and stability.
 4602         (f) Ability to collect, monitor, and analyze data in a
 4603  timely and accurate manner, along with systems that meet the
 4604  department’s standards.
 4605         (g) Commitment to adequate staffing by qualified personnel
 4606  to effectively perform all functions.
 4607         (h) Ability to meet all performance standards established
 4608  by the department.
 4609         (5)(7) The aging resource center shall have a governing
 4610  body which shall be the same entity described in s. 20.41(7),
 4611  and an executive director who may be the same person as
 4612  described in s. 20.41(7). The governing body shall annually
 4613  evaluate the performance of the executive director.
 4614         (6)(8) The aging resource center may not be a provider of
 4615  direct services other than information and referral services,
 4616  and screening.
 4617         (7)(9) The aging resource center must agree to allow the
 4618  department to review any financial information the department
 4619  determines is necessary for monitoring or reporting purposes,
 4620  including financial relationships.
 4621         (8)(10) The duties and responsibilities of the community
 4622  care for the elderly lead agencies within each area served by an
 4623  aging resource center shall be to:
 4624         (a) Develop strong community partnerships to maximize the
 4625  use of community resources for the purpose of assisting elders
 4626  to remain in their community settings for as long as it is
 4627  safely possible.
 4628         (b) Conduct comprehensive assessments of clients that have
 4629  been determined eligible and develop a care plan consistent with
 4630  established protocols that ensures that the unique needs of each
 4631  client are met.
 4632         (9)(11) The services to be administered through the aging
 4633  resource center shall include those funded by the following
 4634  programs:
 4635         (a) Community care for the elderly.
 4636         (b) Home care for the elderly.
 4637         (c) Contracted services.
 4638         (d) Alzheimer’s disease initiative.
 4639         (e) Aged and disabled adult Medicaid waiver.
 4640         (f) Assisted living for the frail elderly Medicaid waiver.
 4641         (g) Older Americans Act.
 4642         (10)(12) The department shall, prior to designation of an
 4643  aging resource center, develop by rule operational and quality
 4644  assurance standards and outcome measures to ensure that clients
 4645  receiving services through all long-term-care programs
 4646  administered through an aging resource center are receiving the
 4647  appropriate care they require and that contractors and
 4648  subcontractors are adhering to the terms of their contracts and
 4649  are acting in the best interests of the clients they are
 4650  serving, consistent with the intent of the Legislature to reduce
 4651  the use of and cost of nursing home care. The department shall
 4652  by rule provide operating procedures for aging resource centers,
 4653  which shall include:
 4654         (a) Minimum standards for financial operation, including
 4655  audit procedures.
 4656         (b) Procedures for monitoring and sanctioning of service
 4657  providers.
 4658         (c) Minimum standards for technology utilized by the aging
 4659  resource center.
 4660         (d) Minimum staff requirements which shall ensure that the
 4661  aging resource center employs sufficient quality and quantity of
 4662  staff to adequately meet the needs of the elders residing within
 4663  the area served by the aging resource center.
 4664         (e) Minimum accessibility standards, including hours of
 4665  operation.
 4666         (f) Minimum oversight standards for the governing body of
 4667  the aging resource center to ensure its continuous involvement
 4668  in, and accountability for, all matters related to the
 4669  development, implementation, staffing, administration, and
 4670  operations of the aging resource center.
 4671         (g) Minimum education and experience requirements for
 4672  executive directors and other executive staff positions of aging
 4673  resource centers.
 4674         (h) Minimum requirements regarding any executive staff
 4675  positions that the aging resource center must employ and minimum
 4676  requirements that a candidate must meet in order to be eligible
 4677  for appointment to such positions.
 4678         (11)(13) In an area in which the department has designated
 4679  an area agency on aging as an aging resource center, the
 4680  department and the agency may shall not make payments for the
 4681  services listed in subsection (9) (11) and the Long-Term Care
 4682  Community Diversion Project for such persons who were not
 4683  screened and enrolled through the aging resource center. The
 4684  department shall cease making these payments for enrollees in
 4685  qualified plans as qualified plans become available in each of
 4686  the regions pursuant to s. 409.973(2).
 4687         (12)(14) Each aging resource center shall enter into a
 4688  memorandum of understanding with the department for
 4689  collaboration with the CARES unit staff. The memorandum of
 4690  understanding must shall outline the staff person responsible
 4691  for each function and shall provide the staffing levels
 4692  necessary to carry out the functions of the aging resource
 4693  center.
 4694         (13)(15) Each aging resource center shall enter into a
 4695  memorandum of understanding with the Department of Children and
 4696  Family Services for collaboration with the Economic Self
 4697  Sufficiency Unit staff. The memorandum of understanding must
 4698  shall outline which staff persons are responsible for which
 4699  functions and shall provide the staffing levels necessary to
 4700  carry out the functions of the aging resource center.
 4701         (14)(16) If any of the state activities described in this
 4702  section are outsourced, either in part or in whole, the contract
 4703  executing the outsourcing must shall mandate that the contractor
 4704  or its subcontractors shall, either physically or virtually,
 4705  execute the provisions of the memorandum of understanding
 4706  instead of the state entity whose function the contractor or
 4707  subcontractor now performs.
 4708         (15)(17) In order to be eligible to begin transitioning to
 4709  an aging resource center, an area agency on aging board must
 4710  ensure that the area agency on aging which it oversees meets all
 4711  of the minimum requirements set by law and in rule.
 4712         (18) The department shall monitor the three initial
 4713  projects for aging resource centers and report on the progress
 4714  of those projects to the Governor, the President of the Senate,
 4715  and the Speaker of the House of Representatives by June 30,
 4716  2005. The report must include an evaluation of the
 4717  implementation process.
 4718         (16)(19)(a) Once an aging resource center is operational,
 4719  the department, in consultation with the agency, may develop
 4720  capitation rates for any of the programs administered through
 4721  the aging resource center. Capitation rates for programs must
 4722  shall be based on the historical cost experience of the state in
 4723  providing those same services to the population age 60 or older
 4724  residing within each area served by an aging resource center.
 4725  Each capitated rate may vary by geographic area as determined by
 4726  the department.
 4727         (b) The department and the agency may determine for each
 4728  area served by an aging resource center whether it is
 4729  appropriate, consistent with federal and state laws and
 4730  regulations, to develop and pay separate capitated rates for
 4731  each program administered through the aging resource center or
 4732  to develop and pay capitated rates for service packages which
 4733  include more than one program or service administered through
 4734  the aging resource center.
 4735         (c) Once capitation rates have been developed and certified
 4736  as actuarially sound, the department and the agency may pay
 4737  service providers the capitated rates for services if when
 4738  appropriate.
 4739         (d) The department, in consultation with the agency, shall
 4740  annually reevaluate and recertify the capitation rates,
 4741  adjusting forward to account for inflation, programmatic
 4742  changes.
 4743         (20) The department, in consultation with the agency, shall
 4744  submit to the Governor, the President of the Senate, and the
 4745  Speaker of the House of Representatives, by December 1, 2006, a
 4746  report addressing the feasibility of administering the following
 4747  services through aging resource centers beginning July 1, 2007:
 4748         (a) Medicaid nursing home services.
 4749         (b) Medicaid transportation services.
 4750         (c) Medicaid hospice care services.
 4751         (d) Medicaid intermediate care services.
 4752         (e) Medicaid prescribed drug services.
 4753         (f) Medicaid assistive care services.
 4754         (g) Any other long-term-care program or Medicaid service.
 4755         (17)(21) This section does shall not be construed to allow
 4756  an aging resource center to restrict, manage, or impede the
 4757  local fundraising activities of service providers.
 4758         Section 57. Paragraphs (c) and (d) of subsection (3) of
 4759  section 39.407, Florida Statutes, are amended to read:
 4760         39.407 Medical, psychiatric, and psychological examination
 4761  and treatment of child; physical, mental, or substance abuse
 4762  examination of person with or requesting child custody.—
 4763         (3)
 4764         (c) Except as provided in paragraphs (b) and (e), the
 4765  department must file a motion seeking the court’s authorization
 4766  to initially provide or continue to provide psychotropic
 4767  medication to a child in its legal custody. The motion must be
 4768  supported by a written report prepared by the department which
 4769  describes the efforts made to enable the prescribing physician
 4770  to obtain express and informed consent to provide for providing
 4771  the medication to the child and other treatments considered or
 4772  recommended for the child. In addition, The motion must also be
 4773  supported by the prescribing physician’s signed medical report
 4774  providing:
 4775         1. The name of the child, the name and range of the dosage
 4776  of the psychotropic medication, and the that there is a need to
 4777  prescribe psychotropic medication to the child based upon a
 4778  diagnosed condition for which such medication is being
 4779  prescribed.
 4780         2. A statement indicating that the physician has reviewed
 4781  all medical information concerning the child which has been
 4782  provided.
 4783         3. A statement indicating that the psychotropic medication,
 4784  at its prescribed dosage, is appropriate for treating the
 4785  child’s diagnosed medical condition, as well as the behaviors
 4786  and symptoms the medication, at its prescribed dosage, is
 4787  expected to address.
 4788         4. An explanation of the nature and purpose of the
 4789  treatment; the recognized side effects, risks, and
 4790  contraindications of the medication; drug-interaction
 4791  precautions; the possible effects of stopping the medication;
 4792  and how the treatment will be monitored, followed by a statement
 4793  indicating that this explanation was provided to the child if
 4794  age appropriate and to the child’s caregiver.
 4795         5. Documentation addressing whether the psychotropic
 4796  medication will replace or supplement any other currently
 4797  prescribed medications or treatments; the length of time the
 4798  child is expected to be taking the medication; and any
 4799  additional medical, mental health, behavioral, counseling, or
 4800  other services that the prescribing physician recommends.
 4801         6. For a child 10 years of age or younger who is in an out
 4802  of-home placement, the results of a review of the administration
 4803  of the medication by a child psychiatrist who is licensed under
 4804  chapter 458 or chapter 459. The review must be provided to the
 4805  child and the parent or legal guardian before final express and
 4806  informed consent is given. The review must include a
 4807  determination of the following:
 4808         a. The presence of a genetic psychiatric disorder or a
 4809  family history of a psychiatric disorder;
 4810         b. Whether the cause of a psychiatric disorder is physical
 4811  or environmental; and
 4812         c. The likelihood of the child being an imminent danger to
 4813  self or others.
 4814         (d)1. The department must notify all parties of the
 4815  proposed action taken under paragraph (c) in writing or by
 4816  whatever other method best ensures that all parties receive
 4817  notification of the proposed action within 48 hours after the
 4818  motion is filed. If any party objects to the department’s
 4819  motion, that party shall file the objection within 2 working
 4820  days after being notified of the department’s motion. If any
 4821  party files an objection to the authorization of the proposed
 4822  psychotropic medication, the court shall hold a hearing as soon
 4823  as possible before authorizing the department to initially
 4824  provide or to continue providing psychotropic medication to a
 4825  child in the legal custody of the department.
 4826         1. At such hearing and notwithstanding s. 90.803, the
 4827  medical report described in paragraph (c) is admissible in
 4828  evidence. The prescribing physician need not attend the hearing
 4829  or testify unless the court specifically orders such attendance
 4830  or testimony, or a party subpoenas the physician to attend the
 4831  hearing or provide testimony.
 4832         2. If, after considering any testimony received, the court
 4833  finds that the department’s motion and the physician’s medical
 4834  report meet the requirements of this subsection and that it is
 4835  in the child’s best interests, the court may order that the
 4836  department provide or continue to provide the psychotropic
 4837  medication to the child without additional testimony or
 4838  evidence.
 4839         3. At any hearing held under this paragraph, the court
 4840  shall further inquire of the department as to whether additional
 4841  medical, mental health, behavioral, counseling, or other
 4842  services are being provided to the child by the department which
 4843  the prescribing physician considers to be necessary or
 4844  beneficial in treating the child’s medical condition and which
 4845  the physician recommends or expects to provide to the child in
 4846  concert with the medication. The court may order additional
 4847  medical consultation, including consultation with the MedConsult
 4848  line at the University of Florida, if available, or require the
 4849  department to obtain a second opinion within a reasonable
 4850  timeframe as established by the court, not to exceed 21 calendar
 4851  days, after such order based upon consideration of the best
 4852  interests of the child. The department must make a referral for
 4853  an appointment for a second opinion with a physician within 1
 4854  working day.
 4855         4. The court may not order the discontinuation of
 4856  prescribed psychotropic medication if such order is contrary to
 4857  the decision of the prescribing physician unless the court first
 4858  obtains an opinion from a licensed psychiatrist, if available,
 4859  or, if not available, a physician licensed under chapter 458 or
 4860  chapter 459, stating that more likely than not, discontinuing
 4861  the medication would not cause significant harm to the child.
 4862  If, however, the prescribing psychiatrist specializes in mental
 4863  health care for children and adolescents, the court may not
 4864  order the discontinuation of prescribed psychotropic medication
 4865  unless the required opinion is also from a psychiatrist who
 4866  specializes in mental health care for children and adolescents.
 4867  The court may also order the discontinuation of prescribed
 4868  psychotropic medication if a child’s treating physician,
 4869  licensed under chapter 458 or chapter 459, states that
 4870  continuing the prescribed psychotropic medication would cause
 4871  significant harm to the child due to a diagnosed nonpsychiatric
 4872  medical condition.
 4873         5. If a child who is in out-of-home placement is 10 years
 4874  of age or younger, psychotropic medication may not be authorized
 4875  by the court absent a finding of a compelling governmental
 4876  interest. In making such finding, the court shall review the
 4877  psychiatric review described in subparagraph (c)6.
 4878         6.2. The burden of proof at any hearing held under this
 4879  paragraph shall be by a preponderance of the evidence.
 4880         Section 58. Paragraph (a) of subsection (1) of section
 4881  216.262, Florida Statutes, is amended to read:
 4882         216.262 Authorized positions.—
 4883         (1)(a) Except as Unless otherwise expressly provided by
 4884  law, the total number of authorized positions may not exceed the
 4885  total provided in the appropriations acts. If a In the event any
 4886  state agency or entity of the judicial branch finds that the
 4887  number of positions so provided is not sufficient to administer
 4888  its authorized programs, it may file an application with the
 4889  Executive Office of the Governor or the Chief Justice; and, if
 4890  the Executive Office of the Governor or Chief Justice certifies
 4891  that there are no authorized positions available for addition,
 4892  deletion, or transfer within the agency or entity as provided in
 4893  paragraph (c), may recommend and recommends an increase in the
 4894  number of positions.,
 4895         1. The Governor or the Chief Justice may recommend an
 4896  increase in the number of positions for the following reasons
 4897  only:
 4898         a.1. To implement or provide for continuing federal grants
 4899  or changes in grants not previously anticipated.
 4900         b.2. To meet emergencies pursuant to s. 252.36.
 4901         c.3. To satisfy new federal regulations or changes therein.
 4902         d.4. To take advantage of opportunities to reduce operating
 4903  expenditures or to increase the revenues of the state or local
 4904  government.
 4905         e.5. To authorize positions that were not fixed by the
 4906  Legislature due to through error in drafting the appropriations
 4907  acts.
 4908         2. Actions recommended pursuant to this paragraph are
 4909  subject to approval by the Legislative Budget Commission. The
 4910  certification and the final authorization shall be provided to
 4911  the Legislative Budget Commission, the legislative
 4912  appropriations committees, and the Auditor General.
 4913         3. The provisions of this paragraph do not apply to
 4914  positions in the Department of Health which are funded by the
 4915  County Health Department Trust Fund.
 4916         Section 59. Section 381.06014, Florida Statutes, is amended
 4917  to read:
 4918         381.06014 Blood establishments.—
 4919         (1) As used in this section, the term:
 4920         (a) “Blood establishment” means any person, entity, or
 4921  organization, operating within the state, which examines an
 4922  individual for the purpose of blood donation or which collects,
 4923  processes, stores, tests, or distributes blood or blood
 4924  components collected from the human body for the purpose of
 4925  transfusion, for any other medical purpose, or for the
 4926  production of any biological product. A person, entity, or
 4927  organization that uses a mobile unit to conduct such activities
 4928  within the state is also a blood establishment.
 4929         (b) “Volunteer donor” means a person who does not receive
 4930  remuneration, other than an incentive, for a blood donation
 4931  intended for transfusion, and the product container of the
 4932  donation from the person qualifies for labeling with the
 4933  statement “volunteer donor” under 21 C.F.R. s. 606.121.
 4934         (2) An entity or organization may not hold itself out and
 4935  engage in the activities of a Any blood establishment in this
 4936  state operating in the state may not conduct any activity
 4937  defined in subsection (1) unless it operates in accordance that
 4938  blood establishment is operated in a manner consistent with the
 4939  provisions of Title 21 C.F.R. parts 211 and 600-640, Code of
 4940  Federal Regulations.
 4941         (3) A Any blood establishment determined to be operating in
 4942  the state in a manner not consistent with the provisions of
 4943  Title 21 C.F.R. parts 211 and 600-640, Code of Federal
 4944  Regulations, and in a manner that constitutes a danger to the
 4945  health or well-being of donors or recipients as evidenced by the
 4946  federal Food and Drug Administration’s inspection reports and
 4947  the revocation of the blood establishment’s license or
 4948  registration is shall be in violation of this chapter, and shall
 4949  immediately cease all operations in the state.
 4950         (4) The operation of a blood establishment in a manner not
 4951  consistent with the provisions of Title 21 parts 211 and 600
 4952  640, Code of Federal Regulations, and in a manner that
 4953  constitutes a danger to the health or well-being of blood donors
 4954  or recipients as evidenced by the federal Food and Drug
 4955  Administration’s inspection process is declared a nuisance and
 4956  inimical to the public health, welfare, and safety, and must
 4957  immediately cease all operations in this state. The Agency for
 4958  Health Care Administration or any state attorney may bring an
 4959  action for an injunction to restrain such operations or enjoin
 4960  the future operation of the blood establishment.
 4961         (4) A local government may not restrict access to or the
 4962  use of any public facility or infrastructure for the collection
 4963  of blood or blood components from volunteer donors based on
 4964  whether the blood establishment is operating as a for-profit or
 4965  not-for-profit organization.
 4966         (5) In determining the service fee of blood or blood
 4967  components received from volunteer donors and sold to hospitals
 4968  or other health care providers, a blood establishment may not
 4969  base the service fee of the blood or blood component solely on
 4970  whether the purchasing entity is a for-profit or not-for-profit
 4971  organization.
 4972         (6) A blood establishment that collects blood or blood
 4973  components from volunteer donors must disclose the following
 4974  information on its Internet website in order to educate and
 4975  inform donors and the public about the blood establishment’s
 4976  activities, and the information required to be disclosed may be
 4977  cumulative for all blood establishments within a business
 4978  entity:
 4979         (a) A description of the steps involved in collecting,
 4980  processing, and distributing volunteer donations.
 4981         (b) By March 1 of each year, the number of units of blood
 4982  components which were:
 4983         1. Produced by the blood establishment during the preceding
 4984  calendar year;
 4985         2. Obtained from other sources during the preceding
 4986  calendar year;
 4987         3. Distributed during the preceding calendar year to health
 4988  care providers located outside this state. However, if the blood
 4989  establishment collects donations in a county outside this state,
 4990  distributions to health care providers in that county are
 4991  excluded. Such information shall be reported in the aggregate
 4992  for health care providers located within the United States and
 4993  its territories or outside the United States and its
 4994  territories; and
 4995         4. Distributed during the preceding calendar year to
 4996  entities that are not health care providers. Such information
 4997  shall be reported in the aggregate for purchasers located within
 4998  the United States and its territories or outside the United
 4999  States and its territories.
 5000         (c) The blood establishment’s conflict-of-interest policy,
 5001  policy concerning related-party transactions, whistleblower
 5002  policy, and policy for determining executive compensation. If a
 5003  change occurs to any of these documents, the revised document
 5004  must be available on the blood establishment’s website by the
 5005  following March 1.
 5006         (d) Except for a hospital that collects blood or blood
 5007  components from volunteer donors:
 5008         1. The most recent 3 years of the Return of Organization
 5009  Exempt from Income Tax, Internal Revenue Service Form 990, if
 5010  the business entity for the blood establishment is eligible to
 5011  file such return. The Form 990 must be available on the blood
 5012  establishment’s website within 60 calendar days after it is
 5013  filed with the Internal Revenue Service; or
 5014         2. If the business entity for the blood establishment is
 5015  not eligible to file the Form 990 return, a balance sheet,
 5016  income statement, and statement of changes in cash flow, along
 5017  with the expression of an opinion thereon by an independent
 5018  certified public accountant who audited or reviewed such
 5019  financial statements. Such documents must be available on the
 5020  blood establishment’s website within 120 days after the end of
 5021  the blood establishment’s fiscal year and must remain on the
 5022  blood establishment’s website for at least 36 months.
 5023  
 5024  A hospital that collects blood or blood components to be used
 5025  only by that hospital’s licensed facilities or by a health care
 5026  provider that is a part of the hospital’s business entity is
 5027  exempt from the disclosure requirements of this subsection.
 5028         (7) A blood establishment is liable for a civil penalty for
 5029  failing to make the disclosures required under subsection (6).
 5030  The Department of Legal Affairs may assess a civil penalty
 5031  against the blood establishment for each day that it fails to
 5032  make such required disclosures, but the penalty may not exceed
 5033  $10,000 per year. If multiple blood establishments operated by a
 5034  single business entity fail to meet such disclosure
 5035  requirements, the civil penalty may be assessed against only one
 5036  of the business entity’s blood establishments. The Department of
 5037  Legal Affairs may terminate an action if the blood establishment
 5038  agrees to pay a stipulated civil penalty. A civil penalty so
 5039  collected accrues to the state and shall be deposited as
 5040  received into the General Revenue Fund unallocated. The
 5041  Department of Legal Affairs may terminate the action and waive
 5042  the civil penalty upon a showing of good cause by the blood
 5043  establishment as to why the required disclosures were not made.
 5044         Section 60. Subsection (9) of section 393.063, Florida
 5045  Statutes, is amended, present subsections (13) through (40) of
 5046  that section are redesignated as subsections (14) through (41),
 5047  respectively, and a new subsection (13) is added to that
 5048  section, to read:
 5049         393.063 Definitions.—For the purposes of this chapter, the
 5050  term:
 5051         (9) “Developmental disability” means a disorder or syndrome
 5052  that is attributable to retardation, cerebral palsy, autism,
 5053  spina bifida, Down syndrome, or Prader-Willi syndrome; that
 5054  manifests before the age of 18; and that constitutes a
 5055  substantial handicap that can reasonably be expected to continue
 5056  indefinitely.
 5057         (13) “Down syndrome” means a disorder that is caused by the
 5058  presence of an extra chromosome 21.
 5059         Section 61. Section 400.023, Florida Statutes, is reordered
 5060  and amended to read:
 5061         400.023 Civil enforcement.—
 5062         (1) A Any resident who whose alleges negligence or a
 5063  violation of rights as specified in this part has are violated
 5064  shall have a cause of action against the licensee or its
 5065  management company, as identified in the state application for
 5066  nursing home licensure. However, the cause of action may not be
 5067  asserted individually against an officer, director, owner,
 5068  including an owner designated as having a controlling interest
 5069  on the state application for nursing home licensure, or agent of
 5070  a licensee or management company unless, following an
 5071  evidentiary hearing, the court determines there is sufficient
 5072  evidence in the record or proffered by the claimant which
 5073  establishes a reasonable basis for finding that the person or
 5074  entity breached, failed to perform, or acted outside the scope
 5075  of duties as an officer, director, owner, or agent, and that the
 5076  breach, failure to perform, or action outside the scope of
 5077  duties is a legal cause of actual loss, injury, death, or damage
 5078  to the resident.
 5079         (2) The action may be brought by the resident or his or her
 5080  guardian, by a person or organization acting on behalf of a
 5081  resident with the consent of the resident or his or her
 5082  guardian, or by the personal representative of the estate of a
 5083  deceased resident regardless of the cause of death.
 5084         (5) If the action alleges a claim for the resident’s rights
 5085  or for negligence that:
 5086         (a) Caused the death of the resident, the claimant must
 5087  shall be required to elect either survival damages pursuant to
 5088  s. 46.021 or wrongful death damages pursuant to s. 768.21. If
 5089  the claimant elects wrongful death damages, total noneconomic
 5090  damages may not exceed $250,000, regardless of the number of
 5091  claimants.
 5092         (b)If the action alleges a claim for the resident’s rights
 5093  or for negligence that Did not cause the death of the resident,
 5094  the personal representative of the estate may recover damages
 5095  for the negligence that caused injury to the resident.
 5096         (3) The action may be brought in any court of competent
 5097  jurisdiction to enforce such rights and to recover actual and
 5098  punitive damages for any violation of the rights of a resident
 5099  or for negligence.
 5100         (10) Any resident who prevails in seeking injunctive relief
 5101  or a claim for an administrative remedy may is entitled to
 5102  recover the costs of the action, and a reasonable attorney’s fee
 5103  assessed against the defendant not to exceed $25,000. Fees shall
 5104  be awarded solely for the injunctive or administrative relief
 5105  and not for any claim or action for damages whether such claim
 5106  or action is brought together with a request for an injunction
 5107  or administrative relief or as a separate action, except as
 5108  provided under s. 768.79 or the Florida Rules of Civil
 5109  Procedure. Sections 400.023-400.0238 provide the exclusive
 5110  remedy for a cause of action for recovery of damages for the
 5111  personal injury or death of a nursing home resident arising out
 5112  of negligence or a violation of rights specified in s. 400.022.
 5113  This section does not preclude theories of recovery not arising
 5114  out of negligence or s. 400.022 which are available to a
 5115  resident or to the agency. The provisions of chapter 766 do not
 5116  apply to any cause of action brought under ss. 400.023-400.0238.
 5117         (6)(2)If the In any claim brought pursuant to this part
 5118  alleges alleging a violation of resident’s rights or negligence
 5119  causing injury to or the death of a resident, the claimant shall
 5120  have the burden of proving, by a preponderance of the evidence,
 5121  that:
 5122         (a) The defendant owed a duty to the resident;
 5123         (b) The defendant breached the duty to the resident;
 5124         (c) The breach of the duty is a legal cause of loss,
 5125  injury, death, or damage to the resident; and
 5126         (d) The resident sustained loss, injury, death, or damage
 5127  as a result of the breach.
 5128         (12) Nothing in This part does not shall be interpreted to
 5129  create strict liability. A violation of the rights set forth in
 5130  s. 400.022 or in any other standard or guidelines specified in
 5131  this part or in any applicable administrative standard or
 5132  guidelines of this state or a federal regulatory agency is shall
 5133  be evidence of negligence but may shall not be considered
 5134  negligence per se.
 5135         (7)(3) In any claim brought pursuant to this section, a
 5136  licensee, person, or entity has shall have a duty to exercise
 5137  reasonable care. Reasonable care is that degree of care which a
 5138  reasonably careful licensee, person, or entity would use under
 5139  like circumstances.
 5140         (9)(4) In any claim for resident’s rights violation or
 5141  negligence by a nurse licensed under part I of chapter 464, such
 5142  nurse has a shall have the duty to exercise care consistent with
 5143  the prevailing professional standard of care for a nurse. The
 5144  prevailing professional standard of care for a nurse is shall be
 5145  that level of care, skill, and treatment which, in light of all
 5146  relevant surrounding circumstances, is recognized as acceptable
 5147  and appropriate by reasonably prudent similar nurses.
 5148         (8)(5) A licensee is shall not be liable for the medical
 5149  negligence of any physician rendering care or treatment to the
 5150  resident except for the administrative services of a medical
 5151  director as required in this part. Nothing in This subsection
 5152  does not shall be construed to protect a licensee, person, or
 5153  entity from liability for failure to provide a resident with
 5154  appropriate observation, assessment, nursing diagnosis,
 5155  planning, intervention, and evaluation of care by nursing staff.
 5156         (4)(6) The resident or the resident’s legal representative
 5157  shall serve a copy of any complaint alleging in whole or in part
 5158  a violation of any rights specified in this part to the agency
 5159  for Health Care Administration at the time of filing the initial
 5160  complaint with the clerk of the court for the county in which
 5161  the action is pursued. The requirement of Providing a copy of
 5162  the complaint to the agency does not impair the resident’s legal
 5163  rights or ability to seek relief for his or her claim.
 5164         (11)(7) An action under this part for a violation of rights
 5165  or negligence recognized herein is not a claim for medical
 5166  malpractice, and the provisions of s. 768.21(8) do not apply to
 5167  a claim alleging death of the resident.
 5168         Section 62. Subsections (1), (2), and (3) of section
 5169  400.0237, Florida Statutes, are amended to read:
 5170         400.0237 Punitive damages; pleading; burden of proof.—
 5171         (1) In any action for damages brought under this part, a no
 5172  claim for punitive damages is not shall be permitted unless,
 5173  based on admissible there is a reasonable showing by evidence in
 5174  the record or proffered by the claimant, which would provide a
 5175  reasonable basis for recovery of such damages is demonstrated
 5176  upon applying the criteria set forth in this section. The
 5177  defendant may proffer admissible evidence to refute the
 5178  claimant’s proffer of evidence to recover punitive damages. The
 5179  trial judge shall conduct an evidentiary hearing and weigh the
 5180  admissible evidence proffered by the claimant and the defendant
 5181  to ensure that there is a reasonable basis to believe that the
 5182  claimant, at trial, will be able to demonstrate by clear and
 5183  convincing evidence that the recovery of such damages is
 5184  warranted. The claimant may move to amend her or his complaint
 5185  to assert a claim for punitive damages as allowed by the rules
 5186  of civil procedure. The rules of civil procedure shall be
 5187  liberally construed so as to allow the claimant discovery of
 5188  evidence which appears reasonably calculated to lead to
 5189  admissible evidence on the issue of punitive damages. No
 5190  Discovery of financial worth may not shall proceed until after
 5191  the trial judge approves the pleading on concerning punitive
 5192  damages is permitted.
 5193         (2) A defendant, including the licensee or management
 5194  company, against whom punitive damages is sought may be held
 5195  liable for punitive damages only if the trier of fact, based on
 5196  clear and convincing evidence, finds that a specific individual
 5197  or corporate defendant actively and knowingly participated in
 5198  intentional misconduct, or engaged in conduct that constituted
 5199  gross negligence, and that conduct contributed to the loss,
 5200  damages, or injury suffered by the claimant the defendant was
 5201  personally guilty of intentional misconduct or gross negligence.
 5202  As used in this section, the term:
 5203         (a) “Intentional misconduct” means that the defendant
 5204  against whom a claim for punitive damages is sought had actual
 5205  knowledge of the wrongfulness of the conduct and the high
 5206  probability that injury or damage to the claimant would result
 5207  and, despite that knowledge, intentionally pursued that course
 5208  of conduct, resulting in injury or damage.
 5209         (b) “Gross negligence” means that the defendant’s conduct
 5210  was so reckless or wanting in care that it constituted a
 5211  conscious disregard or indifference to the life, safety, or
 5212  rights of persons exposed to such conduct.
 5213         (3) In the case of vicarious liability of an employer,
 5214  principal, corporation, or other legal entity, punitive damages
 5215  may not be imposed for the conduct of an identified employee or
 5216  agent unless only if the conduct of the employee or agent meets
 5217  the criteria specified in subsection (2) and officers,
 5218  directors, or managers of the actual employer corporation or
 5219  legal entity condoned, ratified, or consented to the specific
 5220  conduct as alleged by the claimant in subsection (2).:
 5221         (a) The employer, principal, corporation, or other legal
 5222  entity actively and knowingly participated in such conduct;
 5223         (b) The officers, directors, or managers of the employer,
 5224  principal, corporation, or other legal entity condoned,
 5225  ratified, or consented to such conduct; or
 5226         (c) The employer, principal, corporation, or other legal
 5227  entity engaged in conduct that constituted gross negligence and
 5228  that contributed to the loss, damages, or injury suffered by the
 5229  claimant.
 5230         Section 63. Subsections (3) and (4) of section 408.7057,
 5231  Florida Statutes, are amended, subsection (7) of that section is
 5232  redesignated as subsection (8), and a new subsection (7) is
 5233  added to that section, to read:
 5234         408.7057 Statewide provider and health plan claim dispute
 5235  resolution program.—
 5236         (3) The agency shall adopt rules to establish a process to
 5237  be used by the resolution organization in considering claim
 5238  disputes submitted by a provider or health plan which must
 5239  include a hearing, if requested by the respondent, and the
 5240  issuance by the resolution organization of a written
 5241  recommendation, supported by findings of fact and conclusions of
 5242  law, to the agency within 60 days after the requested
 5243  information is received by the resolution organization within
 5244  the timeframes specified by the resolution organization. In no
 5245  event shall The review time may not exceed 90 days following
 5246  receipt of the initial claim dispute submission by the
 5247  resolution organization.
 5248         (4) Within 30 days after receipt of the recommendation of
 5249  the resolution organization, the agency shall adopt the
 5250  recommendation as a final order subject to chapter 120.
 5251         (7) This section creates a procedure for dispute resolution
 5252  and not an independent right of recovery. The conclusions of law
 5253  contained in the written recommendation of the resolution
 5254  organization must identify the provisions of law or contract
 5255  which, under the particular facts and circumstances of the case,
 5256  entitle the provider or health plan to the amount awarded, if
 5257  any.
 5258         Section 64. Paragraphs (f), (h), (j), and (l) of subsection
 5259  (1) and subsection (2) of section 409.1671, Florida Statutes,
 5260  are amended to read:
 5261         409.1671 Foster care and related services; outsourcing.—
 5262         (1)
 5263         (f)1. The Legislature finds that the state has
 5264  traditionally provided foster care services to children who are
 5265  have been the responsibility of the state. As such, foster
 5266  children have not had the right to recover for injuries beyond
 5267  the limitations specified in s. 768.28. The Legislature has also
 5268  determined that foster care and related services need to be
 5269  outsourced pursuant to this section and that the provision of
 5270  such services is of paramount importance to the state. The
 5271  purpose for such outsourcing is to increase the level of safety,
 5272  security, and stability of children who are or become the
 5273  responsibility of the state.
 5274         1. One of the components necessary to secure a safe and
 5275  stable environment for such children is for that private
 5276  providers to maintain adequate liability insurance. As Such,
 5277  insurance needs to be available and remain available to
 5278  nongovernmental foster care and related services providers
 5279  without the resources of such providers being significantly
 5280  reduced by the cost of maintaining such insurance. To ensure
 5281  that these resources are not significantly reduced, specified
 5282  limits of liability are necessary for eligible lead community
 5283  based providers and subcontractors engaged in the provision of
 5284  services previously performed by the department.
 5285         2. The Legislature further finds that, by requiring the
 5286  following minimum levels of insurance, children in outsourced
 5287  foster care and related services will gain increased protection
 5288  and rights of recovery in the event of injury than provided for
 5289  in s. 768.28.
 5290         (h) Other than an entity to which s. 768.28 applies, an any
 5291  eligible lead community-based provider, as defined in paragraph
 5292  (e), or its employees or officers, except as otherwise provided
 5293  in paragraph (i), must, as a part of its contract, obtain
 5294  general liability coverage for a minimum of $200,000 per claim
 5295  or $300,000 per incident a minimum of $1 million per claim/$3
 5296  million per incident in general liability insurance coverage.
 5297         1. The eligible lead community-based provider must also
 5298  require that staff who transport client children and families in
 5299  their personal automobiles in order to carry out their job
 5300  responsibilities to obtain minimum bodily injury liability
 5301  insurance on their personal automobiles in the amount of
 5302  $100,000 per claim or, $300,000 per incident, on their personal
 5303  automobiles. In lieu of personal motor vehicle insurance, the
 5304  lead community-based provider’s casualty, liability, or motor
 5305  vehicle insurance carrier may provide nonowned automobile
 5306  liability coverage. This insurance provides liability insurance
 5307  for automobiles that the provider uses in connection with the
 5308  provider’s business but does not own, lease, rent, or borrow.
 5309  This coverage includes automobiles owned by the employees of the
 5310  provider or a member of the employee’s household but only while
 5311  the automobiles are used in connection with the provider’s
 5312  business. The nonowned automobile coverage for the provider
 5313  applies as excess coverage over any other collectible insurance.
 5314  The personal automobile policy for the employee of the provider
 5315  shall be primary insurance, and the nonowned automobile coverage
 5316  of the provider acts as excess insurance to the primary
 5317  insurance. The provider shall provide a minimum limit of $1
 5318  million in nonowned automobile coverage.
 5319         2. In any tort action brought against such an eligible lead
 5320  community-based provider or employee, net economic damages are
 5321  shall be limited to $200,000 $1 million per liability claim,
 5322  $300,000 per liability incident, and $100,000 per automobile
 5323  claim, including, but not limited to, past and future medical
 5324  expenses, wage loss, and loss of earning capacity, offset by any
 5325  collateral source payment paid or payable. In any tort action
 5326  brought against an eligible lead community-based provider, the
 5327  total economic damages recoverable by all claimants is limited
 5328  to $500,000 in the aggregate. In any tort action brought against
 5329  such an eligible lead community-based provider, noneconomic
 5330  damages are shall be limited to $200,000 per claim and $300,000
 5331  per incident. In any tort action brought against an eligible
 5332  lead community-based provider, the total noneconomic damages
 5333  recoverable by all claimants are limited to $500,000 in the
 5334  aggregate.
 5335         3. A claims bill may be brought on behalf of a claimant
 5336  pursuant to s. 768.28 for any amount exceeding the limits
 5337  specified in this paragraph. Any offset of collateral source
 5338  payments made as of the date of the settlement or judgment shall
 5339  be in accordance with s. 768.76. The lead community-based
 5340  provider is shall not be liable in tort for the acts or
 5341  omissions of its subcontractors or the officers, agents, or
 5342  employees of its subcontractors.
 5343         (j) Any subcontractor of an eligible lead community-based
 5344  provider, as defined in paragraph (e), which is a direct
 5345  provider of foster care and related services to children and
 5346  families, and its employees or officers, except as otherwise
 5347  provided in paragraph (i), must, as a part of its contract,
 5348  obtain general liability insurance coverage for a minimum of
 5349  $200,000 per claim or $300,000 $1 million per claim/$3 million
 5350  per incident in general liability insurance coverage.
 5351         1. The subcontractor of an eligible lead community-based
 5352  provider must also require that staff who transport client
 5353  children and families in their personal automobiles in order to
 5354  carry out their job responsibilities obtain minimum bodily
 5355  injury liability insurance in the amount of $100,000 per claim,
 5356  $300,000 per incident, on their personal automobiles. In lieu of
 5357  personal motor vehicle insurance, the subcontractor’s casualty,
 5358  liability, or motor vehicle insurance carrier may provide
 5359  nonowned automobile liability coverage. This insurance provides
 5360  liability insurance for automobiles that the subcontractor uses
 5361  in connection with the subcontractor’s business but does not
 5362  own, lease, rent, or borrow. This coverage includes automobiles
 5363  owned by the employees of the subcontractor or a member of the
 5364  employee’s household but only while the automobiles are used in
 5365  connection with the subcontractor’s business. The nonowned
 5366  automobile coverage for the subcontractor applies as excess
 5367  coverage over any other collectible insurance. The personal
 5368  automobile policy for the employee of the subcontractor is shall
 5369  be primary insurance, and the nonowned automobile coverage of
 5370  the subcontractor acts as excess insurance to the primary
 5371  insurance. The subcontractor shall provide a minimum limit of $1
 5372  million in nonowned automobile coverage.
 5373         2. In any tort action brought against such subcontractor or
 5374  employee, net economic damages shall be limited to $200,000 $1
 5375  million per liability claim, $300,000 per liability incident,
 5376  and $100,000 per automobile claim, including, but not limited
 5377  to, past and future medical expenses, wage loss, and loss of
 5378  earning capacity, offset by any collateral source payment paid
 5379  or payable. In any tort action brought against such
 5380  subcontractor or employee, the total economic damages
 5381  recoverable by all claimants is limited to $500,000 in the
 5382  aggregate. In any tort action brought against such
 5383  subcontractor, noneconomic damages shall be limited to $200,000
 5384  per claim and $300,000 per incident. In any tort action brought
 5385  against such subcontractor or employee, the total noneconomic
 5386  damages recoverable by all claimants is limited to $500,000 in
 5387  the aggregate.
 5388         3. A claims bill may be brought on behalf of a claimant
 5389  pursuant to s. 768.28 for any amount exceeding the limits
 5390  specified in this paragraph. Any offset of collateral source
 5391  payments made as of the date of the settlement or judgment shall
 5392  be in accordance with s. 768.76.
 5393         (l) The Legislature is cognizant of the increasing costs of
 5394  goods and services each year and recognizes that fixing a set
 5395  amount of compensation actually has the effect of a reduction in
 5396  compensation each year. Accordingly, the conditional limitations
 5397  on damages in this section shall be increased at the rate of 5
 5398  percent each year, prorated from the effective date of this
 5399  paragraph to the date at which damages subject to such
 5400  limitations are awarded by final judgment or settlement.
 5401         (2)(a) The department may contract for the delivery,
 5402  administration, or management of protective services, the
 5403  services specified in subsection (1) relating to foster care,
 5404  and other related services or programs, as appropriate.
 5405         (a) The department shall use diligent efforts to ensure
 5406  that retain responsibility for the quality of contracted
 5407  services and programs and shall ensure that services are of high
 5408  quality and delivered in accordance with applicable federal and
 5409  state statutes and regulations. However, the department is not
 5410  liable in tort for the acts or omissions of eligible lead
 5411  community-based providers or their officers, agents, or
 5412  employees, or liable in tort for the acts or omissions of the
 5413  subcontractors of eligible lead community-based care providers
 5414  or their officers, agents, or employees. Further, the department
 5415  may not require eligible lead community-based providers or their
 5416  subcontractors to indemnify the department for the department’s
 5417  acts or omissions or require eligible lead-based community
 5418  providers or their subcontractors to include the department as
 5419  an additional insured on an insurance policy.
 5420         (b) The department shall must adopt written policies and
 5421  procedures for monitoring the contract for the delivery of
 5422  services by lead community-based providers. These policies and
 5423  procedures must, at a minimum, address the evaluation of fiscal
 5424  accountability and program operations, including provider
 5425  achievement of performance standards, provider monitoring of
 5426  subcontractors, and timely followup of corrective actions for
 5427  significant monitoring findings related to providers and
 5428  subcontractors. The These policies and procedures must also
 5429  include provisions for reducing the duplication of the
 5430  department’s program monitoring activities both internally and
 5431  with other agencies, to the extent possible. The department’s
 5432  written procedures must ensure that the written findings,
 5433  conclusions, and recommendations from monitoring the contract
 5434  for services of lead community-based providers are communicated
 5435  to the director of the provider agency as expeditiously as
 5436  possible.
 5437         (c)(b) Persons employed by the department in the provision
 5438  of foster care and related services whose positions are being
 5439  outsourced under this statute shall be given hiring preference
 5440  by the provider, if provider qualifications are met.
 5441         Section 65. Section 458.3167, Florida Statutes, is created
 5442  to read:
 5443         458.3167Expert witness certificate.—
 5444         (1) A physician who holds an active and valid license to
 5445  practice allopathic medicine in any other state or in Canada,
 5446  who submits an application form prescribed by the board to
 5447  obtain a certificate to provide expert testimony and pays the
 5448  application fee, and who has not had a previous expert witness
 5449  certificate revoked by the board shall be issued a certificate
 5450  to provide expert testimony.
 5451         (2) A physician possessing an expert witness certificate
 5452  may use the certificate only to give a verified written medical
 5453  expert opinion as provided in s. 766.203 and to provide expert
 5454  testimony concerning the prevailing professional standard of
 5455  care for medical negligence litigation pending in this state
 5456  against a physician licensed under this chapter or chapter 459.
 5457         (3) An application for an expert witness certificate must
 5458  be approved or denied within 5 business days after receipt of a
 5459  completed application. An application that is not approved or
 5460  denied within the required time period is deemed approved. An
 5461  applicant seeking to claim certification by default shall notify
 5462  the board, in writing, of the intent to rely on the default
 5463  certification provision of this subsection. In such case, s.
 5464  458.327 does not apply, and the applicant may provide expert
 5465  testimony as provided in subsection (2).
 5466         (4) All licensure fees, other than the initial certificate
 5467  application fee, including the neurological injury compensation
 5468  assessment, are waived for those persons obtaining an expert
 5469  witness certificate. The possession of an expert witness
 5470  certificate alone does not entitle the physician to engage in
 5471  the practice of medicine as defined in s. 458.305.
 5472         (5) The board shall adopt rules to administer this section,
 5473  including rules setting the amount of the expert witness
 5474  certificate application fee, which may not exceed $50. An expert
 5475  witness certificate expires 2 years after the date of issuance.
 5476         Section 66. Subsection (11) is added to section 458.331,
 5477  Florida Statutes, present paragraphs (oo) through (qq) of
 5478  subsection (1) of that section are redesignated as paragraphs
 5479  (pp) through (rr), respectively, and a new paragraph (oo) is
 5480  added to that subsection, to read:
 5481         458.331 Grounds for disciplinary action; action by the
 5482  board and department.—
 5483         (1) The following acts constitute grounds for denial of a
 5484  license or disciplinary action, as specified in s. 456.072(2):
 5485         (oo) Providing misleading, deceptive, or fraudulent expert
 5486  witness testimony related to the practice of medicine.
 5487         (11) The purpose of this section is to facilitate uniform
 5488  discipline for those acts made punishable under this section
 5489  and, to this end, a reference to this section constitutes a
 5490  general reference under the doctrine of incorporation by
 5491  reference.
 5492         Section 67. Section 459.0078, Florida Statutes, is created
 5493  to read:
 5494         459.0078Expert witness certificate.—
 5495         (1) A physician who holds an active and valid license to
 5496  practice osteopathic medicine in any other state or in Canada,
 5497  who submits an application form prescribed by the board to
 5498  obtain a certificate to provide expert testimony and pays the
 5499  application fee, and who has not had a previous expert witness
 5500  certificate revoked by the board shall be issued a certificate
 5501  to provide expert testimony.
 5502         (2) A physician possessing an expert witness certificate
 5503  may use the certificate only to give a verified written medical
 5504  expert opinion as provided in s. 766.203 and to provide expert
 5505  testimony concerning the prevailing professional standard of
 5506  care for medical negligence litigation pending in this state
 5507  against a physician licensed under this chapter or chapter 458.
 5508         (3) An application for an expert witness certificate must
 5509  be approved or denied within 5 business days after receipt of a
 5510  completed application. An application that is not approved or
 5511  denied within the required time period is deemed approved. An
 5512  applicant seeking to claim certification by default shall notify
 5513  the board, in writing, of the intent to rely on the default
 5514  certification provision of this subsection. In such case, s.
 5515  459.013 does not apply, and the applicant may provide expert
 5516  testimony as provided in subsection (2).
 5517         (4) All licensure fees, other than the initial certificate
 5518  application fee, including the neurological injury compensation
 5519  assessment, are waived for those persons obtaining an expert
 5520  witness certificate. The possession of an expert witness
 5521  certificate alone does not entitle the physician to engage in
 5522  the practice of osteopathic medicine as defined in s. 459.003.
 5523         (5) The board shall adopt rules to administer this section,
 5524  including rules setting the amount of the expert witness
 5525  certificate application fee, which may not exceed $50. An expert
 5526  witness certificate expires 2 years after the date of issuance.
 5527         Section 68. Subsection (11) is added to section 459.015,
 5528  Florida Statutes, present paragraphs (qq) through (ss) of
 5529  subsection (1) of that section are redesignated as paragraphs
 5530  (rr) through (tt), respectively, and a new paragraph (qq) is
 5531  added to that subsection, to read:
 5532         459.015 Grounds for disciplinary action; action by the
 5533  board and department.—
 5534         (1) The following acts constitute grounds for denial of a
 5535  license or disciplinary action, as specified in s. 456.072(2):
 5536         (qq) Providing misleading, deceptive, or fraudulent expert
 5537  witness testimony related to the practice of osteopathic
 5538  medicine.
 5539         (11) The purpose of this section is to facilitate uniform
 5540  discipline for those acts made punishable under this section
 5541  and, to this end, a reference to this section constitutes a
 5542  general reference under the doctrine of incorporation by
 5543  reference.
 5544         Section 69. Subsection (23) of section 499.003, Florida
 5545  Statutes, is amended to read:
 5546         499.003 Definitions of terms used in this part.—As used in
 5547  this part, the term:
 5548         (23) “Health care entity” means a closed pharmacy or any
 5549  person, organization, or business entity that provides
 5550  diagnostic, medical, surgical, or dental treatment or care, or
 5551  chronic or rehabilitative care, but does not include any
 5552  wholesale distributor or retail pharmacy licensed under state
 5553  law to deal in prescription drugs. However, a blood
 5554  establishment is a health care entity that may engage in the
 5555  wholesale distribution of prescription drugs under s.
 5556  499.01(2)(g)1.c.
 5557         Section 70. Subsection (21) of section 499.005, Florida
 5558  Statutes, is amended to read:
 5559         499.005 Prohibited acts.—It is unlawful for a person to
 5560  perform or cause the performance of any of the following acts in
 5561  this state:
 5562         (21) The wholesale distribution of any prescription drug
 5563  that was:
 5564         (a) Purchased by a public or private hospital or other
 5565  health care entity; or
 5566         (b) Donated or supplied at a reduced price to a charitable
 5567  organization,
 5568  
 5569  unless the wholesale distribution of the prescription drug is
 5570  authorized in s. 499.01(2)(g)1.c.
 5571         Section 71. Paragraphs (a) and (g) of subsection (2) of
 5572  section 499.01, Florida Statutes, are amended to read:
 5573         499.01 Permits.—
 5574         (2) The following permits are established:
 5575         (a) Prescription drug manufacturer permit.—A prescription
 5576  drug manufacturer permit is required for any person that is a
 5577  manufacturer of a prescription drug and that manufactures or
 5578  distributes such prescription drugs in this state.
 5579         1. A person that operates an establishment permitted as a
 5580  prescription drug manufacturer may engage in wholesale
 5581  distribution of prescription drugs manufactured at that
 5582  establishment and must comply with all of the provisions of this
 5583  part, except s. 499.01212, and the rules adopted under this
 5584  part, except s. 499.01212, which that apply to a wholesale
 5585  distributor.
 5586         2. A prescription drug manufacturer must comply with all
 5587  appropriate state and federal good manufacturing practices.
 5588         3. A blood establishment, as defined in s. 381.06014,
 5589  operating in a manner consistent with the provisions of Title 21
 5590  C.F.R. parts 211 and 600-640 and manufacturing only the
 5591  prescription drugs described in s. 499.003(54)(d) is not
 5592  required to be permitted as a prescription drug manufacturer
 5593  under this paragraph or to register its products under s.
 5594  499.015.
 5595         (g) Restricted prescription drug distributor permit.—
 5596         1. A restricted prescription drug distributor permit is
 5597  required for:
 5598         a. Any person located in this state that engages in the
 5599  distribution of a prescription drug, which distribution is not
 5600  considered “wholesale distribution” under s. 499.003(54)(a).
 5601         b.1.Any A person located in this state who engages in the
 5602  receipt or distribution of a prescription drug in this state for
 5603  the purpose of processing its return or its destruction must
 5604  obtain a permit as a restricted prescription drug distributor if
 5605  such person is not the person initiating the return, the
 5606  prescription drug wholesale supplier of the person initiating
 5607  the return, or the manufacturer of the drug.
 5608         c.A blood establishment located in this state which
 5609  collects blood and blood components only from volunteer donors
 5610  as defined in s. 381.06014 or pursuant to an authorized
 5611  practitioner’s order for medical treatment or therapy and
 5612  engages in the wholesale distribution of a prescription drug not
 5613  described in s. 499.003(54)(d) to a health care entity. The
 5614  health care entity receiving a prescription drug distributed
 5615  under this sub-subparagraph must be licensed as a closed
 5616  pharmacy or provide health care services at that establishment.
 5617  The blood establishment must operate in accordance with s.
 5618  381.06014 and may distribute only:
 5619         (I) Prescription drugs indicated for a bleeding or clotting
 5620  disorder or anemia;
 5621         (II) Blood-collection containers approved under s. 505 of
 5622  the federal act;
 5623         (III) Drugs that are blood derivatives, or a recombinant or
 5624  synthetic form of a blood derivative;
 5625         (IV) Prescription drugs that are identified in rules
 5626  adopted by the department and that are essential to services
 5627  performed or provided by blood establishments and authorized for
 5628  distribution by blood establishments under federal law; or
 5629         (V) To the extent authorized by federal law, drugs
 5630  necessary to collect blood or blood components from volunteer
 5631  blood donors; for blood establishment personnel to perform
 5632  therapeutic procedures under the direction and supervision of a
 5633  licensed physician; and to diagnose, treat, manage, and prevent
 5634  any reaction of either a volunteer blood donor or a patient
 5635  undergoing a therapeutic procedure performed under the direction
 5636  and supervision of a licensed physician,
 5637  
 5638  as long as all of the health care services provided by the blood
 5639  establishment are related to its activities as a registered
 5640  blood establishment or the health care services consist of
 5641  collecting, processing, storing, or administering human
 5642  hematopoietic stem cells or progenitor cells or performing
 5643  diagnostic testing of specimens if such specimens are tested
 5644  together with specimens undergoing routine donor testing.
 5645         2. Storage, handling, and recordkeeping of these
 5646  distributions by a person required to be permitted as a
 5647  restricted prescription drug distributor must comply with the
 5648  requirements for wholesale distributors under s. 499.0121, but
 5649  not those set forth in s. 499.01212 if the distribution occurs
 5650  pursuant to sub-subparagraph 1.a. or sub-subparagraph 1.b.
 5651         3. A person who applies for a permit as a restricted
 5652  prescription drug distributor, or for the renewal of such a
 5653  permit, must provide to the department the information required
 5654  under s. 499.012.
 5655         4. The department may adopt rules regarding the
 5656  distribution of prescription drugs by hospitals, health care
 5657  entities, charitable organizations, or other persons not
 5658  involved in wholesale distribution, and blood establishments,
 5659  which rules are necessary for the protection of the public
 5660  health, safety, and welfare.
 5661         Section 72. Subsection (4) is added to section 626.9541,
 5662  Florida Statutes, to read:
 5663         626.9541 Unfair methods of competition and unfair or
 5664  deceptive acts or practices defined.—
 5665         (4) WELLNESS OR HEALTH IMPROVEMENT PROGRAMS.—
 5666         (a) An insurer issuing a group or individual health benefit
 5667  plan may offer a voluntary wellness or health improvement
 5668  program and may encourage or reward participation in the program
 5669  by authorizing rewards or incentives, including, but not limited
 5670  to, merchandise, gift cards, debit cards, premium discounts or
 5671  rebates, contributions to a member’s health savings account, or
 5672  modifications to copayment, deductible, or coinsurance amounts.
 5673         (b) An insurer may require a health benefit plan member to
 5674  provide verification, such as an affirming statement from the
 5675  member’s physician, that the member’s medical condition makes it
 5676  unreasonably difficult or inadvisable to participate in the
 5677  wellness or health improvement program.
 5678         (c) A reward or incentive offered under this subsection is
 5679  not an insurance benefit or violation of this section if it is
 5680  disclosed in the policy or certificate. This subsection does not
 5681  prohibit insurers from offering other incentives or rewards for
 5682  adherence to a wellness or health improvement program if
 5683  otherwise authorized by state or federal law.
 5684         Section 73. Paragraph (b) of subsection (1) of section
 5685  627.4147, Florida Statutes, is amended to read:
 5686         627.4147 Medical malpractice insurance contracts.—
 5687         (1) In addition to any other requirements imposed by law,
 5688  each self-insurance policy as authorized under s. 627.357 or s.
 5689  624.462 or insurance policy providing coverage for claims
 5690  arising out of the rendering of, or the failure to render,
 5691  medical care or services, including those of the Florida Medical
 5692  Malpractice Joint Underwriting Association, must shall include:
 5693         (b)1.Except as provided in subparagraph 2., a clause
 5694  authorizing the insurer or self-insurer to determine, to make,
 5695  and to conclude, without the permission of the insured, any
 5696  offer of admission of liability and for arbitration pursuant to
 5697  s. 766.106, settlement offer, or offer of judgment, if the offer
 5698  is within the policy limits. It is against public policy for any
 5699  insurance or self-insurance policy to contain a clause giving
 5700  the insured the exclusive right to veto any offer for admission
 5701  of liability and for arbitration made pursuant to s. 766.106,
 5702  settlement offer, or offer of judgment, when such offer is
 5703  within the policy limits. However, any offer of admission of
 5704  liability, settlement offer, or offer of judgment made by an
 5705  insurer or self-insurer shall be made in good faith and in the
 5706  best interests of the insured.
 5707         1.2.a. With respect to dentists licensed under chapter 466,
 5708  a clause clearly stating whether or not the insured has the
 5709  exclusive right to veto any offer of admission of liability and
 5710  for arbitration pursuant to s. 766.106, settlement offer, or
 5711  offer of judgment if the offer is within policy limits. An
 5712  insurer or self-insurer may shall not make or conclude, without
 5713  the permission of the insured, any offer of admission of
 5714  liability and for arbitration pursuant to s. 766.106, settlement
 5715  offer, or offer of judgment, if such offer is outside the policy
 5716  limits. However, any offer for admission of liability and for
 5717  arbitration made under s. 766.106, settlement offer, or offer of
 5718  judgment made by an insurer or self-insurer must shall be made
 5719  in good faith and in the best interest of the insured.
 5720         2.b. If the policy contains a clause stating the insured
 5721  does not have the exclusive right to veto any offer or admission
 5722  of liability and for arbitration made pursuant to s. 766.106,
 5723  settlement offer or offer of judgment, the insurer or self
 5724  insurer shall provide to the insured or the insured’s legal
 5725  representative by certified mail, return receipt requested, a
 5726  copy of the final offer of admission of liability and for
 5727  arbitration made pursuant to s. 766.106, settlement offer or
 5728  offer of judgment and at the same time such offer is provided to
 5729  the claimant. A copy of any final agreement reached between the
 5730  insurer and claimant shall also be provided to the insurer or
 5731  his or her legal representative by certified mail, return
 5732  receipt requested within not more than 10 days after affecting
 5733  such agreement.
 5734         Section 74. Present subsection (12) of section 766.102,
 5735  Florida Statutes, is redesignated as subsection (13), and a new
 5736  subsection (12) is added to that section, to read:
 5737         766.102 Medical negligence; standards of recovery; expert
 5738  witness.—
 5739         (12) If a physician licensed under chapter 458 or chapter
 5740  459 is a party against whom, or on whose behalf, expert
 5741  testimony about the prevailing professional standard of care is
 5742  offered, the expert witness must otherwise meet the requirements
 5743  of this section and be licensed as a physician under chapter 458
 5744  or chapter 459, or must possess a valid expert witness
 5745  certificate issued under s. 458.3167 or s. 459.0078.
 5746         Section 75. Subsection (1) of section 766.104, Florida
 5747  Statutes, is amended to read:
 5748         766.104 Pleading in medical negligence cases; claim for
 5749  punitive damages; authorization for release of records for
 5750  investigation.—
 5751         (1) An No action shall be filed for personal injury or
 5752  wrongful death arising out of medical negligence, whether in
 5753  tort or in contract, may not be filed unless the attorney filing
 5754  the action has made a reasonable investigation, as permitted by
 5755  the circumstances, to determine that there are grounds for a
 5756  good faith belief that there has been negligence in the care or
 5757  treatment of the claimant.
 5758         (a) The complaint or initial pleading must shall contain a
 5759  certificate of counsel that such reasonable investigation gave
 5760  rise to a good faith belief that grounds exist for an action
 5761  against each named defendant. For purposes of this section, good
 5762  faith may be shown to exist if the claimant or his or her
 5763  counsel has received a written opinion, which shall not be
 5764  subject to discovery by an opposing party, of an expert as
 5765  defined in s. 766.102 that there appears to be evidence of
 5766  medical negligence. If the court determines that the such
 5767  certificate of counsel was not made in good faith and that no
 5768  justiciable issue was presented against a health care provider
 5769  that fully cooperated in providing informal discovery, the court
 5770  shall award attorney’s fees and taxable costs against claimant’s
 5771  counsel, and shall submit the matter to The Florida Bar for
 5772  disciplinary review of the attorney.
 5773         (b) If the cause of action requires the plaintiff to
 5774  establish the breach of a standard of care other than negligence
 5775  in order to impose liability or secure specified damages arising
 5776  out of the rendering of, or the failure to render, medical care
 5777  or services, and the plaintiff intends to pursue such liability
 5778  or damages, the investigation and certification required by this
 5779  subsection must demonstrate grounds for a good faith belief that
 5780  the requirement is satisfied.
 5781         Section 76. Subsection (5) of section 766.106, Florida
 5782  Statutes, is amended to read:
 5783         766.106 Notice before filing action for medical negligence;
 5784  presuit screening period; offers for admission of liability and
 5785  for arbitration; informal discovery; review.—
 5786         (5) DISCOVERY AND ADMISSIBILITY.—No statement, discussion,
 5787  written document, report, or other work product generated by the
 5788  presuit screening process is discoverable or admissible in any
 5789  civil action for any purpose by the opposing party. All
 5790  participants, including, but not limited to, physicians,
 5791  investigators, witnesses, and employees or associates of the
 5792  defendant, are immune from civil liability arising from
 5793  participation in the presuit screening process. This subsection
 5794  does not prohibit a physician licensed under chapter 458 or
 5795  chapter 459, or a physician who holds a certificate to provide
 5796  expert testimony under s. 458.3167 or s. 459.0078, who submits a
 5797  verified written expert medical opinion from being subject to
 5798  disciplinary action pursuant to s. 456.073.
 5799         Section 77. Subsection (11) of section 766.1115, Florida
 5800  Statutes, is amended to read:
 5801         766.1115 Health care providers; creation of agency
 5802  relationship with governmental contractors.—
 5803         (11) APPLICABILITY.—
 5804         (a) This section applies to incidents occurring on or after
 5805  April 17, 1992.
 5806         (b) This section does not apply to any health care contract
 5807  entered into by the Department of Corrections which is subject
 5808  to s. 768.28(10)(a).
 5809         (c) This section does not apply to any affiliation
 5810  agreement or other contract subject to s. 768.28(10)(f).
 5811         (d)Nothing in This section does not reduce or limit in any
 5812  way reduces or limits the rights of the state or any of its
 5813  agencies or subdivisions to any benefit currently provided under
 5814  s. 768.28.
 5815         Section 78. Section 766.1183, Florida Statutes, is created
 5816  to read:
 5817         766.1183Standard of care for Medicaid providers.—
 5818         (1) As used in this section:
 5819         (a) The terms “applicant,” “medical assistance,” “medical
 5820  services,” and “Medicaid recipient” have the same meaning as in
 5821  s. 409.901.
 5822         (b) The term “provider” means a health care provider as
 5823  defined in s. 766.202 or an entity that qualifies for an
 5824  exemption under s. 400.9905(4)(e). The term includes:
 5825         1. Any person or entity for whom a provider is vicariously
 5826  liable; and
 5827         2. Any person or entity whose liability is based solely on
 5828  such person or entity being vicariously liable for the actions
 5829  of a provider.
 5830         (c) The term “wrongful manner” means in bad faith or with
 5831  malicious purpose or in a manner exhibiting wanton and willful
 5832  disregard of human rights, safety, or property, and shall be
 5833  construed in conformity with the standard set forth in s.
 5834  768.28(9)(a).
 5835         (2) A provider is not liable in excess of $200,000 per
 5836  claimant or $300,000 per occurrence for any cause of action
 5837  arising out of the rendering of, or the failure to render,
 5838  medical services to a Medicaid recipient, except as provided
 5839  under subsection (3). However, a judgment may be claimed and
 5840  rendered in excess of the amounts set forth in this subsection.
 5841  That portion of the judgment that exceeds these amounts may be
 5842  reported to the Legislature, but may be paid in part or in whole
 5843  by the state only by further act of the Legislature.
 5844         (3) A provider may be liable for an amount in excess of
 5845  $200,000 per claimant or $300,000 per occurrence only if the
 5846  claimant pleads and proves, by clear and convincing evidence,
 5847  that the provider acted in a wrongful manner. If the claimant so
 5848  pleads, the court, after a reasonable opportunity for discovery,
 5849  shall conduct a hearing before trial to determine if there is a
 5850  reasonable basis in evidence to conclude that the provider acted
 5851  in a wrongful manner. A claim for wrongful conduct is not
 5852  permitted, to the extent it exceeds the amounts set forth in
 5853  subsection (2), unless the claimant makes the showing required
 5854  by this subsection.
 5855         (4) At the time an application for medical assistance is
 5856  submitted, the Department of Children and Family Services shall
 5857  furnish the applicant with written notice of the provisions of
 5858  this section.
 5859         (5) This section does not limit or exclude the application
 5860  of any law, including s. 766.118, which places limitations upon
 5861  the recovery of civil damages.
 5862         (6) This section does not apply to any claim for damages to
 5863  which s. 768.28 applies.
 5864         Section 79. Section 766.1184, Florida Statutes, is created
 5865  to read:
 5866         766.1184Standard of care; low-income pool recipient.—
 5867         (1) As used in this section, the term:
 5868         (a) “Low-income pool recipient” means a low-income
 5869  individual who is uninsured or underinsured and who receives
 5870  primary care services from a provider which are delivered
 5871  exclusively using funding received by that provider under
 5872  proviso language accompanying specific appropriation 191 of the
 5873  2010-2011 fiscal year General Appropriations Act to establish
 5874  new or expand existing primary care clinics for low-income
 5875  persons who are uninsured or underinsured.
 5876         (b) “Provider” means a health care provider, as defined in
 5877  s. 766.202, which received funding under proviso language
 5878  accompanying specific appropriation 191 of the fiscal year 2010
 5879  11 General Appropriations Act to establish new or expand
 5880  existing primary care clinics for low-income persons who are
 5881  uninsured or underinsured. The term includes:
 5882         1. Any person or entity for whom a provider is vicariously
 5883  liable; and
 5884         2. Any person or entity whose liability is based solely on
 5885  such person or entity being vicariously liable for the actions
 5886  of a provider.
 5887         (c) “Wrongful manner” means in bad faith or with malicious
 5888  purpose or in a manner exhibiting wanton and willful disregard
 5889  of human rights, safety, or property, and shall be construed in
 5890  conformity with the standard set forth in s. 768.28(9)(a).
 5891  
 5892  The funding of the provider’s primary care clinic must have been
 5893  awarded pursuant to a plan approved by the Legislative Budget
 5894  Commission, and must be the subject of an agreement between the
 5895  provider and the Agency for Health Care Administration,
 5896  following the competitive solicitation of proposals to use low
 5897  income pool grant funds to provide primary care services in
 5898  general acute hospitals, county health departments, faith-based
 5899  and community clinics, and federally qualified health centers to
 5900  uninsured or underinsured persons.
 5901         (2) A provider is not liable in excess of $200,000 per
 5902  claimant or $300,000 per occurrence for any cause of action
 5903  arising out of the rendering of, or the failure to render,
 5904  primary care services to a low-income pool recipient, except as
 5905  provided under subsection (3). However, a judgment may be
 5906  claimed and rendered in excess of the amounts set forth in this
 5907  subsection. That portion of the judgment that exceeds these
 5908  amounts may be reported to the Legislature, but may be paid in
 5909  part or in whole by the state only by further act of the
 5910  Legislature.
 5911         (3) A provider may be liable for an amount in excess of
 5912  $200,000 per claimant or $300,000 per occurrence only if the
 5913  claimant pleads and proves, by clear and convincing evidence,
 5914  that the provider acted in a wrongful manner. If the claimant so
 5915  pleads, the court, after a reasonable opportunity for discovery,
 5916  shall conduct a hearing before trial to determine if there is a
 5917  reasonable basis in evidence to conclude that the provider acted
 5918  in a wrongful manner. A claim for wrongful conduct is not
 5919  permitted, to the extent it exceeds the amounts set forth in
 5920  subsection (2), unless the claimant makes the showing required
 5921  by this subsection.
 5922         (4) In order for this section to apply, the provider must:
 5923         (a) Develop, implement, and maintain policies and
 5924  procedures to:
 5925         1. Ensure that funds described in subsection (1) are used
 5926  exclusively to serve low-income persons who are uninsured or
 5927  underinsured;
 5928         2. Determine whether funds described in subsection (1) are
 5929  being used to provide primary care services to a particular
 5930  person; and
 5931         3. Identify whether an individual receiving primary care
 5932  services is a low-income pool recipient to whom the provisions
 5933  of this section apply.
 5934         (b) Furnish a low-income pool recipient with written notice
 5935  of the provisions of this section before providing primary care
 5936  services to the recipient.
 5937         (c) Be in compliance with the terms of any agreement
 5938  between the provider and the Agency for Health Care
 5939  Administration governing the receipt of the funds described in
 5940  subsection (1).
 5941         (5) This section does not limit or exclude the application
 5942  of any law, including s. 766.118, which places limitations upon
 5943  the recovery of civil damages.
 5944         (6) This section does not apply to any claim for damages to
 5945  which s. 768.28 applies.
 5946         Section 80. Subsection (5) is added to section 766.203,
 5947  Florida Statutes, to read:
 5948         766.203 Presuit investigation of medical negligence claims
 5949  and defenses by prospective parties.—
 5950         (5) STANDARDS OF CARE.—If the cause of action that is the
 5951  basis for the litigation requires the plaintiff to establish the
 5952  breach of a standard of care other than negligence in order to
 5953  impose liability or secure specified damages arising out of the
 5954  rendering of, or the failure to render, medical care or
 5955  services, and the plaintiff intends to pursue such liability or
 5956  damages, the presuit investigations required of the claimant and
 5957  the prospective defendant by this section must ascertain that
 5958  there are reasonable grounds to believe that the requirement is
 5959  satisfied.
 5960         Section 81. Paragraph (b) of subsection (9) of section
 5961  768.28, Florida Statutes, is amended, and paragraph (f) is added
 5962  to subsection (10) of that section, to read:
 5963         768.28 Waiver of sovereign immunity in tort actions;
 5964  recovery limits; limitation on attorney fees; statute of
 5965  limitations; exclusions; indemnification; risk management
 5966  programs.—
 5967         (9)
 5968         (b) As used in this subsection, the term:
 5969         1. “Employee” includes any volunteer firefighter.
 5970         2. “Officer, employee, or agent” includes, but is not
 5971  limited to, any health care provider when providing services
 5972  pursuant to s. 766.1115;, any member of the Florida Health
 5973  Services Corps, as defined in s. 381.0302, who provides
 5974  uncompensated care to medically indigent persons referred by the
 5975  Department of Health; any nonprofit independent college or
 5976  university located and chartered in this state which owns or
 5977  operates an accredited medical school, and its employees or
 5978  agents, when providing patient services pursuant to paragraph
 5979  (10)(f);, and any public defender or her or his employee or
 5980  agent, including, among others, an assistant public defender and
 5981  an investigator.
 5982         (10)
 5983         (f) For purposes of this section, any nonprofit independent
 5984  college or university located and chartered in this state which
 5985  owns or operates an accredited medical school, or any of its
 5986  employees or agents, and which has agreed in an affiliation
 5987  agreement or other contract to provide, or to permit its
 5988  employees or agents to provide, patient services as agents of a
 5989  teaching hospital, is considered an agent of the teaching
 5990  hospital while acting within the scope of and pursuant to
 5991  guidelines established in the contract. To the extent allowed by
 5992  law, the contract must provide for the indemnification of the
 5993  state, up to the limits set out in this chapter, by the agent
 5994  for any liability incurred which was caused by the negligence of
 5995  the college or university or its employees or agents.
 5996         1. For purposes of this paragraph, the term:
 5997         a. “Employee or agent” means an officer, employee, agent,
 5998  or servant of a nonprofit independent college or university
 5999  located and chartered in this state which owns or operates an
 6000  accredited medical school, including, but not limited to, the
 6001  faculty of the medical school, any health care practitioner or
 6002  licensee as defined in s. 456.001 for which the college or
 6003  university is vicariously liable, and the staff or administrator
 6004  of the medical school.
 6005         b. “Patient services” mean:
 6006         (I) Comprehensive health care services as defined in s.
 6007  641.19, including any related administrative service, provided
 6008  to patients in a teaching hospital or in a health care facility
 6009  that is a part of a nonprofit independent college or university
 6010  located and chartered in this state which owns or operates an
 6011  accredited medical school, pursuant to an affiliation agreement
 6012  or other contract with a teaching hospital;
 6013         (II) Training and supervision of interns, residents, and
 6014  fellows providing patient services in a teaching hospital or in
 6015  a health care facility that is a part of a nonprofit independent
 6016  college or university located and chartered in this state which
 6017  owns or operates an accredited medical school, pursuant to an
 6018  affiliation agreement or other contract with a teaching
 6019  hospital;
 6020         (III) Participation in medical research protocols; or
 6021         (IV) Training and supervision of medical students in a
 6022  teaching hospital or in a health care facility owned by a not
 6023  for-profit college or university that owns or operates an
 6024  accredited medical school, pursuant to an affiliation agreement
 6025  or other contract with a teaching hospital.
 6026         c. “Teaching hospital” means a teaching hospital as defined
 6027  in s. 408.07 which is owned or operated by the state, a county
 6028  or municipality, a public health trust, a special taxing
 6029  district, a governmental entity having health care
 6030  responsibilities, or a not-for-profit entity that operates such
 6031  facilities as an agent of the state or a political subdivision
 6032  of the state under a lease or other contract.
 6033         2. The teaching hospital or the medical school, or its
 6034  employees or agents, must provide written notice to each
 6035  patient, or the patient’s legal representative, receipt of which
 6036  must be acknowledged in writing, that the college or university
 6037  that owns or operates the medical school and the employees or
 6038  agents of that college or university are acting as agents of the
 6039  teaching hospital and that the exclusive remedy for injury or
 6040  damage suffered as the result of any act or omission of the
 6041  teaching hospital, the college or university that owns or
 6042  operates the medical school, or the employees or agents of the
 6043  college or university while acting within the scope of duties
 6044  pursuant to the affiliation agreement or other contract with a
 6045  teaching hospital, is by commencement of an action pursuant to
 6046  the provisions of this section.
 6047         3. This paragraph does not designate any employee providing
 6048  contracted patient services in a teaching hospital as an
 6049  employee or agent of the state for purposes of chapter 440.
 6050         Section 82. Legislative findings and intent.
 6051         (1) The Legislature finds that:
 6052         (a) Access to high-quality, comprehensive, and affordable
 6053  health care for all persons in this state is a necessary state
 6054  goal and that teaching hospitals play an intrinsic and essential
 6055  role in providing that access.
 6056         (b) Graduate medical education, provided by nonprofit
 6057  independent colleges and universities located and chartered in
 6058  this state which own or operate medical schools, helps provide
 6059  the comprehensive specialty training needed by medical school
 6060  graduates to develop and refine the skills essential to the
 6061  provision of high-quality health care for our state residents.
 6062  Much of that education and training is provided in teaching
 6063  hospitals under the direct supervision of medical faculty who
 6064  provide guidance, training, and oversight, and serve as role
 6065  models to their students.
 6066         (c) A large proportion of medical care is provided in
 6067  teaching hospitals that serve as safety nets for many indigent
 6068  and underserved patients who otherwise might not receive the
 6069  medical help they need. Resident physician training that takes
 6070  place in such hospitals provides much of the care provided to
 6071  this population. Medical faculty, supervising such training and
 6072  care, are a vital link between educating and training resident
 6073  physicians and ensuring the provision of quality care for
 6074  indigent and underserved residents. Physicians that assume this
 6075  role are often called upon to juggle the demands of patient
 6076  care, teaching, research, health policy, and budgetary issues
 6077  related to the programs they administer.
 6078         (d) While teaching hospitals are afforded sovereign
 6079  immunity protections under s. 768.28, Florida Statutes, the
 6080  nonprofit independent colleges and universities located and
 6081  chartered in this state which own or operate medical schools and
 6082  which enter into affiliation agreements or contracts with the
 6083  teaching hospitals to provide patient services are not afforded
 6084  such sovereign immunity protections.
 6085         (e) The employees or agents of nonprofit independent
 6086  colleges and universities located and chartered in this state
 6087  which enter into affiliation agreements or contracts with
 6088  teaching hospitals to provide patient services do not have the
 6089  same level of protection against liability claims as teaching
 6090  hospitals and their employees and agents that provide the same
 6091  patient services to the same patients. Thus, these colleges and
 6092  universities and their employees and agents are
 6093  disproportionately affected by claims arising out of alleged
 6094  medical malpractice and other allegedly negligent acts. Given
 6095  the recent growth in medical schools and medical education
 6096  programs and ongoing efforts to support, strengthen, and
 6097  increase physician residency training positions and medical
 6098  faculty in both existing and newly designated teaching
 6099  hospitals, this exposure and the consequent disparity in
 6100  liability exposure will continue to increase. The vulnerability
 6101  of these colleges and universities to claims of medical
 6102  malpractice will only add to the current physician workforce
 6103  crisis in Florida and can be alleviated only through legislative
 6104  action.
 6105         (f) Ensuring that the employees and agents of nonprofit
 6106  independent colleges and universities located and chartered in
 6107  this state which own or operated medical schools are able to
 6108  continue to treat patients, provide graduate medical education,
 6109  supervise medical students, engage in research, and provide
 6110  administrative support and services in teaching hospitals is an
 6111  overwhelming public necessity.
 6112         (2) The Legislature intends that:
 6113         (a) Employees and agents of nonprofit independent colleges
 6114  and universities located and chartered in this state which own
 6115  or operate medical schools, who provide patient services as
 6116  agents of a teaching hospital be immune from lawsuits in the
 6117  same manner and to the same extent as employees and agents of
 6118  teaching hospitals in this state under existing law, and that
 6119  such colleges and universities and their employees and agents
 6120  not be held personally liable in tort or named as a party
 6121  defendant in an action while providing patient services in a
 6122  teaching hospital, unless such services are provided in bad
 6123  faith, with malicious purpose, or in a manner exhibiting wanton
 6124  and willful disregard of human rights, safety, or property.
 6125         (b) Nonprofit independent private colleges and universities
 6126  located and chartered in this state which own or operate medical
 6127  schools and which permit their employees or agents to provide
 6128  patient services in teaching hospitals pursuant to an
 6129  affiliation agreement or other contract, be afforded sovereign
 6130  immunity protections under s. 768.28, Florida Statutes.
 6131         (3) The Legislature declares that there is an overwhelming
 6132  public necessity for extending the state’s sovereign immunity to
 6133  nonprofit independent colleges and universities located and
 6134  chartered in this state which own or operate medical schools and
 6135  provide patient services in teaching hospitals, and to their
 6136  employees and agents, and that there is no alternative method of
 6137  meeting such public necessity.
 6138         (4) The terms “employee or agent,” “patient services,” and
 6139  “teaching hospital” used in this section have the same meaning
 6140  as the terms defined in s. 768.28, Florida Statutes, as amended
 6141  by this act.
 6142         Section 83. Section 1004.41, Florida Statutes, is amended
 6143  to read:
 6144         1004.41 University of Florida; J. Hillis Miller Health
 6145  Center.—
 6146         (1) There is established the J. Hillis Miller Health Center
 6147  at the University of Florida, including campuses at Gainesville
 6148  and Jacksonville and affiliated teaching hospitals, which shall
 6149  include the following colleges:
 6150         (a) College of Dentistry.
 6151         (b) College of Public Health and Health Professions.
 6152         (c) College of Medicine.
 6153         (d) College of Nursing.
 6154         (e) College of Pharmacy.
 6155         (f) College of Veterinary Medicine and related teaching
 6156  hospitals.
 6157         (2) Each college of the health center shall be so
 6158  maintained and operated so as to comply with the standards
 6159  approved by a nationally recognized association for
 6160  accreditation.
 6161         (3)(a) The University of Florida Health Center Operations
 6162  and Maintenance Trust Fund shall be administered by the
 6163  University of Florida Board of Trustees. Funds shall be credited
 6164  to the trust fund from the sale of goods and services performed
 6165  by the University of Florida Veterinary Medicine Teaching
 6166  Hospital. The purpose of the trust fund is to support the
 6167  instruction, research, and service missions of the University of
 6168  Florida College of Veterinary Medicine.
 6169         (b) Notwithstanding the provisions of s. 216.301, and
 6170  pursuant to s. 216.351, any balance in the trust fund at the end
 6171  of any fiscal year shall remain in the trust fund and shall be
 6172  available for carrying out the purposes of the trust fund.
 6173         (4)(a) The University of Florida Board of Trustees shall
 6174  lease the hospital facilities of the health center known as the
 6175  Shands Teaching Hospital and Clinics on the Gainesville campus
 6176  of the University of Florida and all furnishings, equipment, and
 6177  other chattels or choses in action used in the operation of the
 6178  hospital, to Shands Teaching Hospital and Clinics, Inc., a
 6179  private not-for-profit corporation organized solely for the
 6180  primary purpose of supporting operating the University of
 6181  Florida Board of Trustees’ health affairs mission of community
 6182  service and patient care, education and training of health
 6183  professionals, and clinical research. In furtherance of that
 6184  purpose, Shands Teaching Hospital and Clinics, Inc., shall
 6185  operate the hospital and ancillary health care facilities as
 6186  deemed of the health center and other health care facilities and
 6187  programs determined to be necessary by the board of Shands
 6188  Teaching Hospital and Clinics, Inc. the nonprofit corporation.
 6189  The rental for the hospital facilities shall be an amount equal
 6190  to the debt service on bonds or revenue certificates issued
 6191  solely for capital improvements to the hospital facilities or as
 6192  otherwise provided by law.
 6193         (b) The University of Florida Board of Trustees shall
 6194  provide in the lease or by separate contract or agreement with
 6195  Shands Teaching Hospital and Clinics, Inc., the not-for-profit
 6196  corporation for the following:
 6197         1. Approval of the articles of incorporation of Shands
 6198  Teaching Hospital and Clinics, Inc., the not-for-profit
 6199  corporation by the University of Florida Board of Trustees and
 6200  the governance of that the not-for-profit corporation by a board
 6201  of directors appointed, subject to removal, and chaired by the
 6202  President of the University of Florida, or his or her designee,
 6203  and vice chaired by the Vice President for Health Affairs of the
 6204  University of Florida, or his or her designee.
 6205         2. The use of hospital facilities and personnel in support
 6206  of community service and patient care, the research programs,
 6207  and of the teaching roles role of the health center.
 6208         3. The continued recognition of the collective bargaining
 6209  units and collective bargaining agreements as currently composed
 6210  and recognition of the certified labor organizations
 6211  representing those units and agreements.
 6212         4. The use of hospital facilities and personnel in
 6213  connection with research programs conducted by the health
 6214  center.
 6215         5. Reimbursement to the hospital for indigent patients,
 6216  state-mandated programs, underfunded state programs, and costs
 6217  to the hospital for support of the teaching and research
 6218  programs of the health center. Such reimbursement shall be
 6219  appropriated to either the health center or the hospital each
 6220  year by the Legislature after review and approval of the request
 6221  for funds.
 6222         (c) The University of Florida Board of Trustees may, with
 6223  the approval of the Legislature, increase the hospital
 6224  facilities or remodel or renovate them, provided that the rental
 6225  paid by the hospital for such new, remodeled, or renovated
 6226  facilities is sufficient to amortize the costs thereof over a
 6227  reasonable period of time or fund the debt service for any bonds
 6228  or revenue certificates issued to finance such improvements.
 6229         (d) The University of Florida Board of Trustees is
 6230  authorized to provide to Shands Teaching Hospital and Clinics,
 6231  Inc., the not-for-profit corporation leasing the hospital
 6232  facilities and its not-for-profit subsidiaries and affiliates
 6233  comprehensive general liability insurance including professional
 6234  liability from a self-insurance trust program established
 6235  pursuant to s. 1004.24.
 6236         (e)Shands Teaching Hospital and Clinics, Inc., may, in
 6237  support of the health affairs mission of the University of
 6238  Florida Board of Trustees and with its prior approval, create
 6239  for-profit or not-for-profit corporate subsidiaries and
 6240  affiliates, or both. The University of Florida Board of
 6241  Trustees, which may act through the President of the University
 6242  of Florida or his or her designee, has the right to control
 6243  Shands Teaching Hospital and Clinics, Inc. Shands Teaching
 6244  Hospital and Clinics, Inc., and any not-for-profit subsidiaries
 6245  are conclusively deemed corporations primarily acting as
 6246  instrumentalities of the state, pursuant to s. 768.28(2), for
 6247  purposes of sovereign immunity.
 6248         (f)(e)If In the event that the lease of the hospital
 6249  facilities to Shands Teaching Hospital and Clinics, Inc., the
 6250  not-for-profit corporation is terminated for any reason, the
 6251  University of Florida Board of Trustees shall resume management
 6252  and operation of the hospital facilities. In such event, the
 6253  University of Florida Board of Trustees is authorized to utilize
 6254  revenues generated from the operation of the hospital facilities
 6255  to pay the costs and expenses of operating the hospital facility
 6256  for the remainder of the fiscal year in which such termination
 6257  occurs.
 6258         (5)(f)Shands Jacksonville Medical Center, Inc., and its
 6259  parent Shands Jacksonville Healthcare, Inc., are private not
 6260  for-profit corporations organized primarily to support the
 6261  health affairs mission of the University of Florida Board of
 6262  Trustees in community service and patient care, education and
 6263  training of health affairs professionals, and clinical research.
 6264  Shands Jacksonville Medical Center, Inc., is a teaching hospital
 6265  affiliated with the University of Florida Board of Trustees,
 6266  located on the Jacksonville Campus of the University of Florida.
 6267  Shands Jacksonville Medical Center, Inc., and Shands
 6268  Jacksonville Healthcare, Inc., may, in support of the health
 6269  affairs mission of the University of Florida Board of Trustees
 6270  and with its prior approval, create for-profit or not-for-profit
 6271  corporate subsidiaries and affiliates, or both.
 6272         (a) The University of Florida Board of Trustees, which may
 6273  act through the President of the University of Florida or his or
 6274  her designee, has the right to control Shands Jacksonville
 6275  Medical Center, Inc., and Shands Jacksonville Healthcare, Inc.
 6276  Shands Jacksonville Medical Center, Inc., Shands Jacksonville
 6277  Healthcare, Inc., and any not-for-profit subsidiary of Shands
 6278  Jacksonville Medical Center, Inc., are conclusively deemed
 6279  corporations primarily acting as instrumentalities of the state,
 6280  pursuant to s. 768.28(2), for purposes of sovereign immunity.
 6281         (b) The University of Florida Board of Trustees is
 6282  authorized to provide to Shands Jacksonville Healthcare, Inc.,
 6283  and its not-for-profit subsidiaries and affiliates and any
 6284  successor corporation that acts in support of the board of
 6285  trustees, comprehensive general liability coverage, including
 6286  professional liability, from the self-insurance programs
 6287  established pursuant to s. 1004.24.
 6288         Section 84. Sections 409.9121, 409.919, and 624.915,
 6289  Florida Statutes, are repealed.
 6290         Section 85. Section 409.942, Florida Statutes, is
 6291  transferred and renumbered as section 414.29, Florida Statutes.
 6292         Section 86. Paragraph (a) of subsection (1) of section
 6293  443.111, Florida Statutes, is amended to read:
 6294         443.111 Payment of benefits.—
 6295         (1) MANNER OF PAYMENT.—Benefits are payable from the fund
 6296  in accordance with rules adopted by the Agency for Workforce
 6297  Innovation, subject to the following requirements:
 6298         (a) Benefits are payable by mail or electronically.
 6299  Notwithstanding s. 414.29 409.942(4), the agency may develop a
 6300  system for the payment of benefits by electronic funds transfer,
 6301  including, but not limited to, debit cards, electronic payment
 6302  cards, or any other means of electronic payment that the agency
 6303  deems to be commercially viable or cost-effective. Commodities
 6304  or services related to the development of such a system shall be
 6305  procured by competitive solicitation, unless they are purchased
 6306  from a state term contract pursuant to s. 287.056. The agency
 6307  shall adopt rules necessary to administer the system.
 6308         Section 87. Sections 409.944, 409.945, and 409.946, Florida
 6309  Statutes, are transferred and renumbered as sections 163.464,
 6310  163.465, and 163.466, Florida Statutes, respectively.
 6311         Section 88. Sections 409.953 and 409.9531, Florida
 6312  Statutes, are transferred and renumbered as sections 402.81 and
 6313  402.82, Florida Statutes, respectively.
 6314         Section 89. The Agency for Health Care Administration shall
 6315  submit a reorganizational plan to the Governor, the Speaker of
 6316  the House of Representatives, and the President of the Senate by
 6317  January 1, 2012, which converts the agency from a check-writing
 6318  and fraud-chasing agency into a contract compliance and
 6319  monitoring agency.
 6320         Section 90. Effective December 1, 2011, if the Legislature
 6321  has not received a letter from the Governor stating that the
 6322  federal Centers for Medicare and Medicaid has approved the
 6323  waivers necessary to implement the Medicaid managed care reforms
 6324  contained in this act, the State of Florida shall withdraw from
 6325  the Medicaid program effective December 31, 2011.
 6326         Section 91. If any provision of this act or its application
 6327  to any person or circumstance is held invalid, the invalidity
 6328  does not affect other provisions or applications of the act
 6329  which can be given effect without the invalid provision or
 6330  application, and to this end the provisions of this act are
 6331  severable.
 6332         Section 92. This act shall take effect upon becoming a law.